PCOS: The Complete Guide for Indian Women

Diagnosis without over-testing

Two of three Rotterdam criteria after excluding thyroid/prolactin issues: irregular ovulation, androgen signs, polycystic ovaries. Ultrasound alone never diagnoses PCOS.

Weight, sleep, stress and insulin resistance drive most cases — all modifiable.

Lifestyle is first-line medicine

Five to ten percent weight loss restores ovulation for many. Strength training 3x/week beats cardio alone for insulin sensitivity. Protein 1.2–1.6 g/kg, low-GI carbs, 8-hour sleep.

Hormonal pills regulate bleeding/acne when not trying to conceive; letrozole under specialists aids fertility when planning.

Diagnosis done right: Rotterdam plus exclusions

PCOS needs 2 of 3 Rotterdam criteria: irregular/absent ovulation, clinical or biochemical androgen excess (acne, hirsutism, hair thinning, high testosterone), and polycystic ovaries on ultrasound. Crucially, thyroid disease, high prolactin, late-onset CAH and Cushing's must be excluded first — ultrasound alone never diagnoses PCOS.

Teens need extra caution: irregular cycles in the first 2–3 years after menarche are often physiological. Labelling too early causes needless anxiety; watchful follow-up with lifestyle is usually correct.

• Baseline labs: TSH, prolactin, HbA1c, lipids, vitamin D, androgens as indicated
• Pelvic ultrasound timing matters — early follicular phase in cycling women
• Document hirsutism (Ferriman-Gallwey) and acne severity to track treatment response

The lifestyle prescription that restores ovulation

Five to ten percent weight loss restores ovulation in many women with overweight PCOS — not through a magic diet but sustained energy deficit with high protein (1.2–1.6 g/kg) and low-GI carbs. Strength training 3x/week improves insulin sensitivity more than cardio alone in trials.

Sleep 7–8 hours and stress management directly affect androgens and cravings. Inositol (myo-inositol) has modest supportive evidence as an adjunct; it complements — never replaces — lifestyle and prescribed medicines.

Medicines: when each option fits

Combined hormonal pills regulate bleeding, acne and hirsutism when pregnancy isn't planned; they don't 'cure' PCOS but protect the endometrium and skin while lifestyle works. Metformin suits insulin resistance, prediabetes or metformin-responsive cycles — GI side effects ease with slow titration and extended-release forms.

For fertility, letrozole is first-line ovulation induction under specialist monitoring, outperforming clomiphene in PCOS trials. Weight optimisation before conception improves every downstream outcome for mother and baby.

Skin and hair: timelines that prevent despair

Acne improves in 3–6 months on consistent treatment (topical retinoids/benzoyl peroxide plus hormonal regulation where indicated); hirsutism needs 6–12 months because hair cycles are slow — laser works best on dark hair with light skin after hormones stabilise. Hair shedding (telogen effluvium) recovers 3–6 months after iron, thyroid and crash-diet triggers are fixed.

Avoid waxing/threading irritants during active acne flares, and never use steroid fairness creams — they worsen acne, pigmentation and rebound flares.