PCOS and PCOD: Signs, Causes, Diagnosis and Treatment

What is PCOS?

PCOS (polycystic ovary syndrome) is one of the most common hormone conditions in girls and women, and one of the most misunderstood. Many girls and women who have it do not know.

PCOS usually involves a mix of three things. The ovaries do not release an egg regularly, which shows up as irregular or missed periods. The body makes more androgens, hormones such as testosterone that everyone has in small amounts. And the ovaries carry many small follicles that show up on an ultrasound. Not everyone has all three.

Despite the name, these are not true cysts. They are follicles: tiny sacs in which eggs grow, which stopped growing before an egg was released. They are not harmful, and you do not need them to be diagnosed with PCOS.

PCOS and PCOD: is there a difference?

In India you will often hear "PCOD". In practice, doctors and patients use it for the same condition. International guidelines use only the name PCOS, and do not describe PCOD as a separate, milder disease. So a "PCOD" label does not mean the long-term health risks below do not apply to you.

What causes PCOS?

The exact cause is not known. Several things play a part.

• Hormones. Higher androgen levels can stop eggs from maturing and being released, so many small follicles stay on the ovary.
• Family history. PCOS runs in families. If your mother or sister has it, your own chance is higher.
• Insulin resistance. Many people with PCOS have insulin resistance: the body does not respond well to insulin, so it makes more. High insulin can push the ovaries to make more androgens. This makes symptoms such as irregular periods, acne and weight gain worse.
• Lifestyle. PCOS is not caused by anything you did. But weight gain, little activity and a diet high in sugar and processed food can make insulin resistance and symptoms worse.

Common signs

Signs vary a lot from person to person. They often begin in the teenage years or early twenties.

• Irregular periods: few periods in a year, long gaps between periods, or no periods at all.
• Extra hair on the face, chin, chest, belly or back.
• Acne or oily skin that is hard to treat.
• Thinning hair on the scalp.
• Weight gain, often around the waist. But many people with PCOS are not overweight.
• Dark, velvety patches of skin on the neck, armpits or groin, a sign of insulin resistance.
• Difficulty getting pregnant.
• Low mood, anxiety or worry about how you look.

How is PCOS diagnosed?

There is no single test. A doctor usually diagnoses PCOS when two of these three are present:

1. Irregular or absent ovulation, usually seen as irregular or missed periods.
2. Signs of high androgens, such as excess hair or acne, or high androgen levels in a blood test.
3. Many small follicles on an ultrasound.

First, the doctor rules out other causes of the same signs, such as thyroid problems, a high level of the hormone prolactin, and pregnancy. Expect questions about your periods, a physical check and blood tests. The doctor may also check your blood sugar, cholesterol and blood pressure.

Teenagers are a special case. Periods are often irregular in the first years, and the ovaries often look this way at this age anyway. So an ultrasound is usually not used to diagnose PCOS in teenagers. The doctor looks for both irregular periods and signs of high androgens, and may recheck over time.

PCOS and pregnancy

Because ovulation is irregular, getting pregnant can take longer. But many people with PCOS get pregnant, naturally or with treatment. If you are trying for a baby, see a doctor early. Irregular periods do not mean you cannot get pregnant. If you do not want a pregnancy, talk to a doctor about contraception.

Long-term health

PCOS is not life-threatening, but it raises the risk of some conditions. That is why regular check-ups matter.

• Type 2 diabetes, because of insulin resistance. Ask your doctor how often to test your blood sugar.
• Heart health. High cholesterol and high blood pressure are more common.
• The womb lining. Without regular periods, the lining can build up. Over years, this raises the risk of womb (endometrial) cancer. Treatment lowers this risk. See a doctor if you go three months or more without a period.
• Sleep apnoea, where breathing stops and starts during sleep. Loud snoring and daytime tiredness are signs.

Treatment

There is no cure, but PCOS can be managed well. The right plan depends on your symptoms, your age and whether you want a pregnancy.

Daily habits come first

• Food. Eat mostly whole foods: whole grains, dal, rajma, chana, vegetables, fruit, curd, paneer, eggs and, if you eat them, fish and chicken. Cut down on sugary drinks, sweets, maida and fried packaged snacks.
• Movement. Aim for about 150 minutes of moderate activity a week, such as a brisk 30-minute walk on five days. Add muscle-strengthening exercise on two days. Yoga helps with stress and strength.
• Weight. If you are overweight and your doctor advises it, losing a little weight can make periods more regular and improve insulin resistance. If you are not overweight, the other steps still help.
• Sleep and stress. Regular sleep and time to rest support your overall health.

Medicines

Depending on your needs, a doctor may prescribe:

• hormonal pills, or a hormone called a progestin, to make periods regular and protect the womb lining;
• medicines that reduce the effects of androgens, for acne and excess hair;
• a diabetes medicine, sometimes used to improve insulin resistance;
• medicines that help you ovulate, if you are trying for a baby.

Never start any of these without a doctor. Some are not safe in pregnancy.

What about natural remedies?

You will see many teas, powders and supplements sold for PCOS. Most have little good evidence behind them, and some can interact with medicines. Do not start supplements on your own. If you are worried about a gap, such as low vitamin D, ask your doctor to test for it.

PCOS and your mind

Anxiety, depression and low self-esteem are more common with PCOS. Changes to your hair, skin and weight can be hard to live with. This is not weakness. Tell your doctor how you feel, and ask to see a counsellor if you need one. Regular exercise, good sleep and talking to people you trust also help.

If you ever feel hopeless or have thoughts of harming yourself, please talk to someone today. Call Tele-MANAS, the government's free mental health helpline, on 14416 or 1-800-891-4416, at any hour. In an emergency, call 112.

When to see a doctor

• You go three months or more without a period and you are not pregnant.
• You have fewer than eight periods a year, or your cycles are often longer than 35 days (or longer than 45 days in the first few years after periods start).
• Hair grows on your face, chest or belly, or your acne is severe.
• Dark, velvety patches appear on your neck, armpits or groin.
• You have been trying for a baby for a year, or for six months if you are 35 or older.
• You feel very thirsty, pass urine often, or feel low most days.

Have a question about PCOS or your periods? Call our menstrual helpline on 85888 70999. It answers at any hour.

FAQs

Is PCOD different from PCOS?

In practice, the two names are used for the same condition. International guidelines use the name PCOS and do not treat PCOD as a separate, milder disease.

Does everyone with PCOS have cysts on the ovaries?

No. The "cysts" are small follicles, not true cysts, and you can have PCOS without them. A doctor diagnoses PCOS from two of three signs: irregular ovulation, high androgens and many small follicles.

Can PCOS be cured?

There is no cure, but healthy habits and the right medicines can control symptoms and lower long-term risks.

Can I get pregnant if I have PCOS?

Yes, many people with PCOS do. It may take longer, and some need medicines to help them ovulate. See a doctor early if you are trying for a baby.

Can PCOS cause cancer?

PCOS raises the risk of cancer of the womb lining, mainly because long gaps between periods let the lining build up. Treatment lowers this risk. See a doctor if you often go three months or more without a period.

In short

PCOS is a common hormone condition, not a disease of the ovaries alone. It can affect periods, skin, hair, weight, fertility and long-term health. A doctor can diagnose it and help you manage it, and daily habits make a real difference.

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