Polycystic ovary syndrome (PCOS) is a common, long-term hormonal and metabolic condition that affects how the ovaries work. It often causes irregular periods, acne or excess hair growth, and is closely linked to insulin resistance. There is no cure, but a correct diagnosis, healthy lifestyle habits and medical care can control symptoms, support fertility and lower long-term health risks.
Key takeaways
- PCOS affects an estimated 10–13% of women of reproductive age worldwide, and Indian studies report similar rates.
- In adults, diagnosis needs two of three features: irregular or absent ovulation, signs of high androgens, and polycystic ovaries on ultrasound or a raised AMH level, after other causes are ruled out.
- Insulin resistance is common in PCOS, even in women who are not overweight, and raises the risk of type 2 diabetes.
- Healthy eating and regular physical activity help all women with PCOS, with benefits even without weight loss.
- Many women with PCOS conceive, sometimes with treatment, so early medical advice is worthwhile if you are planning a pregnancy.
What is PCOS?
In PCOS, the ovaries and other hormone systems do not work in their usual rhythm. Women often have higher levels of androgens (sometimes called "male" hormones, though all women make them) and may not release an egg every month.
The name is misleading: the small "follicles" seen on ultrasound are immature eggs, not true cysts. In 2026, a global consensus published in The Lancet proposed renaming the condition polyendocrine metabolic ovarian syndrome (PMOS), with the switch expected to be phased in over the next few years. You may see both names used.
How common is it?
The World Health Organization estimates that 10–13% of women of reproductive age have PCOS, and that up to 70% of those affected worldwide are undiagnosed. A 2022 meta-analysis of Indian studies found a pooled prevalence of about 11% using the Rotterdam criteria.
Symptoms of PCOS
Symptoms vary widely and can change over time.
| Symptom | What it may look like |
|---|---|
| Irregular periods | Cycles shorter than 21 days or longer than 35 days, fewer than 8 periods a year, or no periods |
| Excess hair growth (hirsutism) | Coarse, dark hair on the face, chin, chest, abdomen or back |
| Acne and oily skin | Persistent acne, often along the jaw, beyond the teenage years |
| Scalp hair thinning | Thinning at the crown or widening of the parting |
| Weight changes | Weight gain, especially around the waist, or difficulty losing weight |
| Dark skin patches | Velvety darkening on the neck, armpits or groin (acanthosis nigricans), a sign of insulin resistance |
| Fertility problems | Difficulty getting pregnant because of irregular ovulation |
| Mood changes | Higher rates of anxiety, depression and low body image |
How PCOS is diagnosed
There is no single test for PCOS. The 2023 International Evidence-based Guideline, developed with experts and patients from many countries, refines the widely used Rotterdam criteria.
The Rotterdam criteria in adults
An adult woman can be diagnosed with PCOS when she has at least two of these three features, and other causes have been excluded:
- Irregular or absent ovulation, usually shown by irregular periods.
- High androgens, either clinical (hirsutism, acne, hair thinning) or biochemical (raised testosterone on a blood test).
- Polycystic ovarian morphology on ultrasound, or a raised anti-Müllerian hormone (AMH) level in adults.
The 2023 guideline advises using either ultrasound or AMH, not both, to avoid over-diagnosis. If a woman has both irregular cycles and high androgens, an ultrasound is not needed for diagnosis.
Diagnosis in teenagers
Irregular periods and acne are common in the first few years after periods start, so diagnosis in adolescents is more cautious. Teenagers need both irregular cycles and signs of high androgens. Ultrasound and AMH are not recommended for diagnosis in this age group. Girls who show some features may be considered "at risk" and reassessed later.
Ruling out other causes
Your doctor will check for look-alike conditions, such as thyroid problems, high prolactin and, less commonly, adrenal disorders.
Insulin resistance and PCOS
Insulin is the hormone that moves sugar from the blood into cells. In insulin resistance, the body needs more insulin to do this job, and high insulin levels can push the ovaries to make more androgens.
Insulin resistance is common in PCOS and can occur in women of any body size. It is a key reason why PCOS is linked to type 2 diabetes. South Asian women are at higher risk of diabetes in general, which makes regular screening especially important in India.
Long-term health risks
PCOS can affect health well beyond the childbearing years.
- Type 2 diabetes and prediabetes
- Gestational diabetes and high blood pressure in pregnancy
- High cholesterol, high blood pressure and heart disease risk
- Fatty liver disease
- Sleep apnoea, particularly with higher body weight
- Endometrial (womb lining) thickening and cancer, linked to infrequent periods
- Anxiety, depression and eating disorders
The 2023 guideline recommends checking blood sugar status at diagnosis and every one to three years, a lipid profile at diagnosis, blood pressure at least once a year, and screening for depression and anxiety. Ask your doctor how often you should be tested.
Lifestyle steps that help
Lifestyle changes are the foundation of PCOS care. The 2023 guideline recommends healthy eating and physical activity for all women with PCOS, and notes that these bring benefits even when weight does not change.
Eating well
No single "PCOS diet" has been proven to be better than others. What matters is a balanced pattern you can sustain.
- Build meals around vegetables, dals and legumes, whole grains and millets such as jowar, bajra and ragi.
- Include protein at each meal, such as paneer, curd, eggs, fish, chicken, sprouts or tofu.
- Cut down on sugary drinks, sweets, maida-based snacks and fried foods.
- Choose whole fruit over juice, and watch portion sizes of rice and rotis.
- Be wary of extreme diets and supplements marketed as "hormone balancing" or "PCOS cures".
Moving more
Regular activity improves insulin sensitivity, mood and heart health. Aim for at least 150 minutes a week of moderate activity, such as brisk walking, dancing, cycling or swimming, plus muscle-strengthening exercises on two days a week. Any type of exercise you enjoy and can keep up is worthwhile.
Weight
For women with higher body weight, even modest weight loss can improve periods, ovulation and metabolic health. The guideline also emphasises preventing further weight gain; focus on habits rather than the scale alone.
Sleep and emotional health
Keep a regular sleep routine, and seek support from a doctor or counsellor if you feel low or anxious.
Treatment options
Your doctor may suggest medicines to regulate periods, reduce acne and hair growth, improve insulin sensitivity or help with ovulation; laser hair removal can also help. The right choice depends on whether you are trying to conceive, so do not start or stop hormonal medicines without medical advice.
PCOS and fertility
PCOS is one of the most common causes of infertility because ovulation may be irregular. However, many women with PCOS conceive naturally, and others succeed with medical help.
If you are planning a pregnancy, see your doctor early. They can check your blood sugar, blood pressure and weight, recommend folic acid, and discuss options to support ovulation if needed. Healthy habits before pregnancy also lower the risk of gestational diabetes.
When to see a doctor
See a gynaecologist or endocrinologist if you have:
- Periods that are very irregular or have stopped for three months or more (when not pregnant)
- Excess hair growth, persistent acne or scalp hair thinning
- Difficulty getting pregnant after 12 months of trying, or 6 months if you are over 35
- Dark, velvety skin patches, excessive thirst or frequent urination
Seek urgent care if you have very heavy bleeding that soaks a pad every hour, severe abdominal or pelvic pain, or fainting. In an emergency, call 108 or 112 in India.
Frequently asked questions
Can PCOS be cured?
PCOS is a long-term condition and cannot currently be cured. However, symptoms can be managed well with lifestyle changes and, when needed, medical treatment.
Do I need an ultrasound to be diagnosed with PCOS?
Not always. If you have both irregular periods and signs of high androgens, PCOS can be diagnosed without an ultrasound once other causes are excluded. Ultrasound is not recommended for diagnosis in teenagers.
Can I have PCOS if I am not overweight?
Yes. PCOS occurs in women of all body sizes, and insulin resistance can be present even at a normal weight.
Can women with PCOS get pregnant?
Yes, many do. Irregular ovulation can make it take longer, but treatments to support ovulation are available. Speak to your doctor before trying to conceive for a check-up and advice.
Is there a special diet for PCOS?
No single diet has been shown to work best. A balanced eating pattern with plenty of vegetables, legumes, whole grains and protein, and less sugar and refined food, supports metabolic health. Choose an approach you can sustain long term.
Sources
- Polycystic ovary syndrome – WHO fact sheet
- Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of PCOS – Human Reproduction
- International PCOS/PMOS Guideline – Monash Centre for Health Research and Implementation
- Prevalence of polycystic ovarian syndrome in India: a systematic review and meta-analysis – Cureus, 2022
- Polycystic ovary syndrome (PCOS) – NHS