What is PCOS? Symptoms, causes, PCOS vs PCOD and treatment

PCOS in simple words

In a normal cycle, one egg matures in the ovary each month and is released. In PCOS, many eggs start to grow but stop early. They stay as small fluid-filled follicles, which look like a "string of pearls" on ultrasound. Despite the name, these are not true cysts and they do not need an operation. Because ovulation is irregular, periods become irregular, and the hormone balance shifts towards more androgens (male-type hormones that every woman makes in small amounts).

PCOS is one of the most common hormone conditions in women. The WHO estimates that it affects about 1 in 10 women of reproductive age and that up to 70% of them are not diagnosed. South Asian women tend to have more insulin resistance, so PCOS here is often linked with belly fat, high sugar and a family history of diabetes.

PCOS vs PCOD: is there a difference?

In Pakistan and India, many doctors and websites use "PCOD" (polycystic ovarian disease), and some describe it as a milder version of PCOS. International guidelines do not recognise PCOD as a separate condition; they use only PCOS. Two situations get confused:

• Polycystic-looking ovaries on an ultrasound, with regular periods and no hormone signs: very common in young women and not PCOS. It needs no treatment.
• Irregular periods with acne, extra hair or high androgens (with or without ultrasound changes): this is PCOS, whatever name is written on the report.

If your report says "PCOD", ask your doctor which of the criteria below you meet. That decides your care, not the label.

Symptoms of PCOS in females

• Irregular periods: long gaps, fewer than 8 periods a year, or no periods; sometimes heavy bleeding after a long gap
• Extra hair (hirsutism) on the chin, upper lip, cheeks, chest, belly or back
• Acne that is persistent, often on the jaw and chin, and oily skin
• Hair thinning on the top of the scalp
• Weight gain, mostly around the belly, and difficulty losing it
• Dark, velvety skin on the neck, armpits or groin (acanthosis nigricans) and skin tags, signs of insulin resistance
• Difficulty getting pregnant, because ovulation is irregular
• Low mood, anxiety and poor body image, which are more common in PCOS and deserve care too

No woman has all of these. One woman may only have irregular periods; another has regular-looking cycles but severe acne and high testosterone.

How PCOS is diagnosed

Doctors use the Rotterdam criteria, updated in the 2023 international guideline. PCOS is diagnosed when two of these three are present and other causes have been ruled out:

Teenagers are different. In the first years after periods start, irregular cycles and acne are normal. A girl is diagnosed only if she has both irregular periods and high androgens. Ultrasound is not used for diagnosis at this age, and an internal scan is never needed.

Tests your doctor may order

The LH : FSH ratio, still printed on many reports, is no longer used to diagnose PCOS. For ranges, see TSH normal range, normal sugar level, HbA1c and lipid profile.

What causes PCOS

• Genes: PCOS runs in families. A mother or sister with PCOS, or a family history of type 2 diabetes, raises the chance.
• Insulin resistance: high insulin levels push the ovaries to make more testosterone. This is why weight, sugar and PCOS are so closely linked. See insulin resistance.
• Hormone signals: the brain sends more LH, which also drives androgen production.
• Weight gain makes all of these worse, but thin women get PCOS too.

Why PCOS matters beyond periods

PCOS raises the long-term risk of type 2 diabetes, diabetes in pregnancy, high cholesterol and blood pressure, fatty liver and sleep apnoea. When periods stay away for months, the womb lining can thicken, which over many years raises the risk of endometrial cancer; this is why doctors aim for at least a few bleeds a year. Regular check-ups catch these early, and lifestyle change lowers every one of them.

PCOS treatment

There is no single PCOS medicine. Treatment depends on the symptom that troubles you most and on whether you want to get pregnant. Lifestyle (diet, activity, sleep) comes first for every woman, at every weight.

Inositol supplements are widely sold for PCOS; the 2023 guideline found the evidence limited and says they are experimental. Discuss any supplement with your doctor before you buy it.

Treatment for unmarried girls

Many families in Pakistan delay PCOS care for unmarried daughters, worried about examinations, the pill or "what people will say". The facts:

• No internal examination is needed. Diagnosis uses the period history, the skin and hair, and blood tests; in adults an abdominal ultrasound is enough.
• The contraceptive pill is a hormone treatment here, used to regulate periods and treat acne and hair. It does not harm future fertility.
• Diet and activity work at any age and are the base of treatment.
• Early care is better. Treating PCOS in the teens and twenties prevents weight and sugar problems from building up, and protects future fertility.

Common PCOS myths in Pakistan

• "Shadi ke baad theek ho jayega." Marriage does not change hormones, and pregnancy does not cure PCOS.
• "PCOS means you can never have children." Most women with PCOS can conceive, some with help.
• "Cysts need an operation." PCOS follicles are not true cysts and are not removed.
• "Only overweight girls get PCOS." Lean PCOS is common.
• "This herbal course cures PCOS permanently." No product cures PCOS. Some unlabelled herbal medicines contain steroids or harm the liver.

Where diet fits in

Food is the part of PCOS treatment you control every day. Regular meals, whole-grain roti in sensible portions, protein at every meal, half a plate of sabzi and far less sugar and maida lower insulin, which helps periods, skin and weight. If you are overweight, losing 5 to 10% of your weight often brings back regular cycles. The full Pakistani meal plan, with a 7-day chart, is on the PCOS diet plan page. For a plan around your own reports, medicines and goals, see our PCOS consultation.