PCOS/PCOD Treatment

Polycystic ovary syndrome is a hormonal and metabolic condition in which the ovaries stop releasing an egg reliably. The name is misleading: what a scan shows is not cysts in the ordinary sense but a large number of small follicles that began to develop and stalled, and they are harmless in themselves.

Two things drive it and they feed each other. The ovaries produce more androgen than usual, which is what disturbs the cycle and produces changes in skin and hair. Alongside that, the body's tissues respond poorly to insulin, so more insulin is made to do the same job, and the extra insulin pushes the ovary to make still more androgen.

It is common among women of reproductive age, and in South Asian women it tends to appear earlier and at a lower body weight than Western figures suggest. It is a long-term condition managed across decades, and what matters most about it changes with the stage of life you are in: cycles and skin in your twenties, conceiving in your thirties, and blood pressure, sugar and the lining of the uterus in the years after that.

The diagnosis is made on the pattern, and your doctor builds it from what you report and what they find on examining you. They will ask how many cycles you have in a year, for how long they have been like that, and what changed. Height, weight, waist measurement and blood pressure are recorded at that first visit and they matter as much as anything else taken that day.

On examination your doctor looks for the physical signs of raised androgens in skin and hair, and for the darkened velvety skin at the neck, armpits and groin that goes with insulin resistance. Blood is taken to confirm the hormone picture and, as importantly, to exclude thyroid disease, a raised prolactin and the less common conditions that imitate the syndrome, since those are treated in completely different ways. A pelvic ultrasound counts the follicles and measures the volume of each ovary.

Two of three features are needed: cycles that show ovulation is not happening regularly, evidence of raised androgens either on examination or in the blood, and the ovarian appearance on the scan. In a girl within a few years of her first period the scan is left out, because that appearance is normal at her age and would label half her classmates.

PCOS is managed and not cured, and every part of it moves in months. Changes to what you eat and how much you move are the base of every plan. A loss of five to ten per cent of body weight restores cycles in a large proportion of women who are carrying extra weight, and that much takes three to six months to achieve, with the effect on cycles showing a few months behind.

Treatment aimed at the cycle is judged over three cycles. Treatment aimed at skin and unwanted hair is slower, because hair grows in cycles of its own: allow six months before you decide whether it is working, and expect to continue something to hold the improvement. Treatment for the skin usually needs a dermatologist's input alongside.

Where you are trying to conceive, treatment runs in monthly rounds with a scan in each, and your doctor will agree in advance how many rounds are attempted before the approach changes. Everything works better on a background of steady weight and regular activity, and that background is the part that keeps working after the treatment stops.