PCOS: Symptoms, Causes and Treatment Options for Women

Periods that come every two or three months, stubborn pimples along the jawline, extra hair on the face and a waistline that keeps growing. For many young women in Pakistan these seem like separate problems, and they are often treated one at a time. Very often they share a single cause: polycystic ovary syndrome, or PCOS. It is one of the most common hormonal conditions in women of childbearing age, and it is manageable once it is recognised.

What is PCOS?

PCOS is a hormonal condition in which the ovaries do not release eggs regularly and the body makes slightly more male hormones (androgens) than usual. Despite the name, you do not need to have cysts, and having cysts on a scan does not by itself mean you have PCOS. The cause is not fully known, but insulin resistance, genes and weight all play a part. South Asian women tend to develop PCOS at a lower body weight than women in some other parts of the world.

PCOS symptoms

• Irregular, infrequent or missed periods, or very long cycles
• Extra, coarse hair on the face, chest or abdomen (hirsutism)
• Acne, especially around the chin and jaw, and oily skin
• Thinning hair on the scalp
• Weight gain, mostly around the belly
• Dark, velvety patches on the neck or underarms
• Difficulty getting pregnant
• Low mood, anxiety or poor sleep

How PCOS is diagnosed

Doctors usually diagnose PCOS when two of these three are present: irregular or absent ovulation, signs or blood tests showing high male hormones, and polycystic-looking ovaries on ultrasound. Other conditions, such as an underactive thyroid or high prolactin, are checked and ruled out first. You may be asked to have hormone tests, a sugar test or HbA1c, a lipid profile and a pelvic ultrasound.

Why PCOS matters beyond periods

Over time, PCOS raises the chances of type 2 diabetes, high cholesterol, fatty liver, high blood pressure and sleep apnoea. Going months without a period also lets the lining of the womb thicken, which can increase the risk of heavy bleeding and, in rare cases, womb cancer. Regular check-ups are a good investment.

Lifestyle comes first

Even a modest weight loss of 5 to 10 percent can bring back regular ovulation in many women.

• Walk, cycle or exercise for about 30 minutes on most days.
• Choose whole-wheat roti, daliya, daal, chana, vegetables and salads over white bread, bakery items and sweets.
• Cut sugary drinks, and keep fried snacks occasional.
• Do not skip meals or crash diet, because that often backfires.
• Get enough sleep and find a way to manage stress.

PCOS medicines your doctor may consider

Treatment depends on what bothers you most and whether you want to get pregnant.

• To regulate periods: hormonal pills, or a short course of a progestin such as norethisterone to bring on a period.
• For acne and extra hair: hormonal pills and anti-androgen medicines such as spironolactone. These must never be used in pregnancy, so reliable contraception is needed.
• For insulin resistance: metformin, which can also help with weight and periods.
• Supplements: inositol is widely used, though the evidence is modest.
• When trying to conceive: ovulation-inducing medicines such as letrozole or clomiphene, and folic acid before and during early pregnancy.

Cosmetic hair removal, such as laser or waxing, works alongside medicines and is not a substitute for them. For painful periods, see our guide to severe period pain.

When to see a doctor

• No period for three months or more, or fewer than about eight periods a year
• Trying to conceive for 12 months (6 months if you are over 35) without success
• Very heavy bleeding or bleeding that is prolonged
• Rapidly worsening acne or hair growth

Key takeaways

• PCOS is a hormonal and metabolic condition, not just a problem of ovarian cysts.
• Irregular periods, acne, extra hair and difficulty conceiving are the classic signs.
• Weight loss, exercise and a lower-sugar diet are the foundation of treatment.
• Medicines are chosen according to your goals, and some must be avoided in pregnancy.

Related medicines on Medimart

These are commonly prescribed by doctors for PCOS and related concerns:

• Metformin: helps with insulin resistance
• Inositol: a supplement often used in PCOS
• Spironolactone: an anti-androgen for acne and excess hair
• Norethisterone: a progestin used to regulate periods
• Letrozole: used by doctors to induce ovulation
• Clomiphene: another ovulation-inducing medicine
• Folic acid: advised before and during early pregnancy

Prescription medicines are supplied only against a valid prescription. Please take them only as advised by your doctor.

Browse PCOS and fertility medicines on Medimart with delivery across Pakistan. Prescription medicines are supplied only against a valid prescription.

This guide is for general information and does not replace advice from a doctor. If you suspect PCOS, please see a gynaecologist or endocrinologist.