Polycystic ovary syndrome affects roughly one in ten women of reproductive age. It is also routinely diagnosed on the basis of a single ultrasound report, which is not how it is meant to be diagnosed at all — and equally routinely missed in women who have had the symptoms since adolescence.
The name is misleading
The “cysts” are not cysts. They are ordinary follicles — the small fluid-filled sacs that every ovary contains, each holding an egg. In PCOS, more of them than usual sit part-developed because ovulation is not happening reliably, so on a scan the ovary shows many small follicles arranged around the edge.
They are not dangerous, they do not need removing, and their presence alone does not mean you have PCOS. Plenty of women have this appearance on ultrasound with no PCOS whatsoever.
How it is actually diagnosed
Diagnosis requires two out of these three, with other causes excluded:
- Irregular or absent ovulation — usually showing up as cycles that are infrequent, unpredictable, or absent
- Excess androgen — either visible as excess hair growth on the face, chest or abdomen, persistent acne or scalp hair thinning, or measured on a blood test
- Polycystic ovaries on ultrasound
Two of three. Which means a scan on its own is never enough, and a woman with irregular cycles and clear androgen symptoms has PCOS whether or not her scan shows anything.
One important exception: in a teenager within about eight years of her first period, ultrasound should not be used to make the diagnosis at all, because the multi-follicle appearance is normal at that age. Diagnosing PCOS in adolescents on a scan is a common and consequential error.
Other conditions have to be ruled out first — thyroid disease, a raised prolactin level, and some less common hormonal disorders. That is why proper diagnosis involves blood tests, not just a scan.
What is actually going on underneath
For most women with PCOS, insulin resistance sits at the centre of it. The body produces insulin but responds to it poorly, so it produces more. High insulin levels push the ovaries to produce more androgen, and the excess androgen disrupts ovulation. That is the loop that generates the irregular cycles, the acne and the excess hair growth together.
This matters because it explains why treatment that only addresses one symptom tends to disappoint, and why the things that improve insulin sensitivity improve several symptoms at once.
It also matters because it is not caused by anything you did.
What genuinely helps
Movement and dietary change
First-line, and the evidence for it is real rather than obligatory. Even a modest reduction in weight where there is excess weight can restore ovulation in a meaningful proportion of women. Regular activity improves insulin sensitivity independently of any weight change — which matters, because lean women get PCOS too.
The useful version of this advice is specific and local: manage the amount and type of carbohydrate at each meal rather than eliminating it, get enough protein, and find activity you will still be doing in six months. A plan you abandon in three weeks achieves nothing.
Metformin
Targets insulin resistance directly. Helps cycles in many women, and is often used alongside lifestyle change rather than instead of it.
The combined pill
Where pregnancy is not the current goal, it regulates cycles, reduces androgen symptoms, and protects the lining of the uterus. That protection matters more than most people realise — see below.
Treatment for hair and skin
Specific treatments exist for excess hair growth and acne, and they work. These symptoms have a significant effect on how women feel about themselves and they are worth treating in their own right, not dismissed as cosmetic.
Help conceiving
Most women with PCOS who want to become pregnant are able to. Ovulation can usually be induced with tablets, and letrozole is now the preferred first-line option for this. PCOS is one of the most treatable causes of difficulty conceiving.
The part that gets left out
If your periods are very infrequent — fewer than about four a year — the lining of the uterus can keep thickening without being shed. Over years this raises the risk of abnormal changes in the lining. It is straightforward to prevent, with treatment that ensures the lining sheds regularly. It is one of the main reasons PCOS deserves ongoing management rather than being left alone between pregnancies.
PCOS also raises the long-term risk of type 2 diabetes, and is associated with higher rates of sleep apnoea, anxiety and depression. None of these are inevitable, and all of them are easier to address when someone is watching for them.
Why we run it as a programme
A single consultation and a prescription does not manage a lifelong hormonal condition well. Cycles, weight, skin, hair, insulin resistance and fertility plans all move over months, and they move together. That is the reasoning behind the Balance programme — proper diagnosis first, then a plan with scheduled reviews so nothing quietly drifts for two years.
If any of this sounds like you
Cycles longer than 35 days or fewer than eight periods a year, unexplained hair growth, persistent adult acne, difficulty conceiving, or a scan report that mentioned polycystic ovaries — those are all reasons to have it looked at properly. Our irregular periods and PCOS self-check guide is a good place to start recording what has been happening.
A note on this article
This is general information, not advice about your particular situation — no article can replace being examined. If something here matches what you’re experiencing, that is a reason to come in, not a reason to self-treat. Walk in during clinic hours or call +91 93660 92897.