Quick answer: PCOS (polycystic ovary syndrome) is caused by a mix of inherited tendency, insulin resistance and excess androgen (male-type hormone) production that disrupts ovulation. It cannot be cured, but it can be controlled well with lifestyle changes, hormonal pills, metformin or ovulation-inducing tablets, chosen according to your symptoms and whether you want to conceive.
Key takeaways
- PCOS affects roughly 1 in 10 women of reproductive age and is one of the commonest causes of irregular periods and ovulation-related infertility.
- The main drivers are genetics, insulin resistance, high androgens and altered brain–ovary hormone signalling, often worsened by weight gain and inactivity.
- Diagnosis needs two of three features: irregular or absent ovulation, signs of high androgens, and polycystic ovaries on scan (or a raised AMH in adults), after other causes are ruled out.
- Treatment is matched to your goal: regular cycles, clearer skin, fertility, or lowering long-term risks of diabetes and heart disease.
- Even a 5–10% weight loss, where weight is a factor, can restart ovulation and improve symptoms.
What is PCOS?
PCOS is a long-term hormonal and metabolic condition in which the ovaries do not release an egg regularly and often produce more androgens than usual. It is not simply “cysts on the ovaries”.
The “cysts” seen on ultrasound are actually many small follicles (immature egg sacs) that have stopped growing before ovulation. Some women with PCOS have normal-looking ovaries, and many women with polycystic-looking ovaries do not have PCOS. That is why a scan alone never makes the diagnosis.
What causes PCOS?
There is no single cause. PCOS develops when an inherited tendency meets hormonal and lifestyle triggers, and each factor feeds the others.
1. Genetics and family history
PCOS runs in families. If your mother or sister has PCOS, irregular periods or type 2 diabetes, your own risk is higher. Many genes each add a small effect; there is no single “PCOS gene”.
2. Insulin resistance
Up to 7 in 10 women with PCOS have some degree of insulin resistance, including many who are not overweight. The body makes extra insulin to keep blood sugar normal, and high insulin tells the ovaries to make more testosterone. Our detailed guide to diet for PCOS with insulin resistance explains how to break this cycle with food.
3. Excess androgens
Raised androgens stop follicles maturing, so ovulation fails. They also cause acne, oily skin, excess facial and body hair (hirsutism) and scalp hair thinning.
4. Brain–ovary signalling
In PCOS the hypothalamus and pituitary often release luteinising hormone (LH) in faster, stronger pulses, which further drives androgen production. Read more in how the hypothalamus is involved in PCOS.
5. Inflammation, weight and environment
Low-grade inflammation, weight gain around the waist, poor sleep, chronic stress and inactivity worsen insulin resistance. Research is also exploring a possible role for endocrine-disrupting chemicals such as BPA, though this is not yet proven to cause PCOS.
What are the symptoms of PCOS?
Symptoms vary widely, and you may have only one or two of them.
- Irregular, infrequent or absent periods (cycles longer than 35 days or fewer than 8 periods a year). See PCOS and irregular periods.
- Acne, oily skin, excess hair on the face, chest or abdomen, or thinning scalp hair
- Weight gain or difficulty losing weight, especially around the waist
- Dark, velvety skin patches on the neck or underarms (acanthosis nigricans), a sign of insulin resistance
- Difficulty getting pregnant
- Low mood, anxiety or poor body image, which are more common with PCOS
How is PCOS diagnosed?
PCOS is diagnosed using the Rotterdam criteria, updated in the 2023 international evidence-based PCOS guideline: you need at least two of the three features below, with other causes excluded.
- Irregular or absent ovulation, usually shown by irregular cycles
- High androgens, either on blood tests (total or free testosterone) or clinically (acne, hirsutism)
- Polycystic ovarian morphology on transvaginal ultrasound, or a raised AMH blood level in adults
Your doctor will also check thyroid function, prolactin and sometimes 17-hydroxyprogesterone to rule out conditions that mimic PCOS, plus a pregnancy test where relevant. In teenagers, ultrasound and AMH are not used for diagnosis within eight years of the first period, because irregular cycles and multi-follicular ovaries are normal at that age.
Once PCOS is confirmed, screening for diabetes (fasting glucose, HbA1c or an oral glucose tolerance test), cholesterol and blood pressure is recommended, and repeated every one to three years.
What are the treatment options for PCOS?
PCOS treatment is chosen around your main concern. Lifestyle care underpins everything; medicines are added for specific goals.
| Goal | Common first-line options | Notes |
|---|---|---|
| Regular periods, protect the womb lining | Combined oral contraceptive pill, or cyclical progestogen | Fewer than 4 periods a year raises the risk of a thickened womb lining |
| Acne and excess hair | Combined pill; anti-androgens such as spironolactone if needed; laser or other hair removal | Anti-androgens need reliable contraception; results take 6 months or more |
| Insulin resistance and weight | Diet, activity, sleep; metformin | Metformin may also help cycles; stomach upset is the main side effect |
| Getting pregnant | Letrozole for ovulation induction; then gonadotropins, IUI or IVF if needed | Letrozole has higher live-birth rates than clomiphene in PCOS |
| Mood and wellbeing | Screening, counselling, peer support | Anxiety and depression should be asked about at every visit |
Inositol supplements are popular; evidence is limited but they are generally safe. Our article on herbal supplements for PCOS reviews what the research shows. For food choices, see the PCOS diet and nutrition guide.
What are the long-term risks of PCOS?
PCOS is more than a period problem. Over time it raises the risk of type 2 diabetes, gestational diabetes, high cholesterol, fatty liver, sleep apnoea and, if periods are very infrequent for years, endometrial (womb lining) hyperplasia and cancer. Regular check-ups and early lifestyle changes reduce these risks considerably.
Does PCOS change after pregnancy?
Pregnancy does not cure PCOS. Periods may be irregular again once breastfeeding reduces, and women who had gestational diabetes need a glucose test after delivery. Our guide to PCOS after pregnancy covers this stage in detail.
When to see a gynaecologist
Book a consultation if any of these apply:
- No period for three months or more (and you are not pregnant), or fewer than eight periods a year
- Very heavy or prolonged bleeding, or bleeding between periods
- Rapidly worsening facial hair, a deepening voice or other signs of virilisation, which need urgent tests
- Trying to conceive for 12 months (or 6 months if you are over 35, or sooner if cycles are irregular)
- Excessive thirst, frequent urination or dark skin patches suggesting high blood sugar
- Persistent low mood or anxiety
How Dr. Divya Venugopalan can help
Dr. Divya Venugopalan is a gynaecologist and fertility specialist in North Bengaluru with over 14 years of experience and a Fellowship in Reproductive Medicine (FRM). She is a member of the PCOS Society and focuses on confirming the diagnosis properly, explaining your test results in plain language and building a plan around your priorities, whether that is regular cycles, skin and hair concerns or pregnancy.
When fertility is the goal, she offers ovulation induction with careful follicle monitoring and, where needed, IUI or IVF. For broader concerns she provides ongoing gynaecology care. Local patients can also read about PCOS treatment in Bengaluru.
She consults at Thanisandra, Sahakar Nagar and HRBR Layout, Monday to Saturday. Book an appointment or call +91 99459 26987.
Frequently asked questions
Can PCOS be cured permanently?
No. PCOS is a lifelong tendency, but symptoms can be controlled very well. Many women have regular cycles, clear skin and healthy pregnancies with the right lifestyle changes and treatment, and symptoms often ease after the late thirties.
Can I get pregnant if I have PCOS?
Yes. Most women with PCOS can conceive, often with simple ovulation-inducing tablets such as letrozole. Weight optimisation where needed, timed intercourse and follicle monitoring improve the chances, and IUI or IVF are options if tablets do not work.
Do thin women get PCOS?
Yes. Lean PCOS is common, and insulin resistance can still be present at a normal weight. Diagnosis depends on cycles, androgen signs and ovarian findings, not body weight.
Is the contraceptive pill safe for long-term PCOS treatment?
For most women it is safe and effective for regulating periods and improving acne and hair growth. Your doctor will check blood pressure, migraine history, smoking and clot risk before prescribing and review you regularly.
Does PCOS go away after menopause?
Irregular periods stop at menopause, but the metabolic side of PCOS, such as the risk of diabetes and high cholesterol, continues. Ongoing screening and a healthy lifestyle remain important.
Medically reviewed by: Dr. Divya Venugopalan, MBBS, DNB (OBG), FRM, FMAS. Gynaecologist & fertility specialist, Bengaluru (KMC Reg. No. 91293). Last reviewed: 27 October 2026.
This article is for general information and does not replace a personal consultation. In an emergency, visit the nearest hospital emergency department.
