PCOS (PCOD): Symptoms, Medicines for Periods, Acne and Fertility

Irregular periods that come every two or three months, or not at all. Acne that will not clear, extra hair on the face and body, thinning hair on the scalp, weight that rises easily, and difficulty getting pregnant. Polycystic ovary syndrome (PCOS, or PCOD) affects a large share of women in Pakistan, and yet many learn about it only when they struggle to conceive. It is a hormonal and metabolic condition, it is common, and it can be managed.

This guide explains what PCOS is, how it is diagnosed, how the main medicines work for periods, acne, hair and fertility, what lifestyle changes make the biggest difference, and when to see a gynaecologist.

What is PCOS?

In PCOS, the ovaries and adrenal glands make more male-type hormones (androgens) than usual, and the body responds poorly to insulin (insulin resistance). Ovulation becomes irregular or stops, which causes irregular periods and difficulty conceiving. The name comes from small follicles seen on the ovaries on ultrasound, but not every woman with cysts has PCOS, and some women with PCOS do not have cysts.

Symptoms

• Irregular, infrequent or absent periods, or very heavy bleeding when they come.
• Acne, oily skin, and extra dark, coarse hair on the face, chest, belly or back (hirsutism).
• Thinning hair on the scalp, in a male pattern.
• Weight gain, especially around the waist, and difficulty losing it.
• Dark, velvety patches of skin on the neck or armpits (acanthosis nigricans), a sign of insulin resistance.
• Difficulty becoming pregnant, or miscarriages.
• Mood changes, anxiety, low mood and poor sleep.

How is it diagnosed?

Doctors usually diagnose PCOS when at least two of the following are present, after other causes have been excluded: irregular or absent ovulation, signs of high androgens (on examination or blood tests), and polycystic ovaries on ultrasound. Tests commonly include hormone levels, thyroid tests, prolactin, blood sugar or glucose tolerance, a lipid profile, and a pelvic ultrasound. Thyroid disease can look like PCOS. See our guide to thyroid disorders.

Why it matters beyond periods

PCOS raises the long-term risk of type 2 diabetes, high blood pressure, high cholesterol, fatty liver, sleep apnoea, depression and, if periods are very infrequent for years, thickening of the womb lining. Regular check-ups matter. See our guides to diabetes medicines and high cholesterol.

Lifestyle: the foundation of treatment

• Even a modest weight loss (about 5 to 10 per cent of body weight) can restore ovulation and improve all symptoms in women who are overweight. See our guide to weight and BMI at home.
• Exercise for at least 150 minutes a week, such as brisk walking, cycling or swimming, plus some strength training.
• Food: choose whole grains, daal, vegetables, fruit, nuts and lean protein. Cut down on sugar, sweets, white bread, bakery items, sugary drinks, fried food and large portions of white rice.
• Sleep seven to eight hours, and manage stress.
• Avoid crash diets and miracle teas, which do not last, and can harm. If food and weight have become a source of distress, talk to your doctor.

Medicines for PCOS

The right medicine depends on whether you want to get pregnant, and on your main symptoms. All of these are prescription medicines, which need a doctor’s advice.

To regulate periods and protect the womb lining

• Progestin tablets such as dydrogesterone (Efaston 10 mg, Dirogest) or norethisterone, taken for some days each month, trigger a withdrawal bleed and protect the womb lining. They do not prevent pregnancy.
• Combined oral contraceptive pills regulate periods, reduce acne and hair growth, and also prevent pregnancy. Some contain cyproterone, such as Diane-35 and Divestra, which is particularly good for acne and hirsutism, but carries a higher clot risk, and is not meant for contraception alone. They are not suitable for smokers, women with migraine with aura, past clots, or certain other conditions.

To improve insulin resistance

• Metformin improves insulin sensitivity, helps periods and may help weight. Nausea and diarrhoea are the commonest side effects, and often settle if taken with food or in a slow-release form.
• Inositol (myo-inositol) supplements are widely used, and may help ovulation and insulin resistance in some women. Evidence is promising but not as strong as for metformin.

For acne and unwanted hair

• Anti-androgen medicines such as spironolactone reduce hair growth and acne, but must be used with reliable contraception, because they can harm a male baby, and need blood tests for potassium.
• Topical acne treatments, and hair removal methods such as laser, waxing and threading. Read our guide to acne creams.
• Hair loss on the scalp needs a dermatologist. See our guide to hair regrowth treatments.

To get pregnant

• Clominol (clomiphene) and letrozole stimulate ovulation. Letrozole is now often preferred. They are used for a limited number of cycles, with ultrasound monitoring to avoid multiple pregnancy.
• Injectable hormones, and IVF, when tablets do not work. Weight loss before treatment improves results.
• Start folic acid before trying for pregnancy. See our guide to pregnancy vitamins and supplements.

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Emotional health

PCOS can be hard on confidence, with acne, hair and weight, and the pressure to conceive. Anxiety and depression are common. Talk to your doctor if you feel low. See our guide to depression and anxiety medicines. Many women improve with support and the right treatment.

When to see a gynaecologist

• Periods that are irregular for more than three months, or absent.
• Very heavy bleeding, or bleeding between periods. Read our guide to sanitary pads for signs of heavy bleeding.
• Difficulty conceiving after six months to a year of trying, or after 35, after six months.
• Rapid hair growth, deepening voice or other signs of very high male hormones.
• Excess thirst, frequent urination or very high weight gain.
• Pelvic pain, or sudden severe belly pain.

Frequently asked questions

Can PCOS be cured?

It cannot be cured, but its symptoms and risks can be controlled with lifestyle and treatment, and many women conceive naturally or with help.

Do I have PCOS if my ultrasound shows cysts?

Not necessarily. The diagnosis depends on symptoms and tests as well.

Will the pill make me infertile?

No. Fertility returns after you stop, though PCOS itself may cause irregular ovulation.

Is it safe to take hormonal medicines for years?

Your doctor will review risks and benefits, and monitor you.

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This article is for general information and is not a substitute for advice from your doctor or gynaecologist. It does not include doses; your doctor decides the medicine and amount. Always follow the directions on the pack or from your doctor.