PCOS / PCOD Treatment in Hyderabad — Hormonal Therapy

Polycystic Ovary Syndrome (PCOS) — also commonly called PCOD (Polycystic Ovarian Disease) in India — is the most common hormonal disorder among women of reproductive age, affecting an estimated 1 in 5 women in India and approximately 10–13% of women globally. It is the leading cause of anovulatory infertility (failure to ovulate) and is strongly associated with metabolic complications including insulin resistance, type 2 diabetes, cardiovascular disease, and endometrial cancer. Despite its prevalence, PCOS remains significantly underdiagnosed and undertreated in Hyderabad and across India.

What Is PCOS / PCOD? — Understanding the Condition

PCOS is a syndrome of ovarian dysfunction, androgen excess (elevated male hormones), and polycystic ovarian morphology — diagnosed using the internationally recognised Rotterdam Criteria (2003), which requires at least 2 of the following 3 features:

Rotterdam Criterion	Clinical Definition	Investigation
Oligo/anovulation	Irregular or absent periods (cycles >35 days or <8 cycles/year) — reflecting infrequent or absent ovulation	Menstrual history; basal body temperature charting; mid-luteal progesterone
Clinical or biochemical hyperandrogenism	Hirsutism (excess hair), acne, androgenic alopecia; elevated serum testosterone or free androgen index	Ferriman–Gallwey hirsutism scoring; serum total and free testosterone; DHEAS; SHBG
Polycystic ovarian morphology (PCOM)	Ultrasound showing ≥20 follicles per ovary (2–9mm each) OR total ovarian volume >10mL on TVS	Transvaginal ultrasound (TVS) on day 2–5 of cycle

PCOM alone (polycystic-looking ovaries on ultrasound) is NOT sufficient for PCOS diagnosis — at least 2 of the 3 Rotterdam criteria must be present.

Symptoms of PCOS / PCOD

Irregular or absent periods — cycles longer than 35 days or fewer than 8 periods per year; in severe cases, complete absence of menstruation (amenorrhoea)
Hirsutism — excess dark hair on the face (upper lip, chin), chest, abdomen, back, and inner thighs; the most distressing symptom for many women
Acne — persistent adult acne on the face, chest, and back; often unresponsive to standard dermatological treatment because the root cause is androgen excess
Androgenic alopecia (hair thinning) — thinning of scalp hair in a male pattern; frontotemporal recession or diffuse crown thinning
Weight gain and obesity — central (abdominal) obesity; insulin resistance drives weight gain and makes weight loss difficult; obesity worsens PCOS and creates a vicious cycle
Acanthosis nigricans — dark, velvety skin discolouration in skin folds (neck, armpits, inner thighs) — a cutaneous marker of insulin resistance
Infertility — irregular or absent ovulation means few opportunities to conceive naturally; PCOS is the most common cause of anovulatory infertility
Mood disorders — depression and anxiety occur at significantly higher rates in women with PCOS; partly hormonal, partly related to the visible symptom burden

PCOS and Long-Term Health Risks

PCOS is not merely a reproductive condition — it carries significant long-term metabolic and oncological risks:

Type 2 diabetes — women with PCOS have a 5–10× higher lifetime risk of type 2 diabetes than women without PCOS; up to 40% develop gestational diabetes in pregnancy
Cardiovascular disease — dyslipidaemia (high triglycerides, low HDL), hypertension, and endothelial dysfunction increase cardiovascular risk
Endometrial cancer — women with PCOS who do not ovulate regularly have prolonged unopposed oestrogen exposure — increasing endometrial hyperplasia and endometrial cancer risk; progestogen therapy (COCP or Mirena) reduces this risk
Non-alcoholic fatty liver disease (NAFLD) — independently associated with insulin resistance in PCOS
Obstructive sleep apnoea — 5–30× more common in obese women with PCOS

PCOS Treatment — Comprehensive Stepwise Management

Step 1: Lifestyle – The Most Important Intervention

For overweight and obese women with PCOS, weight loss of just 5–10% of body weight — achieved through a calorie-controlled diet and regular aerobic exercise — restores menstrual regularity in 55–80% of women, significantly reduces androgen levels, and improves insulin sensitivity.

Step 2: Medical Management for Specific Symptoms

Combined oral contraceptive pill (COCP) — regulates the menstrual cycle, reduces hirsutism and acne, and protects the endometrium from cancer risk.

Metformin — reduces insulin resistance, lowers androgen levels, and improves menstrual regularity in women with PCOS and insulin resistance.

Spironolactone / cyproterone acetate — anti-androgens that block androgen receptors and help control hirsutism and acne.

Step 3: Fertility Treatment for PCOS

Ovulation induction with clomiphene citrate — stimulates ovarian follicle development and improves fertility outcomes.

Letrozole (aromatase inhibitor) — preferred first-line ovulation induction agent according to current international guidelines.

Gonadotrophin injections (FSH / hMG) — used for clomiphene or letrozole resistant PCOS.

IVF — recommended when conception does not occur after ovulation induction treatments.

Step 4: Laparoscopic Ovarian Drilling (LOD)

Laparoscopic ovarian drilling is a surgical procedure that reduces androgen-producing ovarian tissue and can help restore ovulation in women with treatment-resistant PCOS.

Frequently Asked Questions — PCOS / PCOD Treatment Hyderabad

What is the difference between PCOS and PCOD?

Can PCOS be cured permanently?

How does PCOS affect fertility and what are the treatment options?

Does PCOS cause weight gain, or does weight gain cause PCOS?

What diet is best for PCOS?

Can I get pregnant with PCOS?

Is metformin effective for PCOS?

What is laparoscopic ovarian drilling (LOD) for PCOS?

Does PCOS increase cancer risk?

Is PCOS treatment covered by health insurance in India?

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