PCOS: Symptoms, Causes, Diagnosis, Treatment & Prevention

If you've had irregular periods for months, noticed stubborn acne or extra facial hair, or struggled to lose weight no matter what you try, you are far from alone. A nationwide study using the latest international diagnostic guideline found that nearly 7% of women in Bangladesh have Polycystic Ovary Syndrome (PCOS) — and in women specifically being evaluated for excess hair growth, that figure has been reported as high as 90% in smaller clinical samples. Yet because routine gynaecological check-ups are still uncommon here and periods remain a taboo topic in many households, most women are diagnosed only years later, often when they start trying to conceive. This guide explains what PCOS actually is, how doctors diagnose it using current international criteria, what the real long-term health risks are, and what treatment options — from lifestyle changes to specific medicines — are actually available.

What Is PCOS?

Polycystic Ovary Syndrome is a common hormonal disorder that affects how the ovaries work. Despite the name, it is not primarily a disease of "cysts" — the small, immature follicles seen on an ultrasound in some women with PCOS are not true cysts, and plenty of women with PCOS have normal-looking ovaries on imaging. PCOS is better understood as a whole-body hormonal and metabolic condition that happens to show up most visibly through its effects on the menstrual cycle and skin.

The exact cause is still not fully understood, but research points to two tightly linked drivers:

• Insulin resistance: In PCOS, the body's cells respond poorly to insulin, so the pancreas produces more of it to keep blood sugar normal. This excess insulin pushes the ovaries to produce more androgens (male-type hormones), which disrupts ovulation. Insulin resistance is considered one of the central features of PCOS, present in a majority of affected women regardless of body weight.
• Hormonal imbalance: Many women with PCOS have a higher ratio of luteinizing hormone (LH) to follicle-stimulating hormone (FSH), along with elevated androgens, both of which interfere with normal egg release each month.
• Genetics: PCOS tends to run in families — if your mother or sister has it, your own risk is meaningfully higher, suggesting a strong inherited component layered on top of lifestyle and environmental factors.

Symptoms of PCOS

PCOS symptoms vary widely between women, and not every woman has every symptom. The most commonly reported features include:

• Irregular or absent periods — cycles longer than 35 days, fewer than 8-9 periods a year, or periods that stop altogether
• Hirsutism — excess hair growth on the face, chin, chest, or back due to elevated androgens
• Acne and oily skin, often persisting well beyond the teenage years
• Scalp hair thinning in a male-pattern distribution
• Weight gain or difficulty losing weight, especially around the abdomen
• Acanthosis nigricans — dark, velvety patches of skin on the neck, armpits, or groin, which is a visible marker of underlying insulin resistance
• Difficulty conceiving due to irregular or absent ovulation

Because acne, irregular periods, and even some weight gain are common during normal adolescence, symptoms in teenage girls can be harder to interpret, which is exactly why diagnostic guidelines treat younger patients differently (see below).

How Is PCOS Diagnosed?

The current reference standard is the 2023 International Evidence-based Guideline for the Assessment and Management of PCOS, developed by an international panel (including Monash University and global reproductive health societies) and published in the Journal of Clinical Endocrinology & Metabolism. It refines the older Rotterdam criteria:

• For adults: A diagnosis needs at least two of three features — (1) clinical or blood-test evidence of excess androgens, (2) irregular or absent ovulation, and (3) polycystic-appearing ovaries on ultrasound or an elevated Anti-Müllerian Hormone (AMH) level — once other conditions that mimic PCOS (such as thyroid disease or other hormonal disorders) have been ruled out. If a woman already has both irregular cycles and clinical signs of excess androgens, an ultrasound or AMH test isn't even required to confirm the diagnosis.
• For adolescents: The guideline is deliberately stricter. Both excess androgens AND ovulatory dysfunction must be present, and ultrasound or AMH testing is specifically not recommended, because multi-follicular ovaries and irregular cycles are extremely common in the first few years after a girl's first period and don't reliably indicate PCOS at that age.

In practice, a doctor will usually take a detailed menstrual and symptom history, examine for signs of excess androgen (hair growth pattern, acne, scalp hair), and order blood tests — including a hormone panel, fasting glucose or an oral glucose tolerance test (OGTT), and a lipid profile — alongside a pelvic ultrasound. In Bangladesh, this evaluation is typically done by a gynaecologist, and many women only undergo it after months or years of unexplained irregular periods, or while investigating difficulty conceiving, since routine reproductive health check-ups remain uncommon and periods are still a subject many families avoid discussing openly.

Why PCOS Is More Than a "Period Problem": Long-Term Health Risks

PCOS is often dismissed as just a menstrual inconvenience, but it carries real long-term risks that deserve ongoing medical attention even outside of fertility concerns:

• Type 2 diabetes: Women with PCOS have roughly a 5 to 10 times higher risk of developing type 2 diabetes compared to women without the condition. Clinical guidance recommends an oral glucose tolerance test at the time of diagnosis, repeated every one to three years depending on additional risk factors such as weight and family history.
• Cardiovascular risk factors: PCOS is associated with a higher likelihood of high blood pressure, abnormal cholesterol levels, abdominal obesity, and sleep apnea — all of which raise long-term heart disease risk and are worth screening for, alongside asking about smoking and family history of early heart disease.
• Endometrial cancer: Because infrequent periods mean the uterine lining is exposed to unopposed oestrogen for longer stretches, women with PCOS have been reported to have roughly three times the risk of endometrial cancer compared to the general population. Routine screening (such as biopsy or ultrasound of the lining) is not recommended for women without symptoms, but any abnormal or heavy bleeding should be reported to a doctor promptly, and regulating cycles with hormonal treatment is thought to lower this risk.
• Mental health: Anxiety and depression are more common among women with PCOS, likely from a combination of hormonal effects, visible symptoms like acne and hair growth affecting self-esteem, and the frustration of fertility struggles. Screening for mood symptoms is now part of recommended PCOS care.
• Fatty liver disease is also reported more frequently in women with PCOS, tied to the same underlying insulin resistance.

PCOS vs. Other Causes of Irregular Periods

Irregular periods have many possible causes besides PCOS — thyroid disorders, extreme weight loss or gain, high stress, excessive exercise, and other hormonal conditions can all disrupt the cycle. This is exactly why the diagnostic guideline insists on ruling out these other causes with blood tests before confirming PCOS. If you have irregular periods, don't self-diagnose as PCOS — a proper evaluation, including thyroid function tests, is needed to identify the actual cause and the right treatment.

Treatment and Management

There is no single cure for PCOS, but it can be managed effectively, and treatment is tailored to what matters most to each woman — symptom control, metabolic health, or fertility.

• Lifestyle changes are the foundation of treatment for almost everyone. A balanced diet and regular physical activity — ideally combining aerobic exercise with strength training, which improves insulin sensitivity by building muscle — can meaningfully improve symptoms. Research indicates that even a modest 5-10% reduction in body weight can be enough to restore regular ovulation in many women, regardless of their starting weight.
• For women not trying to conceive: Combined hormonal contraceptive pills are commonly prescribed to regulate the menstrual cycle, reduce the endometrial cancer risk from infrequent periods, and improve acne and hirsutism. Anti-androgen medicines such as spironolactone may be added specifically for troublesome hair growth or acne, under a doctor's supervision, as they require monitoring and are not suitable during pregnancy.
• Metformin, the same medicine widely used for type 2 diabetes, is also an established treatment for PCOS. It improves insulin sensitivity, which can help regulate cycles and improve metabolic markers. It's generally well tolerated but can cause stomach upset in some people when starting out.
• Myo-inositol, a naturally occurring compound related to the B-vitamin family, has become a well-studied supplement option. Evidence from systematic reviews suggests its effects on hormonal and metabolic markers are broadly comparable to metformin, with fewer gastrointestinal side effects, and some research suggests combining the two may work better than either alone — though this should still be discussed with a doctor rather than self-prescribed.
• For women trying to conceive: Letrozole is now generally preferred as a first-line medicine to induce ovulation in women with PCOS, with clomiphene citrate as another established option. If these don't succeed, further fertility treatment including IVF may be considered by a specialist.

None of the specific medicines named above should be started without a doctor's assessment — dosing, suitability, and monitoring needs differ significantly from person to person, especially since several of these medicines are contraindicated in pregnancy or require regular blood tests.

PCOS, Fertility, and Pregnancy

A PCOS diagnosis does not mean you cannot have children. Most women with PCOS can and do conceive — some naturally, though it may take longer because ovulation is irregular, and others with the help of ovulation-inducing medicines or assisted reproduction. Maintaining a healthy weight before and during pregnancy helps lower the risk of pregnancy complications associated with PCOS, such as gestational diabetes. Interestingly, many women notice their PCOS symptoms become less prominent during pregnancy, as hormone patterns shift — only for symptoms to return in the postpartum period once hormones settle back to baseline.

When to See a Doctor

You should see a gynaecologist or your doctor if you notice any of the following:

• No period for three months or more, when you are not pregnant
• Periods that are consistently irregular, very heavy, or accompanied by severe pain
• New or worsening excess hair growth, scalp hair thinning, or persistent acne into adulthood
• Difficulty conceiving after a year of trying (or six months if you are over 35)
• Symptoms suggestive of diabetes, such as excessive thirst, frequent urination, or unexplained fatigue

Prevention and Living Well With PCOS

Because genetics play a significant role, PCOS itself cannot always be prevented. However, its severity and long-term complications can often be reduced through early recognition and consistent management: maintaining a healthy weight, staying physically active, eating a balanced diet with controlled intake of refined sugars and carbohydrates, getting adequate sleep, and attending regular follow-up for blood sugar, blood pressure, and cholesterol checks once diagnosed. Girls and women with a family history of PCOS, diabetes, or irregular periods should consider mentioning this to their doctor early, so that monitoring can begin before symptoms become severe. Above all, PCOS is a manageable, long-term condition rather than an emergency — with the right combination of lifestyle habits and, where needed, medical treatment, most women lead full, healthy lives and achieve their fertility goals.

Sources: The 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome (Journal of Clinical Endocrinology & Metabolism), alongside Bangladesh-based prevalence research and clinical guidance from major reproductive health and endocrinology bodies.