PCOS explained: symptoms, causes, diagnosis

A lot of women in India first hear about PCOS from a radiologist's report, a friend's WhatsApp message, or an aunty at a wedding who has an opinion about it. By the time they reach a doctor, they have collected a list of foods to avoid and a fair amount of worry. This guide sticks to what the evidence says, so you can walk into your appointment knowing what to ask.

What PCOS is

Polycystic ovary syndrome (PCOS) is a long-term condition that affects hormones, metabolism and the ovaries together. Three things tend to go on at the same time:

• Irregular ovulation. The ovaries release an egg less often than usual, so periods are irregular, far apart, or missing.
• Higher androgens. Androgens are hormones such as testosterone that everyone makes in small amounts. Higher levels can cause acne, extra facial or body hair, and hair thinning on the scalp.
• Insulin resistance. The body responds less well to insulin, which pushes insulin levels up. This affects many women with PCOS, including slim women, and drives some of the long-term health risks.

It is a syndrome, meaning a pattern of features, so it looks different from one woman to the next.

The new name: PMOS

On 12 May 2026, after a consensus process led by Monash University with input from patients and professional groups, PCOS was renamed polyendocrine metabolic ovarian syndrome (PMOS). The new name reflects that the condition involves several hormone systems and metabolism, not just the ovaries, and that the “cysts” were never really cysts. The diagnostic criteria and treatments have not changed. Both names will be used for a few years while guidelines, lab reports and hospital records catch up, which is why we still use “PCOS” in our headings.

PCOD vs PCOS: is there a difference?

This is one of the most searched questions in India. In everyday Indian practice, “PCOD” (polycystic ovarian disease) is often used for the same thing as PCOS, and sometimes for ovaries that simply look polycystic on a scan. You may read online that PCOD is a milder, “only ovaries” version and PCOS is the serious one. International guidelines do not recognise PCOD as a separate diagnosis.

What matters is not the label on your report but whether you meet the diagnostic criteria below, and what your symptoms and blood tests show. Many women have ovaries that look polycystic on ultrasound without having the condition at all.

Symptoms of PCOS

Symptoms often begin in the late teens or twenties, although some women only find out when they try to conceive. Common features include:

• Periods that are irregular, more than 35 days apart, fewer than eight a year, or absent
• Acne that persists past the teenage years, often along the jawline
• Coarse, dark hair on the face, chest, tummy or back (hirsutism)
• Thinning hair on the top of the scalp
• Dark, velvety patches of skin on the neck, underarms or groin (acanthosis nigricans), a sign of insulin resistance
• Weight gain around the waist, or finding it hard to lose weight
• Difficulty getting pregnant
• Low mood, anxiety or poor body image, which are more common with PCOS and deserve attention in their own right

Our guide to PCOS, skin and hair covers acne, facial hair and hair fall in more detail.

What causes PCOS?

There is no single cause. PCOS runs strongly in families, so genes play a large part. Insulin resistance and higher androgens feed into each other: high insulin prompts the ovaries to make more androgen, and androgens interfere with ovulation. Weight gain can make symptoms worse, but PCOS is not caused by eating too much or by anything you did. Slim women get it too.

Indian women may be at particular risk because of the higher tendency to insulin resistance and fat around the middle seen in South Asian populations. In the large ICMR-commissioned study of Indian women, nearly a third of women with PCOS had fatty liver and around a quarter had metabolic syndrome.

How PCOS is diagnosed

There is no single test for PCOS. Doctors use the criteria set out in the 2023 International Evidence-based Guideline. In adults, PCOS is diagnosed when at least two of these three are present, and other conditions have been ruled out:

If you have both irregular cycles and signs of high androgens, no ultrasound or AMH test is needed. In teenagers within eight years of their first period, both irregular cycles and high androgens are needed, and ultrasound and AMH are not used, because many healthy teenage ovaries look polycystic and cycles take time to settle. Teenagers with some features may be told they are “at risk” and checked again later.

Tests you may have

Your doctor will decide which tests you need. Common ones include:

• Blood tests for androgens, usually total and free testosterone.
• Tests to rule out other causes of irregular periods and excess hair, such as thyroid function (TSH), prolactin, and sometimes 17-hydroxyprogesterone. A pregnancy test may be done if your period is late.
• A pelvic ultrasound in adults, often through the vagina for a clearer view if you are comfortable with it. AMH can be used instead in adults.
• Metabolic checks (see below).

Hormone tests are best done when you are not on the contraceptive pill, so tell your doctor about any hormonal medicines you take.

Long-term health checks

PCOS is more than a period problem. The international guideline recommends regular checks for:

• Blood sugar: ideally a glucose tolerance test at diagnosis, then repeated every one to three years depending on your risk. Women with PCOS are more likely to develop type 2 diabetes and diabetes in pregnancy.
• Blood pressure every year, and cholesterol at diagnosis.
• Weight and waist, measured with your consent and without judgement.
• Mood: screening for depression and anxiety, and for disordered eating.
• Sleep: snoring and daytime sleepiness can point to sleep apnoea.
• The womb lining: very infrequent periods over a long time can thicken the lining of the womb, so tell your doctor if you go months without a period or have unusual bleeding.

Lifestyle is the foundation of care. Our guide to PCOS diet and lifestyle with Indian food explains how much to move and how to build your plate, and PCOS treatment options covers medicines.

Questions to ask your doctor

• Do I meet the criteria for PCOS, and which ones?
• Which other causes have we ruled out?
• Which health checks do I need now, and how often?
• What should I focus on first: periods, skin, weight, fertility or mood?

Frequently asked questions

Sources

1. Teede HJ, et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab 2023;108(10):2447–2469.
2. Monash University. International Evidence-based Guideline for PCOS 2023.
3. Ganie MA, et al. Prevalence, phenotypes, and comorbidities of polycystic ovary syndrome among Indian women. JAMA Netw Open 2024;7(10):e2440583.
4. Endocrine Society. Polyendocrine Metabolic Ovarian Syndrome: new name to improve diagnosis and care. 12 May 2026.

This article is general information for adults in India and is not a diagnosis or a treatment plan. Always discuss results and any changes with your own doctor. Read our editorial policy.