PCOS treatment options

If you have been told to “just lose weight” or “start the pill and come back when you want a baby”, you are not alone. Many women in India leave their first PCOS appointment with a prescription but little explanation. This page is not a treatment plan; it explains what each option does so you can have a better conversation with your gynaecologist or endocrinologist.

Do not start, stop or change any medicine based on this page. Several PCOS medicines are not safe in pregnancy, and your doctor has to weigh your other health conditions.

Start with your goals

The 2023 International Evidence-based Guideline puts your priorities at the centre of treatment. Before choosing anything, it helps to be clear about which of these matter most to you right now:

Lifestyle: the base for everyone

Regular movement and healthy eating help insulin resistance, mood and cycles, and they help whatever your weight. If you are carrying extra weight, losing even 5 to 10% of it can improve periods and metabolic health. No particular diet has been shown to be best for PCOS; the one you can keep up is the one that works. Our guide to PCOS diet and lifestyle with Indian food covers this in detail.

The combined oral contraceptive pill

The combined pill (oestrogen plus a progestin) is the most common first medicine for adult women with PCOS who are not trying to conceive. It:

• Brings on regular, lighter bleeds and protects the lining of the womb.
• Lowers androgen levels, which helps acne and, more slowly, excess hair. Hair changes usually take six months or more to show.
• Provides contraception, which matters if you also take an anti-androgen.

The pill does not suit everyone. Your doctor will check your blood pressure and ask about migraine with aura, smoking, blood clots and other risks before prescribing it. A common worry in India is that the pill will cause infertility later. It does not; fertility returns after stopping, although PCOS itself may still need treatment when you want to conceive.

Metformin

Metformin is a diabetes medicine that improves how the body responds to insulin. In PCOS it is used:

• alongside the pill, especially for women with a higher BMI or metabolic risk;
• on its own when the pill is not suitable or not wanted;
• to help weight, blood sugar and cycles in some women.

The main side effects are stomach upset and loose motions, which often settle. Over years it can lower vitamin B12. Metformin is not a weight-loss pill, and on its own its effect on hair and acne is small.

Anti-androgen medicines

Medicines such as spironolactone block the effect of androgens on the skin and hair follicles. The guideline suggests considering them for hirsutism if the pill and cosmetic treatments have not helped enough after about six months. They can harm a developing baby, so they are only used with reliable contraception.

Weight-loss medicines

Newer anti-obesity medicines, such as GLP-1 medicines, may be considered for women with PCOS who have a higher BMI, alongside lifestyle changes. They are prescription medicines, they are not suitable in pregnancy or when trying to conceive, and they need a doctor's supervision. Bariatric surgery is an option for a small group with severe obesity.

Inositol and other supplements

Myo-inositol and other inositol products are heavily marketed for PCOS in India. The international guideline found the evidence too limited to recommend them routinely; it suggests they can be considered as an experimental option if a woman wants to try, with realistic expectations. The same applies to many “PCOD kits”, herbal powders and teas sold online. Be wary of anything that promises to cure PCOS or “dissolve cysts”, and tell your doctor about everything you take, because some products interact with medicines or affect hormone tests.

If you want to conceive

Treatment changes when pregnancy is the goal, because the pill and anti-androgens are stopped. Letrozole, a tablet that helps the ovaries release an egg, is the first-choice medicine for ovulation in PCOS. Other options include metformin, clomiphene, injectable hormones (gonadotrophins), a keyhole procedure on the ovaries, and IVF. Our guide to PCOS and fertility explains each step.

Mood, body image and wellbeing

Women with PCOS are more likely to experience depression, anxiety, disordered eating and low self-esteem, and the constant comments about weight, skin and “when will you have children” do not help. The guideline recommends screening for these and treating them as part of PCOS care, not as an afterthought. Talking therapies help, and so can connecting with others who understand.

Questions to ask your doctor

• Which of my symptoms is this medicine meant to help, and when should I expect a change?
• What side effects should I watch for, and what should I do if they happen?
• Is it safe if I become pregnant?
• How will we check whether it is working, and when do we review it?
• Do I need any blood tests before or during treatment?

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.

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.