Polycystic ovary syndrome (PCOS)
Also called: PCOS, PCOD, polycystic ovarian disease, polycystic ovarian syndrome, Stein-Leventhal syndrome, polyendocrine metabolic ovarian syndrome (PMOS)
Polycystic ovary syndrome (PCOS) is a common, long-term hormone condition in women. It can cause irregular periods, extra hair, acne and trouble getting pregnant, and raises the risk of diabetes. There is no cure, but healthy habits and treatment control it well.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Polycystic ovary syndrome (PCOS) is one of the most common hormone problems in women of child-bearing age. WHO estimates that about 1 in 8 to 1 in 10 women in this age group have it, and most of them do not know. The body makes more androgens (male-type hormones) than usual, and the ovaries often do not release an egg each month. This leads to irregular or missed periods and is a leading cause of difficulty getting pregnant.
Despite the name, you do not need cysts to have PCOS. The small 'cysts' seen on a scan are really egg sacs (follicles) that did not mature, and many women with PCOS have normal-looking ovaries. Many women with PCOS also have insulin resistance (the body does not respond well to insulin), which makes weight gain, prediabetes and type 2 diabetes more likely.
PCOS is lifelong, and symptoms change with age. There is no cure, but it can be managed well. Healthy eating and regular activity help everyone with PCOS, even without weight loss. Medicines can control periods, reduce extra hair and acne, and help with pregnancy. Regular checks for diabetes, blood pressure, cholesterol and mood are an important part of care.
In Pakistan: what studies show
Pakistan has no national survey of PCOS, only small local studies. Among female medical students, one Lahore college found 19.4% had PCOS and a Karachi survey found 10.9% reported a diagnosis, and one Rawalpindi hospital study found 29.2% of women with PCOS had metabolic syndrome.
- At one medical college in Lahore in 2017, 19.4% of 242 female medical students met the standard (Rotterdam) criteria for PCOS.[1] (cross-sectional, data April - December 2017)
- In a questionnaire survey of 377 medical students at universities in Karachi, 10.9% said they had been diagnosed with PCOS.[2] (cross-sectional, data not stated (six-month study, published 2023))
- In the same Karachi survey of medical students, 77.2% knew the term PCOS.[2] (cross-sectional, data not stated (six-month study, published 2023))
- In a study of 440 women with PCOS at hospitals and clinics in Abbottabad, Kohat and Islamabad, 71.8% had irregular periods.[3] (cross-sectional, data September 2016 - July 2017 (stated for infertility clinic recruitment))
- In the same study of women with PCOS in Abbottabad, Kohat and Islamabad, 33.2% had infertility (trouble getting pregnant).[3] (cross-sectional, data September 2016 - July 2017 (stated for infertility clinic recruitment))
- In the same study, 85% of the women with PCOS had a poor quality of life, with low mood (depression) the biggest reason.[3] (cross-sectional, data September 2016 - July 2017 (stated for infertility clinic recruitment))
- At one military hospital in Rawalpindi in 2022, 29.2% of 277 women with PCOS aged 18 to 35 had metabolic syndrome (a mix of belly fat, high blood pressure, sugar and blood fat problems).[4] (cross-sectional, data January - December 2022)
- In a survey of doctors at hospitals and clinics in Karachi, 71.3% said they use the standard Rotterdam criteria to diagnose PCOS.[5] (cross-sectional, data not stated (published 2025))
What we do not know yet: There is no national or community survey of PCOS in Pakistan and no Pakistan-specific guideline was found; prevalence figures come only from small studies of medical students, and they differ (19.4% in Lahore by Rotterdam criteria vs 10.9% self-reported in Karachi) because of different methods. The Abbottabad/Kohat/Islamabad study's abstract gives obesity, diabetes and blood pressure figures that do not match its own tables, so those were left out; Pakistan figures from the Global Burden of Disease could not be opened.
Pakistan studies cited
- Ahmad M, Tufail S, Ayub F, et al. Frequency of polycystic ovarian syndrome in female medical students of Combined Military Hospital Lahore Medical College. Pakistan Armed Forces Medical Journal 2020;70(1):180-84. Open source
- Khalfe SAH, Rafi U, Fatima B Prevalence and awareness of polycystic ovarian syndrome among medical students of Karachi, Pakistan. Journal of Shifa Tameer-e-Millat University (JSTMU) 2023;6(2):78-82. doi:10.32593/jstmu/Vol6.Iss2.260. Open source
- Sidra S, Tariq MH, Farrukh MJ, et al. Evaluation of clinical manifestations, health risks, and quality of life among women with polycystic ovary syndrome. PLoS ONE 2019;14(10):e0223329. doi:10.1371/journal.pone.0223329. PMID 31603907. Open source
- Waseem Z, Riaz T, Shafique S, et al. Prevalence and Risk Factors of Metabolic Syndrome in Women with Polycystic Ovarian Syndrome. Journal of Liaquat University of Medical & Health Sciences (JLUMHS) 2024;23(2):121-124. doi:10.22442/jlumhs.2024.01059. Open source
- Shakeel S, Iffat W, Nesar S, et al. Physicians' agreement with evidence-based guidelines for polycystic ovary syndrome management: implications for future policy and practice. Bangladesh Journal of Medical Science 2025;24(1):230-238. doi:10.3329/bjms.v24i1.78737. Open source
Symptoms
- Irregular, infrequent or absent periods (sometimes heavy or long periods)
- Difficulty getting pregnant
- Extra hair on the face, chest, back or tummy (hirsutism)
- Acne or oily skin
- Thinning hair or hair loss on the scalp
- Weight gain, often around the tummy
- Dark, velvety skin in body folds such as the neck or armpits (acanthosis nigricans)
- Low mood, anxiety or poor body image
Causes and risk factors
Causes
- The exact cause is not known
- Raised androgen (male-type hormone) levels that stop the ovaries releasing an egg regularly
- Insulin resistance, where high insulin levels push the ovaries to make more testosterone
- Genes: many small gene changes together make PCOS more likely; it often runs in families
- Extra body weight, which can make insulin resistance and symptoms worse
What makes it more likely
- Mother or sister with PCOS
- Family history of type 2 diabetes or metabolic syndrome
- Overweight or obesity, including in childhood
- Inactive lifestyle
- Very low or very high birth weight
- Early signs of puberty from the adrenal glands (premature adrenarche)
- Use of the epilepsy medicine valproate
Complications
PCOS raises the risk of several long-term problems. These include insulin resistance, prediabetes and type 2 diabetes, high blood pressure, high cholesterol, heart disease and stroke. Sleep apnoea (breathing stops during sleep) and fatty liver are more common. If periods are absent for a long time, the womb lining can thicken, which slightly raises the risk of womb (endometrial) cancer; treatment lowers this risk. In pregnancy there is a higher chance of miscarriage, diabetes in pregnancy (gestational diabetes), high blood pressure and pre-eclampsia, preterm birth, a small baby and caesarean birth. Depression, anxiety and eating problems are also more common, and stigma about weight, hair growth and infertility can affect daily life.
When to see a doctor
- Very fast new hair growth, a deepening voice or other strong male-type body changes (these need checks for a hormone-producing tumour)
- Bleeding between periods, unusual or very heavy bleeding, or bleeding after a long gap without periods (needs checks of the womb lining)
- You are pregnant or planning pregnancy: tell your doctor or midwife early, because PCOS raises the risk of diabetes and high blood pressure in pregnancy
- Feeling hopeless, very low, or having thoughts of self-harm (seek help the same day)
Are you a PMDC-registered doctor who treats Polycystic ovary syndrome (PCOS)? List your profile free.
Diagnosis
PCOS is diagnosed when an adult has at least two of three features, after other causes are ruled out: signs of high androgens (extra hair, acne, scalp hair loss, or raised testosterone on a blood test), irregular or absent periods, and polycystic ovaries on an ultrasound scan or a raised anti-Mullerian hormone (AMH) blood test. If a woman already has irregular periods and signs of high androgens, a scan is usually not needed. In teenagers, both irregular periods and high androgens must be present, and scans and AMH are not used because they are unreliable during puberty.
Blood tests check hormone levels and rule out other conditions, such as thyroid disease, a high prolactin level and an adrenal gland condition (congenital adrenal hyperplasia). Hormone tests are less reliable while taking the contraceptive pill. After diagnosis, doctors check weight, blood pressure, blood sugar (often with a glucose tolerance test) and cholesterol, and ask about mood.
Treatment
- Start with healthy eating and regular physical activity; if overweight, losing about 5% of body weight can bring back periods and improve symptoms
- For irregular periods, extra hair or acne, the doctor usually offers a combined contraceptive pill; progestogen tablets or a hormone coil are other ways to protect the womb lining
- Metformin may be added for weight and blood sugar, or used for irregular periods if the pill is not suitable
- If extra hair is still a problem after at least 6 months, an anti-androgen medicine and hair-removal methods (laser, electrolysis, creams) may be added, always with reliable contraception
- For women trying to conceive, a specialist usually starts with letrozole; clomifene, metformin, hormone injections (gonadotrophins), keyhole ovarian surgery or IVF are later options
- Have regular checks for diabetes, blood pressure, cholesterol and mood, and get help early for depression or anxiety
Medicines in Pakistan
Medicines a doctor may use, by group. Read the role: some are only for special cases. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Combined hormonal contraceptives (the combined pill) | First choice for irregular periods, extra hair and acne in women not trying to get pregnant; also protects the womb lining. Your doctor checks if the pill is safe for you | Levonorgestrel + Ethinyl estradiol (2 brands) |
| Progestogens | Tablets or a hormone coil that bring on regular bleeds or protect the womb lining when the combined pill is not suitable | Medroxyprogesterone acetate (9 brands), Norethisterone (3 brands) |
| Insulin sensitisers (metformin) | Helps insulin work better; used for weight and blood sugar, for irregular periods when the pill cannot be used, and sometimes with fertility treatment | Metformin (152 brands) |
| Anti-androgens (male-hormone blockers) | Added for extra hair or acne when the pill alone has not helped after 6 months. Not safe in pregnancy or when trying to conceive because they can harm an unborn baby, so reliable contraception is needed | Spironolactone (11 brands) |
| Ovulation induction medicines | Help the ovaries release an egg in women trying to conceive; letrozole is the usual first choice in current guidelines, clomifene is an alternative. Started and monitored by a specialist | Letrozole (102 brands), Clomifene citrate (52 brands) |
| Statins (cholesterol-lowering medicines) | May be used if cholesterol is high; your doctor decides | Atorvastatin (86 brands), Rosuvastatin (6 brands) |
Also used (not yet in our price list): Cyproterone acetate (in some combined pills; a second-line choice), Eflornithine cream (for facial hair), Gonadotrophin injections (fertility specialist only), Orlistat (weight loss)
Self-care and prevention
Self-care
- Eat a balanced, healthy diet that suits you and your family; no single diet is best for PCOS
- Be active most days; any activity you enjoy helps, even if your weight does not change
- If you are overweight, aim for slow, steady weight loss; a dietitian can help
- Keep a record of your periods and tell your doctor if they are irregular or stop
- If extra hair bothers you, temporary hair removal (such as threading or waxing), laser or electrolysis can help
- Talk to someone you trust or a health worker if PCOS affects your mood or confidence
- If you want to get pregnant, see your doctor before trying to plan checks and safe medicines
Prevention
- PCOS itself cannot be prevented, but a healthy weight and regular activity reduce symptoms
- Ask for regular blood sugar, blood pressure and cholesterol checks to catch problems early
- Treat absent periods so the womb lining is protected
- Plan pregnancy with your doctor or midwife so that risks can be checked early
Common questions
Can I get pregnant if I have PCOS?
Yes. Most women with PCOS can become pregnant, some on their own and others with treatment. Losing weight if you are overweight can help, and a specialist can offer medicines to help you release an egg. Pregnancy in PCOS has higher risks, so you need early and regular antenatal checks.
Is PCOS the same as having cysts on the ovaries?
No. The 'cysts' seen on a scan are small egg sacs that did not mature, not true cysts. You can have PCOS with normal-looking ovaries, and some women have ovarian cysts without PCOS.
Can PCOS be cured?
There is no cure, but symptoms can be controlled. Healthy eating, activity and the right medicines help with periods, hair, acne and fertility. Symptoms such as extra hair and acne often ease with age.
Does PCOS lead to diabetes?
It raises the risk a lot. CDC says more than half of women with PCOS develop type 2 diabetes by age 40. Regular blood sugar checks, staying active and keeping a healthy weight lower this risk.
Which PCOS medicines should I stop in pregnancy?
Anti-androgen medicines, such as spironolactone, are not safe in pregnancy or when trying to conceive. Tell your doctor or midwife as soon as you are pregnant or planning a pregnancy, and let them decide about every medicine you take.
Sources
- World Health Organization (fact sheet). Polycystic ovary syndrome (2026).
- Medical Journal of Australia (Teede et al., guideline authors). Summary of the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome: an Australian perspective (2024).
- CDC. Diabetes and Polycystic Ovary Syndrome (PCOS) | Diabetes | CDC (2024).
- StatPearls (NCBI Bookshelf). Polyendocrine Metabolic Ovarian Syndrome - StatPearls - NCBI Bookshelf (2025).
- NHS 111 Wales. NHS 111 Wales - Health A-Z : Polycystic ovary syndrome (n.d.).
- MedlinePlus Genetics. Polycystic ovary syndrome (2020).
- Pakistan Armed Forces Medical Journal (Sadeeqa et al.). PREVALENCE AND MANAGEMENT OF POLYCYSTIC OVARY SYNDROME AND ITS ASSOCIATION WITH DEMOGRAPHICS (2020).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.
Related conditions
Type 2 diabetes mellitusAcneHigh cholesterol (dyslipidaemia)Depression