PCOS Treatment in Ahmedabad: How I Diagnose and Manage PCOS / PCOD

PCOD Problem in Female Patients: What Actually Happens in the Body

PCOS is a hormonal condition that causes irregular periods, acne, extra hair and weight gain, and it can delay pregnancy. It is a common condition with three threads running through it: eggs are released irregularly, androgen (male-type hormone) levels are mildly raised, and the body uses insulin less efficiently. The "cysts" people talk about are not true cysts - they are small follicles whose development has stalled. For that reason an ultrasound picture on its own never settles the diagnosis, and a woman can have PCOS even when her ovaries look normal on a scan.

I confirm PCOS using defined criteria before any treatment is planned.

Two processes drive most of the symptoms:

• Raised androgens cause acne and extra hair growth and interfere with normal follicle development.
• Insulin resistance, present in most women with PCOS whether or not they are slim, pushes the ovaries to make more androgen and encourages weight gain around the waist.

PCOS tends to run in families. It is more common in South Asian women, who develop insulin resistance at lower body weights. An inactive routine, refined carbohydrates and weight gain make PCOS worse, but they do not cause it.

PCOS Symptoms I Ask About

• Periods that are irregular, infrequent or stop altogether - and sometimes a very heavy bleed after a long gap.
• Acne, oily skin, and hair growth on the face, chin, chest or abdomen (hirsutism).
• Thinning of scalp hair, particularly along the parting.
• Weight gain, mainly around the abdomen, that is hard to shift.
• Dark, velvety patches of skin on the neck, in the armpits or in the groin (acanthosis nigricans) - a sign of insulin resistance.
• Difficulty conceiving, because ovulation is irregular.
• Low mood, anxiety and worries about body image - more common with PCOS, and worth raising with me.

The Criteria I Use to Confirm PCOS

In an adult, I diagnose PCOS when at least two of these three features are present and other causes have been excluded:

1. Irregular ovulation
2. Signs of excess androgen - seen on examination or in blood tests.
3. Polycystic ovaries on ultrasound and/or a raised AMH level.

These are the Rotterdam criteria as refined by the 2023 international evidence-based guideline.

• For an adult, irregular cycles mean periods less than 21 days apart, more than 35 days apart, or fewer than 8 periods in a year.
• On a transvaginal scan, an ovary counts as polycystic with 20 or more follicles, or a volume of 10 ml or more.
• In girls within 8 years of their first period, I do not use the scan or AMH. The diagnosis depends on cycles that stay irregular together with signs of androgen excess.
• Before calling it PCOS, I rule out conditions that look similar: thyroid disease, a raised prolactin level and, when suspected, non-classic adrenal hyperplasia. If periods have stopped, a pregnancy test comes first.

PCOS Test List: The Investigations You Can Expect

• Pelvic ultrasound: transvaginal for married women and abdominal for girls and unmarried women, ideally in the first week of the cycle.
• Hormone tests: testosterone (preferably as a free androgen index), TSH and prolactin; 17-hydroxyprogesterone if an adrenal cause is suspected.
• 75 g oral glucose tolerance test: it picks up prediabetes that a fasting sugar or HbA1c can miss.
• Lipid profile and blood pressure: a starting point for heart health.
• Weight, BMI and waist, judged by Asian cut-offs: a BMI of 23 or more counts as overweight, and a waist over 80 cm signals higher metabolic risk.
• AMH, when it helps with an adult diagnosis or with fertility planning.

PCOD Treatment in Ahmedabad Built Around Your Main Goal

Your goal is likely to change over the years, and the treatment changes with it.

PCOS Treatment for Unmarried Girls and Young Women

For a girl or unmarried woman, PCOS treatment aims at regular periods, clearer skin and a healthy weight now, while keeping her future fertility in mind. The visit does not need an internal examination; I use an abdominal scan when one is needed. For girls within 8 years of their first period, the diagnosis rests on the cycle pattern and signs of androgen excess, not on the scan.

• Daily habits first - regular meals, protein at each meal, less sugar and maida, and daily activity often do more than any tablet.
• A regular bleed - the combined pill or cyclical progesterone every 1–3 months protects the womb lining when periods are far apart.
• Acne and facial hair - the combined pill for at least six months, with skin care and cosmetic hair removal.
• Metformin - considered when insulin resistance or weight gain is significant.

Parents often ask whether these tablets affect later fertility. The pill and progesterone do not stop a woman from conceiving after she stops them; when she plans a pregnancy, we simply reassess.

PCOS Treatment: Diet, Exercise and Sleep in an Indian Home

The PCOS diet I suggest is your usual home food, rebalanced. That means more protein and fibre in every meal, fewer refined carbohydrates and sugary drinks, and meals at regular times.

• Choose millet or multigrain rotli rather than maida.
• Include protein at every meal - dal, sprouts, curd, paneer, eggs or chicken.
• Let vegetables fill half of your plate.
• Keep sweets, fried farsan, packaged juices and bakery items as occasional treats.
• Aim for at least 150 minutes of moderate activity a week, plus muscle-strengthening exercise twice a week - more if you are trying to lose weight.
• Protect your sleep: poor sleep worsens insulin resistance and cravings
• Inositol is sold widely, but the evidence for it is limited, and it is no substitute for these basics.

If you are overweight, losing 5–10% of your body weight often brings ovulation back. Small changes you can keep up work better than crash diets.

PCOS Treatment for Pregnancy, and Care Once You Conceive

Many women with PCOS do conceive, either naturally or with treatment, although no outcome can be promised for any one person.

• Letrozole, taken for 5 days early in the cycle, is the first-line tablet for bringing on ovulation. Follicle-tracking scans show whether it is working and help time intercourse.
• If tablets have not worked after several cycles, the next steps are low-dose gonadotropin injections, laparoscopic ovarian drilling, or IVF for some women.
• Ovaries with PCOS can over-respond to fertility medicines, so I monitor closely to reduce the chance of twins and of ovarian hyperstimulation.
• Start folic acid at least 3 months before trying, and bring your weight, blood pressure and sugar into a healthy range.
• In pregnancy, PCOS raises the risk of gestational diabetes, high blood pressure, pre-eclampsia and preterm birth. I usually test sugar early - often in the first trimester rather than waiting for 24–28 weeks - and keep a closer watch.

My FNB is in High Risk Pregnancy & Perinatology, so once you conceive I can continue your antenatal care at the same hospital.

Looking After Your Health Long-Term with PCOS

• Womb lining: many months without a period lets the lining thicken, which over years raises the risk of hyperplasia and cancer. I advise having a bleed at least every 3–4 months.
• Blood sugar: checked again every 1–3 years depending on your risk, because prediabetes and type 2 diabetes are more likely.
• Blood pressure every year, and cholesterol from time to time.
• Sleep apnoea: tell me about loud snoring or daytime sleepiness, as these are more common with PCOS.
• Emotional health: I screen for anxiety, depression and eating concerns
• After 40: cycles often become more regular, but the metabolic risks remain, so the checks should continue.

Seeing a PCOS Doctor in Ahmedabad: How I Organise Your Care

• At the first visit I take a full history, look at your skin, hair and weight, and arrange the scans and blood tests that will confirm or rule out PCOS.
• I explain the results in plain language and leave time for your questions, in Gujarati, Hindi or English.
• We agree a plan built around your goal and review it at 3–6 months.
• If you want to conceive, follicle scans are done at the hospital in Gota, and after conception your antenatal care stays with me.

PCOS Care with Me, Step by Step

1. History and examinationyour cycle pattern, skin and hair changes, weight trend, family history and goals.
2. Testspelvic ultrasound and blood tests (androgens, thyroid, prolactin, glucose tolerance) to confirm the diagnosis and exclude look-alike conditions.
3. A plan for your goaltreatment chosen for periods, skin and hair, weight, or pregnancy.
4. Follow-upI review your response at 3–6 months and adjust the plan.
5. Long-term checkssugar, blood pressure and cholesterol at intervals, with care continuing into pregnancy if you conceive.

PCOS Treatment: How Many Months Before You See a Change?

I review the plan at 3–6 months because most changes take that long to show. Cycles may settle within a few months of weight loss or starting the pill. Acne and new hair growth need at least six months of treatment. Ovulation tablets are usually tried over several cycles before the next step is considered.

PCOS Treatment Cost: What It Depends On

PCOS care is usually spread over months rather than paid for once, so the cost depends on what your plan includes.

• Consultations - the first visit and the reviews at 3–6 months.
• Tests to confirm the diagnosis - pelvic ultrasound, hormone tests (testosterone, TSH, prolactin), the 75 g glucose tolerance test and a lipid profile; AMH only when it helps.
• Medicines - the pill, progesterone or metformin are taken over months, so their monthly cost adds up.
• Fertility treatment, if you want a pregnancy - follicle-tracking scans each cycle, and the higher cost of injections or laparoscopic ovarian drilling if tablets have not worked.
• Long-term checks - sugar, blood pressure and cholesterol at intervals.

Current consultation and test charges are given by Divine Women's Hospital on request.

Signs It Is Time to Get PCOS Checked

• Your periods are more than 35 days apart, or you have fewer than 8 a year.
• You have had no period for 3 months or more and you are not pregnant.
• Acne, facial hair or thinning scalp hair has appeared or is getting worse.
• Your teenage daughter's cycles are still very irregular 2–3 years after her first period.
• A year of trying has not led to a pregnancy (or six months, from age 35) - or less time if your periods are irregular.
• You know you have PCOS and are planning a pregnancy.

PCOS Myths I Correct in Clinic

Questions Patients Ask Me About PCOS and PCOD