PCOS – What Has Changed in Treatment? What's Different Today and What Remains the Same

PCOS treatment — quick answers

What is the latest treatment for PCOS?

For women trying to conceive, letrozole is now the first-choice ovulation drug, ahead of clomiphene. For everyone with PCOS, treatment now targets weight, insulin resistance and long-term heart and diabetes risk, not only irregular periods.

Can PCOS be cured?

No. PCOS is a lifelong condition, but its symptoms — irregular periods, excess hair, acne, weight gain and infertility — can be controlled well, and many women become symptom-free with the right plan.

Is metformin still used for PCOS?

Yes, but more selectively. It helps women with insulin resistance, prediabetes or a high BMI, and is no longer given to every woman with PCOS.

Can a woman with PCOS get pregnant?

Yes. PCOS is one of the most treatable causes of infertility. Weight loss of even 5 percent, ovulation induction with letrozole, and if needed IVF, help the large majority of women conceive.

Does PCOS go away after menopause?

Periods stop, but the metabolic side of PCOS — insulin resistance and higher risk of diabetes and heart disease — continues, so long-term follow-up remains important.

---

Polycystic ovary syndrome (PCOS) affects roughly one in five Indian women of reproductive age, and the way it is understood and treated has changed considerably over the past decade. If you were diagnosed some years ago, or a family member was, some of the advice you remember may now be out of date. Here is what has changed, and what has not.

What has changed

1. Letrozole has replaced clomiphene for ovulation

For years clomiphene citrate was the standard tablet to make women with PCOS ovulate. Large trials have shown that letrozole produces more ovulations, more pregnancies and more live births, with fewer twins and less thinning of the uterine lining. International PCOS guidelines now recommend letrozole as the first-line ovulation induction agent.

2. The diagnosis is stricter and uses newer tests

Modern ultrasound machines see so many follicles that the old cut-off of 12 follicles per ovary labelled many normal women as "polycystic". The threshold is now 20 or more follicles per ovary, and the blood test AMH (anti-Müllerian hormone) can be used instead of an ultrasound in adults. In teenagers, ultrasound is no longer used for diagnosis at all, because many normal adolescent ovaries look polycystic.

3. PCOS is treated as a metabolic condition, not only a period problem

Up to 70 percent of women with PCOS have insulin resistance, and they have a higher lifetime risk of type 2 diabetes, high blood pressure, fatty liver and heart disease. Care now includes screening for these from the time of diagnosis, whatever the woman's weight.

4. Metformin is used with more precision

Metformin is no longer prescribed to every woman with PCOS. It is reserved for those with insulin resistance, impaired glucose tolerance or a high BMI, where it improves periods, weight and ovulation. It is not a fertility drug on its own.

5. Newer options for weight and hormones

Newer weight-management medicines (GLP-1 receptor agonists) are being used in selected women with obesity and PCOS, with encouraging effects on weight, cycles and ovulation. Inositol supplements have some evidence for improving ovulation, though they are not a replacement for proven treatments.

6. Mental health is part of the treatment

Anxiety, depression, disordered eating and poor body image are far more common in PCOS, and guidelines now recommend screening for them at diagnosis and offering support.

7. Ovarian drilling has become a last resort

Laparoscopic ovarian drilling, once common, is now used only when letrozole and injections have failed, because medicines work for most women and drilling can reduce ovarian reserve.

What remains the same

Lifestyle is still the foundation

No new drug has replaced it. Losing 5 to 10 percent of body weight restores regular periods and ovulation in a large proportion of women with PCOS, and it improves the response to every other treatment. A diet lower in refined carbohydrates and sugar, regular exercise, and adequate sleep remain the first prescription.

The combined pill for period regulation

For women not trying to conceive, the combined oral contraceptive pill is still the most effective way to regulate cycles, reduce acne and excess hair, and protect the lining of the uterus from the effects of infrequent periods.

Protecting the endometrium matters

Going months without a period allows the uterine lining to thicken abnormally, which over years raises the risk of endometrial cancer. Whatever the treatment, ensuring at least four periods a year is still a core goal.

Hair and skin treatments

Anti-androgen medicines, laser hair removal and standard acne treatment remain the mainstays for hirsutism and acne.

The condition needs long-term follow-up

PCOS does not end with pregnancy or with menopause. Regular checks of weight, blood pressure, blood sugar and lipids continue throughout life.

Where that leaves you

If your PCOS treatment has not been reviewed in a few years, it is worth a fresh assessment: the diagnosis may need confirming with current criteria, and the treatment for ovulation, weight and long-term health may be different from what you were first offered.

At Iswarya Hospital in OMR, Chennai, our gynaecology and fertility teams manage PCOS together with endocrinology and dietetics, covering period regulation, fertility, weight and long-term metabolic health.