PCOS remains one of the most talked-about health concerns among women today, particularly in India. Worldwide estimates suggest that 10–13% of women of reproductive age are affected by PCOS, and yet nearly 70% remain undiagnosed due to low awareness or subtle symptoms.
Once a rarely heard term, PCOS now feature in mainstream conversations, social media discussions, and even school-health sessions. In this exclusive interview with Dr Duru Shah, the Founding President of “The PCOS Society” (India), we explore the medical perspective behind PCOS, from its definition and diagnosis to why it seems more common now than ever before, bringing clarity to a condition that affects millions of women across India. Dr Shah is the Director of Gynaecworld, the “CENTER for Women’s Health & Fertility”. She is also a member of the Board of Asia Pacific Initiative on Reproduction (ASPIRE).
Could you help us understand what PCOS means and how the condition is defined?
PCOS is the term we currently use. Earlier it was called Stein–Leventhal syndrome. This condition was identified as early as 1935. At that time, two clinicians observed a pattern among some women: those with excessive facial hair, irregular periods, and difficulty in conceiving. Since there was no ultrasound or laparoscopy then, they used open abdominal surgery to examine the ovaries. They found that these ovaries were enlarged, smooth, and resembled pigeon eggs rather than normal ovaries. Based on these findings, the condition was named after them, Stein–Leventhal syndrome.
Over the years, with advances in hormone testing, ultrasound, laparoscopy, and now molecular diagnostics, our understanding evolved. Today, after nearly 75–80 years of research, we recognise this condition as polycystic ovarian syndrome.
Importantly, it is not a disease. A disease implies something that can be cured. PCOS cannot be cured as of today; it can only be managed. That’s why the term “syndrome” is more appropriate. In fact, there’s a growing international movement to rename PCOS altogether because the ovaries are not the root cause; the problem lies elsewhere. Surveys are ongoing, and we may see a new name soon.
Why there is a sudden increase in such cases nowadays?
It’s not really a sudden rise. The condition always existed; awareness did not. Even doctors were not uniformly updated. Earlier, women were treated in fragments. Acne or facial hair led them to dermatologists. Irregular periods or infertility led them to a gynaecologist. Weight gain or metabolic issues sent them to endocrinologists or physicians. These issues were treated separately, without connecting them.
As gynaecologists, we realised women were not getting holistic care. Beyond cosmetic or fertility issues, PCOS has serious long-term implications, including diabetes and cardiovascular disease, conditions that are preventable if identified early. That’s why we created the PCOS Society of India in August 2015. Over the past eight years, we’ve worked extensively with gynaecologists, endocrinologists, diabetologists, nutritionists, fitness experts, cardiologists, liver specialists, paediatricians, and adolescent health experts across the country.
As per reports, 1 in 5 women in India may have PCOS. What does this mean for the country as a whole?
India’s diversity makes it difficult to determine the exact prevalence. Different ethnicities present differently; North Indian women may have more facial hair, while others may have irregular periods or obesity. These are different phenotypes.
The concern is that PCOS is a major risk factor for diabetes. India is already one of the diabetes capitals of the world. If we identify PCOS early, especially in adolescents, we can prevent progression to diabetes.
If a woman with PCOS becomes pregnant with uncontrolled sugar and high male hormones, the intrauterine environment affects the child epigenetically, increasing the risk of PCOS in the next generation. Preventing PCOS today can reduce diabetes tomorrow; that’s our agenda.
Education and awareness seem crucial. How important are early interventions?
They’re critical. Healthy habits must start early. Social media and screen time are major contributors to obesity. As doctors, we must also educate women before pregnancy. Only 5% consult doctors preconceptionally. Many women are already pre-diabetic or hormonally imbalanced when they conceive, increasing risks for themselves and their children.
Also, PCOS is not limited to women. Men can be affected too. Early baldness before age 35 in men can signal metabolic disorders like diabetes, hypertension, or dyslipidemia. These men should seek medical evaluation instead of cosmetic fixes. PCOS is only 10% genetically inherited. Most cases are epigenetic, lifestyle-driven changes during fetal development.
Do economic factors also affect diagnosis and treatment?
Diagnosis isn’t expensive, just a consultation and basic tests. Treatment is largely lifestyle-based. However, there’s a lack of detailed nutritional and exercise knowledge among both doctors and patients.
That’s why the PCOS Society is launching a structured nutrition course for doctors and nutritionists. Patients are often told to “eat low-calorie” or “do cardio”, without clear guidance. Education can save both money and health. Insurance support is also crucial, especially for cosmetic and mental health concerns, which are often overlooked but deeply affect women with PCOS.
What’s your view on home remedies and alternative treatments?
There is no proven cure for PCOS because we don’t know its exact cause. Many theories exist – inflammation, gut health, and insulin resistance. Herbs, probiotics, and traditional remedies may help some women, but we lack tools to quantify their effects scientifically.
If a patient feels better, that’s good. But we must rely on evidence where possible.
Social media is full of information. How do you think it’s helpful or harmful?
Everyone is an Internet doctor today. My advice is to rely on credible sources, professional societies, medical organisations, or verified platforms. Always check who authored the content.
Is PCOS reversible through natural interventions?
There is no cure, but symptoms can be reversed with motivation and lifestyle change. I’ve seen women lose 30 kg, stop medications, and regain regular cycles. We use medications like metformin not to treat diabetes but to prevent it by improving insulin sensitivity. Once lifestyle improves, medications can often be discontinued.
Weight loss should be gradual, no more than 3 kg per month. Extreme weight loss is harmful. Awareness programmes matter.
What is your message to women living with and managing PCOS?
My life’s purpose is to leave something meaningful behind for women, menstrual education, infertility coverage, anaemia prevention, and now PCOS awareness. We proved intravenous iron reduces maternal deaths, published it in The Lancet, and today it’s implemented nationwide.
My two key messages are
- School canteens should not serve sugar or high-calorie foods.
- One hour of physical activity should be compulsory in all schools.
These two steps alone can drastically reduce obesity and future metabolic disease. If we prevent PCOS, we prevent diabetes, heart disease, and suffering.
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