PCOS in Young Women: A Practical, Patient-First Clinical Approach

Dr Bharti Kalra, Consultant Gynecologist, Bharti Hospital, Karnal, India

A structured, patient-centred approach helps clinicians diagnose PCOS accurately and tailor treatment to symptoms, metabolic risk, and future fertility goals.

Polycystic ovarian syndrome (PCOS) remains one of the most frequently encountered endocrine disorders in young women, yet it continues to challenge clinicians because of its varied presentation and long-term implications. Irregular menstrual cycles, acne, hirsutism, and weight gain are often the first visible signs, but beneath these lie insulin resistance, metabolic risk, and future fertility concerns.

A simplified, structured approach can help physicians manage suspected PCOS with confidence. Diagnosis should rely on the Rotterdam criteria, using a careful blend of clinical features, targeted hormonal tests, and pelvic ultrasound—while actively excluding more serious mimics such as thyroid disease, hyperprolactinaemia, or androgen-secreting tumours. Importantly, not every woman needs all three criteria, and polycystic ovaries alone do not confirm the diagnosis.

Management must be individualised and guided by the patient’s priorities. For a woman in her twenties with irregular periods and acne who is not planning pregnancy, the focus shifts to lifestyle optimisation, cycle regulation, and symptom control. Cyclical progesterone or low-androgen oral contraceptives can protect the endometrium and regulate menses, while anti-androgens address acne and hirsutism. Metformin plays a valuable role in improving insulin sensitivity and reducing long-term metabolic risk.

Equally vital is counselling—about future fertility, cardiometabolic health, and when specialist referral may be needed. PCOS care works best when it is shared, proactive, and centred on the woman, not just the diagnosis.

(Source: Afroze A, Mohammed I. Diagnosis and Management of Polycystic Ovarian Syndrome: Primary Care Perspective. Sch J Med Case Rep. 2026 Jan;1:107-12. )