7 min readConcept sheetOften a 5-mark answer; sometimes a 10-mark answer

Polycystic ovary syndrome (PCOS)

PCOS is a hormonal disorder with irregular ovulation and excess androgens, often driven by insulin resistance. Losing 5-10% of body weight with a low-GI diet helps most.

Rotterdam criteria (2003)Any 2 of 3: irregular or no ovulation, excess androgens, polycystic ovaries on scan

Key driverInsulin resistance and high insulin, which push the ovaries to make androgens

Diet goal5-10% weight loss if overweight; low-GI, high-fibre meals

Activity150-300 minutes of moderate activity a week (international PCOS guideline 2023, as for all adults)

At a glance

DefinitionA common hormonal disorder of women of reproductive age with irregular or absent ovulation, high male hormones (androgens) and often many small cysts (follicles) in the ovaries

CausesInsulin resistance, genes and family history, abdominal obesity, inactivity; PCOS also occurs in lean women

SymptomsIrregular or missed periods, acne, excess facial and body hair (hirsutism), thinning scalp hair, weight gain around the waist, dark velvety skin on the neck (acanthosis nigricans), difficulty conceiving

Long-term risksType 2 and gestational diabetes, high lipids, hypertension, fatty liver, endometrial cancer, depression

Draw it: how insulin resistance drives PCOS

Weight loss and a low-GI diet lower insulin and break this chain.

Dietary principles

Nutrient	Recommendation	Why
Energy	If overweight, a deficit of about 500-750 kcal a day (international PCOS guideline); aim for 5-10% weight loss	Even modest loss restores cycles and ovulation in many women
Carbohydrate	Low-GI, high-fibre: millets, whole wheat, oats, pulses; limit sugar, maida and sweets; spread through the day	Lowers insulin peaks
Protein	Adequate in every meal (dal, sprouts, curd, egg, fish, paneer)	Improves fullness and slows sugar rise
Fat	Limit saturated and trans fat; include omega-3 (fish, flaxseed, walnuts)	Protects against high lipids and heart disease
Fibre	25-40 g a day	Improves insulin sensitivity and fullness
Meal pattern	Regular meals; avoid long gaps and late-night eating	Steadier blood sugar and appetite
Diet type	No single 'PCOS diet' has proven better; any healthy, calorie-controlled pattern works	Choose one the woman can follow long-term

Foods and a sample one-day menu

Item	Details
Include	Ragi, jowar, bajra, oats, whole wheat, brown rice, all dals, sprouts, green leafy vegetables, salads, guava, apple, orange, curd, eggs, fish, flaxseed, walnuts
Avoid or limit	Sugar, sweets, bakery items, sugary drinks, white bread, fried snacks, vanaspati, large rice portions
Breakfast	Moong dal chilla (2) with mint chutney; buttermilk
Mid-morning	Guava; a few walnuts
Lunch	Brown rice (1 cup) or phulka (2), rajma, keerai poriyal, cucumber salad, curd
Evening	Roasted chana; tea with toned milk, no sugar
Dinner	Bajra roti (2), fish curry or paneer bhurji, mixed vegetable sabzi with flaxseed powder sprinkled

At the bedside

Many college-age girls with PCOS try crash diets. The dietitian sets a realistic goal (5-10% loss), builds low-GI Indian meals, and adds daily exercise, which matters as much as the diet.

Exam angle

2 marks: “What are the Rotterdam criteria for PCOS?” Any two of three: irregular or absent ovulation, clinical or blood signs of excess androgens, polycystic ovaries on ultrasound.

5 marks: “Explain the dietary management of PCOS.” Energy deficit for 5-10% weight loss, low-GI high-fibre carbohydrate, protein each meal, less saturated fat, omega-3, regular meals, exercise.

10 marks: “Discuss the causes, symptoms and dietary management of PCOS.” Define with Rotterdam criteria, insulin resistance diagram, symptoms and long-term risks, principles table, foods, menu, activity.

Remember it

PCOS: 'Lower the insulin, lower the androgens': low GI, lose 5-10%, move every day.