PCOS in Nepal: Causes, Symptoms and Treatment Options in Pokhara

Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in women of reproductive age worldwide — and Nepal is no exception. Despite its prevalence, PCOS is frequently misdiagnosed, dismissed as “just irregular periods,” or managed inadequately with symptomatic treatment that does not address the underlying hormonal imbalance. Women with untreated PCOS face long-term risks including infertility, diabetes, cardiovascular disease, and endometrial cancer.

A&B International Hospital in Pokhara provides complete PCOS evaluation and management — from initial diagnosis through individualized treatment plans that address the specific concerns of each patient, whether that is irregular periods, acne, excess hair, weight management, or difficulty conceiving.

What Is PCOS and How Common Is It in Nepal?

PCOS is a hormonal condition characterized by elevated androgens (male hormones), irregular ovulation or anovulation (failure to ovulate), and often polycystic-appearing ovaries on ultrasound. It is not a disease of the ovaries alone — it affects hormonal regulation at multiple levels involving the hypothalamus, pituitary gland, ovaries, and metabolic pathways.

Global prevalence estimates for PCOS range from 6–13% of women of reproductive age, depending on the diagnostic criteria used. In South Asia, including Nepal, some studies suggest higher prevalence — possibly 9–13% — influenced by dietary patterns, sedentary lifestyle trends, insulin resistance, and genetic predisposition common to the South Asian population.

PCOS is underdiagnosed in Nepal because many of its symptoms — irregular periods, weight gain, acne — are dismissed as normal variation or attributed to stress. Women often live with PCOS for years before it is formally recognized, typically when fertility difficulties bring them to a gynecologist.

What Causes PCOS?

PCOS does not have a single known cause. It is understood as a complex interaction of genetic predisposition and environmental factors, with insulin resistance playing a central role in most affected women.

Key mechanisms in PCOS:

Insulin resistance: Approximately 70% of women with PCOS have insulin resistance — the body’s cells do not respond effectively to insulin, so the pancreas produces more. Elevated insulin stimulates the ovaries to produce excess androgens (testosterone, DHEA-S), which disrupt follicle development and ovulation.
Elevated androgens: Excess testosterone and related hormones cause the characteristic features of PCOS — excess facial and body hair (hirsutism), acne, scalp hair thinning, and disrupted ovulation.
LH/FSH imbalance: The pituitary gland releases an abnormal ratio of LH (luteinizing hormone) to FSH (follicle-stimulating hormone), further disrupting the ovulatory cycle.
Genetic component: PCOS runs in families. First-degree female relatives of women with PCOS have a significantly higher probability of developing it.

Risk factors that increase the likelihood of developing PCOS include obesity, sedentary lifestyle, a family history of PCOS or type 2 diabetes, and South Asian ethnicity.

What Are the Symptoms of PCOS?

PCOS presents differently in different women — there is no single symptom pattern. The diagnosis requires meeting two of three criteria (Rotterdam criteria): irregular ovulation, clinical or biochemical signs of excess androgens, and polycystic ovaries on ultrasound.

Common symptoms in women with PCOS:

Irregular or absent periods: The most universal presenting symptom. Cycles may occur every 35–90 days, or be completely absent for months. When periods do occur, they may be heavy.
Excess facial and body hair (hirsutism): Male-pattern hair growth on the chin, upper lip, chest, lower abdomen, and thighs — caused by elevated androgens. A significant source of distress for affected women.
Acne: Hormonal acne along the jawline, chin, and lower cheeks that does not respond well to standard topical treatments.
Scalp hair thinning (androgenic alopecia): Diffuse thinning, particularly at the crown.
Weight gain and difficulty losing weight: Insulin resistance promotes fat storage and makes weight loss harder. Weight tends to accumulate in the abdominal region.
Acanthosis nigricans: Darkening of the skin in the neck creases, armpits, and groin — a sign of insulin resistance.
Difficulty conceiving: Irregular ovulation means unpredictable fertility. PCOS is the most common cause of ovulatory infertility.
Mood disturbances: Anxiety and depression are more common in women with PCOS — partly hormonal, partly related to symptom burden.

How Is PCOS Diagnosed at A&B Hospital Pokhara?

PCOS diagnosis at A&B follows the Rotterdam criteria, which require two of the three following features: clinical or biochemical evidence of excess androgens, menstrual irregularity (oligo/anovulation), and polycystic ovarian morphology on ultrasound.

Blood tests used in PCOS diagnosis:

Testosterone and DHEA-S: Elevated in most women with PCOS
LH and FSH: Elevated LH:FSH ratio (>2:1) is common
Prolactin and TSH: To rule out other causes of irregular periods (hyperprolactinemia, thyroid disease)
Fasting glucose and HbA1c: Screen for pre-diabetes and type 2 diabetes — both highly prevalent in PCOS
Fasting insulin and HOMA-IR (where available): Quantify insulin resistance
Lipid profile: Dyslipidemia is common in PCOS
AMH (anti-Müllerian hormone): Elevated in PCOS; also used as a fertility marker

Pelvic ultrasound: The ovaries in PCOS typically appear enlarged with 12 or more small follicles (antral follicles 2–9 mm) arranged around the periphery — the “string of pearls” or “pearl necklace” appearance. However, polycystic ovarian morphology alone is not sufficient for PCOS diagnosis without clinical or biochemical criteria.

What Are the Treatment Options for PCOS in Pokhara?

PCOS has no cure, but its symptoms and long-term risks are effectively managed through a combination of lifestyle changes, medications, and — where fertility is the primary concern — ovulation induction.

Lifestyle Changes — The First and Most Important Treatment

For women with PCOS and overweight or obesity, even a 5–10% reduction in body weight measurably improves hormonal parameters, restores menstrual regularity, and improves fertility. Weight loss reduces insulin resistance, which in turn reduces androgen production.

Specific lifestyle recommendations at A&B:

Low-glycemic index diet (reduce refined carbohydrates, sugar, white rice; increase vegetables, protein, whole grains)
Regular aerobic exercise (150 minutes per week of moderate activity) combined with resistance training
Adequate sleep — sleep deprivation worsens insulin resistance
Stress reduction — cortisol from chronic stress worsens hormonal imbalance

Medication for Cycle Regulation

Combined oral contraceptive pill (OCP): Regulates the menstrual cycle, reduces androgen levels (improving acne and hirsutism), and prevents endometrial hyperplasia from prolonged anovulation. The most commonly used medication for women with PCOS who are not trying to conceive.
Progestin-only cycle: For women who cannot take estrogen — regular progestin courses protect the endometrium and induce regular withdrawal bleeds.

Medication for Insulin Resistance

Metformin: An oral antidiabetic drug that improves insulin sensitivity. In PCOS, it reduces androgen levels, may restore ovulation, and is particularly beneficial in women with pre-diabetes or insulin resistance markers. It is used long-term in women with significant metabolic risk.

Medication for Excess Hair and Acne

Spironolactone or cyproterone acetate (anti-androgens): Reduce the effect of excess androgens on the skin and hair follicles — improving acne and hirsutism over 6–12 months. Cannot be used in pregnancy.
Topical treatments: Eflornithine cream for facial hair; standard acne topicals (benzoyl peroxide, retinoids) for acne — combined with hormonal treatment for best results

Fertility Treatment

Clomiphene citrate (clomid): The first-line oral ovulation induction medication — stimulates the pituitary to release FSH, triggering follicle growth and ovulation. Used in monitored cycles with ultrasound and timed intercourse.
Letrozole: An aromatase inhibitor that has become preferred over clomiphene for ovulation induction in PCOS — higher live birth rates and lower multiple pregnancy risk
Gonadotropin injections and IUI: For clomiphene/letrozole-resistant PCOS — requires specialist fertility monitoring
Laparoscopic ovarian drilling: A surgical procedure that destroys androgen-producing tissue in the ovaries — can restore ovulation in some women; an option when medication has failed

What Are the Long-Term Health Risks of Untreated PCOS?

Untreated PCOS — particularly the metabolic component — is associated with significant long-term health risks that extend well beyond reproductive concerns.

Type 2 diabetes: Women with PCOS have 5–10 times the risk of developing type 2 diabetes compared to unaffected women; risk is highest in those with obesity and insulin resistance
Cardiovascular disease: Dyslipidemia, hypertension, and insulin resistance all increase cardiovascular risk in PCOS
Endometrial cancer: Chronic anovulation causes the uterine lining to build up without the protective shedding of a regular period — significantly increasing risk of endometrial hyperplasia and cancer
Mental health: Higher rates of depression, anxiety, and eating disorders

Regular monitoring at A&B — annual glucose test, blood pressure check, lipid profile, and ensuring regular menstrual cycles or endometrial protection — reduces these long-term risks.

PCOS Treatment and Support in Pokhara

PCOS is a manageable condition with the right clinical support. A&B International Hospital provides comprehensive PCOS assessment and personalized treatment plans in Pokhara — from initial diagnosis through long-term hormonal and metabolic management.

A&B International Hospital

Pokhara-02, Bindhyaabasini

Phone: +977 061-412512

Website: abinthospital.com

ECHS-eligible patients receive cashless gynecology care. Appointments available by call or walk-in.