PCOS and Surgery — When Lifestyle Changes Are Not Enough

Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, affecting approximately 5-10% of women worldwide — with Indian women having a particularly high prevalence. The condition is characterised by irregular ovulation, elevated male hormones (androgens), and polycystic ovaries on ultrasound. While lifestyle modification and medication are the mainstays of treatment, certain situations warrant surgical intervention.

When Is Surgery Considered for PCOS?

Surgery is not a first-line treatment for PCOS. It is considered when a woman has not ovulated despite months of medication (clomiphene citrate or letrozole), when there are associated conditions requiring surgical management — such as large ovarian cysts, or when endometrial protection is needed due to prolonged unopposed oestrogen exposure. The primary surgical option is Laparoscopic Ovarian Drilling (LOD).

Laparoscopic Ovarian Drilling (LOD)

LOD is a minimally invasive procedure performed through 2-3 small abdominal incisions. Using laser or diathermy, the surgeon creates 4-10 tiny punctures in each ovary. This reduces the amount of androgen-producing tissue, which can restore normal ovulatory cycles in approximately 50-80% of women. The effect can last for years, unlike medication which requires ongoing use. LOD also carries a lower risk of multiple pregnancy compared to ovulation-inducing medications.

Other Surgical Considerations

Women with PCOS are at higher risk for endometrial hyperplasia — a thickening of the uterine lining that, if left untreated for prolonged periods, can progress to endometrial cancer. In cases where medical management has not induced regular shedding of the endometrium, a hysteroscopic evaluation or dilation and curettage (D&C) may be recommended. At SurgeonForU, our gynaecology team takes a comprehensive approach — combining medical management, lifestyle guidance, and surgical expertise when needed — always with the goal of preserving fertility and long-term health.