PCOS: what to do in the first ninety days

Start by getting the right tests, because most PCOS diagnoses in India are made on an ultrasound and a conversation, and the metabolic half never gets measured at all.

Weeks one to two: measure

Fasting insulin and glucose. HbA1c. Total and free testosterone, SHBG, DHEAS. TSH with free T4, because hypothyroidism mimics a great deal of this. Vitamin D and B12, which are deficient in most Indian adults and worth correcting regardless. A lipid panel.

Weeks three to six: change three things, not thirty

• Put protein at breakfast. Most Indian breakfasts are close to pure starch. Curd, egg, sprouts, paneer, a besan chilla instead of plain poha.
• Eat vegetables and protein before the rice or roti at your two main meals. Same food, different order, measurably lower glucose response.
• Start resistance training twice a week. Not cardio, not more cardio. Muscle is where glucose goes.

Weeks seven to twelve: hold, then reassess

Do not add anything new. Twelve weeks is roughly the interval at which HbA1c and fasting insulin are worth repeating, and cycle changes tend to show between months three and five, not month one. The most common mistake here is impatience — adding a fourth, fifth and sixth intervention at week five, so that when something does improve you have no idea which change did it.

Inositol is reasonable and reasonably evidenced. It is not a substitute for muscle, protein and sleep, and it will not outrun four hours a night.

If you are on metformin, letrozole or oral contraceptives, none of the above conflicts with them and none of it is a reason to stop. Those decisions belong to the doctor who made them.

Written by Meera Bhandari, MSc Clinical Nutrition · Registered Dietitian (IDA). General information, not a diagnosis or a prescription, and not a substitute for advice from your treating physician.