The Rotterdam criteria for polycystic ovary syndrome (PCOS) include oligo- or anovulation, polycystic ovarian morphology, and clinical and/or biochemical hyperandrogenism. A diagnosis of PCOS is established when at least two of these three criteria are present, after excluding other relevant causes.
Prevalence
PCOS affects an estimated 10–13% of women of reproductive age. Globally, up to 70% of women with PCOS may remain undiagnosed. PCOS is the most common cause of anovulation in women and is a leading cause of infertility worldwide.1
Insulin resistance and early clinical features of PCOS
Higher levels of dehydroepiandrosterone sulfate (DHEAS) in females may be associated with genetic factors linked to early-onset balding and insulin resistance. The development of insulin resistance is influenced by lifestyle, genetic, familial, and environmental factors. Obesity may contribute to insulin resistance through increased adipose tissue and subsequent impairment of insulin signaling. PCOS may manifest during early adolescence or even earlier, with features such as early menarche and the onset of pubertal hair growth.
Dinacharya and Ratricharya: Supporting circadian and hormonal balance
Dinacharya (waking during Brahma Muhurta, Abhyanga, Vyayama, timely meals, and meditation) and Ratricharya (an early, light dinner, screen-free relaxation, and 7–8 hours of sleep, preferably by 10–11 PM) are intended to promote alignment with circadian rhythms. These practices may support healthy sleep–wake patterns, serotonin–melatonin pathways, and hypothalamic–pituitary–ovarian (HPO) axis function.
Ayurveda emphasizes maintaining optimal ovarian health to support fertility. Neglecting Ritucharya (seasonal regimens), Ritumati Charya (regimens during menstruation), and Dinacharya (daily regimens) may contribute to stress, unhealthy dietary habits, and disruption of physiological balance. These factors may be associated with hormonal imbalance, obesity, and menstrual disturbances such as amenorrhea.2
- Exercise and PCOS:
- Vyayama (moderate physical activity) is traditionally considered to pacify Vata, supporting reproductive functions and ovulatory balance, while reducing Kapha, which is associated with metabolic imbalance and conditions such as PCOS. It also supports Pitta and Agni, contributing to healthy metabolism and hormonal function.
- Regular moderate exercise, such as 30–60 minutes of brisk walking or yoga daily, may help regulate insulin sensitivity and cortisol levels, thereby supporting ovulatory function.
- Exercise also promotes metabolic health and may positively influence HPO axis function and GnRH pulsatility. Maintaining a healthy BMI of 18.5–24.9 through regular physical activity may support fertility. In women with obesity-related anovulation, even modest weight reduction can improve metabolic health and increase the likelihood of restoration of ovulation.
- Influence of the biological clock on PCOS:
|
Factor |
SCN/Clock Regulation |
Hormonal Effect |
Physiological Outcome |
Disruption Consequences |
|
Sleep Phase |
Melatonin + Growth Hormone secretion |
Supports GnRH pulsatility, LH surge |
Ovulation, tissue repair, immunity |
Anovulation, menstrual irregularities, PCOS worsening |
|
Chronic Misalignment (shift work, jet lag, irregular lifestyle) |
SCN desynchronization |
Dysregulated melatonin, cortisol, estrogen, and progesterone |
Disturbed cycles, infertility, pregnancy complications |
Metabolic syndrome, PCOS, and early menopause risk |
- Ratricharya and PCOS:
Ratricharya complements the effects of Dinacharya by promoting restorative sleep, building Ojas (vitality), and preventing nocturnal dosha vitiation, which supports Artava regulation and hormonal harmony.3
Diet and lifestyle studies, including population-based research such as NHANES 2025, suggest that holistic lifestyle factors, including regular routines and anti-inflammatory dietary patterns, may support reproductive health by promoting metabolic balance and optimal tissue nourishment (Dhatu poshana). From an integrative perspective, impaired Agni may contribute to Ama formation, which can be conceptually compared with oxidative stress and metabolic dysfunction that may adversely affect oocyte quality. Similarly, imbalances in the Doshas may be viewed alongside modern mechanisms underlying hormonal dysregulation, insulin resistance, PCOS, and anovulation.
Conclusion
PCOS is a complex endocrine and metabolic disorder with significant implications for ovulation and fertility. Early recognition, appropriate diagnosis, and lifestyle-based management are essential for improving reproductive and metabolic health. From an integrative Ayurvedic perspective, Dinacharya, Ratricharya, Ritucharya, balanced nutrition, and regular Vyayama may complement contemporary approaches by supporting circadian alignment, metabolic balance, stress regulation, and reproductive function. Further high-quality clinical research is needed to establish the effectiveness and mechanisms of Ayurvedic interventions in PCOS.
References:
- Polycystic ovary syndrome. World Health Organization. January 22, 2026. Accessed on October 5, 2026. https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome
- Pardhekar AD, Waskar R, Pardhekar A, Deshpande M. Ayurvedic Approaches to Holistic Management of Polycystic Ovary Syndrome (PCOS). J Pharm Bioallied Sci. 2024;16(Suppl 4):S4179-S4181. doi:10.4103/jpbs.jpbs_819_24. https://pmc.ncbi.nlm.nih.gov/articles/PMC11805180/
- Gujarathi JG. IAMJ. May 2026. https://doi.org/10.46607/ia. https://www.researchgate.net/profile/Jasmine-Gujarathi/publication/405259982_DINACHARYA_AND_RATRICHARYA_AYURVEDIC_ROUTINES_FOR_ALIGNING_DOSHAS_CIRCADIAN_RHYTHMS_AND_FEMALE_REPRODUCTIVE_HEALTH_IN_INFERTILITY_MANAGEMENT/links/6a1524324b954c78f5e8efd7/DINACHARYA-AND-RATRICHARYA-AYURVEDIC-ROUTINES-FOR-ALIGNING-DOSHAS-CIRCADIAN-RHYTHMS-AND-FEMALE-REPRODUCTIVE-HEALTH-IN-INFERTILITY-MANAGEMENT.pdf