PCOS – everyone seems to know a least one woman with it, and yet, most understand very little about it. Polycystic ovarian syndrome (PCOS) is a hormonal condition that can affect women post-puberty and through their child-bearing years. Because of competing clinical definitions of PCOS, reports of prevalence vary widely. But it appears PCOS affects roughly 9-23% of Indian women, many of whom face related health problems and difficulty conceiving.

WHAT IS PCOS?

PCOS occurs when there’s an imbalance of hormones that regulate ovulation and the production of sex hormones. In an average woman, the pituitary gland – the body’s signaling mechanism – releases set levels of two hormones: luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These hormones, in the right proportion, cause the ovaries to produce set amounts of sex hormones and to mature and release an egg.

In a woman with PCOS, however, the pituitary gland doesn’t produce the normal balance of LH and FSH – sometimes for reasons unknown, sometimes connected to high insulin levels. Consequently, the body’s recipe for ovulation is disrupted. More LH and less FSH cause the ovaries to produce more testosterone and other male sex hormones. While these hormones are naturally present in women in small amounts, too much causes excessive facial and body hair growth, acne, and thinning or hair loss on the head—all symptoms of PCOS.

Meanwhile, the imbalanced LH and FSH are unable to act together correctly to stimulate ovarian follicles to mature and release eggs, resulting in irregular or no periods, the headline symptom. The condition takes its name from the underdeveloped follicles, which appear as cysts on ultrasound scans.

“Often, PCOS mimics the symptoms of an early menopause,” says Dr Sudha Swaroop, a gynecologist at Anandit Patient Care Home in Meerut, UP, “but it is a condition that can be easily corrected.”

CAUSES AND ASSOCIATED CONDITIONS

No one can pinpoint exactly what causes PCOS, but a growing body of research indicates a genetic factor. Medical conditions that result in elevated insulin levels, like insulin resistance, diabetes, and metabolic syndrome, can facilitate the hormonal imbalance, says Dr Muffazal Lakdawala, founder of the Centre for Obesity and Digestive Surgery (CDOS) in Mumbai. While these conditions aren’t necessarily thought to cause PCOS, they often occur in tandem.

Another factor is weight. Women who are overweight or obese are at higher risk for PCOS, because the same hormone imbalance that can contribute to obesity can contribute to PCOS – and because excessive weight can, in turn, throw hormones out of whack.

DIAGNOSIS AND TREATMENT

Detection of PCOS at a young age makes it easier to resolve, though diagnosis can be hard since many girls naturally have an irregular period immediately after puberty. Most women are diagnosed between the ages of 20 and 35, when they experience difficulty conceiving as a result of untreated PCOS. Therefore, Dr Swaroop suggests any adolescent girl experiencing a highly irregular period one year after her very first period to get an ultrasound scan of her ovaries and a physical examination by a gynecologist.

Once diagnosed, treatment for PCOS primarily involves regulating the menstrual cycle through oral contraceptive pills, says Dr Swaroop. Oral contraceptives contain progestin and estrogen, synthetic versions of the hormones necessary to mature and release an egg. When these are prescribed in the long term, at least six months to a year, the hormonal imbalance often corrects itself. Metformin, a diabetic medicine, may also be recommended to prevent type-2 diabetes and make periods regular.

Weight management is also a critical aspect of PCOS care.

“The management of obesity in PCOS is similar to the management of obesity in general,” says Dr Lakdawala, who recommends the ‘PCOS diet’ (see below). “Even about 5% reduction in total body weight can help with the issues relating to PCOS.”

CONCEIVING WITH PCOS

After the menstrual cycle is regular and PCOS symptoms subside, women can stop taking the contraceptives and, if they choose, conceive, says Dr Swaroop. But for many women with undiagnosed PCOS, the condition is a barrier to pregnancy.

Such was the case with Rekha,* 33, of Bangalore. She describes her menstrual cycle as “erratic.”

“There were times when I would get my period only once in four to six months,” she says.

For years, she wrote this off as a personal quirk, along with the occasional discomfort of cramping and heavy bleeding. Even steady weight gain and sudden hair sprouting on her chin, while concerning, didn’t give her much reason to pause.

But when she struggled to conceive, Rekha realized it was time to seek medical help.

“After three years of trying and my biological clock ticking away, I grew nervous and panicked,” she says.

She was put on a strict diet and medication and, over time, her PCOS resolved, allowing her to conceive and give birth to a baby girl last year. But she regrets the time she lost while her PCOS went undiagnosed.

“I have a demanding career and I love my job,” she says. “In my early twenties, nothing else mattered to me. But now I regret that I didn’t pay much attention to my body. It could have saved me a great deal of heartache later.”

THE PCOS DIET

Living with PCOS? This diet, from Dr Muffazal Lakdawala, can help. He recommends increasing fiber, vitamin E, and Omega-3 and -6 fatty acids by:

• Eating whole grains and millets (chapatti, whole wheat breads, ragi, jowar, bajra)
• Eating whole fruits, not juices (including the peel whenever possible)
• Eating green, leafy vegetables, gobi, and green beans
• Eating berries
• Eating lean protein like tofu, navy/haricot beans, white beans, nuts and seeds (especially almonds, walnuts, brazil nuts, soya nuts and beans, pumpkin seeds, flax seeds)
• Eating oily fish (salmon, tuna, sardines, herring, mackerel)
• Cooking with healthy oils like soybean oil, sunflower oil, safflower oil, sesame oil and olive oil

And reducing trans and saturated fats by:

• Avoiding animal fat (fatty meats, chicken with skin on)
• Avoiding butter and Vanaspati ghee
• Avoiding full cream dairy products
• Avoiding processed foods and ready-to-eat meals
• Avoiding refined carbohydrates (white breads, biscuits, cakes, desserts)