Journal

by Dr. Ankita Mittal

The past one year has seen a sharp spike in the number of young women missing their periods. This can be attributed to the change in lifestyle due to Covid 19 - drastically reduced physical activity, missing exercise regimes, and a lot of added stress. These are some of the factors which unmask the Poly Cystic Ovarian Syndrome (PCOS) which often presents as missed/ irregular periods.

Let us start from the basics, what is PCOS?

PCOS is a condition that arises due to hormonal imbalance and can lead to distressing changes in the menstrual cycle, fertility, and appearance of the affected lady, though it can be associated with certain long-term complications as well.

What causes PCOS??

Though some degree of genetic predisposition exists, PCOS is a hormonal disorder usually precipitated by an unhealthy lifestyle that interferes with egg production in the ovaries, thus leading to the derangement of two types of hormones:

1. Increase in the active male hormone in the body- which is mainly responsible for the changes in physical appearance
2. Increased insulin levels (due to some degree of resistance to the action of insulin in the affected women) which predispose to diabetes and weight gain

Both the changes further interfere with egg production, thus forming a vicious cycle.

Is it common or rare???

PCOS is a common gynecological disorder and its prevalence varies from 4- 23 women per 100 women. In fact, it is so common in Indian teenagers that it affects almost one in every ten adolescent girls.

What should make someone suspect that they might have PCOS??

You may experience any one or more of the following symptoms-

• irregular periods or no periods at all,
• being overweight or having a tendency to gain weight easily or difficulty losing weight,
• having more facial or body hair than is usual for you,
• hair loss,
• oily skin, acne especially on jawline and chin area
• depression and mood swings
• difficulty in conceiving (getting pregnant)

If you are experiencing any of these symptoms then you can go to your gynecologist/ family physician and share your concern. They will get a few blood tests and/ or an ultrasound done for you which will confirm the diagnosis if that is the case.

I have PCOS, how dangerous is it? Can the cysts be cancerous? Do they need to be removed surgically?  Will I be able to conceive?

PCOS is not cancerous and is not a dangerous / life-threatening disorder in itself but if left uncontrolled then it does predispose the affected individuals to more morbid diseases which can have serious consequences. The name is a misnomer there are no real cysts in the ovaries and hence no need for any surgery to remove them. The majority of the patients are able to conceive with the help of weight reduction and oral medications, though some may require more advanced fertility treatments.

Is it curable?

Unfortunately, PCOS is not curable but the symptoms and disease course can be controlled with lifestyle modifications and medications in the majority of the cases. Severe cases might need surgical treatment which involves drilling holes in the ovaries laparoscopically. Many women manage their symptoms and long-term risks by adopting a healthy lifestyle- diet modification, regular exercise, maintaining optimum weight, adequate sleep, and stress management. Medications mainly include oral hormonal pills and some insulin-sensitizing agents. Cosmetic procedures for hair removal and correction of acne scars and blemishes are often helpful in improving the physical appearance of those affected. At times psychological counseling might be required, especially for adolescent girls as the unwanted changes in their physical appearance due to PCOS often scars their self-esteem and predisposes them to depression.

How does it affect me in the long run?

If you have PCOS then you are at a greater risk of developing the following:

• Insulin resistance and diabetes- one to two in every ten women having PCOS go on to develop diabetes mellitus at some point of time.
• High blood pressure, dyslipidemia, and heart problems are more likely to be related to insulin resistance and overweight.
• Endometrial cancer- the lining of the womb (endometrium) can thicken if you have fewer than 3 periods a year, which may lead to endometrial cancer in a few women.
• Depression and mood swings
• Snoring and day time drowsiness and fatigue

What lifestyle modifications should I make to prevent/ control PCOS??

1. Maintaining a healthy weight- it is important to maintain a healthy BMI* (between 18.5- 24.9 Kg/m2). Higher than normal body weight has been linked with worsening/ onset of symptoms of PCOD. In case you are overweight and experiencing the symptoms of PCOS just losing 5-10% of your weight can bring about significant improvement.
2. Eating healthy - one should follow a well-balanced diet. Food items that are too sugary/ oily and all processed food items should preferably be avoided. A dietician can suggest a PCOS-friendly diet.
3. Regular exercise - the goal should be at least 15 minutes of high-intensity exercises or 30 minutes of medium intensity exercises for at least 5 days a week. Preferably exercises should be a mixture of aerobic exercises, strength training, and flexibility.
4. Adequate sleep - at least 6-8 hours of night sleep is required. Sleeping too much or not sleeping adequately, both are bad for health. Also, staying awake late at night can have detrimental effects on your health including hormonal imbalance which can trigger/ worsen PCOD.
5. Stress management - Almost all of us are struggling with stress and anxiety-related issues. It is important to practice relaxation techniques like meditation, yoga, pursuing a hobby, cognitive behavioral therapy, etc to maintain a sane mind and avoid the surge of harmful hormones in our body.
6. Proper skincare regime

To conclude, PCOS is a common hormonal disorder which though not curable can be managed quite well with a healthy lifestyle.

*BMI (Body Mass Index) is calculated as the weight of a person in kilograms divided by the square of his/ her height in meters. Dr. Ankita Mittal is a gynaecologist based in Gurgaon. She is a mother of two lovely boys and a strong believer in ethical, evidence-based medicine.

Disclaimer: The opinions expressed in this journal are those of the authors and are for information purposes only and not medical advice. Further, they do not reflect the opinions or views of Aminu Wellness Pvt Ltd or any of its directors. Any content provided by the author(s) are of their opinion and are not intended to malign any religion, ethnic group, club, organization, company, individual, or anyone, or anything.