Polycystic Ovary Syndrome is a lifestyle disease caused by hormonal disorders. The incidence of this syndrome affecting young girls and women is on the rise. A mix of lifestyle changes such as healthy food and a regular exercise regime and medications in some cases can help alleviate the symptoms, explain health experts.shillpi a singh
Nutritionist and Health Coach Voomika Mukherjee got a bolt from the blue in 2019 when medical conditions caught her off guard. “I suddenly had many medical issues like PCOD symptoms, one year of stress followed by anxiety, almost six months of sleepless nights, finally into depression and mood swings and a lot more. This whole journey made me gain 40 kg. My personal and professional lives were adversely affected. I lost myself, smile, sleep, and peace and went into depression. The frequent migraine attacks made it worse for me,” recalls Mukherjee, who is one of the many young girls and women who bear the mental burden of a physical disease – Polycystic Ovary Syndrome (PCOS) – silently for years.
Like Mukherjee, lawyer Richa Srivastava also first learned about her PCOS in 2019. The trigger was a missed period! “I was prescribed some hormonal tests to conclude the findings and it was unfortunately confirmed with a high AMH (Anti Mullerian Hormone test). The doctor prescribed a 21-day birth control pill but I refused to take that. I read up that PCOS is a lifestyle disease so was told that making lifestyle changes such as healthy food and a regular exercise regime would definitely help alleviate the symptoms. I tried that for some time but couldn’t follow it religiously,” says Srivastava, recounting her struggles with PCOS.
PCOS is a common hormonal disorder in young girls and women that brings along a lot of physical changes and also mental health issues. The mental burden of being diagnosed with PCOS is because the symptoms have a physical manifestation and also impact mental health. Dr Akanksha Tripathi, Consultant Obstetrics and Gynaecologist, Paras JK Hospital, Udaipur, says, “Patients get panicky when they read about the long-term effects associated with PCOS as results take time. Patients are overweight/obese, have acne or facial hair, thinning of hair, which leads to low self-esteem and poor confidence, impacting their mental health. Sometimes depression has been seen in a few patients.”
Differentiating between Polycystic Ovarian Disorder (PCOD) and PCOS, Dr Gandhali Deorukhkar, Gynaecologist & Obstetrician, Wockhardt Hospital, Mumbai Central, says, “PCOD is a condition in which ovaries produce many immature or partially mature eggs, this happens due to poor lifestyle, obesity, stress and hormonal imbalance. PCOS is a metabolic disorder and a more severe form of PCOD that can lead to anovulation where ovaries stop releasing eggs.”
On the other hand, Dr Neema Sharma, Director, Obstetrics and Gynaecology, Fortis Hospital, Vasant Kunj, says that PCOD is an old term. “PCOD has been replaced by PCOS because it’s not a disorder. It’s just a lifestyle disease and it is a syndrome so it has been replaced by the term called PCOS,” she claims.
Dr Deorukhkar adds that PCOD is a disease in which a lot of obesity is involved, along with cosmetic problems like acne or irritation, a lot of hair fall, hair thinning, bald patches on the head, and male pattern facial hair growth. “So this makes women vulnerable to body shaming and they are depressed. They’re extremely anxious and nervous about facing society and generally in a slump because of the metabolic syndrome,” emphasises Dr Deorukhkar.
Explaining the term, Dr Sharma, states that PCOS has a few clinical features, a few biochemical features and then there are ultrasound parameters. “It is actually a hormonal imbalance or actually it is also a lifestyle disease that can affect young girls and it can happen later as well. The common symptoms are prolonged cycles means a girl starts skipping her periods or they can be scanty periods. It can be in 45 days, two months, sometimes six months or even a year,” says Dr Sharma. Apart from excessive pimples or acne, facial hair, which can be male pattern kind of facial hair on the face or the chest, hair fall, male pattern baldness, there can be excessive weight gain, and a girl/woman suffering from PCOS. “There is usually weight gain in the trunkal part. The waist-hip ratio gets altered,” she explains.
The first thing that Dr Sharma advises is an ultrasound to understand the typical polycystic patterns of the ovary. “The ovary is a little bulky, and there are polycystic ovaries. There are multiple small cysts in the ovaries. We do the blood test on the second day of the period to know the extent of hormonal imbalances like a follicle-stimulating hormone, luteinizing hormone, estradiol, followed by thyroid levels, prolactin levels, blood sugar, lipid profile, and serum testosterone levels. Suppose the girl/woman is having excessive facial hair. In that case, we do certain other tests to know if there’s any other reason for excessive facial hair like dehydroepiandrosterone sulfate 17 and alpha hydroxyprogesterone,” she states.
Dr Tripathi agrees that menstrual irregularity, delayed cycle, acne, skin pigmentation over the neck, increase facial hair growth are all a part of metabolic syndrome. “They are multi-factorial and poor lifestyle, poor eating habits, lack of exercise and a sedentary lifestyle can add to the woes of a girl/woman with PCOS,” she adds.
Dr Sharma says that it can happen to any girl/woman as it’s a lifestyle disease. “PCOS can also be caused because of excess insulin in the body. There is a condition called insulin resistance, which happens in PCOS because excessive insulin resistance, may increase male hormonal levels in the body, which may cause difficulty in ovulation. And as a result, they have male kind of androgen in excess of androgen levels, which can cause acne facial hair, and delayed cycles,” says Dr Sharma.
A woman with PCOS often gets prolonged cycles because of anovulation. It means that they don’t ovulate every month because of the increased insulin levels. “There is no ovulation, and if there is no ovulation, she doesn’t get periods on time and that is the cause of her prolonged cycles. So the diagnosis is a combination of clinical features, ultrasound and blood test. Once we have confirmed that yes, she has PCOS, then it’s important to follow up with these patients with regular monitoring of their blood pressure, regular monitoring of their sugars, cholesterol triglyceride levels, and it’s also important to screen for depression and anxiety,” explains Dr Sharma.
First and foremost, Dr Sharma adds that often PCOS is associated with some kind of mental health issues and it needs to be addressed well on time. “Both proper cycle treatment and psychological counselling are important aspects for young girls/women,” she says.
There is no one size that fits all. There is no such common treatment plan because every girl/woman is a different individual and she could suffer from different symptoms. It could be not getting periods on time, acne, facial hair, difficulty in conceiving or miscarriage or recurrent miscarriages so the management and treatment would be customised accordingly. “A girl/woman may have good skin or she may have acne full skin. Another girl may have regular periods and another PCOD girl may have irregular periods. So the treatment plan is not common for all the PCOD goals and it needs to be individualised as per the patient,” says Dr Deorukhkar.
The first line of PCOS management is always lifestyle modification. “PCOS is all about adopting a healthy lifestyle to improve the hormonal imbalance. A healthy lifestyle includes healthy dietary intake, regular exercise and regular sleep. Complex Carb Diet, a combination of cardio and strength, and staying committing to the goal,” adds Mukherjee.
Dr Sharma explains that dietary changes are needed to maintain weight while including at least 30 minutes of exercise will help maintain BMI. “These together will help maintain a proper waist-hip ratio that gets altered in a woman/girl with PCOS. So that has to be managed.” She advises medications to regularise cycles, fix acne issues, address hair fall and hair thinning, but once these pills are stopped, then the symptoms will reappear. “There is no permanent solution for PCOS. Lifestyle modification alone can help control the symptoms,” argues Dr Sharma.
For facial hair too, the first line of treatment would be conservative – threading, facial or even laser treatment. If these measures don’t work, then there is a medicine to block the effect of male hormones on the skin. “It helps those with excessive facial hair and hair fall. But it is not recommended if one is pregnant or planning to become pregnant. Then there are certain local creams available for facial hair growth, which can be tried,” says Dr Sharma. The tablet is a birth control pill containing estrogen and anti-testosterone, which decreases androgen levels.
There is great emphasis on lifestyle modification if diagnosed with PCOS by all health experts because any lax can have serious consequences. “It can give rise to sub-fertility or infertility. It is a precursor of chronic diabetes, Type 2 diabetes, hypertension, sleep apnoea syndrome, endometrial carcinoma, etc.,” warns Dr Tripathi.
After two years, Srivastava was prescribed another drug to control PCOS but she realised that PCOS can never be cured fully but only controlled to some extent by a mix of drugs and healthy lifestyle choices. “The most drastic side effect that I faced and still am is infertility. It makes it difficult to conceive with PCOS but not to say that PCOS people don’t ever conceive. I have heard and seen many people with a history of PCOS successfully getting pregnant and having healthy children! I hope the same for myself,” she adds on how PCOS has come across as the biggest stumbling block in her motherhood journey.
As for women like Srivastava who have been having difficulty in conceiving, Dr Sharma suggests medication to stimulate the ovaries. “The ovulation-inducing drugs stimulate the ovaries and help in the formation of eggs. Another treatment is Metformin. Suppose if there’s a young girl with very high levels of sugars and a very high level of fasting insulin level, then we advise Metformin, which is actually an insulin sensitizer. It improves insulin resistance, lowers insulin levels, and helps spontaneous ovulation.”
Genes are the cause
Excess insulin is one of the reasons for PCOS. “It is hereditary. There are certain genes but are not yet confirmed,” says Dr Sharma.
Deorukhkar claims that PCOD is a genetic thing and so doesn’t have a permanent cure. “It’s a gene that is passed on from generation to generation. The girls are born with polycystic ovaries and it manifests at some point of time in their life. The ovaries become bulky, due to the storage of eggs,” she elucidates.
The other health complications that could arise because of PCOD could be obesity, high blood pressure and high cholesterol, high triglycerides and high sugars. “That is basically a pre-diabetic or raised insulin levels in PCOD girls which leads to where there could be thyroid imbalance and the prolactin hormone imbalance as well. All factors can lead towards metabolic syndrome, which is a triad of obesity, hypertension and high sugars,” explains Dr Deorukhkar.
She warns that PCOD patients could face a problem called gestational diabetes during pregnancy. “The sugar starts rising in the third trimester and sometimes needs insulin for correction till the delivery of the baby. If the sugars are not controlled, it can lead to harmful effects to the foetus,” she says.
Once the parents notice the tell-tale signs, they can consult the doctor, educate themselves and help their daughters. “Parents can help their girls in developing good eating habits, giving emphasis on outdoor sports or physical exercise, avoiding junk and consult the doctor as soon as the symptoms appear. They could become their exercise partners,” advises Dr Tripathi.
It took 1.5 years of struggle for Mukherjee to get a grip on herself and take adequate steps to manage PCOS that had wreaked havoc in her life. “In short, I went through hell and it took almost 12-18 months to get myself back with a peaceful mind, relaxed calm environment, and proper self-guidance. My parents gave me immense support and now I’m almost out of my medical condition. No PCOS symptoms and no depression. I’m living my life to the fullest,” says Mukherjee.
Parents can help their daughters by educating themselves with the observations and treatment modalities of PCOS patients. Deorukhkar elucidates that there is a PCOS Society of India that can help parents with the necessary information.
The men have an important role to play in the life of a woman diagnosed with PCOS because they need to give full-fledged support to their partners. “These women have been body-shamed because of their obesity. These women have faced the social stigma of having a face full of acne, or hair on the face, and severe hair fall. Some girls need to shave their beard kind of hair on their face. So men need to be educated about PCOD so that they stop making fun of their partners or other females,” says Deorukhkar.
Mukherjee who bravely fought the PCOS battle and won it too has an important piece of advice for those who are yet to come to terms with the syndrome. “I realize that there are a lot of women out there who are shattered after being diagnosed with PCOS. But let me assure you that you can get this under your control with the right knowledge and mentoring. You are the priority for yourself. If you are happy, fit and healthy and have a peaceful mind, then you can stay happy and take care of yourself and your family too,” she says in the parting.
DIETARY GUIDELINES FOR PCOS
(By Voomika Mukherjee)
- It increases the risk of insulin resistance, making the body prone to diabetes.
- Eat more fresh produce with more fibre content.
- PCOS consume more unprocessed grains like wheat, rice, jowar, bajra, ragi, barley etc.
- Include good quality proteins in the daily diet (eg. milk, paneer, curd, eggs, white meat)
- Consuming food sources of unsaturated fats like nuts (walnuts, almonds, cashew nuts) and seed oils (mustard oil, sesame oil, groundnut oil) are important.
- Consume more soybean and flaxseeds as they boost the function of female hormones and make their work more effective.
- Reducing consumption of caffeine-containing beverages may be helpful as they reduce iron absorption in the body.
- Exercising every day for around 30-45 minutes is essential as it helps in increasing insulin sensitivity.
Home remedies for PCOS weight loss
(By Voomika Mukherjee)
- Cinnamon Powder: Add one teaspoon of cinnamon powder to a glass of hot water. Drink it daily for a few months. You can also include this spice in your diet by sprinkling cinnamon powder on your cereal, oatmeal, yoghurt, cottage cheese, peanut butter sandwich and other foods.
- Flaxseeds: Mix one or two tablespoons of freshly ground flaxseeds in a glass of water & drink it daily. Also include ground flaxseeds in your diet regularly by adding them to your smoothies, soups and salads.
- Apple cider vinegar: It helps to control blood sugar and keeps your body from producing too much insulin. Less insulin means less testosterone. Plus, it will help you lose weight and improve your overall health. Take 1 tsp apple cider vinegar with 1 glass of water.
- Spearmint Tea: Spearmint tea can also help deal with PCOS due to its anti-androgenic properties. Drinking spearmint tea can help reduce hirsutism or excess body hair, by reducing free and total testosterone levels and increasing luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels.