Coping with Polycystic Ovary Syndrome

Seema Sharma

SARA (26) was 13 when she was diagnosed with polycystic ovary syndrome (PCOS). Initially, her doctor attributed excessive acne on her face and back, thick facial hair, weight gain and hair fall to hormonal adjustments during teenage years. Symptomatic treatment didn’t help, with acne and other symptoms only worsening. After a year, she was diagnosed with PCOS. Her treatment lasted a few months but the associated risks and management are lifelong.

Sonepat-based Namita (37) was diagnosed with PCOS at 28. She would experience irregular periods and struggled with weight. An ultrasound during treatment for a urinary tract infection (UTI) revealed heavy and bulky ovaries, indicating PCOS. A hormonal disorder prevalent among at least 20 per cent young Indian women, it impacts fertility, besides leading to serious health issues. A mother of a toddler now, Namita’s journey to conception was long and difficult.

Many studies have also found women with PCOS at a higher risk of developing diabetes. Namita has to take metformin for life. Sara, too, became a pre-diabetic during the lockdown after gaining weight.

Both genetic and environmental factors, including family history, a sedentary lifestyle and obesity, are among the possible causes.

Common symptoms across age groups

Irregular menstrual cycles: Heavy, scanty, short or long duration, or absent periods.

Excessive hair growth or hirsutism: On the face, chest and back.

Acne: Severe acne outbreaks on the face and body.

Weight gain: Rapid weight gain or difficulty in managing or losing weight, or unexplained weight gain.

Skin changes: Skin tags, darkening of skin folds, especially around neck and underarms, stretch marks on arms and thighs or abdomen.

Fertility issues: Difficulty in conception due to irregular or no ovulation. Post 30, challenges may become more pronounced.

Hormonal imbalance: Elevated levels of androgens (male hormones) such as testosterone, leading to hirsutism and acne.

Metabolic problems: Increased risk of medical issues associated with metabolic syndrome, including high blood pressure, high cholesterol and insulin resistance. An increase in insulin levels causes ovaries to make and release androgens that suppress ovulation.

Hair loss: Thinning of hair or male-pattern baldness.

Other risk factors

PCOS patients have a higher risk of developing other health issues such as high blood pressure, high cholesterol, anxiety and depression, sleep apnea, heart attack, diabetes and endometrial, ovarian and breast cancers. Women who have PCOS also have a higher rate of miscarriage, gestational diabetes and premature deliveries.

Psychological impact

Increased stress, anxiety and depression are associated with the chronic nature of PCOS and its impact on daily life. There can be body image or self-esteem problems because of acne, hirsutism, over-weight/obesity and hair fall.

If women across any age group experience any of these symptoms, it’s best to consult a gynaecologist for the assessment of PCOS. The specialist may advise a few blood tests to check hormone levels, including luteinizing hormone (LH) and follicle-stimulating hormone (fsh). PCOS patients have an elevated LH-to-FSH ratio. Other tests include testosterone and other androgens, sex hormone-binding globulin (SHBG). Decreased levels may be observed in PCOS. Prolactin, thyroid function tests (thyroid disorders have similar symptoms as PCOS) and ultrasound for ovary imaging can also be done. In PCOS, the ovaries may appear enlarged and have multiple small follicles (cysts) around the periphery.

Women with PCOS may also face psychological/mental health issues because managing weight, acne, irregular periods, etc, may be difficult despite maintaining a healthy lifestyle. Hirsutism and weight gain associated with PCOS can affect body-image perception, leading to low self-esteem and body dissatisfaction. Hormonal imbalances can also contribute to mood swings, irritability and emotional instability.

Studies have shown that women with PCOS have a higher prevalence of depression compared to those without. The chronic nature of the syndrome, coupled with the challenges of managing symptoms and fertility concerns, can contribute to feelings of hopelessness and sadness.

Long-term solutions

A healthy lifestyle with regular exercise and a nutritious diet remains the long-term solution. A healthy weight also helps in regulating the menstrual cycle and hormone balance. Consult with a healthcare provider for personalised treatment options and regular monitoring.

What to eat and avoid

Abstain from processed foods high in sugar, salt and fat, as these can exacerbate symptoms. Avoid skipping meals as it can cause fluctuation in blood sugar. Limit alcohol and caffeine intake. Manage stress through relaxation techniques. Include plenty of fibre-rich foods like vegetables, fruits and whole grains to improve insulin sensitivity. Choose lean protein sources such as chicken, fish and legumes. Incorporate healthy fats in limited quantity from nuts, seeds and other sources.

Lifetime changes

Consistency is the key. Regular exercise, a balanced diet and weight management are crucial. Consult your doctor, who will monitor hormonal levels and other symptoms on a regular basis. Stay informed and adapt your lifestyle to ensure long-term management and improve overall well-being.

Balancing the imbalance

Prachi Nigam, a Class X topper from UP, was recently in the news not for her achievement but for being trolled due to her facial hair. The trolling, though traumatic, also made her parents realise that there may be an underlying health issue.

Residents of Mahmoodabad in Sitapur district, her family recently consulted a doctor in Lucknow, a two-hour journey from her home. Prachi, who turns 16 next month, says, “The doctor told us that the hair growth on my face is because of hormonal imbalance. The exact cause will be known after my blood test reports next month.”

“I also have irregular periods,” says the simple, small-town girl, who does not own a mobile phone. “The doctor also performed a laser treatment for hair removal and has recommended nine more sessions. He has also given me some medication and called us again next month,” says the teenager who wants to be an engineer. TNS

Facts of the matter

• PCOS is the most common endocrine disease affecting 8 to 10 per cent of Indian women in the reproductive age group; 70 per cent of women remain undiagnosed.
• It’s a chronic condition and cannot be cured. However, quality of life may improve with treatment and lifestyle modifications.
• By age 40, nearly 40 per cent of women with PCOS will develop pre-diabetes or type 2 diabetes, making the prevalence of type 2 diabetes 6.8 times higher than those without.
• Sleep disturbances are twice as common.
• Lean PCOS is a term for individuals with BMI less than 25 — that is, they are neither obese, nor overweight.
• PCOS patients are predisposed to various skin infections, UTIs and sexually transmitted infections (STIs), including vaginal yeast infections, bacterial vaginosis, affecting their long-term reproductive health.
• PCOS is associated with higher rates of eating disorders, including binge eating and emotional eating, which can further impact mental health and exacerbate weight management difficulties.

— The writer is associate director, obstetrics and gynaecology, Cloudnine Group of Hospitals, Chandigarh