While many women experience irregular and painful menstrual cycles, often times these symptoms are brushed off as nothing more than the usual nuances of periods. However, these also happen to be the most common indicators of a larger health issue called Polycystic Ovary Syndrome (PCOS). “20-25% of Indian women of the reproductive age suffer from PCOS”, says a study conducted by the Department of Endocrinology and Metabolism, AIIMS.

PCOS, as defined by the Indian National Health Portal (NHP), is a hormonal disorder among women of reproductive age. Recognised as a heterogeneous disorder, it is a triad of oligomenorrhea (irregular menstrual cycle), hirsutism (excessive hair growth on face and body) and obesity. “If left untreated, PCOS might result in increased metabolic disturbances such as insulin resistance, Type 2 diabetes, high cholesterol, high blood pressure and heart diseases. It has also been noted that women with PCOS are at a risk of developing uterine and breast cancers. It is also one of the leading causes of infertility in women,” says Dr Shobha Venkat, with an experience of over 20 years in the field, who is an Obstetrician and Gynaecologist at Bhargavi Clinic, Bengaluru.

In the same study conducted by the Department of Endocrinology and Metabolism at AIIMS, New Delhi, it was found that of the women who suffer from PCOS, 60% are obese, 35-50% have a fatty liver, 70% have insulin resistance with up to 60% having glucose intolerance. Furthermore almost 70% of these women have been observed to have high levels of androgen (male hormones).

Similarly, another study titled “Prevalence of Polycystic Ovarian Syndrome in Indian Adolescents” conducted by researchers at SVYASA University in Bengaluru found that 42 out of 460 girls observed, between the ages of 15 and 18 years were found to be diagnosed with PCOS. Out of the 460 girls who underwent clinical examination, 72 girls with oligomenorrhea and/or hirsutism were invited for biochemical, hormonal and ultra-sonographic evaluation for diagnosis of PCOS.

The study helped researchers in understanding that early diagnosis of PCOS is very crucial for timely treatment and prevention of other serious and dangerous clinical manifestations.

“We see more cases being reported now. If girls don’t come during their teenage, they come to us with the problem of infertility after marriage”, says Dr Savitha C, Professor and HOD of Obstetrics and Gynaecology (OBG) at Vanivilas Hospital, Bengaluru.

How do you recognise you are suffering from PCOS?

As reported in NHP India, girls suffering from PCOS exhibit a wide array of symptoms including weight gain or obesity, generally with extra weight around the waist, increased hair growth on the face, chest, back, thumbs, or toes, pelvic pain, disturbed sleeping patterns, mood changes and skin problems such as acne, oily skin and dandruff. PCOS is also accompanied with signs of anxiety and depression. It also leads to Infertility (unable to conceive) in women, conception may take longer for women with PCOS or they may have fewer children than they had planned. In addition, the rate of miscarriage is also higher in affected women.

“Irregular menstruation or amenorrhea, and heavy or scanty bleeding during menses are typically seen in girls with PCOS. We generally try to treat them based on the specific symptoms, such as excessive hair or irregular menstruation, they display whereas the issue of obesity is constantly observed in all the patients. We also look for other symptoms such as increased levels of androgens (male hormones) and polycystic ovaries”, Dr Shobha tells TNM.

What leads to the development of multiple cysts in ovaries?

In their explanation about the process of ovulation and anovulation, Dr Shobha and Dr Savitha state, “Each month, multiple eggs start to mature in a woman’s ovaries but usually only one matures and is released in the process known as ovulation and anovulation is marked by no release of the egg.”

Dr Shobha further explains, “In a woman/girl with normal cycle of 28 days, ovulation usually happens at the day 14 and this time of ovulation is very difficult to predict in a woman with irregular cycle which is a common symptom of PCOS.”

Therefore, in women with PCOS, the ovary does not receive the correct signals from the brain to produce hormones which it needs for the eggs to fully mature and release.

“Follicles containing these eggs continue to grow but in the absence of the correct signals, their growth is arrested which leads to the collection of the follicles, appearing like a ‘string of pearls’ when observed in an ultrasound. The inability to ovulate, known as anovulation, affects the release of the hormone progesterone which eventually results in irregular menstruation”, adds Dr Savitha.

Hormonal imbalance, lack of proper nutrition in diet and lack of regular exercise are considered as few main reasons behind the increasing cases of PCOS. “The sedentary lifestyle led by the majority of population is an important cause of PCOS,” explains Dr Savitha who also describes how stress and work pressure have added up to this.

“It is a vicious cycle. Hormonal imbalances including insulin resistance, sedentary lifestyle and poor dietary habits lead to obesity which contributes to hormonal imbalances which then can lead to the development of PCOS,” Dr Savitha tells TNM. Insulin resistance leads to excessive release of insulin in the body in order to control the high blood sugar level which also disrupts the normal functioning of ovaries.

Recommended Treatment

Doctors suggest leading a healthy lifestyle as an important way to treat and keep the symptoms of PCOS in control. Both Dr Savitha and Dr Shobha stressed on the importance of a good, nutritious diet along with regular exercise for controlling the symptoms of PCOS.

Dr Shobha says, “My patients feel there is no absolute cure for PCOS; at the same time I reassure them that it is also not a permanent problem. As we know, this disorder mainly depends on the weight and lifestyle of a person. In some cases, PCOS occurs with a gain in weight and even starts disappearing when the patient starts losing weight. The cases of PCOS are on a rise because of the sedentary lifestyle of women which leads to obesity and eventually affects the hormonal balance in the body.”

National Health Portal also suggests the use of oral contraceptive agents/birth control pills to regularize menstrual cycle in women who do not want to get pregnant.

“Since there is no definite way to curb PCOS, we suggest our patients to avoid dairy products such as butter, curd and cheese, artificially sweetened and packaged foods such as chocolates and also bakery products and fried snacks. We also advise them to avoid heavy and oily foods,” Dr Soudhagya, an ayurvedic nutritionist at Sarayu Ayurvedic Wellness Center, explains.

Dr Savitha also suggests yoga and meditation to cope up with the building stress and reduce the weight around the waist/abdomen which is harmful for women suffering from PCOS.