A complete guide to PCOS

Q. What is Polycystic Ovarian Syndrome (PCOS)?

A. PCOS is an imbalance in women’s hormones that leads to growth of many cysts in their ovaries. PCOS is a common health condition affecting 1 in 10 women in India.

Millions of women with PCOS go undiagnosed, untreated and unsupported as the knowledge of the condition and its management is lacking. It has to be first understood and then managed accordingly. 

Q. What are the Causes of PCOS?

A. There are multiple factors which contribute to PCOS:

1. Genetic,

2. Environment,

3. Obesity,

4. Deregulation in ovarian function,

5. Abnormalities in the hypothalamic and pituitary gland function.

Q. What are the Symptoms of PCOS?

A. PCOS signs and symptoms often begin soon after a woman first begins to have periods (Menarche). In some cases, PCOS develops later during the reproductive years, for instance, in response to substantial weight gain.

Although the symptoms of PCOS vary for different individuals, the most common symptoms of are:

1.     Irregular periods- It’s the most common characteristic of PCOS. Having fewer than 8 menstrual cycles a year or failure to menstruate for 4 months or longer. The reason behind irregular periods is insulin. Since insulin is not working effectively, the body produces more insulin can increases the production of androgens or male hormones such as testosterone in the ovaries. This creates difficulty in ovulating and other symptoms.

2.     Infertility- In PCOS, the hormonal imbalance interferes with the growth and release of eggs from ovaries(ovulation), so if you don’t ovulate, you can’t get pregnant.

3.     Abnormalities of hair or skin- A high level of male hormones (Androgens) causes unwanted hair growth on the face, thigh, back, tummy etc. This condition is called hirsutism. The same hormones are responsible for hair loss and acne on face.

4.     Pelvic pain- Ovarian cysts causes the pelvic pain, it can feel like a dull ache or a sharp jolt in the lower belly.

5.     PMS- Women experience in the weeks before their period like- anxiety, depression, insomnia and cravings etc.

6.     Weight gain- Insulin resistance is one of the main reasons for weight gain because it results in deposition of sugar in the bloodstream. These are then biochemically converted into fat and stored in the lower abdomen and body.

 

Q. what’s the long term effect of PCOS?

A. Untreated and undiagnosed PCOS can lead to the following:

 1. Diabetes: Women with PCOS have 50% higher change of developing pre diabetes and type 2 diabetes compared to women without PCOS. That is because women with PCOS have insulin resistance and central obesity.

 2. Cardiovascular Disease: Women with PCOS are at higher risk of heart disease or stroke. This is due to an increased level of triglycerides and other bad cholesterols like LDL and VLDL.

 3. Endometrial Cancer: Untreated PCOS and infrequent periods cause endometrial thickening which can increase the risk of abnormal cells. As women ages, it can develop into cancerous cells.

Q. How to Diagnose PCOS?

A. According to the Indian Fertility Society, the 3 important diagnostic criteria for PCOS are polycystic ovaries, irregular menstrual cycles, and high levels of male hormones. PCOS can be diagnosed in the following ways.

·        Physical Examination: Doctors will ask few questions on frequency of menstrual cycle, hair abnormalities, acne problem and reasons for weight gain etc.

·        Ultrasound: Lower abdominal scan will be required to check the number and size of the cysts in the ovaries.

·        Blood Tests: Doctors will ask for blood tests namely-

1.     Fasting Insulin (To detect insulin resistance),

2.     TSH (Thyroid Hormone increases due to increase in androgen level),

3.     Lipid Profile, and

4.     Other hormonal tests like testosterone, FSH and LH.

Management of PCOS

The overall management of PCOS should include both Medical Management and Lifestyle Management strategies. No two PCOS cases are similar. The management has to be based on individualized patient goals and symptoms like infertility, obesity, hirsutism and acne.

1.     Medical Management-

Consulting gynecologist or endocrinologist, getting the required tests, and following the prescriptions will help with faster results.

Medical Management can be classified as acute and chronic.

a.     Acute Management- In this category, Issues like irregular menstrual cycles, hirsutism and infertility treatment.

b.     Chronic Management- PCOS is a chronic condition itself which required long care. Other than that, Insulin resistance seen in PCOD needs life-long management to prevent diabetes.

2.     Lifestyle Management-

In lifestyle management with a proper dietary approach and exercise are some of the important interventions in the treatment of PCOS.  In women with PCOS and obesity, weight loss through diet control has been shown to improve pregnancy rate, normalize high levels of male hormones and improve insulin sensitivity, menstrual function and hirsutism.

a.     Dietary Choices for PCOS

There are some foods that could be beneficial in PCOS. Here is the list of them that help in improving insulin sensitivity and also in managing some symptoms of PCOS.

1.     Green Tea- It contains Epigallocatechin gallate (EGCG), it reduces the conversion of testosterone to bad form Dihydrotestosterone (DHT), the main culprit for PCOS.

2.     Cinnamon- It helps to improve the insulin sensitivity by reducing the GI of food.

3.     Apple Cider Vinegar (ACV)- It helps in reduce the rise in blood glucose. Also boost the metabolism and helps in weight loss.

Drink 2 tsp of it every morning.

4.     Nuts & Seeds- These are rich source of MUFA & PUFA, Micronutrients and Omega 3 fatty acids. Eg- flaxseeds, sesame seeds, sunflower seeds, pumpkin seeds, chia seeds and almonds etc.

5.     Protein rich Foods- It helps in maintaining health and also reduces the weight. Include more protein in your diet, like- Pulses, whey protein, eggs, non-veg etc.

6.     Good Fats- 70% of women have elevated cholesterol and low HDL levels with PCOS. So it’s very important to focus of consuming good fats like- olive oil, salmon, sesame, coconut oil, walnuts, flaxseeds etc.

7.     Vitamin rich Foods- Vitamins helps to improve immunity and restore good hormonal balance. Include Vitamin rich foods like- spirulina, wheatgrass, barley grass, moringa, fresh fruits and vegetables etc.

8.     Probiotic Supplements- Probiotics have an impact on weight loss, insulin resistance and inflammation, seen in PCOS. Naturally fermented products are rich source of probiotic- Curd, buttermilk, kefir, sauerkraut etc.

9.     Gluten Free Foods- Some researches shows that gluten may impact PCOS as it increases internal inflammation. But it’s not necessary to go gluten-free your entire life , even few weeks will be beneficial.

10.   Dairy Free Foods- Dairy Products may aggravate some symptoms, so it’s good to limit the consumption of dairy or switch to Dairy free products. Ex- Oats milk, Nut milk, tofu etc.

 

b.  Importance of Exercise in PCOS

Regular exercise helps in regularizing insulin levels too which eventually leads to regular menstrual cycle. Research finds that only Cardio exercise may increase the cortisol (stress hormone) levels. Combining cardio with strength training or resistance training helps balancing it.

You can choose from a variety of exercise for managing PCOS-

1.  High Intensity Interval Training(HIIT)

2.  Cardio- Brisk Walking, Cycling & Swimming etc.

3.  Strength Training- weight lifting, gym workouts etc.

4.  Yoga- Asanas and Pranayam help to regulate heart rate and hormonal balance.

c.   Dealing with PMS in PCOS

Almost every woman will have PMS at some point in their lifetime. Premenstrual Syndrome (PMS) are the symptoms many women experience in the weeks before their period. PMS can be manifest both emotionally and Physically.

1.  Emotional & behavioral symptoms are – mood swings, anxiety, fatigue, depression, irritability or anger, insomnia, low self-confidence etc.

Unfortunately, there are no fixes for this but you can improve this with the help of doctor, self-love, meditation and family support etc.

2.  Physical Symptoms are- Tender breasts, feeling bloated, headaches, food cravings, hot flushes or cold sweats, constipation or diarrhea, body ache and facial acne etc. For these symptoms you can take medical help and increase your consumption of the nutrients like- magnesium, vitamin B complex, Mayo-inositol, zinc and calcium.

 

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