When we hear the term “lifestyle diseases”, we tend to think about type 2 diabetes, obesity, high cholesterol or high blood pressure, even cancer and dementia. But rarely do we think of Poly Cystic Ovarian Syndrome (PCOS). But why so? Probably, because most of us attribute PCOS to our genes, or because most of us are oblivious to the complications that can arise due to PCOS.
Fact check
On an average PCOS affects 1 in every 10 women worldwide and if left untreated poses serious chronic health risks. There is no denying the fact that genes from both maternal and paternal pools play a role in PCOS. But genetics is not the only cause. PCOS can stem from a sedentary lifestyle coupled with a nutritionally imbalanced diet.
What is PCOS?
PCOS or Poly Cystic Ovarian Syndrome is a condition in which multiple cysts form inside the ovaries.
Our body secretes female hormones like luteinizing hormone (LH) and follicle-stimulating hormone (FSH) that regulate the monthly menstrual cycle. Ovaries contain many immature eggs inside the fluid-filled sacs called follicles.
FSH and LH help to release the most mature egg through a process called ovulation. This free egg awaits fertilization in the fallopian tube for about 12 – 24 hours and is ejected through menstruation, in case the fertilization does not occur. The remaining immature follicles degenerate.
In the case of PCOS, an abnormally high amount of LH is released that disrupts the normal menstrual cycle. As a result, some of the immature follicles end up as cysts in the ovaries, instead of getting dissolved.
In addition, blood insulin levels could also stay elevated. High insulin together with high LH, can result in excess production of a male hormone called testosterone. Abnormally high levels of testosterone prevent ovulation and lead to infertility. Testosterone is also responsible for causing many of the male pattern physical features associated with PCOS.
Signs and Symptoms of PCOS
Because of hormonal imbalance, PCOS patients show all or a few of the following symptoms –
1. Menstrual cycle disruption with irregular or no periods
The healthy range for the menstrual cycle varies anywhere between 21 to 28 days. If the cycle is completed earlier than 21 days or later than 28 days, then a doctor’s visit would be appropriate.
2. Weight gain
If you notice unexplained weight gain, with no thyroid malfunction, then keep observing for other signs that may indicate PCOS.
3. Infertility
If you have been trying to conceive, but haven’t been able to, even after a substantial time (1 year for women under 35 years of age and 6 months for women above 35 years), please visit a gynaecologist.
4. Hirsutism (excessive hair growth)
Due to excess male hormone production, women with PCOS may develop hair on the face, side of jaws, or abdomen.
5. Hair fall
The surge of male hormones in PCOS may also lead to excess hair fall and male pattern baldness in women.
6. Fatigue and Nausea
Women may experience fatigue even after small tasks and may find it difficult to concentrate on their work. If you feel drained out or anxious often, it could be due to PCOS.
7. Acne and excess sebum production
Excess testosterone may also lead to excessive sweating, and the resultant oily skin may lead to sudden outbursts of painful acne mostly on the face and sides of the jaw.
Although some of the major symptoms are listed here, they do vary from person to person.
Types of PCOS
Based on the primary cause, PCOS can be classified into five broad types:
1. Insulin Resistance linked PCOS
This is the leading cause of PCOS in women today. An unhealthy diet, physical inactivity, mental stress, etc., over time, lead to the development of a condition called insulin resistance and eventually PCOS.
2. Pill induced PCOS
The second most common cause of PCOS is the consumption of certain birth control pills. These pills can curb ovulation leading to the formation of cysts.
3. Inflammatory PCOS
Inflammation-induced by stress, excess weight, toxins in the environment, and inflammation-inducing food can also lead to PCOS. Headaches, skin allergies, Vitamin D deficiency, and thyroid disorder together may account for inflammatory PCOS.
4. Hidden PCOS
Sometimes, PCOS can be induced by dietary deficiencies alone. This takes time to develop and stays hidden or undiagnosed for some time, hence the name. Dietary deficiency of Iodine and Zinc (required for ovarian functions) can be important inducers.
5. Inherited PCOS
PCOS can also be genetic. Inherited PCOS can manifest from as early as 13-15 years of age. Infrequent Periods, PCOS amongst immediate relatives, excessive hairiness in males in the family, etc. are generally associated with genetics of the disorder.
PCOS and Insulin Resistance
PCOS is known to stem from a sedentary lifestyle, stress, and unhealthy food choices, which incidentally also lead to insulin resistance in the body. So, although there is a correlation between the two conditions, a causality, if any, is yet to be proven. However, insulin resistance does elevate the severity of PCOS in the body.
Insulin resistance is a condition wherein its effectiveness to regulate blood sugar has been impaired. So, to compensate, the body ends up producing excess insulin. This excess insulin in the blood is known to worsen the pathology of PCOS. Therefore, to help patients with PCOS, it is vital to reverse the insulin resistance, to the extent possible.
Health Check
If untreated, PCOS aggravates and could lead to complications like obesity, type 2 diabetes, and cardiovascular diseases- a vicious spiral.
Diagnosis of PCOS
There is no one single test for PCOS, as its symptoms are common to other diseases as well. Hence, a differential diagnosis is generally used to eliminate other possible conditions & identify PCOS as the cause of the symptoms. A physical exam, endocrine blood tests, ultrasound, and metabolic blood tests can be prescribed to confirm the diagnosis, along with measurement of hormones like FSH, LH, and testosterone.
PCOS patients are also tested for fasting blood glucose and insulin to ascertain whether the patient is insulin resistant. The medications and lifestyle interventions are then advised accordingly.
Beating PCOS
Though medications like Metformin are prescribed to women with PCOS, it only ends up managing the symptoms, while the underlying condition worsens. PCOS, along with its clinical and physical symptoms, can have a lasting effect on a woman’s quality of life, her overall health, and psychological well-being. Hence it is essential to take a long term holistic approach while treating PCOS, instead of relying on antiandrogen drugs and other medication.
The root cause for PCOS can be addressed mostly through correcting the diet, including physical activity in the daily routine, ensuring adequate sleep, reducing weight to improve the BMI, and taking nutritional supplements, as required.
A compilation of basic hacks that can help beat PCOS:
1. Moderate Physical Activity
Physical exercises to reduce weight can not only help improve insulin sensitivity and lipid profile but also help prevent complications like type 2 diabetes and cardiovascular diseases. Recommended exercise includes moderate physical activity like brisk walking, resistance training, and endurance routines.
2. Healthy balanced diet
Choosing and managing what to eat, when to eat & how much to eat is of utmost importance for PCOS patients. The focus should be on the quantum and quality of carbohydrates, proteins, and fats, instead of blindly following any fad diet. Some dietary interventions that can help improve the condition:
- Choosing complex carbs over “refined” – Improves beta-cell responsiveness & reduces fasting insulin.
- Choosing foods with low GI and more fibre content – Improves insulin sensitivity.
- Adequate intake of proteins and omega-3 fatty acids – Though there is less evidence on the effect of proteins on PCOS, a healthy intake can help regulate your ghrelin and leptin secretion. This promotes satiety and fullness and thereby helps with mood fluctuations as well as weight reduction.
- Intake of antioxidants and supplements – PCOS often leads to a decrease in the concentration of antioxidants in the body, further leading to mitochondrial dysfunction, inflammation, oxidative stress, and insulin resistance. Recommended antioxidants include superoxide dismutase (SOD) and α-lipoic acid (ALA). Along with antioxidants, supplements like inositol can help women with PCOS. They are also found naturally in abundance in foods like peas, nuts, and grains.
Key Takeaway
The root cause for PCOS can be addressed mostly through correcting the diet, including physical activity in the daily routine, ensuring adequate sleep, reducing weight to improve the BMI, and taking nutritional supplements, as required.
