Dr. Sheela Nambiar – ObGyn. Lifestyle Medicine Physician, Dr. Usha Sriram – Endocrinologist, Anjali Uthup Kurian – Radio Jockey and PCOS warrior spoke with PatientsEngage on PCOS (Polycystic Ovary Syndrome) and its effect on Fertility and Obesity.
What is PCOS and what are its typical symptoms?
PCOS, or Polycystic Ovary Syndrome, is a hormonal disorder predominantly affecting women of reproductive age, typically between 15 to 49 years old. However, its impact can extend throughout a woman's life. It's the most common endocrine problem in this demographic, affecting around 15 to 18 percent of women globally, with a substantial prevalence in India alone, where approximately 330 million women fall within the reproductive age range.
Symptoms of PCOS vary but commonly include menstrual irregularities such as amenorrhea (absence of menstruation) or abnormal periods. Additionally, individuals with PCOS may exhibit clinical signs of excess male hormones, such as acne, oily skin, facial hair growth (hirsutism), excess body hair (hypertrichosis), and hair loss from the scalp. These symptoms reflect the hormonal imbalances characteristic of PCOS, where women often have elevated levels of male hormones. Fertility issues are another hallmark of PCOS, with many affected individuals experiencing difficulties conceiving, often termed subfertility. Approximately 50 to 60 percent of women with PCOS are also overweight, which can further compound their symptoms and may prompt them to seek medical consultation. Overall, being aware of these symptoms can aid in the early detection and management of PCOS, emphasizing the importance of timely medical intervention and support for affected individuals.
Listen to Dr.Usha Sriram answering this question: https://www.youtube.com/watch?v=6MLKIn27BMI
What is the difference between PCOS and PCOD?
PCOS stands for Polycystic Ovary Syndrome, encompassing a variety of symptoms and factors, rather than a single issue. Conversely, PCOD stands for Polycystic Ovarian Disease or Disorder. Doctors avoid using PCOD due to the stigma associated with terms like "disease" or "disorder." Given that PCOS already presents its challenges, we prefer using this term to describe the condition, thus avoiding further stigma.
Is PCOS diagnosis more common now? Are young women diagnosed earlier?
Yes, the diagnosis of PCOS is indeed becoming more common nowadays compared to previous years. However, it's essential to note that the criteria for diagnosing PCOS can be somewhat ambiguous. While ultrasounds may reveal multiple cysts in the ovaries, this alone doesn't necessarily confirm PCOS. Factors such as irregular periods, obesity, and elevated lipid levels should also be considered before labeling someone with PCOS. Typically, the first point of contact for young women or teenagers regarding this issue might be a gynecologist or a primary care physician. However, patients must be empowered and informed about their condition, as early detection and management can significantly impact their health outcomes.
When experiencing symptoms related to PCOS, do individuals typically seek initial consultation with a gynecologist, dermatologist, or endocrinologist?
The choice of specialist depends on the primary symptom that concerns the individual. If it's menstrual irregularity or fertility issues, they often consult a gynecologist. Endocrinologists may be sought for weight-related concerns, while dermatologists are commonly visited for skin and hair issues associated with PCOS. In rural areas where specialists are scarce, gynecologists often handle all related issues. In urban areas, the choice may depend on symptom severity and local expertise.
What are the risks associated with self-diagnosis of PCOS?
Yes, self-diagnosis of PCOS is prevalent, with many patients attributing their symptoms to the condition. While some may accurately identify their symptoms, such as irregular periods, hair growth, acne, and weight issues, there are risks associated with self-diagnosis. Over diagnosis is a concern, as polycystic ovaries on ultrasound are common among adolescents, and menstrual irregularities can stem from various causes. Additionally, misdiagnosis is possible, as PCOS is a diagnosis of exclusion, requiring the ruling out of other conditions like Cushing's syndrome or thyroid issues. Therefore, relying solely on self-diagnosis can lead to inappropriate treatment and management. Professional guidance from a physician is crucial for accurate diagnosis and appropriate management of PCOS, considering its long-term impact on women's health.
Listen to the detailed response by Dr.Usha Sriram - https://www.youtube.com/watch?v=gkWfWPHyyxU
Is there a specific diagnostic test or criteria for PCOS, or is it primarily based on exclusion and clinical evaluation?
The most recent and widely accepted diagnostic criteria for PCOS, known as the ASRM criteria or Rotterdam criteria, require meeting two out of three criteria for adults. These include irregular menstruation or anovulation, features indicating excess male hormones either clinically or through blood tests, and the presence of polycystic ovaries on ultrasound. This approach ensures a comprehensive assessment before diagnosing PCOS, emphasizing both clinical presentation and objective findings.
Why do many people resort to self-diagnosis for conditions like PCOS or thyroid issues?
Often, people turn to self-diagnosis because they're reluctant to make lifestyle changes or seek proper medical advice. They observe others managing similar conditions and assume they must have them too. However, effective management requires individualized care and thorough diagnostic tests conducted by medical professionals. Additionally, misconceptions about shortcuts to treatment, like taking medications without supervision, can lead to further health complications. It's essential to understand that conditions like PCOS evolve differently at various stages of life, requiring tailored approaches to management.
How would you define lifestyle management for conditions like PCOS, and what long-term health advice do you offer?
Lifestyle management, especially in the context of conditions like PCOS, involves evidence-based protocols addressing six key pillars: food, nutrition, exercise, sleep, stress, social connectedness, and addictions. It's essential to tailor interventions based on individual needs, considering factors like childhood history, trauma, and current lifestyle habits. Weight management is crucial, but it's not just about dieting; understanding underlying issues like stress eating or past traumas is vital. Motivational interviewing and counseling play significant roles, fostering a therapeutic alliance between patient and doctor. Ultimately, lifestyle management is a multi-pronged, long-term approach that requires patience and commitment from both parties.
How does PCOS impact women at different stages of life, and what are the associated risks and challenges?
PCOS manifests differently at various life stages, starting from irregular periods in puberty, increasing the risk of low birth weight babies and gestational diabetes during pregnancy. Women may face difficulties with conception and higher rates of pregnancy loss. As they enter adulthood, issues like excess weight and eating disorders become prevalent, alongside mental health concerns like anxiety and depression. Menopause brings its own set of challenges, including metabolic changes and increased risks of diabetes and heart disease. Additionally, PCOS elevates the risk of uterine cancer due to irregular menstrual cycles. Overall, PCOS affects a woman's life from birth to old age, presenting complexities beyond common perception.
How does PCOS affect fertility and pregnancy?
PCOS primarily impacts fertility by causing anovulation, meaning the ovaries don't release eggs regularly, or sometimes not at all. This irregular ovulation makes conception difficult. Additionally, PCOS creates a hormonal imbalance, elevating male hormones, which further complicates fertility. Even if conception occurs, there's a higher risk of early pregnancy loss or complications such as gestational diabetes, high blood pressure, and intrauterine growth restrictions. Managing PCOS before pregnancy involves lifestyle changes like diet, exercise, stress management, and sleep regulation, which can improve overall health and increase the chances of spontaneous conception. Weight loss, even as little as five percent, can notably enhance fertility. Empowering women to prioritize their health not only aids in conception but also ensures better outcomes for both mother and child, addressing not just an individual but also societal and cultural influences on health habits.
What challenges and advice did you encounter during pregnancy with PCOS?
Anjali reflected on her pregnancies, noting the contrast between her two experiences. While her first pregnancy was a time of celebration, her second proved more challenging due to early spotting and the need for progesterone treatment and bed rest. Despite these hurdles, she was grateful for the guidance of Dr. Jacob, who emphasized the importance of staying active and opting for natural foods. Anjali's pregnancies were relatively smooth beyond these interventions, with healthy weight gain and the birth of robust, healthy babies. She highlighted the diverse manifestations of PCOS, stressing that not all cases fit the stereotype. Anjali emphasized the ongoing struggles with hormonal imbalances beyond pregnancy, urging understanding and empathy for those battling PCOS.
What is "lean PCOS"? What are the risks associated with it?
Lean PCOS refers to individuals with polycystic ovary syndrome who are of normal or thin weight. While about 50 to 60 percent of those with PCOS are overweight, the remaining individuals can still experience underlying issues like insulin resistance and hormonal imbalances. Weight gain can amplify these problems, unmasking and intensifying symptoms. Despite being thin, individuals with lean PCOS still face risks such as a heightened susceptibility to type 2 diabetes. They may be up to seven times more likely to develop diabetes in their lifetime, with gestational diabetes also being more common. Managing these risks involves adopting a proactive approach, including healthy eating, regular physical activity, and diligent monitoring to mitigate the impact of insulin resistance and maintain overall health.
How do women usually respond to a PCOS diagnosis, and how do you assist them in accepting it?
Surprisingly, some women seem quite nonchalant upon receiving a PCOS diagnosis. It's almost as if having PCOS has become fashionable. However, this casual attitude often stems from a lack of understanding of the long-term risks associated with PCOS, such as diabetes and heart disease. Many focus solely on the immediate symptoms like hair growth, acne, or fertility issues. Yet, as they age, concerns about weight management and chronic conditions become more pressing. For some, the diagnosis offers relief, providing an explanation for their symptoms. Others may feel overwhelmed by the severity of their symptoms, including mood swings, depression, and anxiety. Regardless of initial reactions, it's crucial to stress the importance of proactive management, akin to managing diabetes. Simply taking medication isn't enough; lifestyle changes, like diet and exercise, play a pivotal role in managing PCOS effectively.
Is inflammation a common symptom of PCOS?
Inflammation is indeed associated with conditions like obesity and insulin resistance, which are often present in individuals with PCOS. However, while inflammation may contribute to aches and pains, it's not a direct symptom of PCOS itself. Factors like obesity, vitamin D deficiency, and obstructive sleep apnea can exacerbate inflammation and lead to discomfort. It's essential to address these underlying issues and rule out conditions like hypothyroidism to manage symptoms effectively.
Do people often use metformin casually, thinking it aids with insulin resistance and weight loss?
Yes, there's a misconception that metformin can be taken like a vitamin to address insulin resistance or aid in weight loss. However, as an endocrinologist, I caution against this practice. Metformin should only be used under medical supervision and prescribed when there's evidence of diabetes or pre-diabetes. Using metformin unnecessarily can mask glucose abnormalities and lead to deficiencies like vitamin B12, causing symptoms like numbness, tingling, and memory issues. It's crucial for women to consult their doctor and undergo glucose testing before considering metformin as a treatment option.
Read about PCOS and diabetes - https://www.patientsengage.com/conditions/diabetic-complications-polycystic-ovarian-syndrome
Are fibroids the same as PCOS?
No, they're not. Fibroids are benign growths in the uterine wall and can cause symptoms like heavy bleeding or pain. PCOS, on the other hand, is a hormonal disorder affecting ovulation and can involve symptoms like irregular periods and infertility. While someone may have both fibroids and PCOS, they are distinct conditions.
Can PCOS cause the pancreas to become fatty?
PCOS is often associated with insulin resistance, which can lead to conditions like non-alcoholic fatty liver disease. However, the pancreas itself doesn't typically become fatty. Instead, it's crucial to monitor for conditions like diabetes, as the pancreas plays a role in insulin production. Managing insulin resistance through weight loss is key to addressing associated health issues.
What happens to PCOS when a person reaches menopause?
Menopause marks the end of menstruation, so the menstrual irregularities associated with PCOS typically cease. However, other symptoms like excess hair growth and hair loss may persist due to changes in hormone levels. Women with PCOS may experience a slight increase in male hormones post-menopause, contributing to these symptoms. While the cystic ovaries themselves remain, they usually don't cause issues. However, post-menopausal concerns often revolve around metabolic health, with an increased risk of conditions like diabetes and high cholesterol. Estrogen levels decline, affecting cholesterol levels, potentially leading to an increase in overall cholesterol and a decrease in good cholesterol. This period calls for education and lifestyle adjustments to mitigate these risks.
Anjali's Journey with PCOS: A Tale of Hidden Struggles and Empowerment
Anjali's journey as a PCOS warrior began decades ago, marked by weight gain and challenges conceiving. Despite limited awareness and societal taboos, she sought medical advice and received a diagnosis. Treatment with metformin helped her conceive, but weight gain persisted. Seeking guidance from specialists, Anjali remains determined to reclaim her health and raise awareness about PCOS. She emphasizes the importance of open dialogue and understanding to eliminate stigma and create a supportive environment for those affected by PCOS. Anjali's plea for open conversations seeks to cultivate a more understanding society for those grappling with PCOS.
Closing remarks -
"Women are embodiments of strength, but we're also fragile. PCOS, obesity, fertility issues—these are internal battles that aren't always visible externally. Sometimes, we need to step back and give ourselves the space to heal and regain our strength. My message is simple: respect yourself, respect your body, and extend that respect to others. PCOS, infertility, obesity—they can be incredibly challenging to navigate. But every day, we strive to find happiness. So, let's make a conscious effort to embrace positivity and greet each day with the belief that it'll be a good one. That's what I do, and it makes all the difference." – Anjali Uthup Kurian
"PCOS management isn't just about medication—it's primarily about lifestyle changes. Taking control of your health through healthy eating and regular exercise is empowering. It's a longer journey, but it's one that leads to resilience and strength. Let's embrace this path to empowerment and thrive." – Dr. Sheela Nambiar
"PCOS isn't just a reproductive issue—it's a metabolic problem, possibly renamed as metabolic reproductive syndrome. Beyond acne and irregular periods, it's about preventing diabetes, heart disease, and cancer. By adopting healthy habits like eating well, staying active, and maintaining a positive mindset, women with PCOS can overcome challenges and achieve long-term health."- Dr. Usha Sriram
"Reflecting on the conversations we've had with many individuals dealing with PCOS, it's evident that addressing it requires consistency and commitment. It's not a problem to be tackled in starts and stops. PCOS is a metabolic and lifestyle issue, demanding a dedicated approach. When diagnosed, seek confirmation from a physician and embark on the challenging yet rewarding journey of lifestyle adjustments. Stay the course until healthy habits become second nature. It may seem daunting, especially with competing priorities, but the benefits are immeasurable. That's the message we aim to impart—to embrace the journey and reap the manifold benefits of proactive management." – Aparna Mittal
Some quotes,
"Medications are just one piece of the puzzle—they provide support, but it's ultimately your actions and lifestyle choices that drive real change and improvement in your well-being." – Anjali Uthup Kurian
"There are no shortcuts when it comes to achieving and maintaining good health. It's about embracing a balanced lifestyle that includes nourishing food, regular exercise, and self-care practices." - Anjali Uthup Kurian
"Doctors don't want you in their lives forever; they want to empower you to start living yours." - Anjali Uthup Kurian
“PCOS is not just a reproductive problem, but it's more—a metabolic issue. Women should think beyond symptoms like acne and irregular periods, focusing on long-term health." – Dr.Usha
"PCOS isn't just about popping pills—it's about embracing lifestyle changes. It's not a handout; it's empowerment." – Dr. Sheela Nambiar
Read more related to lifestyle changes and PCOS:
PCOS dietary guidelines - https://www.patientsengage.com/healthy-living/8-dietary-guidelines-pcos
How to overcome PCOS depression - https://www.patientsengage.com/conditions/why-do-women-pcos-have-depression
How do I deal with PCOS https://www.patientsengage.com/conditions/how-do-i-deal-pcos
What helped me manage PCOS - https://www.patientsengage.com/personal-voices/pcos-motivated-me-adopt-healthy-lifestyle
