Polycystic ovarian syndrome, commonly known as PCOS is an endocrinal disorder caused due to hormonal imbalance in the body. 8 in 10 women suffer from the condition but most of the time women are left undiagnosed. Women with PCOS have no periods or have very irregular periods, which ties back to the fact that PCOS is a major cause of infertility. PCOS is not curable but early diagnosis and treatment can help control symptoms and prevent long-term consequences.
Symptoms of PCOS tend to develop gradually although it may become rather an evident post weight gain. Other symptoms of the condition include very few or no menstruation with irregular bleeding, male pattern of balding, acne or oily skin, excessive hair growth etc. PCOS, if left undiagnosed and untreated may lead to serious consequences like infertility and Type 2 diabetes. Insulin resistance is also a major cause of PCOS.
Insulin resistance is a condition in which the body cells fail to respond to insulin and the cells are unable to effectively utilize the insulin. When the body becomes insulin resistant the muscles, fat and liver cells do not respond to insulin the way they should and become unable to absorb glucose from the bloodstream. The sugar is then retained in the blood, hence leading to excess blood sugar. For a brief period of time, the pancreas produces more insulin to keep up with the increased need. Over time the pancreas fails to keep up with the increased need for insulin, leading to Type 2 diabetes. Excess buildup of blood glucose leads to pre-diabetes, type 2 diabetes, and various other health complications. As stated by research, understanding the link between insulin resistance and PCOS is rather crucial in the UAE because 1 in 5 women here suffer from type 2 diabetes.
In other cases, women with PCOS are also at the risk of gestational diabetes, a condition when pregnant women who have never had diabetes, have high sugar levels during pregnancy. If diagnosed with PCOS, complications of developing Type 2 diabetes and gestational diabetes increases drastically.
Another factor linked to both PCOS and diabetes is obesity. Half of the population of women in the UAE is clinically obese. According to the 2015 World Health Statistics report, UAE’s female residents are overweight as compared to men. This data is clearly worrying because of the health complications obese women face, the most common ones being heart diseases and type 2 diabetes.
Experts suggest that PCOS may be linked to hereditary factors but the definitive cause is still unknown. Changing lifestyle habits, early diagnosis to control symptoms and prevent complications, maintaining a healthy body weight, exercising regularly, having a balanced diet etc. will help in controlling symptoms. PCOS and diabetes have a well-established link and creating awareness about the same are extremely necessary.
PCOS is one of the most common endocrine disorders in women of reproductive age, often complicated by chronic anovulatory infertility and hyperandrogenism with the clinical manifestations of oligomenorrhoea, hirsutism, and acne. Many women with this condition are obese and have a higher prevalence of impaired glucose tolerance, type II diabetes and sleep apnoea than is observed in the general population. They exhibit an adverse cardiovascular risk profile, as suggested by a higher reported incidence of hypertension, dyslipidemia, visceral obesity, insulin resistance and hyperinsulinemia. PCOS is frequently diagnosed by gynecologists and it is therefore important that there is a good understanding of the long-term implications of the diagnosis in order to offer a holistic approach to the disorder.
Women should be made aware of the long-term implications of their condition, including their cardiovascular risk, by their doctor, in a way that is tailored to their individual circumstances. Women should be made aware of the positive effect of lifestyle modification, including weight loss, for improving their symptoms. Especially those women who are overweight or obese.
Risk of developing gestational diabetes in women with PCOS :
The prevalence of gestational diabetes mellitus is twice as high among women with PCOS compared to control women. Clinicians may consider offering a 2-hour post 75 g oral glucose tolerance test to all pregnant women with PCOS, similar as for screening in women with any other risk factors for gestational diabetes.
Should women with PCOS be screened for type II diabetes :
Insulin resistance is present in around 65–80% of women with PCOS, independent of obesity, and is further exacerbated by excess weight. Insulin resistance has been shown to worsen reproductive and metabolic features, type II diabetes and cardiovascular disease (CVD) risk in PCOS. Earlier onset hyperglycemia and rapid progression to type II diabetes are also reported in PCOS. PCOS is classified as a nonmodifiable risk factor for type II diabetes. Furthermore, type II diabetes is a major Cardiovascular risk factor, and lifestyle therapy has been shown to prevent or delay progression to type II diabetes. Hence early screening and identification in this high-risk group of women with PCOS are important.
Fasting blood glucose level alone has been shown to be inaccurate and results in underdiagnosis of type II diabetes in PCOS. Use of an HbA1c of 6.5% or greater has been proposed for the diagnosis of diabetes. However, caution should be exercised as patients with type II diabetes may be missed and the utilization of HbA1c for the diagnosis of diabetes in PCOS warrants better definition. Hence an oral glucose tolerance test is considered to be appropriate for screening women with PCOS for diabetes. However, it would be reasonable to carry out HbA1c measurements where women are unwilling to have oral glucose tolerance tests or where the resources are not readily available.
Risk of developing sleep apnoea in women with PCOS :
The prevalence of obstructive sleep apnoea is increased in obese women with PCOS. Androgen levels and insulin resistance are positively associated with obstructive sleep apnoea in PCOS.
Risk of developing cardiovascular disease (CVD) in women with PCOS :
All women with PCOS should be assessed for CVD risk by assessing individual CVD risk factors (obesity, lack of physical activity, cigarette smoking, family history of type II diabetes, dyslipidemia, hypertension, impaired glucose tolerance, type II diabetes) at the time of initial diagnosis.
Risk of having reduced health-related quality of life in women with PCOS :
Women with PCOS are at an increased risk of psychological and behavioral disorders as well as reduced quality of life (QoL). It has been shown that PCOS has a significant detrimental effect on QoL compared with controls and weight issues were most likely to affect QoL in women with PCOS. Women with PCOS are at a higher risk of developing psychological difficulties (such as depression and/or anxiety), eating disorders and sexual and relationship dysfunction.
Risk of cancer in women with PCOS :
Oligo- or amenorrhoea in women with PCOS may predispose to endometrial hyperplasia and later carcinoma.
Strategies for reduction of risk :
Lifestyle management including diet, exercise and weight loss is recommended as the first line of treatment for women with PCOS; these changes should precede and/or accompany pharmacological treatment. In women with PCOS and excess weight, a reduction of as little as 5% of total body weight has been shown to reduce insulin resistance and testosterone levels as well as improving body composition and cardiovascular risk markers
Lifestyle management targeting weight loss (in women with a BMI of 25 kg/m2 or more [overweight/obese]) and prevention of weight gain (in women with a BMI of 18.5–24.9 kg/m2 [lean]) should include both reduced dietary energy (caloric) intake and exercise. This should be the first-line therapy for all women with PCOS for managing long-term consequences. Prevention of weight gain should be targeted in all women with PCOS through a monitored caloric intake and in the setting of healthy food choices, irrespective of diet composition. Behaviour change techniques should target prevention of weight gain in all women with PCOS. Women who have failed to lose weight with lifestyle strategies and who have a BMI of 40 kg/m2 or more or who have a BMI of 35 kg/m2 or more together with a high-risk obesity-related condition (such as hypertension or type II diabetes) should be considered for bariatric surgery
PCOS is a disturbance of metabolic function, which may present with any of the following features:
Irregular or no periods
Acne and greasy skin
Abnormal body hair
PCOS is characterized by excess production of male hormones, hormonal imbalance and/or impaired glucose tolerance. On pelvic ultrasound, ovaries will appear enlarged with multiple small follicular cysts. The incidence of PCOS is up to 8 to 20% of women worldwide and is very common in the female population of the UAE.
The exact cause of PCOS is unknown, but is considered to be caused by genetic factors. The treatment methodology of PCOS focuses on managing individual symptoms and conditions. Women should follow a healthy lifestyle and diet. Obesity and insulin resistance are very common in such women. They are also at a higher risk of developing type 2 diabetes and cardiovascular diseases later on. Weight loss may be difficult but it is very important for the patients’ self-image and reducing the symptoms. Consulting with a specialist, dietician and fitness expert is necessary. Furthermore, a balanced diet and regular exercise is crucial in the management of PCOS.
Understand the word ‘Diet’
Diet does not mean starvation or eating minimal amounts in order to shed extra weight. Dieting is acceptable when it is done the healthy way. Do not indulge in a diet that does not provide with the required nourishment.
Green leafy vegetables
Green leafy vegetables (especially spinach, kale, swiss chard, watercress and arugula) have the most nutrients per calorie than any other food. Moreover, they are rich in vitamin B, which is vital in managing PCOS.
Indulge in a protein rich diet
Proteins from fish, lean meat, chicken, beans, tofu and peanut butter are a prominent part of a healthy PCOS diet. Combine proteins with some amount of carbohydrates to keep the blood sugar levels optimal.
Opt for healthy fats
It is important to know that not all fats are bad or unhealthy. Essential fatty acids are vital for hormone balance such as fat found in tuna, salmon, nuts and seeds (walnuts, pumpkin seeds), olive oil and avocadoes is healthy and can be consumed in moderation.
Fruits are a natural rich source of fiber, vitamins, mineral and phytonutrients. Fruits recommended for PCOS women are cherries, plum, grapefruit, apple, pear, apricot, coconut, kiwi fruit, oranges and prunes.
In addition to consuming certain foods, some foods that need to be avoided include;
Muffins & cakes
Tips to manage insulin resistance
Eat whole grain foods instead of processed, refined foods
Eat whole fruits instead of fruit juice
Eat small, healthy meals and more frequently to manage cravings & hunger pangs
Never miss breakfast
Life style changes
Get support from family & friends
By making these diet and lifestyle changes, women can easily manage symptoms and feel good about themselves.
It is human tendency to believe that certain conditions appear only among adults, failing to realize how ignorance leads to greater health issues in the future. Chicken pox for example, once a child gets chicken pox we believe that it is not going to occur again. Nobody takes the effort to know more in detail about an issue, the causes for it and if it has any future implications. Another major health issue that is considered to affect only adult women is Endometriosis. Endometriosis is a health condition that affects almost 100,000 women in the UAE. It is a condition of equal opportunity, differentiates on no grounds. The youngest patient of Endometriosis as literature states was said to have been 101/2 years of age who had only two previous menstrual flows.
Endometriosis is a condition where the tissue that serves as the lining of the uterus starts growing outside in other places like the ovaries, fallopian tube, outside the uterus, the bladder, the intestines and others. The most common symptom of Endometriosis is adolescents is pain during the menstrual flow. There are other symptoms including heavy bleeding during periods, or irregular periods and spotting, painful urination, pain during sexual activities. In some cases, women experience pain is areas where the tissue or uterus lining has developed.
It is common for women to experience discomfort during menstruation, but the intensity of pain and discomfort experienced is what determines whether or not medical attention is required. In order to understand why women experience pain during menstruation, we need to know what happens inside a female body during menstruation. During each menstrual flow, the lining of the uterus sheds because this is when the uterus is ready to receive the egg released from the ovaries. If the egg is not fertilized, the uterus sheds the uterus lining. One cause of pain during the menstrual cycle is a chemical called prostaglandins, which causes the uterus to contract when the lining is shed and these contractions, in turn, cause pain.
There are no fixed causes for the condition, even Doctors do not have an established reason for the causes of Endometriosis. Although hereditary factors do play a rather strong role in the same, women who have family members suffering from Endometriosis are more likely to develop the condition.
In most cases of adolescents, endometriosis as a health condition is not diagnosed because it is either considered a normal part of menstruating or the abdominal pain is considered to be caused because of some other cause. A lot of times, they themselves are unable to distinguish between what is normal pain and what isn’t, for they may have only experienced the cycle a few times and do not know. Slight pain during the first few days of menstruation is normal but the continued pain that disrupts normal day to day activities isn’t normal. This is how we as individuals can understand that something about the functioning of the body is wrong. Constant pain during periods, worsening of the period pain, heavy flow during periods, back pain, diarrhea, feeling of nausea, constipation, painful urination, feeling of seeing blood when using the bathroom, inability to function normally and refraining from physical activities etc. are some of the most common visible symptoms of Endometriosis.
Yet again, on visible symptoms such as these, we need not conclude that the girl is suffering from Endometriosis, there is a possibility that these symptoms could have occurred because of any infection. Women generally tend to ignore such symptoms, period pain, in particular, is always disregarded as normal but do we know how much pain is normal, the intensity of the pain matters. On viewing any abnormal symptom or anything abnormal in the body, a Gynecologist must be consulted. The Doctor may require certain tests to rule out every other possibility. The only way to conclude that a woman is suffering from Endometriosis is by performing a minimally invasive surgery called Laparoscopy where the doctor views the organs in the pelvic cavity with the use of a thin telescope called as Laparoscope. This gives the doctor a clear picture of the internal cavity, hence making diagnosis easier.
Dealing with Endometriosis is definitely challenging for it has no definite cure but that is no reason to dread the issue, individual symptoms experienced can be controlled. There are certain medications available to control the condition. Surgery may also help if medications do not work at all, although results may vary from person to person. One woman may find it helpful while the other may develop pain again over time. Certain lifestyle changes and exercises like walking and swimming may also help a long way in curbing the condition.
Every girl needs to take their body seriously and never shy away from asking if anything seems different. Regular health checks are a must, moreover, if a condition such as Endometriosis is diagnosed in the very beginning it will help reduce the severity of the condition and a woman may never have to say ‘I wish I had been diagnosed earlier’.
PCOS is one of the most common hormonal disorder caused in women of reproductive age. It is caused by hormonal imbalance and metabolic issues in women, also affecting their physical appearance and overall health. Although most experts believe that there are a number of causes including genetic factors that cause PCOS, the exact cause of the condition still remains unknown. Androgen is a male hormone which is produced in the body of every women but in very small amounts, the excess presence of Androgen causes male pattern baldness and excess facial hair growth which are two symptoms of PCOS. High levels of male hormones can also cause the ovaries to not release an egg during the menstrual cycle. Another cause of PCOS, as believed by experts is Insulin resistance, insulin is a hormone that converts the food we consume into energy. When the body does not respond to insulin, the insulin levels in the blood becomes higher than normal which in the long run could cause Type 2 Diabetes.
Women with PCOS have similar symptoms but they may experience them differently. The severity and the type of symptoms visible in women vary. The most common symptom experienced is irregular periods, delay of normal menstruation, fewer than normal periods and painful menstrual flow. Excessive body or facial hair, male pattern balding from the scalp, acne, infertility, weight issues, skin discoloration, acne, difficulty in losing weight etc are the most commonly seen symptoms of PCOS. This may not all appear together in a woman, some may have one of the symptoms, and others may have more than one. For a lot of women, the process of being diagnosed with PCOS in itself could be a challenge, for instance in the case of balding or skin discoloration, a Gynecologist will not be our choice of Doctor. PCOS can go undiagnosed for a period of time because the symptoms may overlap with other medical conditions women face. On conducting blood tests, physical tests, pelvic test and an ultrasound, if a women has one of any the symptoms; namely multiple cysts on each of the ovaries, excess androgen levels, irregular periods, she will be diagnosed with PCOS.
What is the cure?
There is no permanent cure or treatment for PCOS. Each symptom can be individually managed and treated. On experiencing any visible symptom or any bodily change, one should consult a Doctor, and on being diagnosed with PCOS, the Doctor would prescribe medication and treatment options depending on the symptoms. Fertility treatments are available to help women conceive. But the ideal way to treat PCOS is through nutrition and exercise, losing as little as 5% excess weight can help women reduce symptoms. Losing weight is an extremely important aspect of the condition and even though it may seem difficult to lose weight, one should continue the effort because it helps avoid the risk of certain conditions that may affect women with PCOS much earlier than women without PCOS. Health issues like heart diseases, stroke high cholesterol, diabetes, high BP are linked to long term consequences of PCOS. Surgery is the last resort for PCOS where laparoscopic drilling is done to trigger ovulation in women, the surgery can be an option for women who do not ovulate even after losing weight or trying fertility medicines.
Endometriosis, on the other hand, is a health condition that affects almost 100,000 women in the UAE. It is a condition that sees no differentiation and appears in women across all age groups. Endometriosis is when a condition when the tissue that lines the uterus begins to grow outside the uterus in areas like in pelvic organs and rarely beyond. With endometriosis, the tissue would act like it normally would, it will break down and bleed with each menstrual cycle, but since the tissue is displaced it has no way to exit the body.
Are the symptoms similar to PCOS?
Endometriosis may appear with symptoms or also be asymptomatic. Similar to PCOS, Endometriosis has no designated cause but the menstrual blood containing the lining that has to flow out of the body may flow back into the pelvic cavity through the fallopian tubes in a condition called retrograde menstruation, the immune system may be unable to recognize the tissues growing outside the uterus, heredity factors, a surgical after effect where after a Hysterectomy or C-section the endometrial cells may stick to an incision.
The severity of the condition depends on the exact location, extent, and depth of the endometrial lining deposit. Symptoms of the condition differ in each woman. Some women may experience painful periods, pain during intercourse, painful urination, excessive bleeding, infertility, digestive issues like diarrhea, constipation etc. Sometimes this condition is asymptomatic. Some women wild mild endometriosis may experience severe pain and sometimes women with severe endometriosis may have mild pain.
Can it be treated?
Unlike PCOS, Endometriosis has the option of surgical treatment. Endometriosis is generally treated with medication or surgery depending on the severity of the symptoms and depending on whether or not the woman chooses to conceive.
Surgery is beneficial if the woman is experiencing severe pain. Hormone therapy is used to treat pain related to Endometriosis. Generally, on consultation, doctors would suggest surgery be the last resort and will begin with pain relief medications. Conservative surgery, assisted reproductive technology and hysterectomy are the surgical methods used. Conservative surgery is done in case the woman wishes to become pregnant, assisted reproductive technology like IVF will help in conceiving and is preferable if the conservative surgery does not produce effective or desired results. Hysterectomy is the choice of procedure is the condition is severe and if the woman does not desire to conceive because in this surgical procedure the reproductive organs are removed.
The key to successful fertility treatment
Endometriosis is a progressive disease and can recur after stopping treatment. The key to successful fertility treatment is not delaying pregnancy. A woman diagnosed with Endometriosis desiring pregnancy should complete her family at the earliest. Endometriosis affecting the uterine wall can cause a condition called Adenomyosis can cause severe bleeding and pain during periods, the condition also causes infertility. Laparoscopic surgery is performed if the woman wishes to conceive where the surgeon removes any visible endometriosis implants and scar tissue that may be causing pain or infertility. The definitive or curative treatment for the condition is the removal of the uterus and ovaries.
These are all methods by which the quality of life for a woman living with the condition can be improved. For both PCOS and Endometriosis, the type and method of treatment should be decided by a healthcare professional depending on various factors like age, severity of the condition and the symptoms associated with it. These are both conditions that are widely present in women but generally goes unnoticed because a lot of times women tend to ignore a lot of the symptoms associated with these conditions.