Stress, lifestyle and obesity: Why do you have PCOS?

PCOS is a very common disorder amongst reproductive age women in India, with as many as one in five women suffering from it. Doctors say that lifestyle changes, healthy eating habits, exercising, and regular gynae visits can help you manage and prevent it.

• What is PCOS?
• What are some of the factors that cause PCOS?
• Some women with PCOS don’t have irregular periods and they are missing symptoms. Could you tell us more about that?
• So if women don’t have symptoms, how can they detect it? 
• When you say that there is no cure, what are the kind of treatments that are used then?
• I believe there is a rising incidence of PCOS in teens, Will you talk about that?
• One thing that women worry about when they have PCOS is infertility and getting pregnant. Can you tell us if it is harder to conceive if you have PCOS?
• Are there any preventive measures that women can take against PCOS?
• How important is stress as a factor?
• Are there any specific age groups that are more  at risk?
• Are there any specific tests that you recommend women should get periodically?

It is believed that as many as one in five women in India have PCOS or Polycystic Ovary Syndrome. Women with PCOS produce a higher than usual amount of the male hormone and often have irregular periods. While the exact cause behind PCOS is unknown, doctors say that genetics have a role to play and it can be exacerbated by poor lifestyle, obesity, and unhealthy eating habits.

A study conducted in Maharashtra says that PCOS is also a common diagnosis in women with infertility. It also says that contrary to common perception, PCOS happens in both obese and non-obese women, and patients usually experience irregular periods, hirsutism, acanthosis nigricans (AN) (pigmentation and dark patches on skin), and hypothyroidism (when the thyroid gland is not able to produce enough thyroid hormone).

There are ways to manage the symptoms of PCOS including reducing stress, eating right, losing weight, and birth control pills to regularise periods. Femoai spoke to Dr. Anuradha Sharma, a Delhi-based gynaecologist about PCOS, its causes, and the role of stress and diet in PCOS, infertility, and what can women do about it. Here are edited excerpts:

What is PCOS?

It is a condition wherein your ovaries will have too many follicles (can be seen in an ultrasound) which are filled with fluid; these follicles contain eggs but the brain does not signal any of these to ovulate. It is a complex endocrine disorder with wide ranging clinical signs and symptoms. PCOS patients often come to doctors with symptoms of hyperandrogenism (high levels of androgens, male hormone, in females) like acne, hair growth, excess hair on body and face. 

In India, PCOS is very common, it is especially seen more in urban setups. I wouldn’t, however, be able to comment on the rural sector. Polycystic basically is a metabolic disorder; a syndrome where you can experience irregular periods, infertility, hair growth, acne, obesity, high lipid, high glucose. These are all the things that contribute to it being a syndrome. What happens is that because the eggs are not ovulating, there is a  disbalance between the female and the male hormone in a woman’s body. Normally, estrogen is on the higher levels in women, but here the testosterone also takes over (Testosterone is the primary male sex hormone; women produce a small amount of it in the ovaries and adrenal glands). The balance is disturbed and therefore there is acne, irregular periods, and hair growth etc.

What are some of the factors that cause PCOS?

There are certain factors like your lifestyle; if you become sedentary, and eat a diet rich in glucose and fats, they cause beta cell dysfunction, and insulin resistance. The insulin resistance is because of excess androgens which leads to a host of these problems. The key factors can be stress, lack of exercise, centripetal obesity or abdominal obesity (increased waist-to-hip and waist-to-thigh ratios). Normally we want a waist circumference which is less than 85 cms for women, and when it is more than 88 cms, then we are at risk of polycystic ovaries. The ideal waist to hip ratio is 0.85 for women.

(Editor’s note: The World Health organisation (WHO) defines abdominal obesity as waist–hip ratio above 0.90 for males and above 0.85 for females, or a BMI above 30.0.)

The exact cause of obesity is not known. There are certain genetic factors which play a role in PCOS. Specific genes have been suggested, but nothing is documented yet. There is also lean PCOS, where there is no insulin resistance but LH pulse frequency is disturbed. Though the lean PCOS group is small, you don’t mostly see the cases of lean PCOS, it is usually obese PCOS.

Some women with PCOS don’t have irregular periods and they are missing symptoms. Could you tell us more about that?

Yes, that is true. Earlier we used to stick to Rotterdam’s Criteria which specified symptoms like irregular periods, waist-hip ratio, and number of cysts etc. But now even if you have acne and hair growth, and cysts are detected in your ultrasound, even if it doesn’t fit Rotterdam’s Criteria, you can still be diagnosed with PCOS.

Earlier we used to stick to Rotterdam’s Criteria which specified symptoms like irregular periods, waist-hip ratio, and number of cysts etc. But now even if you have acne and hair growth, and cysts are detected in your ultrasound, even if it doesn’t fit Rotterdam’s Criteria, you can still be diagnosed with PCOS.

So if women don’t have symptoms, how can they detect it? 

An annual checkup is very essential. Every woman should go to the gynae at least once a year. That’s not asking for too much. We should be aware that there are long-term issues related to PCOS, you could become diabetic, you can have endometrial hyperplasia (a condition wherein endometrium or the lining of the uterus thickens), or even coronary heart disease, so you really have to be careful. Going once in a year for a gynae exam is not asking for too much. If you don’t have any problems you should still go for a checkup and a pap smear (a screening procedure to test for cervical cancer). For PCOS, there is no treatment as such, there is no cure, but the symptoms can be stalled, otherwise you can end up with other problems, because it is a syndrome. It is not only one disease that you are dealing with.

When you say that there is no cure, what are the kind of treatments that are used then?

First and foremost it is a lifestyle adjustment, you will have to make an effort and that effort will pay off. You have to undertake a proper diet and exercise, even if you reduce your weight by 5% that is going to help you a lot. It will definitely do wonders. The important thing about weight is that you have to be able to maintain it. Maybe you went to the gym and lost a few kgs, and then you stop, that is not going to help. That has to become a part of your lifestyle. Losing weight does not mean you have to fast or go on a crash diet. You have to be careful about what you eat, what you eat impacts your whole body, not just PCOS. There are certain medications,  but changing certain lifestyle habits, avoiding smoking and drinking, healthy food habits, exercising, these will definitely help you a lot.

First and foremost it is a lifestyle adjustment, you will have to make an effort and that effort will pay off. You have to undertake a proper diet and exercise, even if you reduce your weight by 5% that is going to help you a lot.

I believe there is a rising incidence of PCOS in teens, Will you talk about that?

There is a genetic predisposition; like diabetes, there is an insulin resistance, hyperinsulinemia, that runs in families. But then added to that is a bad lifestyle. For teens as well, lifestyle changes help; if not, then doctors recommend contraceptive pills which can reduce the sex hormone.

One thing that women worry about when they have PCOS is infertility and getting pregnant. Can you tell us if it is harder to conceive if you have PCOS?

When a woman is born, she has a fixed number of follicles, every cycle you are losing those follicles. In PCOS, there are so many eggs that you are losing because they are not being fertilised. So, women who are willing to conceive, it is recommended that they make some lifestyle changes and then, if possible, plan a pregnancy. It’s not that you cannot get pregnant, you don’t need to be unduly stressed about it. But yes, there could be a delay, maybe it will be difficult. Then you will have to seek other procedures like IVF (In vitro fertilisation).

Are there any preventive measures that women can take against PCOS?

Yes, absolutely, a gynae checkup and a visit to the physician periodically is helpful. An annual checkup is a must. Some people just get a blood test done annually, but that is not enough for women. Lifestyle is an extremely important factor. Managing stress is very important as well. I would even recommend yoga and meditation to calm your mind and your body so that good hormones are released which is great for your overall health as well. When you exercise, good hormones are released into the body, that will help with your general well being as well.

How important is stress as a factor?

Stress is a big factor, it affects your insulin. Once insulin resistance develops then different conditions can develop. Once the hormonal balance is altered, it will take some time to come back to normal.  You have to help yourself by exercising and shifting to a healthy lifestyle. You can stall by using drugs, you can even  plan a pregnancy, but if you don’t change your lifestyle you will always be at risk.  You can also be at risk of diabetes,  if you are pregnant you could have gestational diabetes, and later in life you could have type 2 diabetes, coronary heart disease, ovarian cancer. If you have PCOS and if you are not taking care of yourself you could later develop any of these conditions.

Are there any specific age groups that are more  at risk?

Mostly  young adults,  maybe one in five in urban areas suffer from PCOS.

Are there any specific tests that you recommend women should get periodically?

The first is a gynecologist consultation and a checkup.  you should definitely get a breast evaluation,  a pap smear,  and an ultrasound. And, if you have family history you should get your diabetes and lipid checked.  You should also get calcium and Vitamin D, and micronutrient supplements if you are not taking the proper diet. But if you are taking a proper diet then it is not needed.

Sources:

1. Clinical characteristics of polycystic ovary syndrome in Indian women. Sunita J. Ramanand, Balasaheb B. Ghongane, Jaiprakash B. Ramanand, Milind H. Patwardhan,2 Ravi R. Ghanghas, and Suyog S. Jain

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