Polycystic Ovarian Syndrome: A silent misery

A young girl, 15 years old, struggles with acne ever since her periods started. And not too long ago, she noticed dark thick facial hair around her chin and over her cheeks, something that can be socially crippling in school. No amount of waxing, threading and bleaching helps and this 15-year-old is miserable.
A couple has been trying to conceive for nine months with no positive result. In a country with an over-population problem and a serious lack of understanding of infertility and sexual health, there are usually misunderstandings on the varied number of reasons as to why a couple may not be able to conceive. There are grumbling in-laws, a lot of finger-pointing and blaming, usually the women, which does little to help the situation.  
A 27-year-old woman has very irregular periods. She has gained a lot of weight over a year or two. She feels bloated and uncomfortable with friends and family being rather insensitive to her recent weight gains. Not having periods regularly also makes her scared about her future, especially when she thinks about marriage and children.
A 22-year-old woman feels extreme pain in her lower abdomen. When she is rushed to hospital, the doctors suspect appendicitis but ultrasounds show that her appendix is fine. However, because she has a sexually active relationship with her boyfriend and does not want her family or even her doctor to find out, she provides limited information on her symptoms which leads to inconclusive diagnosis.
These are four of innumerable such situations that are now increasingly common among women within their reproductive age. The main reason for these problems is usually this silent, somewhat hidden condition known as Polycystic Ovarian Syndrome (PCOS). While many do not realise what they are suffering from, 22 per cent of women of reproductive age suffer from PCOS in Bangladesh (Journal by Prof. Kohinoor Begum SSMC, in 2000).
Polycystic Ovarian Syndrome patients experience a group of symptoms, of which the most significant are:
Oligo or Anovulation - when eggs or ovums are not released by the ovaries, or are not released every month.
Hyperandrogenism - when there is a higher quantity of male hormone testosterone in the body causing many symptoms like acne, hair loss, facial and body hair, etc.
Polycystic ovaries - when 12 or more peripheral follicular cysts are found in the ovaries on ultrasound.
All other symptoms including infertility, irregular or abnormal periods and obesity are related to these three main problems.
Tests that your doctor may ask you to do:
- An ultrasound
- Blood tests that test the levels of the hormones testosterone, FSH, LH, prolactin etc.
- Blood tests for sugar, especially two hours after breakfast.
Link with infertility
The first detection of PCOS is usually made when couples try to get pregnant but cannot conceive. The most common cause of infertility around the world is PCOS. When women are affected by PCOS they may not ovulate every month and there may be several months during which there is no ovulation.
Therefore a couple may be trying to get pregnant for many months before they can actually get pregnant.
This can be disheartening for many women. Having PCOS doesn't mean you can't get pregnant. It just means you might require a little more time than usual to get pregnant. In some cases certain treatments and lifestyle changes may be required.
All women with PCOS can conceive by diet or exercise, medications like metformin or clomiphene citrate or ovulation induction with gonadotrophins. A minor surgical procedure known as laparoscopic ovarian diathermy may be required.
The most important thing to remember is that having PCOS does not mean you will not be able to get pregnant. If you are diagnosed with PCOS, don't lose hope. Treatments or lifestyle changes can help you conceive.
Treatment
The first step after PCOS detection should be weight loss. All women diagnosed with PCOS are usually slightly overweight. Regular exercise and having a sugar restricted diet will help you lose weight and will improve symptoms of PCOS. PCOS is related to insulin and diabetes. This is why it is recommended that you avoid having very sweet foods. This is so important that many women with PCOS could conceive simply by losing weight.
It is important to eat high GI foods like high GI rice (available under the brand name Purnava in most departmental stores and some pharmacies) and wholegrain flour.
Include phytoestrogens in your diet. These are basically chemicals that act like oestrogen in the body. Though there is some controversy regarding whether these naturally occurring chemicals can help or not, a lot of women have reported positive results by simply increasing intake of phytoestrogens. Phytoestrogens are present in flax seeds (found in muesli), soya milk and tofu. These are normally not a part of our diets but this chemical is present in the highest amount in these foods. Other foods that contain it include peas, beans, cabbage, broccoli, bok choy, carrots, etc. Try increasing your intake of these foods and see if they help you.
Your doctor may recommend birth control pills to make you have a regular cycle. You may also be asked to take ovulation inducing drugs which are basically hormones that help cause ovulation. Clomiphene and metformin are also prescribed to help you get pregnant. There are also many drugs prescribed to help you with acne and other symptoms.
Precautions
It is very difficult to predict who will get PCOS. There is no direct cause for it. However, emphasising on a balanced diet and a healthy lifestyle for young girls may be useful. The most valuable lesson you may give to your daughter would be to teach her the importance of exercise. This is more important for those who have PCOS in the family.
The unhealthy nature of modern living -- including the toxins that we ingest with our food -- may be the reason for this sudden spike in PCOS cases. It is not possible to completely omit all the pesticides and preservatives from your life but it might benefit you if you try to restrict them as much as possible.
 

By Dr Naomi Ferdous Mirza, Medical Specialist, maya.com.bd