One out of every 10 Indian women have polycystic ovary syndrome: Dr Duru Shah, Founder President, PCOS Society

Around 10% of Indian women are affected with Polycystic Ovary Syndrome, commonly known as PCOS. Yet there is a lack of awareness about this condition and it often goes undetected for  years. Disha Shetty speaks to Dr Duru Shah, Scientific Director of Gynaecworld and Founder President the PCOS Society who sheds light on the condition that is affecting more and more young women due to the urban lifestyle, where exercise is often the first casualty.

What is Polycystic Ovary Syndrome?

PCOS was described as early as 1935. Ovaries produce both male and female hormones but due to some reason, that is not yet understood, at times the two hormones are not in balance. Therefore, a woman may experience symptoms like acne, excessive hair growth on the face and body, fat deposits on the lower abdomen etc. The additional secretion of male hormone is responsible for a lot of these changes.

Women experience irregular menstrual cycle. The ovulation is either irregular or does not take place at all. This may even lead to infertility.

Among the ones with PCOS who do get pregnant, they may have a higher chance of suffering a miscarriage as they are not producing enough hormones to support the pregnancy. They are even at a risk of developing gestational diabetes.

How is the menstrual cycle affected in women with PCOS?

Women may have phases where they don’t menstruate at all and then bleed very heavily. For months the lining inside the uterus continues to develop further and gets thicker. That lining is shed off in the form of a heavy period. If it is not treated, some tissues remain and as the years go by they may thicken further and lead to a cancer.

Women in the age group of 40-50 mistake irregular periods for menopause and don’t visit a doctor which is wrong. During menopause the blood flow reduces but if women are bleeding heavily post 40 then they must visit a doctor.

What is the connection between PCOS and being insulin resistant?

Women with polycystic ovaries are also insulin resistant. The pancreas produce normal insulin but somehow it does not bring down the blood glucose levels which is supposed to be its sole function. We still don’t know why that happens. It is believed that patients with PCOS have a problem with the receptor that combine with hormones to bring the desired effect. Sugar levels don’t drop like they should. Pancreas produce more insulin. As the situation worsens insulin levels in the blood rise to keep sugar levels normal. Over time even the high insulin is not able to keep the sugar levels in check. The patient then gets diabetes.

The high insulin levels also works as a growth factor. The woman puts on weight which is visceral fat - it is not deposited inside the skin but under the abdomen. This fat is not good fat and can lead to cardiac problems. The fat also produces more insulin, so it is a vicious cycle. Therefore it is not called a disease but a syndrome. There is no long term study on this syndrome.

What can women do to keep PCOS under control?

We don’t know why PCOS occurs but it can be kept under control by losing weight. Lifestyle change thus becomes the first line of treatment. 80% of those with PCOS are obese but 20% are lean. We tell the lean ones that we don’t want you to lose weight but we want you to increase your metabolic rate. They are asked to exercise anyway. They may look lean from outside but may have a lot of internal fat.

When a patient comes to us we first test the level of male hormone and the insulin levels. We do an ultrasound of the uterus as well as the ovaries – to see if there is any pathology. The treatment will depend on which stage of PCOS the patient has come to us at. Blood tests are also done to see if they have any other hormone issues like thyroid. PCOS is known to co-exist with hypothyroidism (less production of the thyroid hormone). 

Do women with PCOS have cysts on their ovaries?

These are not cysts but multiple small eggs which have not yet matured that we can see on the ovary during an ultrasound. If the patient does not produce enough hormones then the eggs do not mature. Unless the eggs don’t grow and rupture, ovulation and pregnancy cannot occur. 

Eating healthy and exercising is the crux of the matter. I tell patients to target weight loss. I tell them that it is an ongoing treatment. It is good for everyone to have a better lifestyle but for the ones with PCOS, exercise is mandatory. 

Normally what I find is that if the patients are obese to begin with and they lose weight then they are able to manage PCOS on their own without any medication. It is difficult to predict which patient will respond in what way to the treatment. Many women is very reluctant to exercise, the constant answer is I have no time.

Do you see many new cases of PCOS now?

That is what I see. A lot of young women are coming to me. In India one out of every 10 women has PCOS while the global average is 5-7 women. 

We are supposed to be a diabetic country and I think PCOS is a pre-diabetic state. It is a kind of signal, I tell people to not just look at symptoms of one disease. Treat the patient as a whole.