“For women, the rivulet of menstruation indicates her greenness and flowering that blooms in her offspring”                                             

Hildegard of Binge in Causae et Curae (circa 1150)

An increasingly common problem of Polycystic Ovarian Syndrome (PCOS) is frequently a cause of worry among young women and their parents. It is present in 5-10% of women between the age of 15 and 44 years in their reproductive stage. PCOS can affect teen girls and young women. Also known as Polycystic Ovarian Disease (PCOD), it occurs due to an imbalance of hormones released from the ovaries. There is a subtle difference of terminology between PCOS and PCOD. PCOD refers to the medical condition that occurs because of hormonal imbalance of PCOS. As a result, there are menstrual disturbances such as infrequent, irregular or prolonged menstrual periods. There is an often an excess of male hormone (androgen) levels as well as insulin resistance. There are four main types of PCOD: Insulin-resistant, Inflammatory, Hidden (unidentified) cause, and Pill-induced PCOS.

Characteristically, these women have large ovaries with many cysts and menstrual irregularities. They often present with weight gain especially around the abdomen, androgenic features such as excess body hair with a male pattern, acne, oily skin and male-pattern of baldness. Over the time, these women tend to become obese, develop anemia due to excessive bleeding and diabetes mellitus which is frequently insulin-resistant. Infertility is common in the married women, an important cause of worry in the married and soon to be married women. PCOS can also cause recurrent miscarriages because of high levels of testosterone.

There is no permanent cure for PCOS, but several treatment options are available to prevent problems. Treatment is aimed at symptoms, most importantly, overweight and obesity should be managed. PCOS is a treatable cause of infertility. The following management principles are important:

  • Consult your infertility-expert: Drug (hormonal) therapy; tracking of menstrual cycle; reverse of insulin resistance
  • Anti-inflammatory diet in consultation with the dietician.
  • Regular exercises and avoidance of stress: cycling or swimming are especially helpful to increase sensitivity to insulin, and risk of cardiovascular disease and diabetes.

Over-weight and obesity is an important problem which must be avoided. It is advised to reduce the carbohydrate consumption and increase the fibre and protein content of diet. Following foods should be avoided:

  • Processed foods especially those with added sugars, such as cakes, candy, sweetened yogurt, ice creams
  • Sugar and high-fructose corn syrup, Sugary drinks
  • Refined Carbohydrates (ex. white bread, pasta, and pastries)
  • Fried foods
  • Processed meats (ex. sausages, hamburgers, and hot dogs)
  • Artificial trans fats, vegetable and seed oils
  • Excessive alcohol

Permitted foods and drinks

  • It is helpful to consult a dietician for detailed advice on selection of foods
  • Anti-inflammatory diet consisting of fruits and vegetables and foods containing omega-3 fatty acids such as whole grains, lean protein, healthful fats
  • Use of fermented foods and healthy fats is permitted within reasonable limits
  • Drinking lots of water and staying properly hydrated
  • Other permitted drinks: Baking soda + water; tonic of baking soda and water, parsley + ginger green juice Lemon + turmeric tonic, functional food smoothie

Some of the other important complications which can occur in these patients include the following:

  • Facial scars due to acne
  • Diabetes mellitus
  • Hypertension and heart disease
  • Sleep disturbances especially Sleep Apnoea Syndrome
  • Uterine cancers

In summary, PCOS is a common and worrisome condition but manageable with treatment and appropriate changes in life-style particularly with reference to diet and exercise. Infertility due to PCOS is often treatable.