India has a PCOS problem, and we can't ignore it
As Sara Ali Khan said, “If you don’t have PCOS, honestly, you’re the odd one out”
Even at parties, Munjaal Kapadia is used to women walking up to him and confessing that they have PCOS. “It’s not a question. They just tell me when they find out that I’m a gynaecologist,” comments the director at Namaha Superspecialty Hospital for Women. It’s not surprising. Different studies in India on Polycystic Ovary Syndrome (PCOS or PCO) have reported a prevalence of 3.7 per cent to 22.5 per cent and even up to 36 per cent in adolescents. Others say 1 in 5 Indian women can be diagnosed with PCOS.
Most end up quietly living with pain, whether because of a lack of information, fear of judgemental gynaecologists or dismissal from family and peers because “sab ko dard hota hai”.
True, PCOS is a common endocrine system disorder that affects millions of women. That doesn’t make living with it any easier, especially when your symptoms range from weight gain, fatigue, irregular menstrual cycles to hirsutism, pelvic pain and more, while experts are still scratching their heads over pinpointing a specific cause.
It could be genetic – if your mother has it, your aunt too, then chances of you getting it are higher. It could be explained as a stress-induced imbalance that can include insulin resistance and increased production of male hormones. Maybe your case is a random occurrence caused by the modern malaise of urban living – an unhealthy lifestyle. “You see PCOS commonly in urban areas because of the modern, sedentary lifestyle. The lack of exercise, fatty diets and desk jobs don’t go well together,” says gynaecologist Dr Samiha Arora. “Urban women also tend to eat infrequently, skipping breakfast and then binge-eating during lunchtime. We tend to see this pattern more in working people. This routine leads to a lot of hormonal imbalances.”
Medical mysteries aside, culture plays a part too. Girls are often restricted to their homes and not encouraged to be active or sporty. In cities, the punishing lack of open space only exacerbates the issue. With so many restrictions, sedentary life is not always by choice.
When diagnosing a PCOS case, Dr Arora explains that no single test exists and medical experts rely on the symptoms presented (covering at least 2 or 3 main ones), a physical examination, blood tests to see androgen levels and at times, even a pelvic ultrasound. Adding up the evidence can take time, seriously testing a woman’s patience too.
Real PCOS stories because every woman’s experience is different
When Anamika Sharma was 16, she started missing periods. “No one took it seriously at first. Some doctors assumed I was pregnant and lying, others told me that everyone gets PMS pains. My skin completely broke out. I went from 59 kilograms to 70 in 5 months.” A year later, she was diagnosed with PCOS after a bout of tremendous pelvic pain that lasted for a week. With time her symptoms only got more severe. Even with a modified diet and exercise regime in place, it wasn’t getting much better. “I wanted to avoid medicines, but after a point, I didn’t have much of a choice.”
She also saved money from her salary to get full-body laser hair removal done. “I was just sick of people constantly staring and making ‘helpful’ comments,” she adds. “When I tell people I have PCOS, they’re just like ‘oh, you’re just being lazy. You don’t need medication’ and ‘you just need to lose some weight you’ll be fine then’.”
Tanya Vohra* heard the same comments before she was diagnosed. She started putting on weight and getting abnormal hair growth on her face and back. “I was around 23 when I was diagnosed. It was a cycle. PCOS makes you put on weight. If you’re on the heavier side, then PCOS is more likely. Women just can’t catch a break.” Because Vohra was already on medication for mental health, she wanted to avoid pills for PCOS management. With a regime of daily yoga and altering her diet – “I love mithai, can’t believe I managed to give it up“ – she has managed to bring things in control though she has a long way to go.
For Srestha Verma, taking a natural approach has helped since her symptoms weren’t drastic. “I visited a centre in Pondicherry where they help you manage ailments with big changes in your diet,” she explains. “I was apprehensive at first about the treatment, but it’s been three months now that I’m on a vegan plant-based diet and it has really helped.”
Rochelle Pinto was told to keep her weight under control, if she wanted to avoid it getting worse. While she doesn’t have many of the presenting symptoms, she says, “I’ve had days when the pain was so bad, I’ve curled up like a prawn and had to be carried by my boyfriend to the hospital to be put on drips. I’m totally against popping pills, but after those episodes, I realised that some cases call for medication and you shouldn’t be stupid about it.” Ashtanga yoga has helped her regulate her periods and deal with stress, while cutting out refined wheat, caffeine and milk has brought the corresponding skin breakouts and mood swings under control. She admits, “Sugar is my kryptonite, but I know that’s the final frontier in keeping this under control without medical intervention. I’ve been trying to break up with gulab jamuns for a while now, but it’s a struggle.”
If you’re struggling with PCOS, Dr Vishaka Shivdasani has some basic guidelines that might help.
Bad news for all those who’d rather sleep in than go for a run – there is no alternative to physical activity. Since PCOS is characterised by our sedentary lifestyles, “there is no magic pill that you can pop to make this go away,” says Shivdasani. She recommends resistance training for PCOS patients.
Eliminate all forms of simple sugar
Simple sugars should be eliminated as far as possible, and sugars should only come from complex carbohydrates. “To reduce weight and insulin resistance, which are both parts of the PCO complex, it is imperative to eliminate all forms of simple sugar from your diet. This includes natural sugars such as honey, maple syrup and agave,” says Shivdasani. Alternatives to simple sugar are sugar substitutes such as stevia or monk fruit or sugar in the form of vegetables and fruits.
Go natural with your supplements
“There are natural supplements that you can take to decrease insulin resistance that comes with suffering from PCOS. There are instances when these supplements tend to work better than allopathic medication,” says Shivdasani. She recommends Ceylonese cinnamon and turmeric, adding, “Be very careful when picking the variety of cinnamon as the Ceylonese variant helps, however, the other varieties can sometimes do more damage than good. It is also important that all these supplements are completely organic.”
Mental health is as important as physical wellbeing
Shivdasani recommends a holistic approach to tackling PCOS. Diet, physical activity and mental health, all play a role in helping with one’s progress – “It is very important to get adequate sleep, eat healthy, stay fit, and at the same time try and lead a stress-free lifestyle.”