According to an estimate, one out of every four women suffers from Polycystic Ovary Syndrome (PCOS), a common gynaecological disorder in women of reproductive age, in the country. Yet important conversations about this major health issue are silenced by the stigma and stark ignorance about it. As a result, in most cases it goes unchecked, leading to long-term health problems like infertility, diabetes, heart diseases and endometrial cancer, besides depression and anxiety. The HEALTH PIONEER talks to doctors about the symptoms, management and various studies revealing insights into the syndrome. India records over one million cases in a year.
PCOS is a common disorder of the ovaries that can affect up to 10% of women of reproductive age. The ovaries can become enlarged and contain fluid-filled sacs (follicles) that surround the eggs. PCOS can make it difficult for women to become pregnant, and can cause weight gain, thinning hair and oily skin or acne. There have been various studies revealing how PCOS can have long-term adverse impact on the woman’s as well as her babies’ health.
EXCERPTS FROM STUDIES
PCOS in mothers is linked to increased risk of health problems in their children
Children born to mothers with polycystic ovary syndrome (PCOS) have an increased risk of developing infections, allergies and other childhood illnesses by the age of 13, according to a study, published in Human Reproduction.
The study looked at 1,038,375 children born in Quebec, Canada, between 2006 and 2020. Of these, 7,160 children were born to mothers with PCOS.
The researchers found that children of mothers with PCOS were 32% more likely to be admitted to hospital with a variety of health problems than children of mothers without PCOS. They were 31% more likely to be admitted for infectious diseases and 47% more likely to be admitted for allergy-related problems, such as asthma.
The risk of hospitalization was increased for problems relating to metabolism (up by 59%), the gut (72%), central nervous system (74%), and ears (34%); it was also increased for respiratory problems, such as pneumonia (32%), and mental and behavioural problems (68%). There was no link with cancer, and there was little difference between boys and girls in the association of PCOS with hospitalisation.
Several studies have shown links with problems in pregnancy and birth, such as gestational diabetes, pre-eclampsia and preterm birth. However, the long-term effect of PCOS on offspring is poorly understood and has received little attention.
Dr Nathalie Auger, associate professor of epidemiology at the School of Public Health, University of Montreal, Canada, who led the study, said: “These findings fill a big gap in what we know about the long-term health of children whose mothers have PCOS. Primary care doctors and obstetricians should consider identifying women with PCOS before conception and offering early interventions such as weight management and strategies to help prevent problems such as diabetes and heart and blood vessel diseases. Family doctors and paediatricians should consider monitoring children more closely after birth to minimise morbidity. Greater parental awareness may help improve outcomes in children.”
Dr Auger said: “Women with PCOS may have high levels of androgen and insulin resistance, which have been linked to problems with the placenta, such as inflammation of the membrane surrounding the foetus, damage to tissue and impaired function of the placenta. These create a suboptimal environment in the womb for babies that could lead to impaired immune function and low-grade systemic inflammation.”
She said genetic factors could also play a role, with the environment in the womb causing modifications in how some genes work in offspring.
Body weight influences the chance of developing PCOS
A recent study found a clear relationship between obesity and the chance of developing (PCOS). The team reported obesity during childhood and teenage years are particularly vital to the disease’s development.
The goal of the study was to see if obesity had an impact on the development of PCOS. Dr. Laurence Dobbie, an academic junior doctor at the Royal Liverpool University Hospital in the United Kingdom, and Professor Daniel Cuthberson, Professor of Medicine at the Royal Liverpool University Hospital, investigated whether obesity and diabetes markers contribute to PCOS development with colleagues from the University of Liverpool.
The study highlighted that BMI, body fat levels and markers indicative of diabetes are vital in PCOS development. They also showed that girls with overweight who go on to have a normal adult body weight are still more likely to develop PCOS. The team also reported that obesity and overweight during adolescence are particularly important in the development of the condition.
“This study shows that obesity during childhood and teenage years are key factors in the development of PCOS. This opens a way to support women’s health by investing in nutritional and weight management programmes for younger people. This also has the potential to prevent the condition’s consequences which include poorer quality of life, infertility, diabetes and pregnancy complications. Future research should focus on developing new ways to help women affected by PCOS manage their weight”, said Dr Laurence Dobbie.
“The team reports that girls with obesity who go on to have a normal weight in adulthood are still more likely to develop PCOS. This clearly shows that weight management during childhood is vital to prevent PCOS development. This has the potential to improve women’s health,”concluded Professor Cuthbertson.
Cost of mental health disorders linked with PCOS almost USD6 billion in 2021
PCOS is also associated with an increased prevalence of mental health disorders such as depression, anxiety and eating disorders, according to a study led by researcher Adam Bonner, University of Alabama at Birmingham-Heersink School of Medicine in Birmingham, Ala.
The researchers wanted to calculate the healthcare-related costs of mental health disorders in women with PCOS. They reviewed 19 studies which included a total of 28,482 women with PCOS and 27,124 without the condition. They analyzed the odds of anxiety, depression and eating disorders among patients diagnosed with PCOS. They found that women with PCOS were 77% more likely to have anxiety, 53% more likely to have eating disorders and more than twice as likely to have depression compared to women without PCOS.
They then calculated the excess costs of these mental health disorders for women with PCOS in the United States. They estimated the direct PCOS-related healthcare costs in 2021 were USD2.987 billion for depression, USD2.216 billion for anxiety and USD 694 million for eating disorders.
“This work is the first to estimate the excess direct healthcare costs of mental health disorders associated with PCOS in the United States,” Bonner said. “Our findings mandate that the scientific, medical and policy community increase its focus on this important disorder.
Women with PCOS are more likely to develop poor respiratory health issues
As per a study, PCOS may also be responsible for lower lung capacity in some women, which may lead to shortness of breath.
Dr Diana van der Plaat, a RESPIRE 3 fellow based at the National Heart and Lung Institute, Imperial College London, UK said: “We tend to think of lung diseases, like chronic obstructive pulmonary disease, as being more common in men and in smokers. But a striking proportion of COPD patients have never smoked. In recent years, there has been an increase in lung disease and deaths from lung disease in women, and we want to understand why.
“This work is part of a big study looking at hormonal factors and lung health in women. PCOS is very common so it’s important to find out whether this condition is associated with poor lung health.”
Researchers used lung function data from 182,619 women from the UK Biobank project. They also used previously published genetic data on PCOS from several worldwide studies.
The results suggest that women with PCOS were around 10% more likely to have lower lung function, compared to other women. People with low lung function are more likely to suffer with conditions such as cardiovascular disease and they have higher overall mortality rates, even if they are not diagnosed with any chronic respiratory conditions.
We found that women with PCOS have a small increased risk of having impaired lung function. Poor lung function can cause difficulty in breathing and inadequate exchange of oxygen to the blood or carbon dioxide from the blood, said the researchers.
Doctorsspeak
Dr Archana Dhawan Bajaj
Gynaecologist, obstetrician and IVF expert, Nurture IVF
PCOS is a health disorder in which several small, fluid-filled sacs called cysts develop in the ovaries. No ovulation takes place in a woman with PCOS and creates problems during childbearing years. It is a condition that affects a woman’s hormone levels. PCOS affects ovaries, women’s reproductive organs that produce estrogen and progesterone — hormones that balance the menstrual cycle. The ovaries also produce male hormones called androgens but in a small amount. Extra androgens disrupt the cycle, so women with PCOS face irregular menses.
There are two type of hormones which creates right environment for ovulation. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) control ovulation. FSH stimulates the ovary to produce a sac that contains an egg known as follicle, and then LH strikes the ovary to release a mature egg, due to PCOS these eggs never mature enough to trigger ovulation. It is mainly associated with obesity and includes symptoms like irregular or delayed periods, weight gain, baldness, acne, heavy bleeding, hirsutism and darkening of skin. It can contribute to other long term health problems like diabetes and heart diseases, hyperlipidemia, endometrial hyperplasia. Insulin resistance, genetic, sedentary lifestyle or obesity are some of the main causes.
Regarding its management, regular exercise alongside a balanced diet can help improve PCOS symptoms. Foods which are less in carbs or slow glucose releasing carbs are preferable. Avoid junk food, alcohol and ice-cream. Brisk walks, gymming and swimming—ie some form of cardio exercises for 40-50 minutes five days a week has to be followed religiously.
Dr Divya Pandey
Professor, obstetrics and gynaecology, Vardhman Mahavir Medical college and Safdarjung
Hospital, Delhi
There is a need to create awareness among young school girls about the PCOS, about the importance of healthy lifestyle and food habits.
Avoid smoking, excess alcohol, and things that increase risk for cardiovascular disease as women with PCOS are already at a higher risk. Women living in such conditions are more likely to be depressed than women in the general population. Hence, it is important that mental health is not ignored. Yoga, and meditation are very useful.
The causes can be many. Women with PCOS have insulin resistance, which means that their cells can’t use insulin properly. When cells can’t use insulin properly, the body increases demand for insulin. Extra insulin triggers the ovaries to produce more male hormones.
If someone’s family is facing obesity and diabetes from many generations then chances of having PCOS are high. Being overweight can also contribute to inflammation.
It is a very common gynecological disorder found in adolescent girls and females of reproductive age group. While adolescents’ females present with problems like menstrual irregularity or abnormal hair growth or both, they later present with inability to conceive. Those with PCOS are at higher risk of having type 2 Diabetes, Cardiovascular problems and even endometrial malignancy.
Also, those with PCOS are actually at high risk for covid 19 infection, as has been seen in a few British and European studies recently due to association with conditions like obesity, cardio-metabolic derangements, hypertension, diabetes, vitamin D deficiency etc which in turn lowers the immunity.
The key to prevention and management is adoption of a healthy lifestyle. But this again is a real challenge in this busy and fast world. We can sensitise our young girls about the condition and its disastrous consequences, and help them inculcate healthy living, and food habits to curb the problem before it takes gigantic form.
There is a need to create awareness among young school girls about the PCOS, about the importance of healthy lifestyle and food habits.
Avoid smoking, excess alcohol, and things that increase risk for cardiovascular disease as women with PCOS are already at a higher risk. Women living in such conditions are more likely to be depressed than women in the general population. Hence, it is important that mental health is not ignored. Yoga, and meditation are very useful.
The causes can be many. Women with PCOS have insulin resistance, which means that their cells can’t use insulin properly. When cells can’t use insulin properly, the body increases demand for insulin. Extra insulin triggers the ovaries to produce more male hormones.
If someone’s family is facing obesity and diabetes from many generations then chances of having PCOS are high. Being overweight can also contribute to inflammation.
It is a very common gynecological disorder found in adolescent girls and females of reproductive age group. While adolescents’ females present with problems like menstrual irregularity or abnormal hair growth or both, they later present with inability to conceive. Those with PCOS are at higher risk of having type 2 Diabetes, Cardiovascular problems and even endometrial malignancy.
Also, those with PCOS are actually at high risk for covid 19 infection, as has been seen in a few British and European studies recently due to association with conditions like obesity, cardio-metabolic derangements, hypertension, diabetes, vitamin D deficiency etc which in turn lowers the immunity.
The key to prevention and management is adoption of a healthy lifestyle. But this again is a real challenge in this busy and fast world. We can sensitise our young girls about the condition and its disastrous consequences, and help them inculcate healthy living, and food habits to curb the problem before it takes gigantic form.
Dr Namita Jain
Consultant- Obstetrics & Gynaecology,
Paras Hospitals, Gurugram
Although PCOS cannot be cured or treated, its symptoms can be managed if diagnosed early. A lot of diet and lifestyle changes go a long way in keeping you fine even if you have PCOS.
According to recent studies, PCOS affects between 4% to 18% of women globally. The prevalence ranges from 3.7% to 22.5% in India. Even while there is growing evidence for hereditary aspects, the precise origin of PCOS is still unknown. Menstrual irregularities, infertility and long-term health problems like obesity, sleep apnea, diabetes, uterine cancer are other issues that women with this condition may have.
PCOS requires long-term treatment. Consequently, adopting a healthy lifestyle is crucial for managing this disease. All PCOS-diagnosed women are generally advised to follow a customized healthy diet, engage in regular physical activity, and maintain a healthy BMI. Keep in touch with your gynaecologist after the diagnosis to receive the best care possible for the condition. Women with PCOS who want to conceive may require assistance in the form of drugs for egg formation and sometimes IVF.
Dr Ishwar Basavaraddi
Director, Morarji Desai National Institute of Yoga,
Union Ministry of Ayush
In many cases, PCOS is a serious medical condition. Diet modification and a healthy lifestyle will help to manage PCOS. Practices will be modified according to women conditions. These need to be practiced under supervision.
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