I recently shared a post on Facebook of the signs and symptoms of Polycystic Ovarian syndrome (PCOS) and I was stunned at the number of women who reached out. These women came forth with stories of their numerous struggles. Some recounted stories of trying for years to conceive and are unable to because of weight gain, abnormal menstrual cycles, depression, changes to their physical appearance, hair loss, infertility issues, amongst others.

Sadly, most women are still unaware that they have PCOS. Some have suffered for years before their eventual diagnosis. For others, despite having a diagnosis, they are still struggling with the physical and emotional burden of this disease. It seems as if, no matter how many doctors they visit, and how many treatments they receive, they are unable to manage their condition, or achieve a pregnancy. All in all, they are struggling with their diagnosis of PCOS.

It would be an injustice to say I understand their torment. We now live in a world where social media has now defined beauty, and this has subsequently placed an enormous pressure on what women should look like. Additionally, there is the pressure that society exerts on women to have children, and what gives a woman her identity. This week’s column discusses PCOS. It is my hope, that in some way, I can spread awareness on PCOS, to help women suffering to have as normal a life as possible.

2014: THE FIRST TIME I DIAGNOSED A PATIENT WITH PCOS
I recall this 34-year-old patient, who came referring abnormal menstrual cycles (periods of no menstrual bleeding to periods of heavy bleeding), I recall her physical appearance (facial hair, acne, darkened neck (acanthosis nigricans) and obesity. She related trying unsuccessfully for many years to get pregnant. I suspected she had PCOS. We discussed some of the complications of PCOS such as metabolic syndrome, high blood pressure, diabetes, endometrial cancer and so forth. I ordered an RBS (random blood glucose), and unsurprising to me, it was over 400mg/gl. At age 34, this patient had become a diabetic!

LET US TALK PCOS!
PCOS is the most common hormonal disorder that affects women of reproductive age. It is a chronic condition of unknown cause and which so far has no cure. Its clinical manifestations are metabolic syndrome, menstrual and ovulatory dysfunction (causing infertility) and clinical hyperandrogenism (hirsutism, acne, hair loss, virilisation). It affects 200 million women worldwide. While I do not have any statistics on Guyana, I am certain that it is quite common among our women.

SOME HARD FACTS OF PCOS
– There is a nine per cent greater risk of endometrial cancer
– Approximately 50 per cent of women with PCOS will be diabetic by age 40
– Four in 10 cases of diabetes can be linked to PCOS
– 34 per cent of women with PCOS have depression and 45 per cent have anxiety
– One in three women with PCOS has an abnormal glucose tolerance
– About six per cent of PCOS patients have bulimia, compared to about one per cent of other women
– About 20 per cent of women with PCOS have no menstrual periods
– Between 50 per cent and 70 per cent of women with PCOS experience insulin resistance

Because the cause of PCOS is unknown, medications are generally used to help manage the symptoms. However, studies have shown that lifestyle changes can play a major role in controlling the symptoms and even reverse the patient’s phenotype (appearance).

WHAT IS CONSIDERED LIFESTYLE CHANGES?
This means adopting a healthy lifestyle that involves physical exercise and weight loss. In overweight and obese women with PCOS, lifestyle changes are the primary treatment. A weight loss of 0.5–1 kg per week is recommended, with a final target of about 10 per cent decrease in weight.

WHAT DIETS DO WE CHOOSE IN ORDER TO LOSE WEIGHT?
There is not much data on which diet works best for PCOS patients. However, data based on food principles show that a decrease in carbohydrate intake would reduce high insulin levels, which in turn would lower insulin resistance. Therefore, diets that are low in carbohydrates are favoured. What is certain is that less energy intake than energy consumption will result in a weight loss.

WHAT IS THE IMPORTANCE OF PHYSICAL EXERCISE?
Studies show that the type, frequency or duration of the exercise do not influence the results that patients get from it and that regular, aerobic exercise of moderate intensity not only contributes to weight loss and improved insulin resistance, but also improves reproductive outcomes, including ovulation and regulation of menstrual cycles. In view of the improvement of women’s menstrual cycles, and their other symptoms, it is recommended for patients with PCOS to do exercise (preferably aerobic physical activity) of moderate intensity for 90 minutes per week.

My recommendation is to start off simple and adopt a lifestyle that you can maintain. If not, the weight you lose will easily return. Remember, diet is not about starving the body but about reducing your portion size and increasing on vegetable intake. You can join support groups such as Cysterhood Support-Guyana, which offers support to women with PCOS. Together, we can all help spread awareness of this concerning women’s health issue so undiagnosed women can get the support, diagnosis, and treatment needed.