PCOS and Every Question You Had About It

If you are reading this article, it is safe to guess that you have just made acquaintance with PCOS, Polycystic Ovary Syndrome. Sounds scary, doesn’t it? Perhaps, you got diagnosed or someone you know did, and as is with everything today, this too can be googled.

I remember when I was first diagnosed with PCOS. I had been lazy with my workout and hyperactive with binge-watching and eating, for months. It all had to show somewhere and it finally did, when one fine Monday, periods were painful, heavy, and emotionally exhausting. When it didn’t ease down on me after 10 days of constant bleeding, I knew something was wrong.

What followed was a diagnosis, a realization that I was 10kgs overweight, and that I have to go on oral contraceptives to fix this??  None of it made sense. I remember googling anxiously to find the help I was looking for, “What is PCOS?”, “How to fix PCOS?”, but, even after days of Google escapades, I only found articles that petrified me. They told me PCOS meant infertility, one step closer to cardiac problems, and overall a whack reproductive system. 

So, when I sat down with Dr. Liston, my first question was,

“How do we describe PCOS to someone who just got diagnosed and is freaking out?”

Women menstruate when the uterine wall has to be shed. The uterine wall exists to provide support, nourishment, and nutrition to a fertilized egg. In the event that the egg isn’t fertilized, the uterine wall will self-destruct, but what if the egg isn’t there, to begin with? 

PCOS is a condition when a woman’s ovaries have eggs but the follicles that hold these eggs do not release them periodically. This release is called ovulation. An egg that isn’t released can also not be fertilized. 

In PCOS, the eggs are not released regularly. The uterine wall doesn’t form regularly and so it doesn’t break regularly either. After your last period, your body will be on a hormonal low for 14 days. Estrogen comes into play here. Estrogen has to increase naturally and select the follicles which will bear the eggs and release them for the next month. So, if your estrogen is working fine, you have to then look at Follicle-Stimulating Hormone or FSH, which would develop the follicles. Once the follicles are developed, you have sacs full of eggs. Now comes, the Luteinizing Hormone or LH, which is responsible for the release of the egg from the follicle.

After 14 days, your progesterone takes over and it is now responsible to provide for a fertilized egg. Progesterone has to make sure the egg has plenty of blood circulation and an inner wall to cling on. However, if the egg isn’t fertilized both estrogen and progesterone have to fall. This is when you get periods and as the uterine wall breaks, all the excess hormone too gets out of the system. 

The cycle repeats.                                             It looks pretty simple, but any slight fluctuation in these hormone levels and your periods can be disrupted, which is exactly what happens in PCOS.

But, just because you’re late, it doesn’t mean PCOS!

The follicle or sac that holds these eggs grows to an abnormal proportion and has the appearance of a cyst, hence the name – polycystic. However, it isn’t really a cyst, as Dr.Liston would tell us later in this article. When these eggs aren’t released on time, other activities that follow post ovulation also take a setback, menstrual activity being one. 

This leads to irregular periods, scarce or excessive uterine shedding, spotting, and hormonal disbalance in a woman’s body. 

PCOS is more common in women at the peak of their reproductive health. It isn’t very common in women passing through menarche because that is the start of menstruation, a time when hormones aren’t regulated and it’s normal to have irregular periods. That is, in most cases, not PCOS. 

The same goes for menopause. Between 18-35 is when most women are diagnosed with PCOS. 

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“Is PCOS the same as PCOD?”

There are two schools of thought here! The first one states that PCOD and PCOS are synonyms, and in a way that isn’t wrong. However, PCOD is Polycystic Ovary Disorder which is an ovarian dysfunction. PCOS is a syndrome and can be of 3 types: 

• Polycystic ovaries: Where the follicles grow to abnormal proportion.
• Hyperandrogenism: A higher amount of male hormones (testosterone)  
• Endocrine dysfunction: Complete inability to mature eggs

In simple words, PCOD is a disorder that you develop because of hormonal imbalance, however, PCOS is a more severe and multi-faceted PCOS, with more symptoms. 

What causes PCOS? 

This was naturally my next question. 

“To be absolutely honest, PCOS can’t be pinned to one particular cause.”, said Dr.Liston. “We have found that women with a sedentary lifestyle (being inactive), poor sleep, unhealthy diet, are more prone to PCOS. However, there are women with all of that who have none of the symptoms.” 

It sure is like opening a can of worms when you diagnose someone with PCOS.

This reminds me, doctor! “How do we diagnose PCOS?”

The diagnosis itself doesn’t have pre-laid tests. 

Your gynaecologist would ask you about your last menses and how had the bleeding, the pain, or the frequency been. They may recommend a few blood tests to understand your sugar and hormone levels better, which helps doctors rule out other ovarian conditions. 

In the case of PCOS, the symptoms are the diagnosis. 

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Though we may not be able to narrow down the causes of this medical condition, we can accurately map out the symptoms, which are as follows:

• Menstrual discomfort: Heavy or lighter than usual bleeding, irregular cycle, pain, discomfort
• Acne, sudden growth in facial and body hair caused by excessive male hormones
• Severe mood swings and PMS symptoms
• Hair fall, bald patches, pre-mature greying
• Fluctuating sugar levels and insulin resistance: 70-80% of women suffering from PCOS exhibit signs of pre-diabetes and high sugar. They may experience fatigue even after having proper meals or they may crave more sugar and fat. This could be due to insulin resistance and so, PCOS may lead to excessive weight gain and hence, diabetes later in life, another issue that comes with obesity.
• Difficulty losing weight and if lost, it’s hard to maintain the weight at healthy levels
• In the case of slim PCOS, it gets difficult to gain weight
• The biggest symptom, however, is the difficulty to conceive.