PCOS/PCOD

Have you been having,

• weight gain over a period of time?
• Irregular periods?
• Increase in the acne and facial hair?
• Thinning of hair from the scalp?
• Depression?
• Fertility problems?

Then you might be suffering from a hormonal imbalance called Polycystic Ovarian Syndrome (PCOS).  It is very common among the women of reproductive age.  It is characterised by the increase in the male hormones, androgen and enlarged ovaries with multiple cysts (hence the name polycystic).

PCOS or PCOD which is a group of diseases related to ovaries can lead to many serious disorders like Diabetes, heart disease and thyroid issues if they are not managed or treated in the earlier stages.

The global prevalence ranges between 5-10%.  However in India, it is estimated to be between 8-25% with the age group of 18-45 years.

Sonam Kapoor– Sonam Kapoor is one such celebrity in Bollywood who has always been outspoken regarding her journey from being fat to fit. She has shared her experience on how she dealt with her adolescent obesity, starvation and depression and achieved a sustainable and healthy figure before entering into Bollywood.  She is one of those actresses who too once suffered from PCOS. She had once confessed that at the age of 19, she had battled all the issues of being overweight. She had hair on her face and suffered from diabetes.

Apart from those mentioned above, some women can experience one or more of the following symptoms:

• Hormone changes can lead to headache in some women
• Increased risk of developing type 2 diabetes
• Abnormal lipid levels in the blood
• High concentration of C reactive protein which is an indication of coronary heart disease

The exact cause is not clear.  The most probable causes include:

• Genetics - genes are a key factor that determines whether a woman can get PCOS or not.
• Insulin resistance - obesity leads to insulin resistance which can be a causative factor in hormonal imbalance.  PCOS in turn causes insulin resistance making it a vicious cycle.
• High androgen levels - Inflammation in the body can lead to higher levels of androgen, male sex hormone triggering PCOS.  Obesity is one of the reason for the inflammation in the body.

For an effective treatment, early diagnosis is very important.  

1. Symptoms - presence of high concentration of androgen/cysts in ovaries/ irregular menstrual cycle
2. Blood tests - to check levels of androgen.  In later stages, lipid profile, insulin levels and cholesterol levels to check the risk of diabetes or Coronary heart disease
3. Pelvic exam - to check for any growth in ovaries or uterus
4. Ultrasound - to look for abnormal follicle and cysts

Main aim is to manage the symptoms, prevent complication and treat the root cause.  Treatment involves the following:

1. Lifestyle changes
2. Ayurvedic treatments
3. Medical intervention

Lifestyle changes - involves four pillars

• Good quality sleep
• Balanced diet
• Stress management
• Exercise

Sleep

A good quality sleep help in balancing the hormones by regulating cortisol and helps the body in repair and regeneration.  Although sleep disturbances are common in women with PCOS, few strategies can help to get good quality sleep:

• Building a good sleep time routine - getting at least 7-8 hours of sleep
• Avoiding stimulators like electronic gadgets
• Avoiding heavy meals just before sleep time
• Avoiding strenuous exercises before sleeping.

Stress Management and Exercise

• Cortisol - stress causes elevation in cortisol levels and long term effects have been known to cause endocrine dysfunction.
• Stress per se is not the problem.  Our body gets affected only when the stress is not managed properly.

There are ways to manage stress - 

1. Exercising
2. Involving in a hobby - painting, cooking, music, dancing, learning new skills
3. Keeping a pet
4. Reading and socializing

Exercising daily - helps in weight management and releases happy hormones

1. Can be a walk for 30 min or jogging
2. Swimming or cycling
3. Weight lifting once a week help to build up muscle mass
4. Yoga not only helps to manage stress but also keeps the weight in check.

Medical Intervention:

If the symptoms are chronic and need immediate attention then it is better to seek medical intervention as soon as possible.  Medicines aim at managing symptoms and avoiding long term health implications like diabetes or heart disease.

Doctors may prescribe metformin for insulin resistance and birth control pills to balance the reproductive hormones.  There are also medications to help you get pregnant if you are battling infertility for a long period of time.

One of the most important factor in managing PCOS.  From weight loss to managing insulin resistance, diet helps and works parallelly along with other lifestyle changes to help a woman manage her PCOS.

Foods to manage insulin resistance and help in weight loss

• Including moderate protein, low fat and carbohydrate with low glycemic index helps to manage the insulin levels and aid in losing weight.  Weight loss improves ovarian function and reverses some of the associated hormonal abnormalities.
• Include - whole grain cereals, millets and pulses, nuts, seasonal fruits and vegetables, preferably home cooked meals.  Cinnamon has been known to regulate sugars in the blood thereby preventing insulin resistance
• Avoid - sugar, refined cereals like maida and its products, bakery items, fried food, ready to eat products like cookies, noodles, packaged juices, candies and so on.

Foods to manage acne and hair loss

• Important nutrients include iron, zinc, Vitamin C, Vitamin B12 and proteins to manage acne and prevent further loss of hair
• Since people with PCOS may experience heavy bleeding, it is advisable to include food rich in iron everyday i.e. green leafy vegetables, nuts and seeds like flax, pumpkin seeds, almonds, sesame, dates, figs, fish, lean meat
• Vitamin C present in citrus fruits and vegetables like bell peppers help in the absorption of iron.
• Zinc and Vitamin B12 are found in nuts, seeds, mushrooms, dairy.
• Plant protein like nuts, pulses, legumes, broccoli are the best sources to improve protein in the diet.

Foods to manage PMS - include soy products, foods rich in magnesium and cut down on caffeine

• Adding soya to the diet helps in balancing the hormones and also protect from cardiovascular diseases.  However people with thyroid issues need to take an opinion from their health care provider before including soya in the diet.
• Magnesium have been known to alleviate anxiety, reduce blood pressure, promote good sleep and reduce pain during PMS.  Include food such as almonds, spinach, mushrooms, banana which are good source of magnesium.
• Excessive intake of caffeine has been known to interfere with the estrogen levels, hence drink coffee in moderation.
• For pain during PMS, include ajwain in your diet and have an oil massage on the abdomen to alleviate pain.

Anti-inflammatory foods - Studies have proved that mediterranean style diet has been known to help women with PCOS to lose weight, improve insulin sensitivity and also get their periods back to normal.

• Foods rich in omega 3- and omega 6- fatty acids  - fatty fish like tuna or mackerel, flax seeds, pumpkin seeds, walnuts, almonds.  Including handful of nuts and seeds daily not only provides protein but also the good fats which act as anti-inflammatory.
• Cold pressed oil and ghee are a good option than refined variety
• Spices like turmeric and green tea also have anti-inflammatory properties
• Probiotics like kimchi and kombucha helps to regulate sex hormones and reduce inflammation.

Hydration - Keeping yourself hydrated by taking water, green tea, buttermilk help in managing PMS, reduces fatigue, prevents infections and help in weight loss.

Like any other treatments, ayurveda concentrates on correcting the imbalance of doshas or forces of energy.  In this case, the imbalance of Shukra dhatu in women causes an increase in the male hormones leading to infertility.  The following treatments are beneficial -

1. Certain herbs like Shatavari, Ashwagandha, Ajwain, Gokshur are certain herbs which can be taken regularly for hormonal balance and reduction of stress.
2. Panchakarma treatments like Virechana and Basti are useful for regulating the hormonal balance and also reducing insulin resistance .
3. Regular deep breathing techniques and asanas like dhanurasana, naukasana, baddhakonasana , supta baddhakonasana, bhujangasana etc are helpful in hormonal balance.
4. Pranayam and nasya have been known to reduce stress and balance the hormones.  Nasya helps in regulating ovulation.
5. PCOS can be reversed naturally through healthy eating, exercise and managing stress levels.