I have irregular periods. Do I have PCOS?

Irregular periods can be a particularly important indicator of PCOS (Poly Cystic Ovary Syndrome). This is a common hormonal condition affecting an increasing number of women and some statistics point out that it affects 1-in-5 women of reproductive age not only in India but globally.

However, a few irregular periods may not be a sufficient indicator of PCOS. In fact, it can take up to 2 years after the first period for any girl’s menstrual cycle to become regular and in this period, it could be incorrect to recognize missed periods as a sign of PCOS.

If, after two years from the first period if you still have frequent irregular periods, it is better to consult a doctor. Typically, doctors look for other signs of PCOS and may recommend an ultrasound scan to confirm. So, what exactly are the other symptoms of PCOS?

What are the classic symptoms of PCOS?

Typically, doctors diagnose PCOS if at least 2 out of the 3 following symptoms are present:

  1. Menstrual Irregularity – Anovulation
  • Oligomenorrhea- less than 9 menstrual periods per year
  • Amenorrhea- No menstrual periods at all
  1. Hyperandrogenism- Hair and skin-related symptoms

Hyperandrogenism remains one of the main features of PCOS because 70%-80% of PCOS women exhibit clinical features of hyperandrogenism. It is a medical condition characterized by high levels of androgen (a hormone that regulates the development of male characteristics) in females.

  • Excessive hair growth on the face and body (60%-80%)

Excessive hair growth, known as hirsutism, is one of three ways in which excessive levels of male hormone affect the hair follicles of women with PCOS. Hair growth on the chin, upper lip, around the nipples, on the chest or stomach, on the upper arm or thigh, or in other areas with irregular periods is a strong indicator that you have PCOS.

  • Acne (40%-60%)

It is caused by elevated levels of androgens and can appear on the body particularly along the jawline or on the back (Androgenic acne is often moderate to severe.)

  • Scalp hair thinning (40%-70%)

Losing hair from your scalp is another consequence of too much testosterone. You can’t assume that you have PCOS simply because you have thinning scalp hair, although in rare instances it appears as the only symptom.

  • Darkened skin patches (30-50%)

Acanthosis nigricans is a skin condition that causes a dark discoloration in body folds and creases. It typically affects the armpits, groin, and neck. This skin condition characterized by areas of dark, velvety discoloration in body folds and creases. The affected skin can become thickened.

  1. Multiple Cysts in Ovary (as seen in an ultrasound scan)

Other associated symptoms are excess weight, elevated triglyceride, and LDL Cholesterol levels.

What are the risks associated with PCOS?

PCOS condition is increasingly becoming more common in women of reproductive age. It should not be taken lightly and assuming that it will automatically go away is a mistake. The following are some of the major risks associated with having PCOS symptoms.

RISKS

1. Risks for women with PCOS trying to become pregnant:

a. PCOS is the No.1 reason for female infertility in women, globally. PCOS condition does not necessarily mean that women cannot become pregnant. However, for people trying to become pregnant, PCOS makes it harder to time fertile days of their menstrual cycle which is more conducive to become pregnant.

2. Risks during pregnancy for a woman with PCOS

a. High probability of getting gestational diabetes, a type of diabetes which pregnant women get. It could lead to having a larger than average baby leading to delivery and labor complications. Women with gestational diabetes, as well as their children, are at higher risk for type 2 diabetes later in life.

b. Research shows women with PCOS have 3 times more chances of miscarriage or an early loss of pregnancy.

c. PCOS increases the risk of premature delivery

3.Risks apart from pregnancy if PCOS is untreated

One of the root causes of PCOS is insulin resistance. Insulin resistance is the root cause of various lifestyle disorders. Hence PCOS has to be considered as an early predictor of various lifestyle complications in the future including:

a. Impaired glucose tolerance and Type 2 Diabetes

b. Cardiovascular disease

c. Non-alcoholic fatty liver

d. Sleep apnea- This is when momentary and repeated stops in breathing interrupt sleep. Many women with PCOS are overweight or obese, which can cause sleep apnea.

e. Hypertension

f.Endometrial cancer- Irregular menstrual cycles can result in the thickening of the endometrium or uterus lining to develop cancerous cells which may eventually lead to endometrial cancer.

So, if PCOS conditions are taken seriously early on and necessary dietary and lifestyle changes are made, a lot of needless suffering can be avoided in the future.

What are the major causes of PCOS?

Though the exact cause of PCOS is unclear, like in most things in life, ‘nature and nurture’ seems to play a role. Genetics does seem to be involved. If any close relatives, such as mother, sister, or aunt, have PCOS, the risk of PCOS is often increased. However, it is important to note that most genetic factors are only a predisposition, which means if the underlying factors are present then you have a higher chance of getting PCOS. While we may not be able to control the genetic factor, preventing or avoiding the underlying factors is very much in our control.

Three primary triggers are identified for PCOS:

Insulin Resistance based PCOS:

One of the main root causes of PCOS is insulin resistance. Typically, women with insulin resistance-based PCOS tend to be overweight. More than 70% of PCOS cases fall under this type. The hallmark of insulin resistance is excess insulin in the blood. Insulin is one of the most important hormones involved in the energy metabolism process of storage and utilization of glucose. Blood glucose is the primary fuel for most of the cells and tissues in the body and insulin acts as a key to open the cell’s walls to uptake glucose. Due to both genetic predispositions and lifestyle factors, for some people, cells start losing their sensitivity to the insulin hormone, a condition called insulin resistance. As insulin becomes resistant, cells do not get their required glucose, and sensing this, the body produces more and more insulin which further leads to more insulin resistance- a vicious cycle. Insulin resistance is the root cause of multiple disorders like PCOS, Diabetes, and Obesity.

Inflammation based PCOS:

For some women, despite normal levels of insulin, and weight and BMI in the healthy range, PCOS may be present. The primary cause for this seems to be chronic inflammation. These people tend to have the classic symptoms of chronic inflammation: chronic headache, skin ulcers, Vitamin D deficiency, and hypothyroidism. One of the triggers for this inflammation seems to be fat in the adipose tissue even though the overall weight may be normal. Typically, such inflammations are triggered by poor eating habits, consumption of gluten-rich foods, soya, and milk products, and various toxins.

Synthetic- hormone induced PCOS: This kind of PCOS is common for women who have been on the pill or other hormonal birth control options such as the implant, shot, or ring, for a long time. After they are stopped/removed, sometimes their periods do not return to normalcy. The synthetic hormones shut down communication between the pituitary gland and the ovaries to prevent pregnancy and it can take work to bring this communication channel back online.

What is in my control if I have PCOS? What is the appropriate diet for PCOS? Why?

Please note that there are various options available for the treatment of PCOS conditions from a medical point of view and it is very important to consult your doctor to choose appropriate treatment options depending on the type of PCOS.However, considering PCOS as primarily a hormonal disorder, we strongly believe the first option has to be something that we can do from our end – nutrition and lifestyle changes.

The root cause of PCOS is insulin resistance. Caused by high levels of insulin in the blood. What causes high levels of insulin?

1)Eating more insulin-secreting food such as carbohydrates and excess protein.

2)Eating those foods frequently

So naturally, the solution must be a diet with low quantities of insulin-stimulating food and eating less frequently.

In our diet consulting practice at PaletoNutricare, Chennai, we have found that the best diet plan for weight loss and PCOS is the combination of a low carbohydrate diet along with an intermittent fasting protocol.

A well-structured low carbohydrate diet would include moderate quantities of protein and a high amount of healthy fat. Healthy vegetarian fat sources include nuts like almonds and walnuts and seeds like watermelon, pumpkin seeds as well as paneer, ghee, olive oil, etc. All non-vegetarian foods, excluding deep-fried food, can be considered as rich in healthy fats. Low carbohydrate consumption ensures that very little insulin is secreted, and this gradually improves insulin sensitivity.

Intermittent fasting is a research-backed therapeutic tool, which involves a reduced eating window of fewer than 8 hrs in a day. Since no food is taken in the fasting window of 16 hrs, insulin is not triggered, and this gradually improves insulin sensitivity.

The key to success is, of course, proper structuring of the diet, considering other health conditions like thyroid, uric acid, kidney function, and guidance to adapt to intermittent fasting.

At PaletoNutricare, our flagship diet consulting program ‘100 Days Challenge’ effectively combines a customised and well- structured low carbohydrate diet with intermittent fasting and extended fasting, through continuous daily monitoring and guidance. Our multi-functional healthcare team of doctors, nutritionists, and wellness coaches ensures that you are in safe hands. We have seen our clients lose on an average of about 10 kg in 100 days and recover very well from PCOS symptoms.

PCOS MYTHS AND MISUNDERSTANDING

Women with PCOS have a hormonal imbalance and metabolism problems that may affect their health. PCOS is extremely common and affects one in 10 women of reproductive age; however, there are many misconceptions about PCOS which we hope to dispel.

#1 “PCOS is a rare condition”

Polycystic Ovary Syndrome is very common, but it remains undiagnosed and unmanaged in most people who have it. Research shows that it affects 1-in-5 women of reproductive age and most of them go undiagnosed.

#2 “You can’t get pregnant if you have PCOS”

No, it is not true. For people trying to become pregnant, PCOS can make it harder to plan fertility by calculating the fertile days of their menstrual cycle, when ovulation happens. It can also take time to get pregnant if ovulation is only occurring every few months.

But research show that over their lifetimes, both people with and without PCOS have a similar number of pregnancies and children. In fact, most people with PCOS who are trying to conceive will become pregnant and give birth through proper diet plans and exercises.

#3 “It is impossible to lose weight with PCOS”

Many women with PCOS say that even if they exercise more and eat less, the weight still sticks on. Although it could be challenging to control your weight with PCOS, it is not impossible.

It could be probably because of insulin resistance and weight loss is not simply about burning the calories. Changing your diet plans and following a low carb diet clubbed with intermittent fasting and exercises can work wonders on you.

#4 “Everyone with Polycystic ovary syndrome (PCOS) has polycystic ovaries”

No, not everyone with PCOS has polycystic ovaries. Polycystic ovaries are a symptom of PCOS rather than a cause. While they can contribute to hormonal imbalance, the cysts themselves are harmless.

PCOS cysts are different than the kind of ovarian cysts that grow, rupture, and cause pain.

#5 “You don’t have to worry about PCOS if you are not looking to get pregnant”

PCOS does not just affect only a woman’s fertility; it can also impact her long-term wellness. It has been linked to type2 diabetes, high blood pressure, poor cholesterol levels, sleep apnea, depression, anxiety, and endometrial cancer. So even if you are not looking to get pregnant it is important that you follow a healthy lifestyle and consult a doctor about the syndrome.

There is a lot of false information about PCOS around us; hence it is necessary to look for a reliable source of information when you are looking to understand this syndrome.