Polycystic Ovary Syndrome is fast becoming the commonest hormonal disorder seen in medical practice. It is more common than diabetes and is almost as common as thyroid diseases in general population. These patients require special care as they are affected early and, if not properly guided early in course of disease, may lead to great psychological stress and anxiety. There are no absolute defining features for this syndrome and even underlying pathophysiology is not clear. This has led to lot of false beliefs/myths and these patients are generally subjected to overtreatment.
Myth: Any woman presenting with delayed menses and obesity is PCOS.
Fact: Diagnosis of PCOS is not that simple. At any age, diagnosis of PCOS is made only after exclusion of other diseases. These include diseases affecting other hormone producing glands like adrenals (congenital adrenal hyperplasia, Cushing syndrome), Thyroid and pituitary. Most important of these is congenital adrenal hyperplasia, which now contributes more than 12% of cases presenting with symptoms compatible with PCOS. It is pertinent to recognize and ascertain exact diagnosis in these patients as it carries great significance, especially related to outcome of future generations as this is generally inherited.
Myth: People with PCOS are obese because they do not exercise and eat junk food.
Fact: Commonly described equation, weight gain = calories consumed –calories spent, does not apply to people with PCOS. These people are somehow genetically wired to gain weight. They would have difficulty in even retaining same weight during periods of hormonal upheaval i.e. during puberty, pregnancy and even at menopause. These people need great understanding, encouragement and support from their physicians. Moreover, now more people with lean PCOS are also being diagnosed and they may, in-fact, have more severe disease.
Myth: Metformin would make people lose weight.
Fact: This is biggest hoax in PCOS. Metformin is not a weight-losing drug and neither has approval from any scientific community for this use. In our clinical practice, we do see people who lose some weight on metformin but that happens only in very small minority. This does not justify treating every PCOS woman with metformin.
Myth: PCOS can be cured with medications.
Fact: Medications are required to manage different manifestations of this disease. But, medications cannot cure PCOS. Only thing that can reverse or make things better in majority of patients is physical activity and weight loss. A healthy diet low in refined carbohydrates is important, as this can help regulate blood sugar levels. Exercise can also help the body regulate insulin and keep excess weight off. Losing weight is challenging with PCOS, but doing so can help reduce the male hormone levels in the body, and some women will begin to ovulate naturally.
Myth: Doing crash diet would lead to meaningful weight loss
Fact: Actually, we need to realize that lifestyle modification is required for lifetime in PCOS. Doing crash might help in short term, but physical activity in combination with a practical and pragmatic diet plan is vital for success in long term.
So, how do we suspect PCOS? If you have , especially with family background of diabetes, two or more of the following symptoms, you need to have a thorough checkup to determine if you need PCOS treatment:
- Irregular or missing menstrual periods
- Excess or unwanted body or facial hair growth
- Thinning hair on the scalp
- Weight problems, often including weight gain around the waist
- Skin problems, including skin tags, darkening skin and acne
With a proper diagnosis, lifestyle changes and PCOS treatment, women can get relief from this condition and the overwhelming health problems it can cause.
Author: Dr. Rajiv Singla
A leading endocrinologist and diabetologist from New Delhi. An alumnus of University College of Medical Sciences, Dr. Singla completed his MD (Medicine) from Maulana Azad Medical College (MAMC). He went on to pursue DM (Endocrinology & Diabetes) from reputed AIIMS, Delhi.