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Hormonal Disharmony
April 11, 2013 COMMENT comment
     
Hormonal Disharmony
By Purva Bhatia
 
It's a silent agony, one that can strike in any shape or form, and cuts across age and class. PCOS, a condition in which a woman has an imbalance of female sex hormones, now affects more than double the number of women it did 10 years ago. What are the implications, and what can we do about it?
 
Manika Gupta was a slim-bodied sports lover. Soon after her 10th board exams, her weight increased tremendously especially around her abdomen area and she is still embarrassed about the hair growth on her face.

Gitika Chandra, 27, has to deal with drastic mood swings. Sometimes she cries for hours without any apparent reasons. Her menstrual cycle is highly irregular as well.

Suchetna, 32, had to bear various complications conceiving and delivering her baby. It was a miracle how it all happened.

All the three women mentioned here are prey to a clutch of endocrinal imbalances and disorders, and have been diagnosed with a Polycystic Ovary Syndrome (PCOS). In medical terms, this is a condition when a woman does not ovulate properly and her ovaries are filled with fluid cysts and high levels of male hormones and androgens. "The eggs ripen but do not rupture, which causes an irregular menstrual cycle. So the eggs remain inside the ovary every month. These accumulated eggs inside the ovary start producing male hormones," simplifies Dr Indu Bala Khatri, consultant, gynaecology, Moolchand Women's Hospital.

The cases mentioned here are not unique. More and more women in their reproductive years are being diagnosed with it. In fact, there has been a tremendous increase in the syndrome among teenage girls. "I have patients as young as 12–13 being diagnosed with the disorder. Most of them are overweight and expect recovery through medicines instantly," adds Dr Khatri. Although it is more common among obese women, it can happen to slim girls as well.

Due to its vague symptoms, PCOS can go undetected for years. However, doctors caution that it is necessary to detect the disorder early as it could lead to life-threatening diseases such as diabetes, high blood pressure and uterine cancer.

The symptoms for the disorder vary from women to women. Most, like Gupta, witness rapid weight gain, acne and facial hair growth. Obesity and PCOS have a reciprocal relation and it is difficult to say whether weight gain is cause or the effect of the disease. Obese women are more prone to it and women who have the syndrome are likely to gain more weight. In fact, because of the male hormones in the ovary, weight gain is in a masculine pattern usually around the abdomen area. Unexpected changes in the woman's body upset her leading to stress and depression, causing frequent mood swings. Further, PCOS is understood to be one of the leading causes of female infertility and patients have trouble conceiving.

CAUSES
So what are the causes of the syndrome? The question is a difficult one as there are no specific answers. Experts say that the new-age woman's hectic and unhealthy lifestyle is one of the primary reasons. The main aspect of PCOS is hormonal imbalance and besides female sex hormones oestrogen and progesterone, women also have male hormones such as androgens, but in diff erent proportions.

Gynaecologist Dr Monika Rawal from Bhagat Clinic says, "During each menstrual cycle, these hormones are responsible for regulating the normal growth of eggs in the ovaries."

Insulin resistance is another related cause. Women with this hormonal disorder frequently have insulin resistance: Their body does not respond as quickly to insulin, Dr Rawal explains. The slow response causes larger amounts of insulin to be required before glucose is taken into the body tissues, and eventually a change in the way the body deals with sugar.

DIAGNOSIS
This hormonal imbalance could also be hereditary or genetic; this can pass on from a mother with Polycystic Ovary Disorder (PCOS) to her child or even from one sibling another. Medical history is thus an important link in diagnosing the disorder. Unexpected changes in menstrual cycle, increase in weight, change in BMI (body mass index) and other symptoms help identify the disease.

Also, a pelvic examination is essential. This includes ultrasound and sonography that detect if the ovary is enlarged or is swollen because of multiple cysts present in the ovary. Blood tests are helpful in analysing the hormone levels. For example, a test to measure testosterone and LH, which tend to be high in women with PCOS, may be required.

TREATMENT
Unfortunately, there is no cure per se. However, there are treatments that can help the situation. If detected early, most women succeed in winning the battle against PCOS but have to be cautious throughout their lives. Ironically, most patients are first treated with oral contraceptive drugs. These medications contain female hormones and are used to regulate menstrual cycles. So using these drugs initiates regular bleeding. Infertility medicines are given to stimulate the ovulation cycle and help the woman conceive.

However, just like the symptoms, treatments too vary from woman to woman. The patient first needs to analyse her lifestyle and eliminate all unhealthy elements. Weight management is of utmost importance. Losing weight can help reduce male hormone levels in the body and lessen symptoms like unwanted hair growth caused by excess androgen. Monthly cycles may become regular with weight loss.

Diets rich in fibre and omega fatty acids have proven to be beneficial. "Women with PCOS should eat more, vegetables, fruits, low-fat milk, sources of PUFA and MUFA such as olive oil, sesame oil, peanut oil, soya bean oil, whole-grain cereals and oats. Additionally, they should take high omega-3 fat diet such as fish, fish oil and whole grains. The use of salt and sugar should be restricted and caffeine to be avoided," advises Dr Khatri.

Since stress and unhealthy lifestyles are said to be linked to the causes of the condition, many have found relief in yoga, such as 29-yearold Nupur Arora. "I took to yoga to reduce my weight. While regular yoga helped me lose weight, my teacher taught specific asanas like the Butterfl y Pose that helped treat PCOS," she says.

Some patients are given diabetic medicines, which slow down the growth of abnormal hair; after a few months, this may also normalise the ovulation cycle.

In certain cases, surgery is required, such as ovary drilling in which the doctor uses laparoscopy to pierce the ovary with a small needle carrying an electric current that tears down the small portion of the ovary. The effect of the treatment, however, is not permanent. It may only stay for a few months to regulate ovulation. Eventually, the solution lies only in longterm lifestyle changes.

PCOD vs PCOS
PCOD is a disorder and PCOS a syndrome. Both are related to hormonal imbalance. While PCOD is usually linked with heredity and inheritance, PCOS can strike anyone. Between the two, PCOS is more difficult to diagnose and treat.

TESTS REQUIRED
A detailed medical history
Physical examination
Ultrasound
Hormone levels
Blood glucose levels

LIFESTYLE SOLUTIONS
Have a healthy diet plan. Eat what's easy to digest like whole grain and fibre food.
Include plenty of vegetables and fruit in your diet regime.
Instead of three large meals, have smaller portions all day.
Limit processed, canned and preservative-laden foods and those with added sugar.
Physical fitness is important. Try yogic pranayam, breathing exercises, meditation, brisk walk, swimming, cycling, etcetera.

"The eggs ripen but do not rupture, which causes an irregular menstrual cycle. So the eggs remain inside the ovary every month. These accumulated eggs inside the ovaries start producing male hormones."
There is no cure per se but there are treatments that can help the situation. If detected early, most succeed in winning the battle against PCOS but have to be cautious throughout their lives.

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