Polycystic Ovarian syndrome

Polycystic ovarian syndrome (PCOS)


Lately, the diagnosis of this condition especially among young women is becoming more common.I have a lot of women tell me that they have been told they have PCOS, I am not sure all of them actually do!

The American statistics show that 1 in 25 to 1 in 10 women may be having PCOS. But maybe many women are also being over diagnosed.

The data also shows that 1 in 5 women have ovaries with polycystic appearance. So what is the difference?

What is this condition? How can you suspect you have it?

What does it mean for your health? What are the long term implications for this? Can it be treated or controlled?

These are some of the many questions that may be going through your head if u have recently been told you have this condition. There are many myths associated with this condition and I will try and answer and resolve as many of them as I can.

What is PCOS?

PCOS stands for Polycystic ovarian syndrome. It is a condition of hormonal disturbance in females resulting in any or all of the following: irregular periods, weight gain, difficulty in conceiving, acne and some other long term complications.

Polycystic ovaries are a part of this syndrome. Ovaries with a large number of follicles, with a typical appearance on ultrasound are called polycystic ovaries. Not all women with polycystic ovaries have the syndrome.

What are the common symptoms?

The most common symptom of PCOS is irregular periods. The periods usually come at irregular and prolonged intervals, sometimes being absent for 2-3 months also. This may be associated with weight gain, increased facial hair, acne and difficulty in getting pregnant.

How can the diagnosis be confirmed?

The diagnosis is confirmed based on your symptoms, Ultrasound for your ovaries and some blood tests for hormones. It is best to have these tests and ultrasound done on the second or third day of your period.

According to the Rotterdam criteria for diagnosis of PCOS two out of the three criteria should be present.

These are :

  1. Irregular prolonged periods
  2. Signs of increased androgens (male hormones) like excessive hair/ acne OR blood reports suggestive of the same
  3. Ultrasound showing polycystic ovaries : Ovaries which are larger than normal ovaries and have more than double the number of eggs, as seen on ultrasound.

What causes PCOS?

The exact cause behind PCOS is not clearly defined. It is believed to be an imbalance between male and female hormones in the body leading to excessive male hormones which leads to the manifestations of PCOS. The excess of male hormones makes it difficult for the ovary to produce and release an egg every month, resulting in irregular periods and subsequently difficulty in conceiving.

The development of PCOS may also be liked to Insulin resistance and this may be the factor linking it to diabetes in the long run.

What does it mean once I have been diagnosed with PCOS?

PCOS is not a disease. It is a collection of symptoms. But it also has short and long term implications for your health if it is not corrected.

Short term Health concerns:

Weight gain and acne

Excessive hair on face and chest, also called hirsutism

Irregular periods which may be associated with heavy periods also

Inability or difficulty to conceive

Miscarriage in early pregnancy

Long term concerns:

Long standing PCOS, especially if periods remain irregular or less frequent than 3 times a year, can lead to Diabetes, high blood pressure, Obesity, cardiac problems, cancer of the womb, depression, snoring and daytime sleepiness.

What is the treatment for PCOS?

As PCOS is not a disease there is no definite treatment for it. However, there are some lifestyle changes and medications that can help reduce the chances of your having symptoms and any complications of PCOS.

Lifestyle modifications

A healthy diet

Eating a balanced diet with plenty of fruits and vegetables has been associated with improvement in this condition.

Losing weight with diet and exercise also improves the hormonal imbalance. It has been shown that losing even 5 % of your weight might be enough to improve your symptoms. BMI or body mass index is a good way to monitor your health. The BMI depends on a person’s weight and height. It is best to maintain your BMI between 19 and 25.

Regular routine. Sleeping on time i.e. not very late and trying to get up early also helps improve PCOS.

Stress management. Techniques to reduce stress like meditation, music therapy, exercise etc also help reduce the severity of PCOS.


Cyclical hormonal pills: Sometime you may be given hormonal pills like the contraceptive pills to regularize the period. These do not treat he condition but while you are taking the medicines your periods will come on time and the other symptoms like acne and hirsutism may also improve. However they are likely to come back once you stop the pills.

Metformin: Medications that reduce insulin resistance can help reduce the imbalance between male and female hormones and hence improve the symptoms.

But the most important and effective method of dealing with PCOS remains weight loss and lifestyle management.

The take home message is that PCOS is a very common condition among young women and although it may seem difficult in the beginning, can be kept under control with a disciplined lifestyle and a little help from medications.








How to take care of yourself

It’s quite a basic thing, however not something we are taught at school. And that is personal and menstrual hygiene. Some of us  go through most part of their lives doing what they have seen mothers and aunts and cousins do but are really in a  fix when their little sister or daughter asks to questions things.

Well, I thought it best to put together some tips to ensure you feel good about yourself whether you are on your period or not!

Routine care of your vulva and vagina :

The vagina is the tube leading from the outside to your cervix and Uterus and the vulva is the area down below which is the entrance to the vagina.

Both of these need special care to keep them clean and healthy. If not given proper attention it can lead to repeated episodes of itching, bad smell and even long term skin problems.

Some tips:

What to wear?

  • Try and avoid synthetic and tight underwear as it causes you to sweat more and locks the moisture in. Loose cotton panties are best for allowing air to reach your private parts. white coloured underwear is least irritant to the vulval skin. If u want to use dark coloured underwear wash it a few times before you start using it.
  • Avoid very tight clothing for very long periods of time, unless necessary.
  • If you do have to wear a tight dress or uniform at work try and spend the time at home without any underwear or loose cotton stuff.
  • It is best to sleep without your underwear unless you are on your period.
  • Change your underwear daily and its a good idea to buy new stuff every 6 months.
  • Avoid panty liners on a regular basis.

How to wash?

The vulva is covered with skin so it needs routine hygiene measures. The vagina on the other hand has plenty of normal helpful bacteria. So its a good idea to not wash it very vigorously with jet of water or soap as that may cause the good bacteria also to be washed away.

  • The vulva needs to be washed once a day. At the maximum you should wash the vulva and vagina twice a day but not more.
  • There is no need to scrub very hard. It is best to avoid soap. Instead you can use a lactic acid based wash.
  • Showering is better than soaking for long in a bath.
  • After the bath or washing the vagina, let the vulva dry completely or dab it gently with a soft towel. A hair dryer on a cool setting can also be used to dry the vulva.
  • Shampoos can irritate the vulval region. so be careful when you wash you hair and make sure the shampoo is completely washed off with water.
  • It is best to avoid fabric softeners and Biological washing powders while washing your underwear.

And some more advice – 

  • Sometimes creams, even herbal ones can have something that may irritate your vulval skin. Try and avoid using them on the vulva or in the bath.
  • There are emollients available that can be used on the vulva. They also act as a moisturizer. You can check with your doctor or pharmacy for one.
  • If your partner uses condoms and you are regularly have itching after intercourse you may have allergy to the spermicide or lubricant being used.
  • Avoid shaving pubic hair.Use a hair clipper instead.

Having lots of water everyday and including probiotics in your diet( yoghurt etc) also helps to keep you feeling better – overall and down below also!

Hope all this helps you in feeling good about yourself – Inside out !

Pap Smear

The big “C” we are all afraid of. Cancer!

As women a lot of the times we are not just worried about ourselves but we also know what it will do to our families. And that’s a good enough reason to be aware and to “screen” for cancer.

Screening basically means doing some tests to detect a problem even before it has actually become one.

And luckily for us, one of our biggest worries, the cervical cancer is easy to screen for!

Thats where the Pap smear comes in. Pap is short for Papinacolou, the stain used in this test.

So what is the test all about? Well, the basic principle of the test is to obtain some cells ( the tiniest units that make up every part of our body) from the cervix or the mouth of the womb, and to examine them, after applying some special stains, in a laboratory. This will help pick up any abnormal looking cells which may then tell us if there is any changes that may indicate a cancer is developing or likely to develop in the future.

When should you have it? Different countries have different guidelines. The UK guidelines suggest starting your pap smears at 25 years of age or 3 years after your first sexual activity, whichever happened earlier. The Health authority at Abu Dhabi suggests you start at 25 years of age if you are sexually active. You should then repeat it every 3 years if they are normal. Most organisations suggest regular screening till you are 64 years of age. After you turn 50 you may increase the interval to 5 years between your pap smears.

With respect to your period it is best to go 1-2 days after your period has ended so as to get only cells from your cervix and not blood mixed with them.

How is the test done? If you have ever had what we doctors call a speculum examination then that’s exactly what is done for a pap smear. Your doctor would ask you to pass urine to empty your bladder and lie down on a couch after undressing from waist down. She will then insert a small plastic or metal tube like thing from down below and use a light from the foot end to look at your cervix (mouth of the womb). She will then use a brush to gently scrape some cells off the cervix.

pap smear brush
the brush and kit used to collect a pap smear

Trust me you will not even feel that! And that’s it! It’s over!!

You will then get your report from your doctor in a week or so.


What if you get an abnormal result? Pap smear usually picks up problems way, and i mean years, before cancer actually develops. So an abnormal result may not actually mean much. However you may be asked to return for further tests like HPV test ( Human Papilloma Virus ) or Colposcopy. That’s for another blog!

If you have any other queries about a pap smear or need an opinion on you pap smear result and what you should do about it you could leave a comment or email me at drnehagami(at)gmail.com and ill try and get back to you ASAP.

You could also


Happy screening!!



Everything you needed to know about your Periods !!

I have seen that most women have many questions about their periods but don’t know who to ask.

First of all in case u’re confused as to what I am talking about that may be because you might be using another name for your periods. Periods or Menstrual Period refers to the period of bleeding that women have from Puberty till menopause. There are many slang names used to refer to them. Some of them are chums, menses, time of the month and monthlies. Most are used as young women have usually been embarrassed talking about them. However, that seems to be changing. Thankfully!

Menstruation and the Menstrual cycle

Menstruation is the scientific name given to the monthly discharge of blood hat women have from puberty until menopause. It is the result of the perfect and harmonic functioning of the body’s hormones, internal and external genital organs.

Normally the period of bleeding can last from 2-7 days. Anything less or more than that, especially if it was not always like that, should prompt you to consult a gynecologist.

The interval between two periods is what we commonly call “the cycle”. It can be calculated as the number of days between the first day of one cycle to the first day of the next cycle. A regular cycle coming at the same interval every month is a good sign. But a small variation of up to 7 days is also fine. So a cycle length varying form 21-35 days is also normal.

Now, coming to the amount of flow. Every woman has a unique flow pattern. Some criteria to know that your flow is normal is that there should be no or minimal clots, no flooding ( where you suddenly feel a gush of blood coming out) and you should not have to change your sanitary pad or tampon every 1-2 hours. You might feel a little low during your heavy flow days but it should not prevent you from doing your routine activities like going to work, exercising or having a normal social life. Another thing that should alert you is if there a change in your pattern or amount of bleeding.

Scanty flow is when there is very minimal bleeding, lasting for less than 2 days or only spotting and no proper flow. Again, if it was more earlier and you think it is decreasing suddenly, you may want to see your gynecologist.

If you have any other questions feel free to write to me at drnehagami@gmail.com and i will try and get back to you ASAP.