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.

Medications:

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.

 

 

 

 

 

 

 

Pink!

Pink! The colour of the month!

 

Breast Cancer Awareness Talk at GEMS world Academy Parents Association Meeting
Breast Cancer Awareness Talk at GEMS world Academy Parents Association Meeting

October is being celebrated as the breast cancer awareness month all over the world. It is the time of the year when doctors, nurses, dieticians and social workers join hands to strengthen the fight against this deadly cancer.

So why is this so important? Well to start with breast cancer is the second most common cancer affecting women. (the first being lung cancer) One out of every 8 women is expected to suffer from this disease once in her lifetime. Also it is a disease that affects the woman of the house but leaves a mark on the entire family. And most importantly there is enough evidence to show that both prevention and early detection can reduce the damage caused by this cancer.

Before we talk about prevention, we need to know what the risk factors for Breast cancer are. Most important is your age. This cancer is mostly seen in women over the age of 50, but can develop in younger women as well. But the risk increases as you grow older. Then comes family history and genetic factors. If you have had any female member in your immediate family (mother, sister, aunt, grandmother, daughter) with breast cancer, especially before the age of 40 then you are at a higher risk. Two or more relatives with breast cancer at any age is again a risk factor. Although male breast cancer is rare, if anyone in your family has had it, it is again a high risk factor. The point to remember is that if anyone in the family has had breast cancer, you must consult your doctor to discuss specific preventive strategy for you and your family. History of ovarian cancer in family members also increases your risk of both cancers.

Another set of risk factors is linked to your periods, pregnancies and breast feeding. So having periods from an early age, menopause at a late age, first baby at a more advanced age ( let’s say after 35) and not breast feeding, all increase your risk of Breast cancer. SO do think about these when you are planning your life, especially if you have any other risk factors.

Hormonal medications: Oral contraceptives have often been linked with breast cancer. However the evidence is not very strong. Oral contraceptive pills (those that contain both estrogen and progesterone) are known to increase the chance of other non cancer breast conditions. A recent guideline by the NHS (UK) reports a slight increase in breast cancer while you are on the pills. So speak to your gynecologist if you have any concerns. Certain types of hormone replacement therapy (HRT) medicines, used for menopause, do have an increased risk. Again, speak to your doctor if you have been advised to use HRT.

Another very important set of risk factors has to do with lifestyle.

Smoking and alcohol increase your risk of breast cancer. Avoid smoking and limit alcohol to maximum of two drinks per week. Obesity also increases the risk. Being physically active reduces the risk, try and walk for just 15-20 minutes per day and you would have done yourself a huge favour! two and a half hours of moderate activity per week can decrease your risk of having breast cancer by as much as 30 %!!

Sadly, despite the healthiest of lifestyles, many women still get breast cancer. This tells us that no one is really safe or protected from this condition. Here comes the role of early detection.

There are three main ways to achieve this.

Breast Self examination: This is the examination of the breasts by the woman herself, preferable every month after her periods. This was very popular in the 1970s but recently some studies has shown that it may not really increase early detection of cancer. Instead it was found to increase the anxiety in women due to benign lumps and a increased rate of unnecessary biopsies. However if you are motivated to do the Self Breast examination then you must learn the correct technique form your doctor.

Clinical Breast Examination: This refers to Examination by your GP or gynecologist to try and detect any lumps. However this is no more recommended for early detection of breast cancer as studies have not shown much advantage.

Mammogram/ Ultrasound:

The American cancer society recommends that screening mammograms should be offered from the age of 40 with annual mammograms till 54 and then be done every 2 years. The NHS (UK) recommends 2 yearly mammograms between the ages of 50-70 years. They are thinking of increasing the age range from 47-73 years now. More frequent screening will be suggested to you by your doctor if you have a strong family history or any other risk factors.

A mammogram is an X ray of the breasts taken while compressing the breast between two plates. It can be slightly uncomfortable but has no long term harmful effects on you. If there is anything suspicious on the mammogram you may be called back in for further tests like ultrasound, needle aspiration or biopsy. 4 out of every ten women who undergo mammograms are called back in but only one out of them may actually have something serious.

So put on your walking shoes, Get active and do go for your screenings. It might help you to live a healthier and happier life!

Breast Cancer Awareness Talk at GEMS World Academy Parents Association meeting
Breast Cancer Awareness Talk at GEMS World Academy Parents Association meeting

 

PCM in Pregnancy! yes or no?

There has been a recent study which has reported that taking paracetamol (PCM) in pregnancy can possibly increase the risk of your baby having asthma. This was a large study conducted in Norway and published in 2016 (1).
The study showed that paracetamol intake by the mother during pregnancy, increases the risk of the baby going on to develop childhood asthma by 13 %. Also, giving a baby paracetamol in the first 6 months of life increases the risk of asthma by 29 %, as per this study.
However we need to understand that the study does not tell us at what dose this effect is seen. Also, Paracetamol remains the only safe medication to manage fever in pregnancy. And we do know that fever if left untreated can be more harmful for the fetus.
But, the lesson to be learnt from this study is that paracetamol (for that matter any drug) should be consumed in pregnancy only when needed, at the lowest dose possible and for the least amount of time.
So take your PCM with caution and ofcourse after discussing with your doctor!

Reference

1.  Magnus M.C et al. Prenatal and infant paracetamol exposure and development of asthma: the Norwegian Mother and Child Cohort Study Int J Epidemiology first published online February 9, 2016 doi:10.1093/ije/dyv366