PCOS - Common yet Ignored

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A Problem Well Stated is Half Solved

- Charles Kettering

Stating the problem the way it is, and objectively analyzing it from various perspectives is the simplest way to tackle any issue. However, how do you tackle a problem you don't feel comfortable talking about?

After my last blog on PCOS went live (here), I got contacted by a few women who have been diagnosed with PCOS. One of them was a mother of a 14 year old girl who was suffering from menstrual irregularities and facial hair. She had been diagnosed with POCS by her gynecologist and was recommended lifestyle changes. The kid being of such a tender age, I decided to have an online conversation with her parents first. I learnt that she was suffering from delayed and painful periods and had started to gain weight. But I noticed one thing. Every time they said the word 'periods', they said it softly. It happened multiple times so I asked what's the matter.

"How can we talk about this openly, it's awkward", was their response. And I realized I had to work on their beliefs before moving towards their lifestyle.

What we know:

PCOS affects 2 out of 10 women aged 18-45 years. It is as common as 1 in 10 for adolescents between 15-18 years of age. If not monitored in time, the condition can have serious health impacts. Younger women may suffer from irregular periods, experience hirsutism (unwanted male-pattern hair growth), obesity which may lead to anxiety and depression. In the slightly older age group, it may lead to infertility, and heightened risk of miscarriages and even cancer.

The risk of diabetes, high blood pressure and other metabolic diseases also goes up. With time. It's a condition which shows it's presence every month, and the cultural taboo surrounding menstruation and sexual reproduction makes it difficult to seek help.

One of the hardest and most difficult things in life according to me is asking for help. Probably because it comes with being vulnerable and transparent about how you feel about something. Which makes it even harder to diagnose PCOS early on. I was shocked to see the lack of awareness among women too. So I have made it my mission to educate and spread awareness about PCOS among as many people as I can. It is a real physical hormonal imbalance issue.

Understanding the female reproductive cycle:

There is a coordinated release of the luteinizing hormone (LH), and follicle stimulating hormone (FSH) from the pituitary gland which have their effects on Ovaries. In ovaries, the follicles increase in size and eggs mature. They release Estrogen. This rise in estrogen causes the pituitary gland to release a surge of LH which causes the mature follicles to release eggs. This happens during the Follicular phase and peaks leading to ovulation, after which it falls. This happens during mid cycle. The follicular phase is followed by the Luteal phase when a hormone named Progesterone is produced, peaks and falls preparing the body for possible pregnancy. This rise in progesterone acts like a signal for hypothalamus and pituitary which leads to a drop in LH and FSH. In absence of pregnancy, the uterine lining breaks down, and sheds.

In case of PCOS, there are abnormal levels of LH. Follicles do not mature and ovulation does not occur leading to infertility. Immature follicles remain as fluid filled sacs called as cysts. Moreover, there is excess production of Insulin which in combination with LH, leads to excess production of Testosterone by ovaries which further prevents ovulation, leading to infertility.

This intricate sequence of physiological changes are controlled by hormones LH and FSH. And any changes in the sequence of hormone release results in the symptoms of PCOS.

The good news:

Since it was found that the surge in LH results in the disruption of entire process, more and more studies linked overproduction Insulin to it. So there's over production of insulin, which causes the hypothalamus and pituitary glands to over over produce GnRH (Gonadotropin releasing hormone) and LH.

Insulin is released at a very high rate on consumption of ALL type of carbohydrates. Whereas protein and fat stimulates blunted insulin response. Body over produces the hormone Insulin due to:

1. High consumption of carbohydrates in diet

2. A condition when the cells of our body stop responding to Insulin so our pancreas produce more Insulin (imagine trying to fit more clothes in an already full bag by putting your weight on it to pack the clothes in tightly) also known a Insulin Resistance

So, in theory, if you deal with insulin resistance, you deal with PCOS as well. And it works practically as well.

The weight gain that follows PCOS is nothing but a result of these hormonal imbalances and Insulin Resistance. Most of the diets my clients have been following a low calorie 'balanced diet'. It's always eat less, move more which doesn't deal the route cause of Insulin Resistance. The problem continues, with an added problem of lowered metabolism which leads to other health issues, adding to the physical and mental stress.

Good news is, we have now started identifying the issue. We have started stating it well. Which has made it possible to address it properly. We know the cause now, and I can help you get better with diet and lifestyle changes including sleep quality and schedule, stress, meditation, breathing and a lot more. Check out our Freedom 90 program and reach out to me.

If you are someone who has been suffering with menstrual irregularities, seek medical help. It is a condition which can be managed by improving diet and lifestyle. It's a sign that it's time to get serious, focus on your health and educate the people around you. I think the only way forward is for more of us to work together, make it easy to ask for help, and change the future together.

Eat Good, Stay Strong, Live Free!

Cheers,

Sushil Dhokne

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References

1. Effects of insulin on luteinizing hormone and prolactin secretion and calcium signaling in female rat pituitary cells

2. Effects of prolactin on the luteinizing hormone response to gonadotropin- releasing hormone in primary pituitary cell cultures during the ovine annual reproductive cycle. Gregory SJ, Townsend J, McNeilly AS, Tortonese DJ.Biol Reprod. 2004 May;70(5):1299-305. doi: 10.1095/biolreprod.103.022806. Epub 2003 Dec 26.PMID: 14695904

3. The influences of GnRH, oxytocin and vasoactive intestinal peptide on LH and PRL secretion by porcine pituitary cells in vitro. Bogacka I, Siawrys G, Okrasa S, Kaminski T, Przala J.J Physiol Pharmacol. 2002 Sep;53(3):439-51.PMID: 12369740

4. Hypersecretion of luteinizing hormone and the polycystic ovary syndrome. Balen AH.Hum Reprod. 1993 Nov;8 Suppl 2:123-8. doi: 10.1093/humrep/8.suppl_2.123.PMID: 8276945 Review.

5. Insulin modulation of luteinizing hormone secretion in normal female volunteers and lean polycystic ovary syndrome patients.Moret M, Stettler R, Rodieux F, Gaillard RC, Waeber G, Wirthner D, Giusti V, Tappy L, Pralong FP.Neuroendocrinology. 2009;89(2):131-9. doi: 10.1159/000160911. Epub 2008 Oct 2.PMID: 18832802

AND MANY MORE...