The epidemic of Polycystic Ovarian Disorder in Kashmir

An increasing number of women in Kashmir, many of them in their late teens or early twenties, are reporting ovarian cysts. The condition is medically called Polycystic Ovarian Syndrome, PCOS. Apart from negative changes in lifestyle, experts say Kashmiri women are genetically-predisposed towards PCOS. The good news is that timely detection and following a long-term treatment regime can cure the disorder which otherwise can lead to infertility. Nishah Zargar spoke with gynecologist and obstetrician Dr Syed Naseer about the causes, cure and other facets of the disorder.

Q: What is PCOS?

PCOS is classified as a syndrome because it is a heterogeneous disorder. It means not all women with PCOS will express all of the symptoms associated with the disorder. It is actually a metabolic syndrome that transgresses various parameters of health. As such we can’t identify it as a single entity but it can have certain manifestations and implications in certain people and depending upon the age, priority of patient and the stage of life.

In simple terms, it is a problem in which a woman’s hormones are out of balance. It can cause problems with menstrual periods and make it difficult for a woman to get pregnant. PCOS may also cause unwanted changes in the way a woman looks. Most women with PCOS grow many small cysts on their ovaries. That is why it is called polycystic ovary syndrome. The cysts aren’t harmful but lead to hormonal imbalances.

Q: What are the early symptoms of PCOS which should set off the alarm bells?

Symptoms of PCOS can be clinical and biochemical. Clinical parameters include weight gain, menstrual irregularity, unwanted hair growth and acne. While biochemical parameters include glucose, magnesium, uric acid and lipid profile changes.

Q: Does medical research tell us anything about the causes of PCOS?

The exact cause of PCOS isn’t known but there are various factors that can lead to PCOS. It is caused by changes in lifestyle and food habits. Food habits play a major role here. Like we take high carbohydrate and low protein diet due to which we can have abnormal Body Mass Index, BMI. The fat ratio increases and this excess fat contributes to hormonal imbalance. Consumption of junk food adds to this as it gives us excess calories which includes excess of fat and hence adds to the problem.

Other thing is lifestyle. Today people have a very unhealthy and sedentary lifestyle which also contributes to PCOS. Earlier people barely used any means of transport and usually travelled on foot. But today people hardly walk. Besides people mostly like to stay indoors and there is little physical exertion. People have become lethargic which has affected the metabolism which in turn has led to hormonal imbalance.

Q: Does PCOS have anything to do with ethnicity and genetics?

Yes, absolutely, ethnicity and genetics both play a role in PCOS here. Frequency of PCOS cases is increasing day by day in Kashmir and there are many reasons for that.  Besides lifestyle and food habits, there is a genetic predisposition also. I have observed that Kashmiris are genetically rich, that means we have the diseases that rich people have. But unfortunately we are economically poor. Like diabetes is high in west and it is an epidemic here also. Same is the case with PCOS. It is in the genes already and thus is hereditary. Factors like intake of junk food, unhealthy lifestyle etc add to it. PCOS is a syndrome, so we can never be sure exactly what causes it, but we can consider all these factors and diagnose it accordingly.

Q: And tell us about the diagnosis of PCOS?

The diagnosis has to be very accurate and for that we have to have correct clinical and biochemical parameters. Labeling a patient with PCOS just because of increase in ovarian volume and presence of small multiple cysts isn’t medically correct.

There are two things; polycystic ovary without any syndrome and other is with the syndrome in which there are certain clinical and biochemical parameters like the female is obese, has irregular menstrual cycles and unwanted hair growth.

I have seen in many cases where a USG shows cysts, the patients are diagnosed with PCOS. However, they have normal ovarian volume. Some people also think it is a psychological disease which it isn’t. It has been made a taboo topic, and I have seen many patients who have been affected psychologically which isn’t good at all.

To confirm whether a patient has PCOS or not, first we have to see the clinical history. If the female is unmarried we have to see if the menstrual cycles are regular or not, does she have normal weight, are the ovaries having cyst, is there normal endometrial thickness, the activity of ovary by USG and various other biochemical parameters and only then we can be sure whether it is PCOS or not. And if she is married, then we have to look for all these symptoms and see if she is unable to conceive. It is after these examinations we can conclude that it is a case of PCOS.

Q: Can PCOS be completely cured?

Yes, it can be treated and doesn’t have long term effects always but that needs an accurate diagnosis and early treatment. It can affect fertility but not in all cases and if treated on time it can be cured on a long term basis. I have treated hundreds of patients and they have conceived after treatment.

If a young girl is diagnosed of PCOS, I often tell her not to be scared. It is a syndrome which can be treated by taking particular medicines and living a healthy lifestyle. It just needs some time and for that we have to be patient. But in Kashmir, we have a problem that we need fast and ready-made solutions. And in this case that isn’t possible at all and patience plays an important role. Doctors have 40% role to play in curing PCOS while the rest of 60% lies in the hands of patient because the cure is in their eating habits and lifestyle. The patient has to be healthy psychologically as well. PCOS can be easily cured, all we have to do is follow the treatment plan and stay patient.

Q: Is surgical removal of cysts an option you consider?

No, I don’t consider surgery an option for PCOS. Categorically there is no role of surgery in PCOS. At the most when we have resistant ovary that too in patients who are married and are unable to conceive, then we  go for drilling of the ovary. It is done laproscopically and in this a laser fibre or electrosurgical needle punctures the ovary 4 to 10 times. This treatment results in a dramatic lowering of male hormones within days and patient ovulates. Studies have shown that up to 80 percent of patients benefit from such treatment.

Q: Once treated, are there risks of reoccurrence of PCOS?

Yes, there is a reoccurrence in PCOS. If the patient stops having a balanced diet and living a healthy lifestyle thus gaining weight again, PCOS can reoccur in such cases. It is a constant process that the patient has to go through by following specialist advice. Although it isn’t a killer disease, it is a metabolic phenomenon. Only thing is that in long term these patients are prone to develop diabetes.

Q: Given your vast experience of dealing with patients with PCOS, how does it affect the patient mentally?

Once a patient is diagnosed with PCOS here in Kashmir, she is affected psychologically as PCOS in our society isn’t treated as a curable medical condition but something of a curse which is wrong. The patient and her family shouldn’t panic. PCOS isn’t a life-threatening disease and we should try not to make it look like one. At the most, what will happen? The patient won’t have a child. But for that, we have various ways like IVF and a couple can have a child easily by using such methods.

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