By Dr Suhasini Inamdar
One in five women in India is diagnosed with Polycystic Ovary Syndrome (PCOS). This is a hormonal imbalance that affects women and the symptoms could vary from irregular periods, acne, weight gain and can face difficulty conceiving.
A normal conception takes place when the egg is released from the ovary around 13 to 14 days after the start of a menstrual cycle. However, for a person with PCOS, due to the hormonal imbalance, there is deficiency in egg development which could lead to difficulty in conception or risk of a miscarriage. PCOS is also one of the major causes of infertility among women, which is why it needs to diagnosed and controlled.
Although weight gain is a major symptom of PCOS, around 20 per cent of the women diagnosed with the disease are actually in the normal weight range or even underweight. Studies have proved that using BMI as an indicator of PCOS is not accurate. These studies indicated that obese women, whether they had PCOS or not, the weight distribution was not different in their body composition. But in lean women because of the presence of visceral fat, women with PCOS were prone to having more fat in their abdomen area. In this case, their height and weight ratios and BMIs were normal and could not be taken as an indicator of PCOS.
Risks of PCOS in lean women
This would mean that other factors and indicators would have to be considered to understand the risk of PCOS in lean women. They may not have hirsutism and acne, unlike girls and women who are obese. Also, girls of 16 years of age can be diagnosed with PCOS when they are obese but in lean girls and women, it usually goes unnoticed until they struggle to conceive. They also face the same risks of developing diabetes and insulin resistance and may be prone to cardiovascular disease.
Therefore, when an imbalance of hormones is present, or periods are irregular, doctors recommend that women should have their insulin levels and hormone levels tested to determine if they have PCOS. Also, leaner women with PCOS are likely to have lower levels of good cholesterol and higher levels of bad cholesterol.
Leaner women with PCOS have a better success rate at conceiving than obese women, with a ratio almost double that of obese women. They may be put on oral contraceptive pills if their cycles are irregular. Medicines are also given to lower insulin, which in turn helps with ovulation.
But introducing lifestyle and diet changes in PCOS patients to lower insulin levels and maintain weight as they grow older is necessary to avoid diabetes and heart disease. Another challenge faced by women with PCOS is that they are advised to eat fewer calories, which lowers their metabolism further.
The solutions to these problems are:
1. It is important for women with PCOS, whether lean or obese, to stay positive and take care of their health for the long term by following a good lifestyle.
2. Lean women with PCOS should eat foods lower in carbohydrates. They should avoid sweets, carbonated beverages, and calorie-dense foods made of maida and rice. They should switch to whole grains and get a lot of fibre in their food through vegetables and fruit.
3. Healthy fats should be increased in the diet and they should get a good amount of protein. Carbohydrates should be lowered because it is an insulin trigger and raises blood sugar levels causing spikes.
4. They should eat a good breakfast so they don’t overeat during the rest of the day. Breakfast should be their biggest meal and dinner should be very light and eaten early.
5. Smaller meals avoid spiking of insulin levels in the blood. Spacing out their meals through the day is a better idea.
6. Doing resistance training by lifting weights and interval training between moderate and high-intensity exercise will help reduce visceral fat and increase lean muscle in the body. This is good for regulating their hormones as well.
7. Seek professional support for problems of anxiety and stress.
8. Women with PCOS are found to be deficient in Vitamin D. So they are advised to take Vitamin D supplements which will help them reduce the risk of diabetes as well as help them conceive.
9. Taking Omega 3 supplements will help them reduce bad cholesterol and improve good cholesterol levels. It is also known to help with maintaining good insulin levels. They can also have foods rich in good fats like fish, avocados and nuts.
10. Find a doctor who is well-informed and who can help with regular advice and medication.
(The writer is Consultant Obstetrician & Gynecologist, Motherhood Hospitals – Indiranagar, Bangalore.)