Day 7: My tryst with PCOS - a quick peek

PCOS is one of the most common hormonal disorders in women with an incidence of 6-8%. It is not clear what causes this condition. PCOS is characterized by the following features:

1. Menstrual abnormalities: Women with PCOS will initially have infrequent or absent periods but they may eventually develop heavy bleeding.

2. Excessive hair growth or acne: This is also referred to as hyperandrogenism.

3. Polycystic ovaries: An ovary with multiple small cysts, ranging from 0.2 to 0.9 cm in diameter, found on ultrasound examination.

4. Obesity and metabolic disorder: PCOS can be associated with diabetes, high blood pressure, and elevated cholesterol and triglyceride levels. It can also be associated with insulin resistance. When there is insulin resistance, the body produces more insulin because the body does not respond to the normal amount of insulin that is produced and this increased production of insulin can add to the excessive hair growth and acne discussed above.

If a woman has any 2 of the above 3 findings, she can be diagnosed with PCOS.

Since PCOS is a hormonal disorder, treatment goals are generally:

1. restoration of normal regular periods
2. elimination of hyperandrogenism

To restore normal periods and eliminate hyperandrogenism, combination birth control pills that contain both estrogen and progestin are the most common treatment prescribed for women with PCOS who do not wish to become pregnant. By restoring normal periods, birth control pills will also prevent the development of endometrial cancer and endometrial hyperplasia which can turn into cancer. If birth control pills do not get rid of hyperandrogenism, there are medications such as spironolactone that treat excessive hair growth. A drug that is used to treat diabetes, metformin, can also be used to treat the hyperandrogenism associated with PCOS. Some women with PCOS have insulin resistance which means that their bodies do not respond normally to insulin. As a result, these women produce excessive amounts of insulin to try to counteract the resistance. Excessive insulin causes hyperandrogenism. Metformin decreases the glucose production in the liver and by doing this, it decreases the need for the body to produce insulin. There is a large section of society (even patients with PCOS & other illnesses) that resorts to pill shaming and frowns upon taking medications (especially birth control pills) to manage symptoms of chronic illness. But the truth is that some of us actually need these medications to survive and to prevent our condition from worsening,

Weight loss is an important first step according to most doctors for PCOS patients who are overweight. Sometimes this manifests in the form of body shaming, which agitates patients worldwide because the relationship between PCOS and excessive weight gain is cyclic. Due to the hormonal imbalance that happens with PCOS, the human body starts putting on weight. And an overweight or obese body ends up worsening PCOS symptoms. Patients find it extremely hard to break this cycle. It is usually done with the right mix of medications, a healthy diet, and lifestyle changes.

My tryst with PCOS:

During my PCOS diagnosis, it was found that most of my hormones had gone haywire. So, I was referred to an endocrinologist. That's when Dr. D joined my care team alongside Dr. M. They put me on metformin, spironolactone, and combination birth control pills to manage my PCOS. My thyroid levels were alarmingly high, and my iron & vitamin levels were really low. So gradually they also put me on supplements. I was also asked to make some dietary changes-

• cut out sugar
• reduce carb intake
• go diary-free
• go gluten-free

It isn't easy when at 23 you are asked to suddenly let go of so many food items you like, and make drastic changes to your diet. It gets worse when you get stuck fighting your cravings. But the knowledge that my mind had the power to change the course of my physical health motivated me to discipline my body and switch to a healthier diet. There are quite a few fellow cysters (other women with PCOS) I know who have had to make similar changes, and just knowing that I am not alone in this somehow made things a lot easier for me.

Over the last 1.5 years, I have had periodic blood tests done to monitor my hormones, my metabolic panel, and my vitamin & iron levels. I recently had a nutritionist (Dr. H) join my care team to monitor my diet since I hit a plateau in my weight loss journey.

Since we are on the topic of body weight, I want to quickly present my story in the hope that it might bring some relief to my fellow cysters to know that we are all on this journey together. Growing up, I was always an underweight kid despite eating healthy and regularly exercising. That suddenly changed around 2017 after my move to the USA which is when we suspect the onset of PCOS began. I suddenly was at my heaviest, and people were shocked to see my transformation. That is when I first started becoming a victim of body shaming. I wasn't spared by anyone - not friends, not family. I used to hate looking at myself in the mirror, and I dreaded getting on the weighing scale. When in Aug 2019 I first went in to meet my gynecologist I logged a scary 168 lbs. That's also when my hormonal system was a mess.

Fast forward to today... I have lost a considerable amount of weight, and am now at 152 lbs. I still am not within what the medical community defines as a normal BMI, but I have made great improvement and I feel healthier. My latest blood tests came back almost normal, and I don't have any PCOS-related ovarian cysts as of now. This is a much-needed ray of light and is enough motivation to keep me going. While my PCOS hasn't gone away (it never will), I feel like I have learned the art of managing my PCOS symptoms. So here's to my care team, and our continued journey! 🥂

#EndoTheStigma