Polycystic Ovarian Syndrome
Nearly 5 million women, or 5 to 10% women of childbearing age, in the United States suffer from Polycystic ovarian disease or syndrome (PCOD/PCOS). As a medical doctor specializing in hormonal issues, I want to share a typical case – a young girl who learnt to combat PCOS successfully through a combination of diet, lifestyle and medications. I hope this gives others suffering from the condition the confidence to see that a holistic approach can help them address the root causes of the condition.
Patient P.H, a 21-year old girl, visited my office with a history of irregular periods. For the first few years of menarche (start of menstruation), her periods were regular every month. However, as she grew older, she would get them only every alternate month. A time came when her periods stopped completely. She had to consult a doctor and take birth control pills to restore her normal menstrual cycle.
She was also experiencing other complications. She was gaining weight and finding it hard to lose it. Also, thick, hard hair had started to appear on her chin and her upper lip. She was also experiencing a lot of scalp hair loss.
In spite of frequent visits to her doctor, there was no lasting change in her condition. She went through numerous tests, including an ultrasound test of her ovaries and was given repeated short courses of hormonal medications. The scary part was that her periods had become dependent on these medications. As long as she took the medications, her periods were regular, but the moment she stopped them, things became irregular again. When I met her, P.H was rightly upset and frustrated.
I identified her condition as PCOS. The condition comes with irregular periods and other symptoms such as excessive facial hair, scalp hair loss or difficult-to-treat acne. Asian Indians (such as my patient) have a strong genetic risk of developing insulin resistance, which when combined with a sedentary lifestyle and poor dietary habits, increases the risk of PCOS.
Given how much processed junk most young people eat these days, the sedentary lifestyles that most of them follow thanks to spending most of their lives virtually on social media, it’s not surprising that PCOS has become a global epidemic. While genetics seem to play a role in increasing PCOS risk, lifestyle factors seem to be at the core of what finally triggers it. So, in most cases, the patient plays a large role in causing it and in dealing with it.
My philosophy for treating patients is simple. I explain the root cause of their condition, and its short and long term implications on their overall health. Then, I discuss the possible lines of treatment and the potential side effects of medications I plan to prescribe. I try to diagnose the condition through minimum, highly focused investigations. In PCOS, the diagnosis is usually clinical. In other words, the condition can be diagnosed through symptoms alone without any complicated tests and investigations.
I spent the first few minutes explaining to P.H that an imbalance of hormones in her body was the root cause of her condition. I then explained the short-term implications of this condition; that without appropriate, continued and regular treatment, there could be a progressive increase in her facial hair and a decrease in scalp hair. While excess facial excess hair can be dealt with laser treatment, scalp hair loss is very difficult to reverse.
I also impressed upon her the long-term implications of PCOS, such as an increased risk of diabetes, progressive weight gain, hypertension and heart disease, and an adverse impact on fertility. Many young women see irregular periods as an annoyance at best; they don’t understand the far-reaching implications of hormonal imbalance. Most importantly, I explained to my PCOS patient that correcting her diet and lifestyle was crucial to her getting lasting relief from her condition.
I explained to P.H. that a multi-pronged treatment focusing on diet, exercise and medications was needed to provide relief from PCOS.
PCOS is a hormonal imbalance, and as an allopathic doctor, I believe that hormonal medications are needed to address this imbalance. The side effects of hormonal medications are less serious in young girls less than 35 years of age, non-smokers, and non-hypertensives with a body mass index < 35 kg/m2 (which encompasses most of my PCOS patients). There are other modalities like Ayurveda and Chinese Medicine that use herbs and other dietary supplements like Inositol to achieve similar goals, but that is not my forte.
However, what seems common in all these systems is that there is no substitute for lifestyle modifications. Regular high-intensity exercises (such as aerobics, Zumba, weight training, swimming, dancing & cycling) as well as modifications to diet for weight management and reduction of insulin resistance are imperative.
Over the next few months, P.H. continued with her medications and made certain modifications to her lifestyle, such as eliminating junk food from her diet and exercising regularly. Over time, she noticed that her bouts of acne became less frequent and severe. Her existing acne (pimples) began to clear up too. The hair on her face became thinner & softer and she needed to wax less frequently. Her periods are now regular and she has lost 8 lbs. However, she continues to experience hair loss, which will take longer to respond to treatment. Overall, she feels much more confident and energetic.
Apart from medications and changes in lifestyle, a low carbohydrate/ high fat (LCHF diet) could help patients of PCOS. In a recent study overweight women with PCOS responded favorably to an LCHF diet. The researchers noted that the diet “led to significant improvement in weight, percent free testosterone, LH/FSH ratio, and fasting insulin in women with obesity and PCOS over a 24-week period.”
However, I must point out that I personally do not yet advice a LCHF diet to my patients. I stress more on a balanced and healthy diet (free of junk, processed foods) and exercise. As a mainstream allopathic doctor, I am still waiting for larger trials to validate the effectiveness of an LCHF diet for PCOS. However, I can see no harm in patients working with a qualified dietician or a nutritionist/functional medicine doctor to adopt a LCHF diet.
What I would like all readers to take away from this article is: PCOS is not something that should simply be managed with medications that mask the symptoms and induce regular periods. Yes, medications may be necessary for a while, under the supervision of a qualified medical practitioner. At the same time, like my patient P.H., you have to adopt and stick to the right diet and exercise, to achieve lasting improvements. Wish you all fantastic health!
The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: A pilot study
A very low-carbohydrate, low-saturated fat diet for type 2 diabetes management: a randomized trial