How many of us will be really happy to have irregular periods like only 3 to 4 times in a year, instead of 12? 

Happy; right? But if it comes along with overweight or obesity or extreme thinness then I think nobody will opt for it, isn’t it?

What is PCOS?

PCOS or polycystic ovarian syndrome or polycystic ovarian disease is a name given to a hormonal imbalance which may present as following:

• Menstrual irregularities: No menses, irregular menses, less bleeding during menses.
• Abnormal (androgenic pattern) hair growth over chin, upper lip, cheeks etc or excessive hair growth on arms and legs.
• Increase in weight.

There is enlargement of one or both the ovaries which leads the ovaries and a gland (pituitary) in the brain to secrete hormones in an irregular manner. 

This hormonal irregularity further leads to failure of ovulation (egg) from the ovaries and thereby difficulty in conceiving, increased and abnormal hair growth and weight gain.

What is the cause of PCOS?

Various causes have been cited in literature to explain the cause of PCOS, but to pinpoint a single cause is impossible.

• It may run in family and the woman may inherit it from either of her parents. Even males can carry the PCOS gene though the manifestations are different. 
• The underlying problem with PCOS is a hormonal imbalance.
• In women with PCOS, the ovaries make more androgens than normal.
• Commonly seen in teenage girls and young women.

Androgens are primarily male hormones that are produced by females too.

Insulin resistance is a key feature of both obese & lean pcos.

Increased Insulin

Increases androgens

Leads to acne, excessive androgenic hair growth, weight gain & problems with ovulation

Causes weight gain & inflammation as insulin allow cells to use sugar as form of energy

Which further leads obesity , prediabetes , type 2 diabetes & heart diseases

Literature also suggests that PCOS treatment can be precipitated by 

• Stress
• irregular lifestyle (not having timely meals or sleep) 
• faulty diet (eating more junk and / fried food and eating less fruits and vegetables).
• Obesity or overweight per say can also precipitate development of hormonal imbalance; excessive secretion of insulin which acts on ovaries, that in turn produces high level of male hormones called androgens.

 

So why it’s on rise? Where are we going wrong?

Is it our lazy, sluggish & mentally stressful lifestyle which is lack of exercise or may be wrong eating habits? And also not taking enough sleep?

All these factors give rise to excess fat, especially fat around abdomen even with healthy BMI (apple shaped obesity)

Lean thin PCOS has high insulin levels. A proper diet plan with daily exercise is recommended. As muscle cells have more insulin receptors than fat cells where we can decrease insulin resistance by exercise.

How does PCOS cause Infertility?

As already discussed the hormonal imbalance in PCOS women leads to anovulation. This means that the egg does not mature properly and is also not released from the ovaries, hence not able to fertilise with the sperm and form an embryo. In some cases the quality of the egg is also poor. This diminished release of egg leads to infertility and decreases chances of having a baby. In addition increased body fat can also have harmful effect on the lining of the uterus and thereby failure of implantation. Weight gain, which goes hand in hand with PCOS can also affect fertility, though indirectly.

 

What is the treatment for PCOS and infertility?

Simultaneous weight loss significantly helps in achieving results earlier with lesser dosage of drugs and injections. These women are also benefitted by antidiabetic drug called metformin. It affects the way insulin controls blood glucose (sugar) and lowers testosterone production. It also slows the growth of abnormal hair and, after a few months of use, may help return of ovulation. Use of metformin along with ovulation inducing drugs have shown better results and higher pregnancy rates.

If the above treatment modality fails to achieve ovulation than laparoscopic surgery called ovarian drilling can be done. This involves puncturing the ovary with a small needle carrying electric current to destroy small portion of the bulky polycystic ovary. This procedure carries a small risk of adhesion formation, which can however be avoided by washing the ovary with saline after the drilling. This surgery helps lower male hormone levels and ovulation. But, these effects may only last a few months.

The change is must. Lifestyle modification is the first key to modify our day to day diet habits, including a daily exercise protocol according to our body composition type. 

In overweight or obese PCOS, weight loss of 5 to 10 % of body weight is enough to bring in changes to improve insulin resistance, hormonal balance, menstrual cycle, fertility, and the most important is the quality of life. 

So lets talk about healthy nutritious diet plans; 

First change is to make a small plate size of every meal. That means to decrease our meal calorie intake by 250 to 400 kcal daily.

You can start your morning with 2 glasses of warm water followed by raw vegetable juice. Many people have habit to skip breakfast in the morning, especially teenage girls do more often, which is very wrong.

Generally, our stress hormone blood levels, cortisol are higher in the morning when we wake up; by starving or skipping breakfast, can increase sugar levels, can have weight gain because of fat storage and breakdown of muscles, can suppress immune system with digestive problems & also prone for heart disease.

Breakfast:

Vegetarian – Sprout moong chilla / nachni / ragi dosa / bhakri with sprout bhaji / cereals/ Oats/ Musli can be consumed only once a week, when it’s like no time to prepare food when you are in hurry, as that counts as a packed food. 

Say NO to packed/ processed/ & frozen foods. 

Non- vegetarian – good stuffed omlette with veges with a small phulka. Here you get full for next 3 hours, if you are having tea / coffee with very less sugar, & the milk has to be homemade skimmed milk. 

After 3 hours – Consume a healthy fruit like an apple or pear or pomegranate or orange. 

The basic idea is having low glycemic index foods with high fiber like veg, sprouted grains, fruits like apples, apricots, legumes giving enough fullness.

Avoid high glycemic foods like potatoes, corns, rice, wheat, processed sugary foods, bananas, whites like excess salt, sugar, maida white breads.

Drink lot of water, around 2 to 3 litres, always keep a full bottle of water next to your desk.

Lunch – 

Vegetarian – Salads – sprouts, carrot, cucumber or steamed veges which is like ½ portion of plate & ½ portion with different dal preparations, you can make it with spices or tamarind or kokum but with less oil.

Here the question arises that in South East Asian countries, people only eat rice, but yet they are thin built, how? The thing is they eat boiled rice with boiled veges & we eat rice with spicy oily curries full of oil, that means trans fat.

Non – vegetarians – Chicken in grilled/tandoor/roasted form or eggs.

More ideal is eating 3 meals a day at regular interval including healthy complex carbs like whole grains, fruits, vegetables, legumes( beans, peas or lentils) & last meal c/a dinner little early around 7 – 7.30pm, after which should not eat anything c/a intermittent fasting method; where you don’t eat for 12 to 14 hours from night till morning. For this we need to eat good amount of proteins at night for

the ‘fat loss’ & to avoid ‘muscle loss’.

You can consume homemade buttermilk (from curd made out of homemade skimmed milk) in b/w as zero calories.

80% is your diet what we eat is important for weight loss so high fiber foods like flax seeds, nuts, vegetables, fruits, complex carbs, good healthy fats like fish oil or fish, avocados, almonds, walnuts. Avoid fried or frozen fish.

Along with all these healthy foods; other nutrients are also equally important like

Vit D –

• Helps in production of insulin in pancreas. 
• Helps to increase follicular development to regulate menstrual cycle. 

Source of Vit D – egg yolk, fish oil, mushrooms, liver, fish. 

 

Should take weekly supplement of Vit D3.

 

Magnesium –

• Deficiency is commonly seen with insulin resistance.
• Help cells to absorb glucose , signals insulin production in pancreas. 
• Muscle relaxants – helps in dysmenorrhea or muscle cramps, insomnia, fatigue, irregular heart beats.
• Helps in anxiety or depression.

Other nutrients like Zinc, cinnamon, chromium and green tea are also important.

Set a routine exercise protocol for about 45 – 50 mins daily. 

Starting slowly with stretching exercises followed by floor exercises with an increasing count. 

Then you can upgrade them by doing muscle training for good posture with healthy joint protection. 

Last 15 – 20 mins should be breathing exercises followed by guided meditation or shavasan to relax the whole body with mind.

And last but not the least at least 8 hours sound sleep at the right time to keep a perfect pace with our body clock as long said ‘early to bed and early to rise, makes man healthy, wealthy and wise’.