Fertility has become a problem in India. Women fail to conceive and the blame game starts. Either party (man or woman) may have a serious problem or both may have a minor one. Some of these are reversible and treatable. The sperm count can often be increased by adopting a healthy lifestyle, exercising, and not smoking or drinking. In 8 per cent of women, there may be anovulatory cycles, with the ova (eggs) remaining in the ovaries forming fluid-filled sacs called polycystic ovaries (PCOD, PCOS).
Women who develop PCOS have other changes in their bodies as well. They put on weight, have hairy, pimply faces, lose hair from the head and develop ugly black patches on the neck and elbows. This is mistaken for poor hygiene, and the women try to scrub it off. It is actually a condition called acanthosis nigricans caused by deposits of fat under the skin. It cannot be scrubbed off.
A century ago, not many women had PCOS. The incidence has now increased by 65 per cent. The reasons are myriad. The lifestyle has changed and become more inactive. Household appliances have made housework less physically taxing. Houses are smaller. Television and cell phones occupy much of everyone’s spare time.
There is often a genetic predisposition to PCOS, with many women in the family facing difficulties in conception. There may be a family history of diabetes. There may be insulin resistance when the body does not respond appropriately to the insulin secreted by the pancreas. This can lead to a low-grade inflammation which also interferes with the proper formation, maturation and release of eggs. As the body produces more insulin because of the resistance, excess male hormones (androgens) are also produced, causing pimples and a hairy face. Insulin resistance also results in low-grade inflammation, heart disease and hypertension.
To make the menstrual cycle regular, hormonal tablets (oral contraceptive pills) can be prescribed. They regulate the hormones by supplying estrogen and progesterone in the correct proportions. When the tablets are stopped, there is a withdrawal bleed.
Many people are scared of hormone tablets and fear that they will cause cancer. Studies have shown that the low-dose hormones used today do not have this effect. However, since they prevent ovulation, if the person wishes to become pregnant the tablets have to be changed to ovulation-inducing tablets.
Losing as little as 5 per cent of body weight can correct PCOS without medication. However, women with PCOS have an increased appetite, so dieting becomes difficult and requires powerful motivation. Sometimes the diabetic medication metformin may be prescribed to tackle insulin resistance and help with weight loss.
Do not take a second helping, even if the food is tasty. Avoid snacks except for an indulgence once a week. Do not skip meals. Walk, run or jog for 30 minutes a day. Anyone afraid to go outside can jog on the terrace with infinity waking in a figure of eight. Many people cite a lack of time for exercise. Quickly climbing up and down the stairs or spot jogging for 10 minutes may be enough.
PCOS is not something a girl “grows out of”. If it is ignored, complications can set in. She is likely to be infertile and develop diabetes and high blood pressure. Excess fat may be deposited in the liver, causing fatty liver. If she becomes pregnant, she is likely to develop gestational diabetes or hypertension. A pregnancy can even result in a miscarriage or a premature birth.
It isn’t easy to predict who is going to develop PCOS. As parents, it is our duty to ensure that the habit of exercising is ingrained in our girls by the age of five and they are encouraged to take part in sports.
The writer has a family practice at Vellore and is the author of Staying Healthy in Modern India. If you have any questions on health issues, please write to yourhealthgm@yahoo.co.in
