Article on PCOS - causes, symptoms and treatment

You will be shocked to know that at any given time, 20- 40% of teenage girls are plagued by a condition that many have never even heard of- Polycystic Ovarian Syndrome (PCOS). This disease usually leads to irregular periods, acne, excessive hair growth and sufferers are also likely to be overweight. PCOS is nothing but altered state of psychology and abnormal hormone levels. The three main complications in PCOS are Insulin Resistance, Anovulation (absence of ovulation) and Hyperandrogenia (high levels of testosterone).

The high intake of sugar in the form of carbohydrate, sweets, carbonated drinks etc leads to high level of Insulin in blood, which in turn causes an increase in resistance towards insulin. Thus diet becomes an important catalyst in contributing to this disease. High-fat intake also causes and aggravates insulin resistance, so a calorific western style diet (like unhealthy fast foods) is a typical example of the kind of diet that should be avoided in children to prevent PCOS. Insulin resistance typically causes symptoms like tiredness, lethargy, darkening of skin flexures (behind the neck) and increased the occurrence of diabetes even in young adults.

Another symptom in PCOS is the presence of high levels of androgen (male hormone) compared to the normal girls. This can lead to a myriad of psychological symptoms like irritability, aggressiveness, mood variations, anxiety, depression, social isolation, and poor body image. Physical symptoms may include acne and excessive hair growth, but these symptoms may be absent in some girls. These indications can be controlled by routine exercise and a low-calorie diet in most of the cases.

Unfortunately, these girls are repeatedly condemned to silently suffer from these symptoms, as the teachers and parents quite often misinterpret their behavior without attributing the cause to PCOS. As the girls have the tendency to put on weight and are likely to have extra facial hair, they are further ridiculed by peers and this adds to their predicament of loneliness and social isolation. It is common to find suicide notes by teenagers on the sites of counselors requesting for help, as they find no solace from friends/parents. Counseling of parents and girls greatly helps in the recognition and management of what is essentially a treatable problem, so that they grow up to become confident and healthy individuals.

Furthermore, studies show that in India many of the women who have PCOS fall under the lean PCOS group meaning that they have PCOS even if they are normal or even underweight. As doctors and paramedics traditionally associate PCOS with obesity, women falling under this category are many times under diagnosed.

In addition to the problems discussed earlier, PCOS also leads to long term complications such as sub fertility and pregnancy related problems. They are also at a high risk of developing diabetes, high blood pressure, cardiovascular problems, inflammatory diseases, autoimmune diseases and allergic disorders as the body produces inflammatory markers.

In my long career as an infertility specialist, I have seen that one of the main causes of female sub fertility is PCOS. Many of my patients who had previously undergone unsuccessful multiple IVF treatments at other infertility centres have conceived naturally under my treatment just by controlling PCOS. This prompted me to explore this subject deeply by comprehensive reading and understanding the problem by attending numerous international conferences and lectures on PCOS. I have been lucky to meet and gather medical information from prominent doctors and researchers on PCOS. Infertility treatment is quite expensive, making it beyond the reach of many couples and the medicines have side effects if used repeatedly. The long term implications of PCOS are frightful and the sheer volume of girls affected with PCOS is appalling. Hence, I have opened a specialized PCOS wing at GIFT IVF Centre, Kochi for controlling and prevention of this disease, so that many of the affected women can achieve their dream of having a baby and for building a generation of women who are equipped to deal with this menace.

It is the need of the hour that all members of society are aware of this condition that greatly affects the life of not just the woman suffering from PCOS but has a wider impact on her family and society. We need to give priority to introducing fitness programs in school and provide healthy home cooked food to growing children. It is high time to make our young girls healthy and save them from the huge catastrophe related to the pandemic disorder of PCOS.

As a major step towards addressing this concern and for the benefit of our doctors and patients, we are conducting an International Medical Conference on PCOS at Gift IVF centre, Athani( Kochi) on 18/02/18 in collaboration with PCOS Challenge Group USA, where distinguished and prominent International experts on the topic of PCOS will partake and share their invaluable knowledge . This symposium is going to be first of its kind in that PCOS patients and their parents are going to be a part of the conference wherein they can directly interact and clear the doubts with the eminent doctors and related medical faculty learning about the latest methods of treatment.

Dr. Anita Mani

Infertility Specialist at Gift IVF Centre

anitadane@gmail.com
www.giftivf.com 

+91 484 2475031,  +91 484 2475034, 

-----------------------------------------------------------------------------------------------------------------------

Dr. Anita Mani is a renowned infertility specialist in south India with 18 years experience in ART (Assisted Reproductive Technology). Dr. Anita has successfully set up ART hospitals in Cochin and Bangalore,  along with her spouse  Dr. S Mani. She completed MRCOG, from Royal College of Obstetrician and Gynaecologist  London, DFFP from  ART Warwick university and  worked in UK for 5 years. Dr. Anitha believes in scientific and ethical practice and is currently the director of Gift Gyno IVF centre Cochin and  Bangalore.  Apart from advanced laparoscopic surgeries, she is also an expert in various ART techniques including IVF, IUI, ICSI , donor egg / sperm. Her proficiency is in genetic abnormalities and high risk pregnancies.

Facts and information on PCOS discussed in World PCOS conference 2015 - Seattle, USA

PCOS (Polycystic Ovarian Syndrome ) is a common condition affecting numerous teenage girls in the present scenario, causing obesity, irregular periods and excessive hair growth. Recent studies and researches reveal that a shocking 20% of teenagers are affected and the numbers even go up to 60% in some urban cities.  PCOS results in abnormal hormones in the body which often leads to infertility and other metabolic disorders like diabetes and heart diseases. The psychological issues like anxiety and depression and social problems like feeling of isolation are often inadequately recognised by both healthcare providers and the parents.

It was indeed a great learning experience for me to attend the first annual world Polycystic Ovarian Syndrome Conference  held on November 16-18, 2015 in Seattle, Washington, USA. The conference highlighted scientific studies and discussions on PCOS.The selection of top 42 research fellows from all over the world, was impeccable. The expert doctors from around the globe shared creative ideas about the various aspects of research and also various measures to help create public awareness on the subject.

Professor Richard L Stouffer presented a paper on PCOS, after studying the effect of western style diet on monkeys and concluded that the diet developed PCOS in the animals. He is the Senior Scientist in the Division of Reproductive & Developmental Sciences, ONPRC and has published over 200 papers. Presently, the dangerous trend in India is that lot of fast food chains are coming up and we, especially the young generation are embracing this diet with open arms and mind, which could be catastrophic. This could be one explanation for the recent rice in cases of PCOS among Indian teenage population.

Professor Dimitrios Nikolaou from the Imperial College School of Medicine, London, tried to establish that PCOS  is a misnomer ! He is considered as one of the most original thinkers in the field of Reproductive Medicine. He argued that women are protected against early ovarian ageing and have a number of social characteristics due to male hormones  that are advantageous.

Dr. Angeline Beltsos from Fertility Centers of Illinois, USA advocated single frozen embryo transfer in IVF cases for PCOS . Higher IVF implantation rates and improved pregnancy outcomes can be achieved by pre-implantation genetic screening, followed by single frozen embryo transfer which may improve placentation and infant health as well. 

Dr. Yen Hao Chen, a researcher from Georgia Regents University, USA, established a new study to prove that  Adipose tissue ( fat cells ) dysfunction is present in PCOS. This may help in finding new treatment in future.

Dr.Sheng Wu, from Johns Hopkins University did Study of PCOS through the interaction of androgens and insulin.  High levels of male hormones and insulin  are believed to play prominent roles in the genesis and progression of the disease and study revealed intricate cellular mechanism.

Dr. Lora Shahine, had done fellowship in Reproductive Endocrinology and Infertility at Stanford University. Her work was a proof that women with PCOS suffer not only from difficulty in conceiving, but a higher rate of early miscarriage compared to women of the same age without PCOS because of obesity, endometrial defects and hormonal imbalances.

Professor in Clinical Biochemistry at the University of Manchester, Dr.Brian keevil 
focused on the simultaneous measurement of testosterone, androstenedione DHEA, DHT, DHEAS and 17 OHP and their potential use in the investigation of PCOS. The possible use of salivary androgen assays were interesting, which offered a possibility of no blood tests in future.

Dr. Janelle Luk , who graduated from Yale University , and did residency at Harvard, presented paper on IVM ( in vitro maturation ). This is a technique in which immature eggs are collected from women with PCOS and is matured and used in IVF/ ICSI. This technique is probably going to be employed in the future treatments, as it helps in reducing injections and also risks of hyper stimulation.  

The matter of  increasing public health concern, as the incidence is highly associated with the metabolic syndrome  was highlighted by Dr.Donna Vine. She is the recipient of McCalla Professorship in Teaching, Service and Research. 

Russian Professor,  L. A. Ivanova did a study on the effect of thioctic acid on PCOS, and it is now available.

We had expert doctors from various fields who emphasized the side effects of PCOS on different parts of the body. The Dermatologist from Sweden, Dr. Maria Palmetun indicated that quality of life is very badly affected by PCOS and the dentist Dr. Ozgun Ozcaka, from Turkey  Spoke about the connection between PCOS and gingival inflammation.

Dr. Awatif Al Bahar, from Dubai Health Authority, UAE,  threw light at the epidemiology of PCOS and the economic cost which it is causing to the healthcare sector. It is shocking  that every year the health insurance companies incur huge costs to cover the direct and indirect  medical expenses related to PCOS ! 

A new era of medicine has started with study of bacteria in our body. Dr. Felice L Gersh from USA gave a wonderful insight into this new topic titled -  The care and feeding of the microbiome: A new approach to lowering the inflammation of PCOS. More DNA exists within us which derives from the trillions of bacteria comprising our microbiome than from our personal genetic DNA. Bad news is that, the standard Western diet, comprising of huge amounts of processed foods, which are nutrient deficient, chemical laden, antibiotic containing and which are devoid of sufficient quantities of both soluble and insoluble fiber, kills rather than supports a healthy microbiome. Women with PCOS frequently experience gastrointestinal problems, have irritable bowel syndrome and tend to develop chronic low grade systemic inflammation as a consequence of the unhealthy state of their gut bacteria.

Exercise is an extraordinarily effective way to reduce systemic inflammation and lower oxidative stress and should be an integral part of every PCOS treatment program, explained Bob tygenhof, the exercise specialist.

Julie Booker, rightly pinpointed that Stress and anxiety have been found to suppress the ovarian and menstrual cycle. She provided a treatment plan including acupuncture, diet, lifestyle, Chinese herbal medicine and supplements.

My presentation on long term managment of PCOS highlighted that Life style changes including diet, exercise and weight loss should precede any medicines. Protocols should be provided to doctors  to assess  cardiovascular disease (CVD) risks. (currently this protocol is not widely followed, although recommended by Royal colleges of London and Australia) Medicines are rarely needed ,as in  gestogens to induce periods atleast 3-4 times a year to reduce risk of endometrial hyperplasia/cancer.

 
Recent studies suggests that Insulin-sensitising agents like metformin, which is commonly prescribed for PCOS does not seem to have any long-term benefits and should be restricted to only diabetic / glucose intolerant PCOS.

Ovulation inducing agents like clomiphene should be used only for  6 to 12 months, as prolonged use of this medicine increases risk of cancer, the option of IVF should be considered after this period.

Laparoscopic ovarian drilling will induce ovulation in 60% of the subjects for 20 years, especially in PCOS patients who are not overweight. Psychological issues are often easily overlooked, problems like depression and anxiety must be screened, assessed and referred to professionals. 

Creating public health awareness on healthy eating and the necessity of regular exercise is very essential and should be included in the school curriculum. Specialised PCOS clinics with a trained team of doctors, dieticians, exercise specialists and counselors is absolutely needed in proper long-term management of PCOS.

Dr. Anita Mani
Infertility Specialist at Gift IVF Centre

anitadane@gmail.com

www.giftivf.com

-----------------------------------------------------------------------------------------------------------------------

Dr. Anita Mani is a renowned infertility specialist in south India with 15 years experience in ART (Assisted Reproductive Technology). Dr. Anita has successfully set up ART hospitals in Cochin and Bangalore,  along with her spouse  Dr. S Mani. She completed MRCOG, from Royal College of Obstetrician and Gynaecologist  London, DFFP from  ART Warwick university and  worked in UK for 5 years. Dr. Anitha believes in scientific and ethical practice and is currently the director of Gift Gyno IVF centre Cochin and  Bangalore.  Apart from advanced laparoscopic surgeries, she is also an expert in various ART techniques including IVF, IUI, ICSI , donor egg / sperm. Her proficiency is in genetic abnormalities and high risk pregnancies.

PCOS Diet

 

"The human body heals itself and nutrition provide the resources to accomplish the task."

An ideal diet plan for the PCOS  not only comprises food;  the timing of meals, frequency and duration of the meals and the cooking methods are also equally important.

Ideally, within thirty minutes of waking up, we need to take some form of food to kick start our metabolism. A well-balanced breakfast is a must, skipping that would be a big NO NO. It is better to eat every 3 to 4 hours, rather than taking infrequent big meals. Sounds good doesn’t it, you need to eat more often if you want to lose weight and control your PCOS.

Eating should not be a hasty affair, take plenty of time, enjoy every bite to savor the goodness and flavor of the delicious food that nature has kindly bestowed upon us (we do not know how long we are going to get this!). To a great extent, digestion should happen in the mouth itself, so make it a point to chew the food properly. The brain takes about twenty minutes to register that stomach is full, hence if you eat quickly you are at the risk of consuming more food than is required. Chances are there that even though your stomach is full you will go on eating, so go slow.

Likewise, it is vital to understand the significance of glycemic index in controlling PCOS. Glycemic index (GI) indicates the level of sugar in blood after food intake. The rate at which blood sugar level shoots up in our body will vary depending on the type of carbohydrates that we eat. The insulin levels in the body are way too high in PCOS, which is the main reason for insulin resistance and high androgens.     (Androgens are male hormones, which are present in normal women in small quantities) PCOS women should eat low glycemic index foods to avoid sudden spurt of blood sugar level. For more info see http://bangaloreivf.blogspot.ae/2014/09/low-glycemic-food-chart-for-pcos.html

Reduce calorie intake if your weight is on the higher side, around 60 % of women with PCOS are overweight and it has been proven that in a significant number of women losing weight lead to reduction of symptoms of PCOS.

Tips

Food should be always eaten fresh – “eat like Chinese, they always take it boiling”.

1. Take natural foods, avoid processed food, limit sugar and sweet intake. (did you know that sugar undergoes lots of chemical treatment before it looks bright white?) 

2. Choose whole grains like boiled rice, whole wheat flour, millets (Ragi), oats etc.

3. Reduce salt intake, this will help reduce the risk of hypertension and other cardiovascular diseases as well.

4. Choose unsaturated fats. Boil, grill, steam, bake and avoid microwaving and frying.

5. Make sure that you are getting enough protein with every meal for controlling PCOS.

      Varieties of food 

     

     a. Green leafy vegetables are very good for you, so when you go for grocery shopping keep an eye for them

    b. Pulses are very good sources of protein and a good low-calorie alternative to the non-vegetarian food.

     c. Whole grains must occupy only a small portion in your meal plate, bulk should be vegetables, salads and pulses.

     

    d. Fish, chicken, lean meat and lean cuts of red meat can be taken in moderation, but they should not be fried in oil.

    

    

    e. Oil can be olive oil or any other plant source oil, essential fatty acids are as important to health as vitamins but should be consumed in moderation. But it should be noted that olive oil is not suited for Indian style of cooking or deep frying as the smoking point is very low, hence is best used in salads.

     Foods to avoid

Sweets and candies are neither good for you nor for the kids. Generally, people gift candies and chocolates to kids as if they are resistant to the bad effects. Please understand that they are bad for everyone, so please stop buying them for kids as well.  

Instead of ice creams, choose fruit platter when you are eating out. Skip the bakery section in supermarkets, so that you are not tempted to  buy cakes, pastries, biscuits or other sweets. Everyone knows that soft drinks and energy drinks are bad for health, but still continue drinking them. Let us save the health of the future generation, don't show your love for your children by buying them chocolates, ice creams or fast food
http://bangaloreivf.blogspot.ae/2017/08/article-on-pcos-causes-symptoms-and.html

Dr. Anita Mani

Infertility Specialist at Gift IVF Centre

anitadane@gmail.com

www.giftivf.com

-------------------------------------------------------------------------------------------------------- 

Dr. Anita Mani is a renowned infertility specialist in south India with 18 years experience in ART (Assisted Reproductive Technology). Dr. Anita has successfully set up ART hospitals in Cochin and Bangalore, along with her spouse  Dr. S Mani. She completed MRCOG, from Royal College of Obstetrician and Gynecologist, London, DFFP from  ART Warwick university and worked in the UK for 5 years. Dr. Anita believes in scientific and ethical practice and is currently the director of Gift Gyno IVF centre and SATYA Ayurvedic Centre, Cochin.  Apart from advanced laparoscopic surgeries, she is also an expert in various ART techniques including IVF, IUI, ICSI, donor egg/sperm. Her proficiency is in genetic abnormalities and high-risk pregnancies.

Low Glycemic Food Chart for PCOS (Poly Cystic Ovarian Syndrome)

LOW GLYCEMIC FOODS CHART TO CONTROL PCOS

Following a low- glycemic diet is beneficial in controlling PCOS and it will also help to maintain optimum sugar level in diabetes patients. Glycemic index measures the rise in the level of blood sugar after the intake of a particular food from the range of 0 to 100.  Intake of some types of  food causes sudden increase in glucose level in blood, while the glucose is released only gradually in some types of food. The former category of food has high glycemic index and the later has low glycemic index. So if you are suffering from PCOS or diabetes,  include food items which contain low glycemic index in your diet. Body takes more time to digest the low glycemic foods, hence  your frequent hunger pangs are kept at bay, which in turn will help in weight lose. Bakery products, colas and other fizzy beverages, refined flour (maida), rice, potato are some of the food items which have high- glycemic index and should be strictly avoided.  
http://bangaloreivf.blogspot.ae/2017/08/article-on-pcos-causes-symptoms-and.html

The Glycemic index ranks carbohydrate foods based on the rate at which they are broken down into glucose. Food with high GI will release too much glucose in the blood stream at a fast rate, which triggers the pancreas to release the hormone, insulin .  Insulin removes the surplus glucose from the blood and lowers the speed at which the body burns fat. A large surge in insulin, caused by eating high-GI foods will start reactions in the body that leave you feeling lethargic, hungry and craving for more sugar.
http://bangaloreivf.blogspot.ae/2015/08/pcos-diet.html

Eating low-GI carbohydrate foods will only cause a steady rise in the level of glucose in the blood, which in turn leads to a small and gentle rise in insulin. Small increases in insulin keeps you feeling full, satiated and energised for hours after eating and also encourage the body to burn fat. Foods which do not contain much carbohydrate  are naturally non glycemic and most of the green vegetables fall in this group. 

To know more about how PCOS affect fertility visit the link http://bangaloreivf.blogspot.ae/2014/08/dr.html

Below is a list of Low glycemic  food items foods  which should be taken in limited quantity.

Whole wheat 

Barley

Pasta

Brown rice 

Rolled Oats (oatmeal)

Sweet Corn

Whole wheat kernals

Bulgar

Linseed

Rye

Nuts and seeds

vegetables

Legumes

Lentils

Chickpeas

Kidney beans

Beans







                 

                                                                     

 Soyabeans
 Soyamilk
 Dairy Foods

 Almond Milk

 Yogurt

 Meats, poultry, fish

 Eggs, tofu

 Cheese

http://bangaloreivf.blogspot.ae/2014/12/soya-too-much-of-good-is-bad.html

FRESH FRUITS

Most common berries

Plums 

Peaches 

Nectarines

Apricots 

Oranges 

Grapefruit 

Pears 

Papaya 

Apples 

Watermelon 

Blueberries 

Pineapple 

DRY FRUITS 

Apples 

Plums (Prunes) 

Apricots 

Peaches 

Pears 

Figs

Dates

Dr. Anita Mani
Infertility Specialist at Gift IVF Centre

anitadane@gmail.com

www.giftivf.com

PCOS (Polycystic ovarian syndrome) is the common reason for Sub Fertility in women

  

Polycystic ovarian syndrome (PCOS) is extremely prevalent among women now and is one of the common reason for  sub fertility in women. It is associated with metabolic disorders and is very much a life style disorder. Human body was originally engineered to be physically active, but with the modern life style, there is minimum physical exertion along with free availability of rich calorific food without any nutritional value. Both  these factors add up and  results in metabolic disorder and high insulin levels in blood. 

PCOS is commonly found in families with diabetes mellitus. The body develops insulin resistance and  alters hormones like LH  and FSH,  which in turn affects normal menstrual cycle in women. High levels of male hormone, androgens are secreted. Follicles  often get arrested half way in development and doesn't develop into  mature follicles that release eggs. If ovulation doesn’t happen,  the normal menstrual cycle is disturbed leading to irregularities or absence of monthly periods.

Patient’s symptoms and appearance can be suggestive. Blood test for LH and FSH ratio can be done, which will be raised in PCOS. 

Symptoms of PCOS are

a.      Irregular or absence of menstruation

b.     Hirsutism - Excessive hair growth on face and body

c.      Acne, oily skin

d.     Weight gain, obesity ( thin PCOS is also quite common )

e.      Lethargy

f.       Hair fall, male pattern baldness

g.      Difficulty in conceiving 

Vaginal ultra sound scan will show the typical pearl necklace pattern (multiple follicles arranged in the periphery of ovary) .

There is no cure for PCOS, but it can be controlled.  Treatment depends on whether you want to get pregnant or not. Insulin resistance and obesity are two primary causes for PCOS.  Healthy diet and regular exercise can definitely help. Reducing weight in obese women  has been often found effective in tackling PCOS.  A number of obese women who lost  5 to 10 percent of their body weight   were found to start ovulating regularly. Yoga is also extremely helpful in controlling PCOS. Metformin  used to treat diabetes can help regulate ovulation in some women. Intake of birth control pills can regulate periods and control release of male hormones. 

To know about low glycemic food which should be taken in condition of PCOS visit http://bangaloreivf.blogspot.ae/2014/09/low-glycemic-food-chart-for-pcos.html

Fertility medicines like clomiphene and gonadotropins can help women to conceive and up to 20 % success can be achieved with medical treatment. Laparoscopic ovarian drilling can give success of around 60% and is very useful in cases of sub fertility. If the above treatments does not work, there are assisted reproductive techniques like IVF, which can help you start a family.

 

Dr. Anita Mani
Infertility Specialist at Gift IVF Centre

anitadane@gmail.com

www.giftivf.com

Dr. Anita Mani is a renowned infertility specialist in south India with 15 years experience in ART (Assisted Reproductive Technology). Dr. Anita has successfully set up ART hospitals in Cochin and Bangalore,  along with her spouse  Dr. S Mani She completed MRCOG, from Royal College of Obstetrician and Gynaecologist  London, DFFP from  ART Warwick university and  worked in UK for 5 years. Dr. Anitha believes in scientific and ethical practice and is currently the director of Gift Gyno IVF centre Cochin and  Bangalore.  Apart from advanced laparoscopic surgeries, she is also an expert in various ART techniques including IVF, IUI, ICSI , donor egg / sperm. Her proficiency is in genetic abnormalities and high risk pregnancies.