Dr Santanu Acharya is a consultant gynaecologist & obstetrician, Person Responsible, for Ayrshire Fertility Unit, University Hospital Crosshouse, Scotland. He is a member of the National Fertility group, the Scottish government’s policy-making body and current Chair for the Primary – Secondary care interface of Fertility Scotland National Network. He is the Honorary Clinical Associate Professor, the University of Glasgow. He holds key positions at the Royal College of Obstetricians & Gynaecologists and the General Medical Council. He has co-authored several papers in international peer-reviewed journals and is the Research Champion for the Scottish NRS Reproductive Health. He is passionate about global health and was bestowed with the Paul Harris Fellowship, by Rotary International for his contribution towards the improvement of women’s health in the developing world. He is the ambassador of the Scottish charity PCOS Relief (https://pcosrelief.org/) and was recently invited to speak at the Scottish parliament on PCOS.
He exclusively spoke to the newsweekly about rising cases of PCOS in the community.
1) How would you describe PCOS in simple terms for our readers, especially those who may not know that it is not particularly a menstrual disorder?
PCOS is the most common hormone-related disorder in women of reproductive age where the ovaries produce an abnormal amount of androgens, a male sex hormone usually present in women in small amounts. High levels of androgens can cause irregular periods, excessive growth of male-pattern body hair or thinning, weight gain, acne and fertility concerns. It is not restricted to only the reproductive years of the woman but can manifest in later life in the form of metabolic syndrome, type 2 diabetes, cardiovascular disease and psychological issues. Presentation can also vary across the life cycle. Hyperandrogenic features are most often common in adolescents, whereas fertility issues are more prominent among women in their 20-30s and metabolic challenges mostly have their effects in later years.
2) What is the root cause of PCOS?
We do not know yet what is the root cause of PCOS. Since PCOS tends to run in families, the syndrome is probably caused, at least in part, by a change in one or more genes. Many women with PCOS have insulin resistance. This means the body can't use insulin well. Insulin levels build up in the body and may cause higher androgen levels. Obesity can also increase insulin levels and make PCOS symptoms worse.
3) It is a common notion that food habits govern the intensity of PCOS. Are they the prime cause of triggering it?
No known cause could trigger PCOS, however, the symptoms tend to worsen with weight gain. Even 5% weight loss can regulate the periods. Many women with PCOS state that they exercise more and eat less than everyone else they know, and still the weight sticks on. That’s not to say they can’t shed weight; often, patients have been on a successful program in the past. What’s clear, though, is that the idea that weight loss is simply calories in versus calories out is oversimplified. For example, the gut flora may be different in women with PCOS, which can play a role in metabolism. Also, more severe the insulin resistance, the more difficult it may be to achieve weight loss. There is no evidence to support any one type of diet over another. The right diet for an individual is one that is practical, sustainable and compatible with her lifestyle. It is sensible to keep carbohydrate content down and to avoid fatty foods. It is often helpful to sit down with a dietician to work out the best diet.
4) How can Asian households identify early signs of PCOS in their child?
Although 70 % of cases of PCOS remain undiagnosed and it can take a long time to establish the diagnosis, a key sign of PCOS is irregular periods or missed periods. The effects of PCOS on the ovaries can make a girl stop ovulating. PCOS cannot be diagnosed until 2–3 years after a girl's first menstrual cycle because it can take up to 2 years after the first period for any girl's cycle to become regular. Moreover, obesity can mimic many of the symptoms of PCOS. Also, ultrasound scans can falsely overdiagnose PCOS before the age of 20 years.
5) What can be done at a primary level to help a girl/woman manage PCOS?
Although PCOS doesn’t have a cure, the single most important intervention in symptomatic women is to lose weight, if they are overweight. A healthy lifestyle with an appropriate diet and exercise can keep the symptoms at bay.
6) Is PCOS curable?
There's no cure for PCOS, but the symptoms can be treated. However, if a woman with PCOS is overweight, losing weight and eating a healthy, balanced diet can make some symptoms better. Medicines are also available to treat symptoms such as excessive hair growth, irregular periods and fertility problems.
7) What are the myths you would like to bust?
There are several myths surrounding this common condition.
1. I have ‘cysts’ in my ovaries – PCOS is a misnomer. There are usually no cysts in the ovaries. Follicles are fluid-filled sacs in the ovary that contain eggs. The number of these follicles (cysts) in women with PCOS is more than other women of her age.
2. Ultrasound scan is required to diagnose PCOS – A scan is not required if symptoms of irregular cycles and evidence of androgen excess are proven. Indeed women with PCOS can have normal ovaries and all women with polycystic ovaries do not necessarily have PCOS.
3. My chronic pain in the tummy is due to PCOS – usually abdominal pain is not associated with PCOS unless the periods are heavy.
4. I can’t get pregnant since I have PCOS – Many women with PCOS especially if they have periods albeit irregular, can conceive without needing any help.
5. I have normal weight so PCOS is ruled out – 60% of women with PCOS can be obese ie many women can be of normal weight and indeed can have quite severe PCOS.
8) What is the current data indicating when it comes to PCOS in South Asians?
PCOS is a chronic condition that affects 1 in 8 women globally but disproportionately more from South Asian descent. South Asians with PCOS have a higher degree of male-pattern hair growth, infertility and acne; and experience lower live birth rates even following in-vitro fertilisation. Many families tell girls to keep it to themselves due to what the condition could mean for their fertility — and, ultimately, her desirability as a partner or wife. The stigma attached to infertility can be devastating and can cause severe mental health issues.
