Always a skinny girl, Swati (name changed), a 25-year-old biochemist, started putting on weight in her early twenties. Chalking it down to a slowing metabolism, she didn’t think much of it. Until she missed her period. And missed it again in the following months. After visiting her gynaecologist and undergoing an ultrasound exam, Swati was diagnosed with polycystic ovarian syndrome, or PCOS.
Put simply, PCOS is a metabolic syndrome that manifests in women of childbearing age (between 15-30 years). Its external symptoms include irregular or no period for months, growth of excess facial and body hair, mild to severe acne, and weight gain. Internally, it’s characterised by increased levels of androgens (male hormones) in the body, resistance to insulin and/or multiple cysts (follicles containing immature eggs) on one or both ovaries.
Swati’s blood work bore this out. It confirmed high levels of androgens, leading to hirsutism (excess growth of hair on the female body), and above normal (>100mg/dL) fasting sugar levels, indicating insulin resistance. And Swati is far from alone. It is estimated that PCOS affects 1 in 5 women in India, compared with a global prevalence of 1 in 10.
Women with PCOS are at risk of developing type 2 diabetes, obesity, cardiovascular disorders (CVD) and infertility. And while research is yet to prove exactly why women develop this condition, lifestyle and genetics are considered to be major factors.
But here’s the thing—we don’t know what comes first.
Does weight gain, due to an unhealthy lifestyle, cause insulin resistance that, in turn, leads to the production of excess androgens and irregular menstrual cycles? Or does genetic predisposition to developing insulin resistance lead to a hormonal imbalance that causes women to miss their period and consequently put on weight?
Opinion is divided.
Dr Padmaja Pepalla, for example, believes it is heavily lifestyle related. Poor eating, sleeping and exercise habits, she says, lead to weight gain. Dr Pepalla is a gynaecologist at Padma Hospital in Vadodara.
Dr Maya Hazra agrees that lifestyle plays a major role in the development of PCOS. However, she leans towards genetic predisposition as the primary cause. “There is a definite correlation with diabetes. I have seen women who have a family history (especially mother or maternal aunt) are extremely prone to developing insulin resistance themselves and consequently PCOS,” she says. Dr Hazra has been a practicing obstetrician and gynaecologist (OB/GYN) in Vadodara for the past forty-five years. She has seen PCOS grow its claws over time, with her experiences leading her to believe it is a condition born of diabetes.
Both Pepalla and Hazra, however, are only making educated guesses. The reason could be both or neither, as research doesn’t clearly spell out the cause.