There are 3 things that cannot be hidden for long: the moon, the sun,
and the truth about PCOS.
BY: FIN RAMLI, BEBE NURFIQAH, SITI QANITAH KHAN
“The knowledge on PCOS was not that prevalent even among doctors. It is a very common hormonal condition that affects women all over the world but we weren’t taught a lot about it in medical school”
National University Hospital of Singapore’s (NUHS) gynaecologist, Dr. Anupriya Arjawal was just in her 20s when she found out she had Polycystic Ovarian Syndrome (PCOs). It is the most common endocrine disorder that is characterised by chronic anovulation, hyperandrogenism (an influx of male hormones) and polycystic ovaries.
Being someone who was studying the medicine field, Dr. Anupriya realised there was not much information regarding PCOs. Since then, it had prompted her to research more and help women who face PCOs
Estimates suggested that 1 in 10 women in the reproductive age globally suffers from PCOS. A survey of 100 women between the ages of 18 to 45 years old reveals that they unanimously agree on the importance of caring for their reproductive health. However, 78 of them do not go for women’s health check-ups thinking that there is ‘nothing wrong with them’. Do they walk their talk?
As with most underdiagnosed conditions, it comes with a lack of awareness. What makes things even more difficult is the variability and vagueness of symptoms in those living with the condition. Despite the name, not all women with PCOS have cysts in their ovaries and not all women who have multiple cysts have PCOS.
“Women who are obese have a higher risk of suffering from this problem, and because obesity is getting more, and more common, the condition is hence getting more prevalent,” added Dr. Anupriya. “NUHS sees at least 1000 cases of PCOS a year.”
No two women have the same set of symptoms and it can be quite hard to make a call in the end because each patient's symptoms are so varied. Some symptoms are mild, while others are extreme.
For the young Dr. Anupriya, battling with her own self-esteem was one of the greatest issues. Being at the more extreme spectrum of PCOS, she had a lot of facial hair. Thanks to the high levels of male hormones in women with the condition, one of the most common side effects of PCOS is the growth of dark hair on the face and body.
“I wouldn’t go out in the sun with people because of all the chemicals and bleach I had to use,” she shared, noting that getting the laser treatment to control her facial hair growth changed her life.
Some women, however, are more fortunate. Republic Polytechnic student, Nurul Farahin, 21, said: “When my period didn’t stop for over a month, I decided it was time for me to go for a check-up at Kandang Kerbau Hospital (KKH). I was sent for a blood test and a pelvic ultrasound, and while I have no cyst in my ovaries, I had been diagnosed with PCOS.”
“I have never heard of that term, so when I was told it was because I had ‘too many male hormones’ I was shocked. I think I even half-laughed. It was like being thrown a curveball and I didn’t know how to react, but it certainly felt like an attack on my womanhood.”
Unlike Dr. Anupriya, she did not suffer from excess hair growth.
“I noticed a lot of my hair falling even after using multiple hair products and supplements. I’m not balding now but it definitely surprised me as of how I’m not bald yet,” Nurul joked.
Androgenic Alopecia (AGA) is the thinning of scalp hair. It is caused by the same thing that causes men to get a receding hairline - androgen hormones. When hair follicles are sensitive to androgens they can decrease the growth of hair on the scalp and increase the growth of hair on a woman’s body.
This is especially true if she has excessive amounts of it. Between 16% and 36% of women with PCOS experience AGA but it is a less common symptom than menstrual disorders, hirsutism or acne. The big difference between hair loss in a male and androgenetic alopecia in women with PCOS is that the hair follicles remain alive in those women.
Weight Loss in PCOS
“Unfortunately, even now, after so many years of medical research, there is no real cure for PCOS,” Dr. Anupriya shared. “Currently we’re just doing symptom management. But because 2 out 3 PCOS patients are obese, I would say with weight management, a lot of these symptoms can be fixed.”
The 46-year-old gynae suggested for women with PCOS to consider omitting large amounts of carbohydrates from their diet. “When a person with PCOS takes carbs, she is not able to digest and metabolises it well, causing an excess of insulin. Unused insulin will then start resulting in excess of male hormones which caused the vicious cycle in women to not ovulate.
“She (referring to a woman with PCOS) will tend to put on more weight than other women because obviously, men are heavier (than women),” she clarified. “they are able to cut down on the carbohydrates, then that will result in the quickest weight loss.” Since her diagnose over 20 years ago, Dr Anupriya has stopped eating excess carbs and focused on choosing healthier alternatives like quinoa and salads. I can’t remember when was the last time I had rice.”
" For me, I just started working out more often and eating organic. My gynae told me to quit eating too many meats because animal protein may contain hormones that could further cause hormonal imbalance in my own body,” said the Year 3 Mass Communication student. Because there is no cure to PCOS, weight loss can only help restore the normal functions of the ovaries and result in normal hormone production, hence controlling the condition from deteriorating further to more serious cases like Endometriosis and cervical cancer.
“The usual age for cancer of the uterus is about 50 to 60 years old. However, women with PCOS may have cancer as young as 25 years old. I had a patient who didn’t seek any treatment earlier and eventually she was diagnosed with cervical cancer at 25,” the gynaecologist shared. To make matters worse, passive mentality towards (hormonal) medication is what resulted in cases going unreported. “Awareness is an issue. As a consequence, women who are not able to correct their bad lifestyle habits just end up with more and more complications and problems.”
Finding Hope in Darkness
While PCOS is a highly under-researched syndrome, women with PCOS do not have to suffer alone. Singapore Motherhood is a support group for women of all ages to come together and share their stories and tips to those who are new with their condition.
With a total of over 713 members, this local support group of all races is there to help those who are in need. Giving them motivations through forums by sharing their experience and guiding them to a much positive life. Most of these women include those who have difficulty conceiving.
PCOS is one of the leading causes of infertility in women, but aspiring mothers might find comfort in Dr. Anupriya’s words who is now a mother of two: “I tell my patients who come to see me for PCOS, that if I am allowed to choose which one fertility condition, I would choose PCOS. Because the majority, maybe 80 to 90% of women with PCOS will eventually with treatment be able to get pregnant.”
“I was among the lucky ones. I didn’t need very invasive treatments and I managed to get pregnant with some tablets. To me, a significant proportion of women who have PCOS and gets pregnant once, often fertility does become pretty okay. You don’t have to keep going (for treatments).”
Most sufferers of PCOS, including Dr. Anupriya and Nurul Farahin, rely on birth control pills to help regulate their menses and manage hormonal imbalance. Women who are trying to conceive in the future and have been on the Pills for long do not have to worry as they do not cause birth defects or affect the health of future children.
“Until the time you want to have a baby, I suppose you should be on your birth control pill. Once you stop, you must see whether you are able to get pregnant within six months. If you get a regular period, you can give yourself 6 to 9 months to try naturally. If you’re not able to get pregnant within that 6 to 9 month or your period is still very irregular after stopping the pill, then it would be good to seek medical attention. With some help, it is very likely you would be able to get pregnant.”
Dr. Anupriya’s tip for women who plan on being mothers one day is to not delay your childbearing age too late and to have a baby early – by the late 20s or early 30s at most.
When asked about what shy women can do to self-check before seeing a specialist, the gynae said: “Look out for hair in the moustache and beard area, balding from the temples or hair around the nipples or the midline of the body and the inner side of the thighs are some tell-tale signs of PCOS.”
Since the cause of PCOS remains a blur and it can either be through genetic or a result of the environmental factor, the NUHS gynae urged women who have irregular menses – periods that do not regularly occur between 4 to 6 weeks and unnatural hair growth to seek medical attention as soon as possible.
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