PCOS

“Ugh, me too”

Polycystic Ovarian Syndrome, or PCOS, is a complex hormonal disorder which affects about 1 in 5 cis women in India. Ever since I was diagnosed with PCOS as a teenager, I’ve come across a surprisingly large number of peers/colleagues who have been diagnosed with it. PCOS manifests in a myriad of ways, affecting each individual who has it to differing extents. Even though it has become increasingly common, it’s still widely misunderstood, or simply not understood. Let’s fix that, shall we?

But first, let’s take a step back and look at what is supposed to happen during the menstrual cycle.

The menstrual cycle is regulated by hormones: primarily estrogen and progesterone (the ‘female’ hormones), and androgen (the ‘male’ one).

In week 1, the blood and tissue lining of the uterus breaks down and leaves the body as period* discharge. This may last for 3-8 days.

All hormone levels are low at this time, and the reduced amount of estrogen may make us irritable or low. Meanwhile, little fluid-filled pockets called ‘follicles’ develop in our ovaries, each one containing an egg. 

Of these, The Chosen One, is nudged on by estrogen to complete its journey as an egg, while the others are reabsorbed by the ovaries. 

In week 2, estrogen levels rise, restoring our ‘feel-good’ endorphins and prepping our uterus walls for a potential baby with blood-filled tissue. Estrogen is at its peak around day 14, and that growing follicle erupts to reveal a shiny new egg. This is the day of ‘ovulation’. 

In week 3, the egg proceeds towards the uterus. Progesterone is released at this stage, helping the uterine walls thicken with nutrition and resources for the egg, should it be fertilised by sperm.

Finally, in week 4, if the egg hasn’t fertilised with some spunky sperm, our estrogen and progesterone levels drop suddenly (hello, mood-swings and PMS). This is offset by tiny amounts of androgen which are released around this time as well. 

And, repeat.

Deviations from this expected monthly cycle could point to PCOS.  

PCOS affects the ovaries - those paired organs that produce estrogen and progesterone. When needed, they also secrete small amounts of androgen and testosterone.

In PCOS, these hormone levels are imbalanced, throwing the regular 28-day menstrual cycle off whack.

Periods become irregular or may not come at all. The ovaries collect fluid in and around their developing follicles, forming cysts. ‘Polycystic’ means ‘many cysts’, and these collections become problematic over time. Because of this, the cysterhood of eggs stick together and may not release into the uterus in a timely manner.

When ovulation doesn’t occur, levels of estrogen, progesterone and other regulatory hormones remain low. The amount of each hormone released may vary from month to month, making periods, mental and physical health, and ovulation unpredictable.

‘S’ for Syndrome

PCOS is a neatly-wrapped package of symptoms. Apart from irregular cycles, it could manifest as acne, hair loss, weight gain, facial hair or the inability to conceive. 

However, this doesn't mean every individual has to put up with them all. I have to deal with weight gain, hair loss and severe cramping regardless of whether an egg descends from my ovaries that month or not.

You may break out with acne despite being twenty years out of your teenager phase or suddenly lose a bunch of weight. Fact of the matter is, we don't always know what to expect either.

PCOS is a lifestyle, not just a monthly bother. 

While our reproductive organs are see-sawing on imbalanced hormones, we may wallow in confusion and disorientation. PCOS causes mental and physiological stress, since the body is constantly trying to cope with unpredictable cycles, fluctuations and discomfort. In addition, it leaves us vulnerable to depression, anxiety and eating disorders - paving the way to obesity, heart disease or diabetes. 

So, is this it? Are we all doomed to unpredictable irregularity?

Thankfully, no.

PCOS affects each person differently and it is challenging to find universal symptom descriptions online - or even the right combination - to fit everything you're going through perfectly. 

While it’s tempting to rely on Google searches, only a gynecologist can listen to your woes, look you in the ovaries and assure you that it'll be alright. Despite being a problematic way of life, PCOS can be managed through a stringent healthy lifestyle and customised medication as needed.

PCOS best practices

How do I love my body when it feels like it doesn’t love me?

• Monitor your periods and health. Use a notebook, calendar or phone apps like Clue, Flo and Ovia to keep track of your cycle, its duration each month and its predictability.
• Find a well-recommended, non-judgemental gynaecologist. Set up at least one visit every six months for routine check ups.
• Don’t self-diagnose or go down online rabbit holes. If you notice any irregularities in your cycles, visit your gynaecologist and take their guidance on how to proceed.
• Make time for routine exercise and avoid highly-processed packaged foods. Maintain a balanced diet and/or visit a nutritionist if you’re not sure what works best for you.
• Don’t self-medicate.

PCOS is manageable. It can be contained and brought under control with some self-love, care and attention.

Be kind to yourself and don’t let this syndrome define who you are or what you’re capable of.

On the flip side, try not to define your self worth based on other people's needs for active movement, rest, or medication.

Let your body tell you what's best for you.

Nobody knows it like you do.