Understanding PCOS in the Indian Context: Where have we flawed?

 

For a child of twelve, it was merely a sense of relief that her period was not a monthly affair and instead a quarterly ordeal. This just meant the reduced frequency of the nagging fear of stains, the annoying gags to her free movement on the playgrounds, and the worst, the cramps playing pins and needles at points that were beyond what she had experienced of in her body. How this irregularity could possibly turn a lifestyle condition that required correction, often dawns as a late realisation – not just for the patient, but her family too.

Polycystic ovary syndrome (PCOS) or PCOD as it is popularly known is quite a code to crack. With this unwarranted discomfort being a common health condition among a good percentage of women between the age group of twenty and thirty, the term has become quite popular among all age categories of men and women alike. However, there is much ambiguity in the manner it is being dealt with by the patients, the medical practitioners and the family of the patients. From the misinterpretation of the condition as a disease, instilled in minds with the over rated usage of the abbreviation PCOD in place of PCOS (which keeps it contained as a mere syndrome, as what it is) to the irrational belief that PCOS makes a female infertile, the riddles around the enigma that it is turning to be, continues.

The incongruence between the observations of the patients and the doctors who treat it, prompted me to conduct a survey among the female community of varied age groups and to arrange for an interview with a medical practitioner settled and practicing abroad. From the garnered resources, it was quite shocking that many a deep rooted myth abuts the approach towards PCOS.

PCOS was seen to be a more common condition among the age groups between 20 and 30, and more than 81% of them had given consultation a thought only after more than two years of getting their first period. According to most gynecologists, two years is an ideal time frame for the regularizing and normalising of any individual’s period pattern, and hence any diagnosis of PCOS before the prescribed 2 years, need not qualify as a solid confirmation. This is of immense significance, if the girl is put on hormone or contraceptive medications or even metformin at such an early stage with no conclusive confirmation as it could have vicious side-effects on her health, which these medicines have even otherwise, including on the patients.

While most doctors in India have mixed opinions on the probable side effects of these medicines and the often trivialized and negated discomforts of the patients, the situation is quite different. A vast 75 percentage of women diagnose the condition before marriage and are mostly driven to consult a specialised medical practitioner for the same. However, in every 4 in 5 cases, the said consultant would be a gynecologist who may not necessarily be one who is specialised in PCOS or is in the routine of dealing with the case on a regular basis. Most of them even admit the fact that, with the minor uncertainties that prevail in the treatment and causes of the condition, there is as it is much bleakness in our Indian scenario with the understanding and handling of the same.

Plainly putting it, there are arguments for and against the contention that the causes for the condition are purely genetic, as much as there are for the choosing of different treatment practices to tackle the same. There are national and international societies that regularly convene to discuss and issue guidelines on the subject. However, it is high time we come face to face with the fact that PCOS is nothing but a lifestyle disorder peculiar to women that is capable of driving up their sugar levels and increasing the tendency of gestational diabetes or early diabetes in them. Thus this is a lifestyle disorder, capable of manifesting itself as a lifestyle disease, if not given proper care.

When more than 65 percent resort to medication, it is good news that there is a substantial remainder working on their diet, routine and lifestyle patterns. In fact, except for in specific cases of a teenager with severe and excessive facial hair growth or a married woman trying to conceive, there is absolutely no compulsion that medicines should be their go-to. Even with excessive facial hair growth there are other ways you can effectively tackle it with lesser side-effects, alongside altering your diet and exercise routines. Regardless, interestingly enough, most of the Indian female crowd, relying on medicines to deal with PCOS are advised the intake of hormone tablets or oral contraceptives without even a second thought, and metformin and insulin regulators come in picture only when they develop the condition of diabetes. This is common in the case of both the married and unmarried, albeit the contraceptives are particularly done away with if the married were trying.

There are ample international health guidelines and studies which show a direct correlation of the patient’s family history and her chances of developing PCOS, where the prevalence of diabetes is a strong hint pointing at it. Which is why, in most foreign countries, any female of any age category approaching the doctor with skipped cycles, abnormal weight gain or loss, excessive acne or facial hair growth, are not immediately sent for ultrasound, but are asked for their family’s medical history. Once it leans in favour of PCOS, blood tests are conducted and an ultrasound scan is the last step in the process. There are innumerable cases in India where these symptoms immediately and directly trigger the need for ultrasound, and if the condition is not confirmed in the first scan, multiple scans are taken on the patient on her subsequent visits. And amusingly, the scans are conducted even on the patients with the symptoms of multiple period cycles in a month, scanty or excessive bleeding and intense menstrual pains and anaemia, which are in no manner directly related to the condition of PCOS. But seldom are the patients’ family history taken on record and analysis undertaken on the same.

Upon confirmation of the condition, more than 55 per cent confess that their doctor did not or devoted very little time to mention the necessity for altering the lifestyle pattern. That leaves the percentage of the accompanying guardian or partner having received any counseling on the patient’s discomforts at a startling high. When most Indian gynaecologists vehemently deny that the widely prescribed oral contraceptives give you no side effects other than a slight nausea or abdominal bloating, 52 percent of the patients who consume the same claimed that they experienced more discomforts than any relief and 29 percent observed absolutely no change. Which when statistically put shows that 81 percent of them absolutely did not seem to be benefitting from the medication.

The statistics gets further intriguing when we discover that nausea and abdominal bloating that were cited as common side effects were seen only in upto 53 percent while emotional instability, aggravated anxiety and irregular sleeping patterns, which were completely shunned by Indian doctors, were experienced by a population of more than 77 per cent of the consumers of oral contraceptives. The latter side effects have also been confirmed to be true to the contraceptives by most of the foreign societies and institutions who are authorities in the subject.

The need of the hour is a holistic study of women’s physical, mental and social health in purview of PCOS, with due importance given on creating requisite awareness among the both the patients and the families. Although we see much research being undertaken on the containment of the physical discomforts of the condition, the mental and social discomforts of the patients have been blindly sidelined in India. This is an open request to the medical community to open their eyes and facilitate in the smooth transition of the approach towards the condition by the doctors, patients and the society. Let us be aware and not silently bear.