Hidden struggles of PCOS: Bridging modern and alternative approaches

This special report delves into the human anguish endured by those afflicted and seeks the insights of medical professionals, both from the realms of modern medicine and alternative therapies, offering hope to those seeking to regain control of their lives and health.

The impact of menstruation stigma on Nikita Phulwani's PCOS journey

Nikita Phulwani, the Managing Director of By Niggi, an influencer marketing and communications agency, began experiencing symptoms of PCOS at the age of 13 or 14. She postponed seeking medical assistance due to the stigma surrounding discussions about menstruation during that period. Nikita recounted, "I wasn't getting my mensuration regularly, and I suspected I had PCOS three to four months before seeking help. I even remember taking time to confide in my mother about it."

Upon receiving her diagnosis, Nikita felt overwhelmed and anxious. She explained, "Knowing that I had a condition related to my identity as a woman felt like a heavy burden. I struggled with being overweight until the age of 28, and I was obese."

Nikita expressed concerns about how her lifestyle exacerbated her PCOS. She faced weight issues and societal comparisons with her peers. She admitted, "My weight was spiraling out of control, and my PCOS seemed uncontrollable too. I went into a state of denial."

Her treatment initially included contraceptive pills, but she had concerns about their long-term effects and discontinued using them. Doctors consistently advised her to lose weight, which initially appeared daunting. About three years ago, weighing 118.2 kg, Nikita embarked on a fitness journey. She committed to regular workouts (five times a week), adopted a balanced diet, increased her water intake, and practiced stress management. Her efforts produced positive results, with doctors noting a significant reduction in her PCOS symptoms. She proudly shared, "Since my second day of weight training, my period returned regularly."

Nikita emphasized how managing lifestyle factors without medication had reversed her PCOS symptoms. She remarked, "It astonishes me to see how, without the help of any medications and solely by taking care of the fundamentals, I managed to reverse my symptoms. I understand that different women may experience various symptoms and causes, but altering my lifestyle was the most effective approach for me."

To maintain her progress, Nikita remained active, engaging in training five times a week and doing cardio six times a week. She ensured she got 6 to 7 hours of sleep daily, consumed 3 to 5 liters of water, and avoided sugar and gluten. She emphasized her commitment to moving her body at least six times a week, stating, "I train five times and do cardio six times a week."

Living with PCOS: Battling anxiety and depression

Living with polycystic ovarian syndrome (PCOS) goes beyond coping with irregular menstrual cycles, hirsutism, and the looming risk of diabetes. It's not just about managing issues like acne, excessive weight gain, reduced fertility, or hair loss.

For me, the most daunting challenge is summoning the inner strength to confront this condition head-on, starting with the simple act of getting out of bed each morning. On most days, I wake up feeling utterly drained, burdened by a profound sense of hopelessness. I often spend nearly 45 minutes scrolling through negative news and content on my phone, desperately trying to avoid facing the emotional pain that PCOS brings.

In my experience, anxiety and depression are the most insidious and least acknowledged symptoms of PCOS. I received my diagnosis at the age of 14 and have carried this burden for 21 years. There was a period in my mid-20s when I thought I had it under control. I became fixated on exercise and eliminated almost all the foods I loved. During this time, I lost nearly 20 kilograms, which was a tremendous relief given my lifelong struggle with weight issues. Finally, I felt "thin."

However, my ongoing struggle with consistency eventually caught up with me. I began to slacken in my exercise routine and healthy eating habits. Before I knew it, the symptoms started to resurface, gradually regaining their hold on me in 2017-18. It all unfolded so gradually that it wasn't until mid-2022 that I mustered the courage to consult a gynaecologist. This decision was partly spurred by the realization that I had regained the 20 kilograms I had worked so hard to lose, especially after a debilitating leg injury that left me incapacitated for two months.

My initial doctor prescribed birth control medication, and another suggested Metformin, a medicine typically reserved for diabetes patients to improve insulin resistance. I endured it for nearly six months, but it came at the cost of severe acidity and indigestion. At this point, I had tried everything from fat burners to extreme diets, followed by devastating binge-eating sessions.

However, a turning point arrived about a month ago. I had grown tired of pumping myself full of medicines, subjecting myself to starvation, and succumbing to excessive eating, only to remain trapped in a seemingly endless cycle. I yearned for genuine change, and a conversation with another PCOS survivor opened my eyes to the truth: consistency is the key. "That's the only way out," she told me. The knowledge that I wasn't alone, that countless women I knew were battling similar or even more challenging symptoms, ignited hope within me. I'm now working on healing by extending forgiveness to myself and taking one small step forward each day.

Men should be educated about PCOS, and families should provide support

Mary Milan Abrao, an architect based in Dubai, was officially diagnosed with PCOS approximately three years ago. However, she suspects she had been living with it for many years before her medical diagnosis. "I visited several doctors back home in India when I presented them with symptoms that weren't typical for PCOS. I've always had extremely regular menstrual cycles; they occur like clockwork. The doctors always dismissed my concerns," said Mary.

"I've carried extra weight since my youth, and I attributed it to my love for food and lifestyle choices. In my younger years, I didn't notice any significant health problems and ignored the issues," she added.

It wasn't until college that Mary experienced rapid weight gain and skin problems, such as darkening around skin folds. Even then, she assumed it had to do with her dietary and lifestyle choices. However, three years before her formal diagnosis, she gained 16 to 17 kg despite not overeating or making significant changes to her diet. Her other symptoms included hirsutism (excessive hair growth) and severe cramps.

At this point, she decided to consult a doctor. The doctor suspected insulin resistance, which is often associated with PCOS. Tests revealed high insulin resistance levels and the possibility of PCOS, confirmed by an ovarian scan showing cysts. "It was a doctor in Dubai who finally diagnosed it," she said.

Mary's case of PCOS was classified as 'inflammatory' PCOS. "Following my diagnosis, I was prescribed Metformin (a drug given to diabetes patients)," she added. Unfortunately, I developed Irritable Bowel Syndrome (IBS) after taking the medicine, prompting me to explore a more holistic approach to my treatment.

She embarked on a journey to address her weight gain and PCOS symptoms through naturopathy. Her strategies included maintaining a regular sleep schedule, practicing yoga, managing stress, and adopting healthier dietary alternatives, such as cutting out junk food in favor of home-cooked meals.

Mary worked with dietitians and coaches, took supplements, and found relief in walking and light weightlifting. Over the last six months, she has lost 3 to 4 kg. "I felt more content, relaxed, and peaceful," she said, attributing her improved well-being to lifestyle changes. This also helped her realize the connection between her mood swings and her condition. "I would also turn to sugary foods for comfort. This worsened the symptoms as it affected my mental health and confidence," she said.

Mary also stressed the importance of raising awareness about PCOS among men and having supportive family members and partners when dealing with this condition.

Bhavna sought alternative therapy to deal with PCOS

Bhavna Wadhwa, a finance manager at a medical technology company who also operates a home clinic for alternative medicine, turned to alternative therapy to address her PCOS (Polycystic Ovary Syndrome) symptoms.

In 2013, Bhavna first noticed symptoms of PCOS, including an irregular menstrual cycle. Her doctors initially recommended Metformin and other medications to manage insulin resistance. However, she was unable to tolerate pills and desired a more natural approach.

Bhavna experienced classic PCOS symptoms such as hair loss, weight gain, and mood swings, which left her feeling uncomfortable and unhappy with her body. She described the sensation as feeling heavy and burdened.

Although Bhavna had the support of her family and friends, coping with PCOS proved challenging. She believed that her parents and previous generations didn't fully comprehend the condition. This lack of understanding was somewhat beneficial, but the medical community often portrayed it as a lifelong disease.

Bhavna's breakthrough came through alternative therapy and a PCOS-tailored diet recommended by a dietitian in Dubai. She combined these approaches, making gradual lifestyle adjustments that significantly improved her symptoms, including mood swings and ovarian cysts. She emphasized that it is possible for PCOS patients to enjoy certain foods like gluten and dairy in moderation, dispelling common fears associated with these foods.

To manage insulin levels and sugar cravings, Bhavna discovered healthier alternatives, such as snacking on homemade chocolate bars. She adopted mindful eating practices, consuming five meals daily, including breakfast, lunch, dinner, and snacks. Additionally, she stressed the importance of maintaining adequate vitamin D levels and understanding that intense workouts may not always be suitable for PCOS patients. Instead, she found slow-paced, light-weight exercises, walks, and swimming to be more effective.

Bhavna stated, "PCOS is not a lifelong condition. Today, my body functions better than clockwork. I encourage people to explore alternative remedies and gain a deeper understanding of their bodies. I firmly believe in the power of conscious choices." As a licensed BodyTalk practitioner, she now helps women make positive lifestyle changes to enhance their health and quality of life.

What is PCOS, and how is it diagnosed?

PCOS is a complex endocrine condition affecting nearly 5% to 10% of women of childbearing age.

The incidence of PCOS is on the rise due to current lifestyle and stress. Having polycystic ovaries on an ultrasound scan doesn't necessarily mean it's PCOS.

A diagnosis of PCOS is made when two out of the following three criteria are present:

• Missed periods, irregular periods, or very light periods.
• Increased facial or body hair and/or blood tests indicating higher testosterone levels than normal.
• An ultrasound scan showing polycystic ovaries.

What are the common symptoms of PCOS, and how can they vary among individuals?

PCOS can manifest with a range of clinical presentations affecting menstrual periods, fertility, hormones, and physical appearance.

Common symptoms of PCOS include:

• Irregular menstrual cycles.
• Excess facial and body hair growth (hirsutism).
• Acne or oily skin.
• Male pattern baldness or hair thinning.
• Weight gain or obesity.
• Infertility.
• Acanthosis Nigricans: Darkening of skin in areas like the neck, armpits, and under the breasts.

What are the potential long-term health risks associated with PCOS?

PCOS is associated with obesity and increased insulin resistance, increasing the risk of diabetes, gestational diabetes (during pregnancy), hypertension, and heart diseases. Women with PCOS also have a higher risk of endometrial cancer, various mental health conditions (depression, anxiety, mood swings), obstructive sleep apnea (OSA), and excessive daytime sleepiness (EDS).

Are there different types or subtypes of PCOS, and how do they differ?

Insulin-resistant PCOS: The most common type, often linked to factors like smoking, sugar intake, pollution, and transfats. High insulin levels hinder ovulation and trigger excess testosterone production.

Pill-induced PCOS: The second most common type, caused by birth control pills suppressing ovulation. Some women may not resume ovulation for months or years after discontinuing the pill.

Inflammatory PCOS: Inflammation prevents ovulation, disrupts hormones, and leads to androgen production. Stress, environmental toxins, and inflammatory diets (e.g., gluten) contribute to this type.

Hidden PCOS: A simpler form of PCOS that resolves when the underlying cause is addressed. Causes include thyroid disease, iodine deficiency, a vegetarian diet (resulting in zinc deficiency), and artificial sweeteners.

What lifestyle changes can help manage PCOS symptoms, such as diet and exercise?

Exercise and a weight loss-focused diet can lower insulin and androgen levels, potentially restoring ovulation. Incorporate complex carbohydrates like peas, lentils, quinoa, and fibre-rich foods like fruits and vegetables into your diet. Limit or eliminate simple carbohydrates like white bread, breakfast cereals, and pasta.

Various exercises, including strength training, cardio, yoga, Pilates, or tai chi, can promote overall health and PCOS recovery. High-intensity interval training (HIIT) can help with fat-burning and insulin resistance. Customize your exercise regimen based on your goals and capabilities.

What’s the difference between PCOD and PCOS?

Polycystic Ovary Disease (PCOD)

"Polycystic Ovary Disease (PCOD) is a condition in which the ovaries produce an excessive number of immature follicles or eggs that later develop into cysts. This can lead to anovulation and infertility. The main contributing factors are poor lifestyle choices, obesity, stress, and hormonal changes. Fortunately, PCOD can be managed and controlled through lifestyle changes and weight loss."

Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) is a metabolic disorder characterized by the overproduction of androgenic (male) hormones by the ovaries. This can result in anovulation, increased hair growth, acne, and in the long term, may lead to conditions such as heart disease, diabetes, depression, non-alcoholic hepatitis, sleep apnea, and even endometrial cancer. Considering its potential severity, lifestyle changes, as mentioned above, can also play a significant role in managing PCOS.”

Available medical treatments for PCOS and how they work

Polycystic ovary syndrome (PCOS) is a condition that can lead to irregular periods, acne, excess facial hair, or hair loss from the head.

Medical Treatments for PCOS

Oral contraceptive pills: These can regulate the menstrual cycle and reduce androgen levels.
Anti-androgen drugs: These can help reduce excessive hair growth and acne.
Metformin: This medication improves insulin resistance, which is often associated with PCOS.
Ovulation induction: This treatment may be prescribed to stimulate ovulation in women with PCOS who want to conceive.
Lifestyle changes: Dietary modifications, exercise, and weight management are recommended to improve insulin sensitivity and overall health.

How does PCOS affect fertility, and what options are available for women with PCOS who want to conceive?

PCOS can result in irregular or absent menstrual cycles, making it challenging to conceive naturally.

Fertility options for women with PCOS

Ovulation induction medications: Medications like clomiphene or letrozole are used to induce ovulation.
Intrauterine insemination (IUI): This procedure can enhance the chances of conception.
In vitro fertilization (IVF): IVF may be considered if other treatments have not been successful.
Lifestyle modifications: Weight loss and lifestyle changes can improve fertility by addressing insulin resistance.

What role does hormone regulation play in PCOS, and how can it be managed?

Managing insulin resistance through lifestyle changes and medications like metformin can help normalise hormone levels. Regulating hormones can reduce the risk of endometrial cancer and correct irregular bleeding, excess hair growth, and acne.

Are there any recent advancements or research findings related to PCOS that patients should be aware of?

Ongoing research in PCOS aims to gain a deeper understanding of its underlying causes and develop more targeted treatments. However, no groundbreaking discoveries have been made recently that can entirely revolutionise the way patients perceive PCOS.

Psychological impact of PCOS

Polycystic Ovary Syndrome (PCOS) can lead to a wide range of psychological symptoms, including anxiety, depression, mood swings, and low self-esteem. PCOS affects everything from one's self-conception and identity to social relationships, intimacy, and sexuality, according to Dr Mohammed Yousef, a Specialist Psychiatrist.

Mood swings can feel like rapidly fluctuating emotions, such as irritability, temper issues, sadness, and anxiety, all resulting from hormonal imbalances. There is a substantial body of scientific evidence linking mood swings to hormonal imbalances. The Psychiatrist, working at the Aster Clinic in Dubai, explained that anxiety, depression, and mood swings can be attributed to decreased serotonin levels in the brain.

Psychological issues associated with PCOS, such as anxiety, depression, mood swings, and low self-esteem, can be effectively managed through psychological treatments like relaxation techniques, cognitive-behaviour therapy (CBT), counselling, or psychotherapy. Yoga and meditation can also provide some relief. If none of these treatments proves effective, medications such as anxiolytics, antidepressants, and mood stabilizers can be considered. Combining medication with psychological treatments is often the most effective approach, Dr Yousef said.

How Ayurveda can help manage PCOS

An increasing number of women in the UAE who suffer from PCOS are turning to alternative medicine, including Ayurveda, for their treatment. The frequency of PCOS diagnoses has also risen recently, with some cases even affecting girls in the pre-menarche stage who show symptoms of insulin resistance.

How Ayurveda approaches hormonal balance and regulation in PCOS cases

While most PCOS cases involve overweight individuals, a small proportion of patients have a normal body mass index, making diagnosis and treatment more challenging. In cases of lean PCOS with irregular periods, we induce menstruation using ghee-based preparations. Stress management and attaining hormonal homeostasis are also given due importance.

In obese PCOS cases, the focus is on metabolic correction, weight management and insulin resistance correction. We address these cases through treatments such as Panchakarma (personalised purificatory therapies/ detox therapies) along with oral medicines. Detox therapies include vamanam (medically induced emesis), virechanam (purgation), snehavasti (oil enema), kashaya vasti (decoction enema) and nasya (nasal instillation of medicines). Along with the regularisation of menstruation, Ayurveda also places significant importance on ovulation and the quality of ova.

What lifestyle modifications and diet are beneficial for PCOS according to Ayurveda?

Regarding diet during Ayurvedic treatment, patients are advised to reduce carbohydrate intake and avoid milk due to the presence of insulin growth factors in it. Excessive meat consumption, processed and canned foods, and junk food should also be avoided. Limiting sugar intake is crucial. Instead, we recommend incorporating horse gram, sesame seeds, sesame oil, garlic, fenugreek, asafoetida, and jaggery into the diet. Yoga is highly recommended, focusing on asanas that target the lower abdomen.

Are there specific guidelines or practices in Ayurveda for long-term PCOS prevention?

Individuals who are mildly overweight may receive medication for approximately three cycles alongside lifestyle modifications. However, relying on medication for a lifetime is generally unsustainable. In such cases, an alternative approach like Panchakarma may be considered after some time, the duration of which depends on the severity of symptoms.

Many individuals effectively manage their PCOS for several years by adopting a clean lifestyle and dietary regimen. This includes maintaining an active lifestyle, ensuring adequate water intake, maintaining a healthy weight and hormonal balance. These changes help reduce the stress associated with PCOS, as women often experience elevated stress levels over time.

How does Traditional Chinese Medicine diagnose PCOS and what are the key patterns or imbalances associated with it?

Traditional Chinese Medicine (TCM) approaches the diagnosis of Polycystic Ovary Syndrome (PCOS) by considering a person's overall health and looking for patterns of disharmony in the body. TCM doesn't directly diagnose PCOS as a Western medical doctor would but instead identifies patterns and imbalances that may contribute to the condition.

Can you recommend specific dietary guidelines based on TCM principles to help manage PCOS symptoms?

Traditional Chinese Medicine (TCM) dietary guidelines for managing PCOS symptoms focus on promoting balance in the body and addressing the specific patterns and imbalances associated with PCOS. Here are some general dietary recommendations based on TCM principles:

1. Balance Yin and Yang
(Balancing Yin and Yang involves harmonizing opposing forces or energies in your life to achieve equilibrium. It's about finding a middle ground between passive and active, dark and light, rest and activity, and other opposing aspects to promote overall well-being and harmony.)
2. Whole foods
3. Moderate protein
4. Healthy fats
5. Limit dairy
6. Low-glycemic carbohydrates
7. Herbal teas
8. Avoid cold and raw foods
9. Mindful eating
10. Hydration

What acupuncture points or acupuncture protocols are commonly used in TCM for addressing PCOS?

Acupuncture is a commonly used Traditional Chinese Medicine (TCM) therapy for addressing PCOS (Polycystic Ovary Syndrome). Acupuncture points and protocols can vary depending on an individual's specific patterns and imbalances, but here are some commonly used acupuncture points and protocols for managing PCOS:

1. Spleen and kidney points
2. Liver points
3. Conception Vessel (Ren Mai) points
4. Governing Vessel (Du Mai) points
5. Lower abdominal points
6. Auricular acupuncture
7. Moxibustion
8. Electroacupuncture
9. Individualized treatment

Are there specific lifestyle recommendations, such as Qi Gong or Tai Chi exercises, that can support PCOS management by TCM principles?

Traditional Chinese Medicine (TCM) offers various lifestyle recommendations that can potentially support the management of Polycystic Ovary Syndrome (PCOS). These recommendations are often tailored to the individual's constitution and may include:

1. Dietary modifications
2. Exercise
3. Stress management
4. Acupuncture
5. Herbal medicine
6. Sleep
7. Weight management
8. Regular routine

Can TCM help with regulating menstrual cycles and addressing fertility issues often associated with PCOS?

Traditional Chinese Medicine (TCM) can be a helpful complementary approach for regulating menstrual cycles and addressing fertility issues often associated with Polycystic Ovary Syndrome (PCOS).

Here's how TCM may assist in these areas:

1. Balancing Hormones
2. Ovulation Induction
3. Improving Blood Flow
4. Reducing Stress
5. Dietary Guidance
6. Lifestyle Adjustments
7. Personalized Treatment

Are there any TCM strategies for the long-term prevention of PCOS-related complications?

Traditional Chinese Medicine (TCM) strategies can be employed for the long-term prevention of complications associated with Polycystic Ovary Syndrome (PCOS). These strategies aim to address the underlying imbalances in the body that contribute to PCOS and promote overall health.

Here are some TCM approaches for long-term prevention:

1. Dietary guidance
• Consuming foods that nourish Yin and Qi, such as leafy greens, whole grains, and legumes.
• Avoiding excessive consumption of greasy, spicy, or sugary foods.
• Incorporating herbal teas like spearmint or cinnamon, may have beneficial effects on hormonal balance.
2. Regular exercise
3. Stress management
4. Acupuncture maintenance
5. Herbal medicine
6. Lifestyle habits
7. Regular check-ups
8. Weight management

How can homoeopathy help in managing the symptoms of PCOS?

The homoeopathic approach is not about managing a disorder; it is about finding the cause and restoring the body's normal functioning. That is the primary aim of the treatment, as opposed to just managing certain associated symptoms of this complex disorder. In other words, it aims for a cure. A holistic analysis of all aspects of the patient reveals the factors leading to this complex hormonal disorder.

Once identified, these factors are addressed using homoeopathic remedies that stimulate the body to reverse the disorder and restore normal healthy function.

What is the expected timeline for seeing improvements in PCOS symptoms with homoeopathic treatment?

Patients usually start seeing changes in a few months. Achieving a lasting and permanent restoration of health may take up to a couple of years, depending on factors like age, lifestyle, and genetic background.

Can homoeopathy address the underlying hormonal imbalance associated with PCOS?

Homeopathic remedies differ from conventional medications in addressing PCOS. The traditional approach aims to oppose the results of a disorder or dysfunction, while the homoeopathic practice is to stimulate the body to restore normal natural functioning. While homoeopathy is suitable for all individuals with PCOS, its effectiveness depends on their ability to self-heal.

Is homoeopathy a suitable approach for all individuals with PCOS, or are there specific criteria for determining its effectiveness?

People with a strong healing ability respond rapidly to energetic homoeopathic doses and show rapid improvements. If general health or lifestyle is poor, effectiveness reduces, as homoeopathic remedies rely on the body's ability to heal itself.

Are there any precautions or contraindications to consider when using homoeopathic remedies alongside other treatments or medications for PCOS?

When using homoeopathic remedies alongside other PCOS treatments or medications, patients must remember that there are no contraindications to stimulating the body's most precious resource: self-healing. Other medications only interfere with natural healing due to their side effects.

Regarding dietary or lifestyle recommendations, homoeopathy patients need to change their diet and lifestyle, with the most common change being the elimination of all dairy, sugar, and processed foods.

Importance of seeking professional medical guidance

While it is essential to empower oneself with knowledge about PCOS, it is equally imperative to stress the importance of seeking professional medical guidance. Self-medication or unverified treatments can potentially exacerbate symptoms and lead to unforeseen complications.