PCOS aka Polycystic Ovarian Syndrome - also known as Stein-Leventhal Syndrome, was described officially by Stein and Leventhal in 1935. From then to now, there have been plenty of changes in the definition of it, in the criteria of diagnosing it, and especially many theories about its cause and treatment. But most importantly - one thing still remains true, that PCOS isn’t just a reproductive issue, or an ovarian problem - it is an endocrine pathology, which in simple terms means that it is caused due to imbalance and mismatch of hormones. This blog will discuss the nitty-gritty of PCOS, and the continued series will discuss a little bit on how to deal with the same.

PCOS symptoms and their causes can simple be described as a vicious cycle. Let us break it down a little. Every disease has a ‘criteria’ that it must fulfill, and only then can an individual be diagnosed with that illness. For PCOS, the diagnosis stands on three pillars: Irregular periods, hyperandrogenism, and polycystic ovaries. One needs at least two out of these three symptom patterns to be officially diagnosed with PCOS, let us break down what these three actually are.

1. Irregular periods: Normal periods occur in a pattern, anywhere from every 21 to 35 days. Anytime that the periods ‘skip’ months, or don’t occur for a long time, or if in general - one has less than nine periods in a year; that raises a red flag immediately. Once pregnancy is excluded and tested for, one must immediately go to the doctor to get things worked up. Irregular periods can mean issues with ovulation, hormonal imbalances, problems with the ovaries, or - PCOS.
2. Hyperandrogenism: This is a prominent symptom. Hyperandrogenism means higher levels of ‘male hormones’, usually testosterone in the blood - which causes symptoms like acne, facial/body hair (hirsutism), hair balding, etc. These can be due to many reasons - can be genetic, or can be due to increased insulin in the body - let us get back to this one later.
3. Polycystic ovaries: This is diagnosed by an abdominal or pelvic ultrasound, and generally indicates immature eggs/cysts collecting on the edge of the ovaries - which cause a lack of ovulation, and hence, lack of regular periods.

Now that the triad is out of the way and understood, it is very important to realize that the exact cause of this disorder is unknown, but that doesn’t mean it cannot be taken care of. 

Let us take a look at this simple diagram

So, here we can see how obesity (aka increased fat cells) can act an ‘aggravating’ and developing factor for PCOS, and further worsen the symptoms. In the same way, following can be risk factors for development of PCOS:

1. Family History
2. Obesity
3. Exposure to certain drugs
4. Insulin Resistance

Hence, these conditions can exacerbate either PCOS that is already present, or it can increase the chances of developing PCOS. So, lifestyle changes and medications are focused towards controlling these risk factors, so the symptoms calm themselves.

A very important point to note is that the fact that PCOS is un-curable is a myth. There are many medications and most importantly - lifestyle changes and factors that can influence one’s trajectory of disease progression and pattern with PCOS. But, if it is not addressed and left on its own - it can lead to a plethora of illnesses like 

• Metabolic Syndrome
• Type 2 diabetes
• Cancers
• Infertility
• Liver failure

And to avoid these repercussions, it is very necessary to understand and personalise a long-term life change to inculcate PCOS as a part of your life. The next two blogs in this series will discuss the biggest pillars in the treatment of PCOS - Diet and Exercise. And we will see how both of them when applied the right way are a saving grace for you and your body. Till then, stay safe and stay informed! Happy Pondering!