Polycystic ovarian syndrome (PCOS)a leading cause of infertilityaffects some 35 per cent of women in their reproductive years and more than 90 per cent of obese women. The incidence of PCOS is rising,perhaps due to changing lifestyles,particularly,altered diet and exercise patterns. Its primary cause remains unclear. Young women who get diagnosed with PCOS commonly seek medical attention because of irregular menstrual periods,missed periods,obesity,infertility,acne,excessive hair growth and thinning of hair on the scalp. Symptoms begin to show up around puberty and start of menstruation. However,many do not develop symptoms until their mid 20s. Symptoms vary with different ethnic groups. In the last decade,it has been shown that PCOS is an insulin-resistant state. This means there is too much insulin which is likely to cause testosterone overproduction by the ovaries. High levels of testosterone lead to absence of egg release (anovulation),amenorrhea (missed periods) and infertility. PCOS has also been linked to high cholesterol levels,high blood pressure and abdominal obesity. It increases the risk of type II diabetes,heart disease,endometriosis and cancer. Anaemia may be seen in women with abdominal obesity.Weight loss is essential for obese women with PCOS. It has been shown that even a 10 to 15 per cent weight reduction resulted in spontaneous conception in about 75 per cent of obese infertile women with PCOS. A healthy diet also helps. Low glycemic foods wheat bran,barley,oats,grainy breads,whole seeds,lentils,kidney beansare recommended as they are digested slowly and induce less insulin secretion. They are associated with increased HDL,weight loss and improvement in insulin sensitivity and PCOS. A high fibre diet consisting of low glycemic whole grains,pulses,vegetables and whole fruits is beneficial. Excessively sweet fruits and fruit juices must be avoided,as also starchy vegetables such as potatoes. Restrict portions of polished rice,pasta,noodles,breads,idli and dosas. Lean proteins from pulses,soybean,tofu,egg,chicken and fish and lean cuts of meat are desirable too. Good fats including omega-3 fats (fish,flax seeds,walnuts) and mono unsaturated fats (mustard oil,olive oil,canola oil,groundnuts,almonds) are useful. Natural sources of fats from nuts and seeds are best way of obtaining good fats. Avoid hydrogenated or partially hydrogenated fats found in margarine,shortening,fast foods and bakery products. Avoid commercially available fried foods which may contain harmful transfats. Useful herbs include fenugreek seeds (methi ),cinnamon (dalchini),bitter gourd (karela) and black berry seeds (jamun). Regular aerobic exercise helps improve insulin resistance in the long run. Alcohol must be restricted as excessive alcohol can worsen insulin resistance. Women who consume alcohol must restrict it to one small drink. Cigarette smoking should be strictly discouraged in all women with PCOS as it will increase the risk of heart disease and diabetes.
