What could be the common link between a teenage girl with irregular or delayed menstrual cycles, a young woman with stubborn body weight who has been trying to get pregnant for two years, a middle-aged diabetic woman on insulin injections, and an elderly woman whose doctor is concerned about the possibility of cancer following an ultrasound check-up?
The answer may be a complex, multi-system, endocrinologic condition called poly-cystic ovarian syndrome, or PCOS, as it is commonly called.
The gynaecology and fertility communities have just marked September as PCOS Awareness Month.
Yet, the challenge with educating the public about PCOS inherently lies in its very name.
The condition was first described by Stein and Leventhal when they demonstrated multiple, peripherally arranged cysts in cross-sections of affected ovaries, and many doctors still diagnose the condition in a patient upon simply observing a similar image on an ultrasound scan.
Hence, many patients who visit my OPD at the Centre of Excellence (COE) in Assisted Reproductive Technology (ART) at IPGMER & SSKM Hospital complain, “Daktarbabu, amar ovary te cyst achhe” (Doctor, there is a cyst in my ovary).
And therein lies the problem. Because the small cysts in PCOS are unlike most other ovarian cysts found in gynaecology practice, many of which can either be ignored, require surgery, or continued medication and follow-up.
In fact, the cysts in PCOS are not the disease in and of themselves at all, but rather, a clinical “sign” of a complex interplay of insulin resistance, impaired glucose and lipid metabolism, hormonal dysregulation, sedentary habits, poor diet and lifestyle, and a chronic system-wide inflammatory response, all of it underpinned by marked genetic
predispositions, particularly in the South Asian population.
Hence, the European Society of Human Reproduction and Embryology (ESHRE) is leading an international drive involving major PCOS research groups around the globe to identify a suitable alternative name for the syndrome, which reflects its
clinical implications more accurately.
As a part of this effort, our team at GD Institute for Fertility Research (GDIFR) has also proposed what we feel is a more appropriate moniker, and we are awaiting the results of the final consensus statement.
But then, what are these long-term implications of PCOS?
Most affected women approach gynaecologists with abnormal menstruation or infertility, as these are the earliest presentations of the disease.
In many cases, they may be treated only for these complaints, without long-term follow-up or surveillance for their possible sequelae.
However, left untreated, PCOS may lead to significant health risks, specific to different decades of life, starting with menstrual irregularities and infertility in young girls, cardiovascular disease and diabetes in middle-aged women, and even the possibility of cancer in the elderly.
It is thus the responsibility of every gynaecologist and fertility specialist to counsel, treat, and provide preventive advice for the entire spectrum of risk whenever consulted by a patient with PCOS.
At GDIFR and IPGMER, our efforts to spread awareness about PCOS continue.
We will be presenting our recent research on optimising the management of PCOS-associated infertility in Cairo next month, following an invitation by the Egyptian Fertility and Sterility Society (EFSS).
Soon after, we will be hosting Enrico Carmina, a professor from Palermo, Italy, to speak on revolutionary new pharmacological treatments for obesity in PCOS patients at the second International Conference on Advances in Reproductive Medicine, Calcutta, in
the first weekend of December.
These drugs — semaglutide and tirzepatide — may be a game-changing development in the fight against obesity.
It is established that nearly one-fifth of all women of reproductive age suffer from PCOS.
In our experience within both private and government sectors, this number seems to be significantly higher in the Indian population, approaching a third of all women we see in the OPD.
The implications of this population left untreated have staggering implications for public health, government spending, as well as gross productivity of the population.
It is time that doctors, policymakers and the public address this issue in partnership.
Biswanath Ghosh Dastidar is the research director at Ghosh Dastidar Institute for Fertility Research and assistant professor at the Centre of Excellence in ART, IPGMER, SSKM Hospital