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Ultimate PCOS / PCOD Guide

40 PCOS questions answered​ comprehensively

dr niveditha murthy

Dr. Niveditha Srinivasamurthy

Ayurveda doctor with 10+ years of experience. Practices in Bangalore with focus on Women’s health and Chronic conditions
Over the past 10 years I have treated many women with PCOS / PCOD successfully. One thing that is common across these women, apart from the fact they have PCOS, is the amount of anxiety and questions they come up with. They try to learn more from where ever they can like internet, friends and family. But still they have questions.

This is an attempt to answer many common questions I have heard over the years, as one single guide. I will be expanding this book to answer more questions over time.

I sincerely hope this helps women in their journey towards healthy and worry free life.

Contents

1

What is PCOS ?

PCOS stands for PolyCystic Ovary Syndrome. PCOS is largely an endocrine disorder caused by imbalance of hormones in female body. Even though it has Ovary in its name it is not an ovarian disorder. The cysts that are present in ovaries are result of hormonal disorder that women have. Hence the name PCOS.

2

What is difference between PCOS and PCOD ?

Even though PCOS and PCOD sounds similar there is a difference between them.

PCOD is case where ovaries have small cysts developed due to hormonal imbalance. Symptoms of this are same as that of PCOS (as mentioned here). Ovaries can become enlarged because of cysts and there is excess androgen secreted along with estrogen.

PCOS is more severe than PCOD. There are typically more than 12 cysts in ovaries. Also the hormonal imbalance levels has to be very high. There will be high level androgen and testosterone secreted by the ovaries. Also PCOS women might have other imbalances like insulin resistance, thyroid imbalance etc., which might not be there in women with PCOD.

Summarizing, PCOD is milder form of PCOS where hormonal imbalance are not that high and its primarily the cysts in ovaries that are triggering these imbalances.

3

Why are there cysts in my ovaries because of PCOS ?

Women’s reproductive organs, the ovaries, produce estrogen and progesterone. These hormones regulate menstrual cycle. Ovaries also produce another hormone called androgens. Ovaries releases eggs to be fertilised and they are released every month during ovulation.


Follicles are sacs that contain eggs that will released from the sac one they mature, during ovulation. In case of PCOS women, there will be sacs but inside the sacs will be immature eggs. They never mature to trigger ovulation. These sacs continue to remain in the ovaries to become cysts.


Now these cysts in ovaries alter the hormones more and mensuration cycle. This in turn leads to more imbalance in hormones. Eventually this causes women to miss mensuration for long period of time.

4

What are the symptoms of PCOS

Most common symptoms of PCOS are

  • 1. Irregular periods
  • 2. Unwanted Hair growth, also called as hirsutism
  • 3. Acne
  • 4. Weight gain
  • 5. Hair loss

You can read more about this here

5

What causes PolyCystic Ovary Syndrome (PCOS)?

Hormonal imbalance causes PCOS. There is no one reason why these hormones are out balance for some women. For some its genetic. for many it is lifestyle related like bad food habits, lack of sleep, stress, lack of exercise etc.,

6

How to do I know that I have PCOS ?

Rotterdam criteria is most widely accepted criteria for identifying if women has PCOS.

Based on Rotterdam Criteria, Two of the following three criteria are required:

  1. 1. Oligoovulation /anovulation – Irregular Period
  2. 2. Hyperandrogenism – Imbalance of androgens, testosterone, Lutenising Hormone
    1. 1. Clinical (Hirsutism or less commonly Male Pattern Alopecia) or
    2. 2. Biochemical (raised FAI or Free Testosterone)
  3. 3. Polycystic ovaries on ultrasound – Scan shows cysts in ovaries

Also other conditions that might show similar symptoms must be excluded like – early stages of cancer, thyroid disfunction, Cushing syndrome etc.,

7

What are the basic tests I need to do to know that I have PCOS ?

Following are the results that are needed
  • 0. Thyroid profile – T3, T4 , TSH
  • 1. CBC
  • 2. Lipid profile
  • 3. HbA1C
  • 4. Hormonal assay – Testosterone, FSH, LH, Prolactin, DHEAS
  • 5. USG Abdomen
  • 6. Optional – Fasting Insulin, Estrogen

8

Is USG scan important to determine PCOS ?

USG scan, also called as Transvaginal Ultrasound scan of uterus is an important criteria to determine if you have PCOS. The presence of follicles—commonly referred to as cysts erroneously is seen in ultrasound and number of follicles identified during this scan plays an important to determine if you have PCOS

9

What is the cure for polycystic ovary syndrome?

There is no cure per se for PCOS. PCOS can be completely managed and kept under control throughout your life and you can lead a happy worry-free life. If you have PCOS take advise as early as you can and get it under control as early as you can.

10

Will the size of cysts in ovaries reduce once PCOS is under control?

In some cases yes, there will be a reduction. For some women it may remain the same. But even with the presence of cysts, if your cycles are regular, then you will have no noticeable symptoms of PCOS.

11

Once I start getting my mensuration normally can I get PCOS again?

Once you start getting your periods and your hormones are normalised, it doesn’t mean PCOS is gone. But it means you have successfully brought PCOS under control. Focus should shift to keep it under control from then on and that’s easy.

Follow a good diet and lifestyle regimen, you will never suffer from any symptom associated with PCOS like irregular cycles, infertility issues, hormonal imbalance, weight gain etc.,

Remember, Your ovaries will always have a few cysts present and that’s ok as long as they don’t cause any trouble.

12

How long will it take to get PCOS under control

It is not easy to define a time period for PCOS treatment. Because it depends on the severity and chronicity of the condition. For example, PCOS can be treated faster in a 16 year old and it takes longer in a 34 year old.

The normal treatment duration for PCOS starts from 3 months and may extend upto 6 months. In very rare cases it may go up to a year. Getting PCOS under control quickly is completely in your hands. Disciplined focus on Nutrition, Hormonal balance and physical activity can get PCOS under control quickly.

pcos general section

13

I am thin and I have PCOS. How should I start managing PCOS ?

Getting PCOS under control for thin women is same as that for regular women. Only difference is that weight loss is not needed. But still focus on nutrition has to be there to ensure that hormones are balanced and medications to address other deficiencies needs to be addressed.

14

I am a teenager diagnosed with PCOS. Should I worry about it now ?

Many women find about PCOS only they are looking to get pregnant. If you have PCOS as teen or if your teenage daughter is diagnosed with PCOS, it is a good thing to start early. Early detection of PCOS helps and acting immediately on it will ensure that you dont end having any long term conditions or side effects. Once as a teen if you bring PCOS under control, you can have worry free happy life ahead. So it is important to act immediately.

15

Which symptoms of PCOS do women with PCOS find most difficult to manage?

We believe hirsutism is one symptom that hard to manage. Some reasons for it are

  • 1. One reason is once excessive hair growth has happened those hair roots wont go way naturally even if PCOS is brought under control.
  • 2. Since it affects appearance, it causes lot of anxiety and stress to women.

Ways to manage this is to first get PCOS under control and then use some mechanical ways to remove unwanted hair.

16

Can Vitamin D deficiency lead to PCOS ?

Vitamin D deficiency cannot lead to PCOS. PCOS women many have Vitamin D deficiency, but deficiency per se does not lead to PCOS.

17

Can Vitamin B deficiency lead to PCOS ?

PCOS women may have Vitamin B deficiency but vitamin deficiency alone does not lead to PCOS

18

What is the relationship between hormones and mensuration ?

For menstruation, the primary criteria is Ovulation, that is your oavries have to release a egg every month. This egg gets released from a sac called Follicle. For every cycle, one follicle will grow in size and rupture to release a egg

The role of hormones is everywhere in a menstrual cycle. For the follicles to grow you need hormones, for the follicles to rupture and release a egg you need hormones.

Once the egg is released and there is no conception, then you need a different set of hormones to induce periods

So hormones are the reason why your have menstruation. And a imbalance of these hormones causes irregular cycles

19

Is there relation between thyroid hormones and PCOS ?

There are studies that shows 22.5% of women with PCOS has hypothyroid. Both genetic and environmental factors are believed to be contributing to thyroid disorders in PCOS. Hypothyroidism is known to cause PCOS-like ovaries and overall worsening of PCOS and insulin resistance. Hypothyroidism can increase testosterone by decreasing the level of sex hormone binding globulin (SHBG), increasing the conversion of androstenedione to testosterone and estradiol, and reducing the metabolic clearance of androstenedione.

you can read more it here

20

Is there a difference between PCOS and fibroid?

Fibroids are non cancerous muscle growth which are seen mostly in the Uterus, . Ovarian cysts are fluid filled sacs on one or both ovaries. Fibroids can cause excessive bleeding during menstruation, leading to anaemia, weakness.  PCOS on the other hand causes irregular cycles, hormonal imbalance and other complications. So these 2 are quite different.

21

Is PCOS genetic ?

There is a genetic predisposition in PCOS. If your mother has PCOS , the chances of you getting PCOS is higher. But it is not the only cause. In fact, the main cause for PCOS is lifestyle changes. Hence the incidence of PCOS has increased a lot in past 10 years

22

Can PCOS be treated naturally ?

Yes. Ayurveda is proven to be effective in treating PCOS. Ayurveda medicines treat hormonal imbalance and other deficiencies. These medicines are natural medicines and have no side effects. With these medicines along with right nutrition and physical exercise, PCOS can be treated naturally.

23

Can Ayurveda help cure PCOS ?

Yes. Ayurveda looks at PCOS / PCOD holistically and provides natural treatment ways to manage PCOS.

Understand how Ayurveda is effective for PCOS

24

Can PCOS be cured by losing weight?

Weight loss alone wont cure PCOS. Weight loss is a very important factor to manage PCOS but you must also address other imbalances, if you have any.

25

Does Oral contraceptive pills and hormonal pills cure PCOS?

No , they help induce periods but giving more hormones to the body but they do not regulate your hormones naturally. So you may end up being dependent on medicines to induce periods. For hormonal regulation, and to regularise cycles, Ayurveda , Diet and lifestyle changes is the best option.

Also hormonal pills or OCP medicines has lot of side effects. More details are present in this research paper. Some side effects include weight gain, migraine, insulin resistance etc.,

Larger question to be asked is, Why be dependent on medicines to get periods when you can cure PCOS  naturally and get periods without medicines.

26

Is it really difficult to lose weight when you have PCOS/PCOD?

Yes , with PCOS , the weight loss journey is slightly more difficult because it is not just obesity that has to be addressed. We need to address hormonal imbalance as well for complete weight loss.

But it definitely is not a impossible task. With the right medical guidance, nutrition and exercise , you will succeed.  read more about it here

27

Are there home remedies for PCOS?

Yes. There are a few home remedies that help in PCOS. But this is just an adjuvant to medical intervention. It is mandatory to consult a doctor. Home remedies can be taken over and above the doctor’s prescription

  • 1. Warm water – drinking about 2 litres of warm water daily is a excellent yet simple way to improve your metabolism, lose weight and thus manage PCOS.
  •  
  • 2. Curry leaves – you can chew 4 fresh curry leaves or have 1 teaspoon of curry leaves powder everyday in empty stomach. Curry leaves help regulate your hormones naturally.
  •  
  • 3. Dates, Black sesame seeds, Jaggery – you can combine all these to make healthy bars, and take them daily. They help improve follicular growth and thus induce periods
  •  
  • 4. Oil Bath – this is a times tested remedy which improves not just your overall health but your reproductive health as well. Apply warm sesame oil or coconut oil all over your body. Leave it on for 30 minutes and then have a warm water bath. Practice it once a week for best results

28

What supplements should I take if I have PCOS ?

Depending on your personal condition, supplements will vary. Apart from metformin, which is a medicine given for women with insulin resistance, supplements might include vitamin tablets, folic acid tablets (in case you are planning to get pregnant), food supplements like seeds for seed cycling, probiotics for gut health.

29

Is metformin safe for women with PCOS ?

Metformin is given to women who have insulin resistance or pre-diabetic or having diabetes. Metformin is an insulin-sensitizing drug primarily used to treat diabetes. Insulin resistance is when the body’s cells stop reacting to normal levels of insulin. As a result, the body thinks that there is not enough insulin in the system. This triggers the production of more insulin than your body needs. Metformin and other insulin-sensitizing medications lower excess levels of insulin in the body.

Metformin is safe to take but any long term usage of drug is not recommended especially starting from young age. So its better you get insulin resistance under control naturally without taking medications. It is possible to do this and many have done this successfully.

pcos nutrition section

30

What is a good diet for PCOS?

There is no one specific diet. It all depends on the condition. Look at nutrition as point solutions like take some seeds, eat this fat, dont eat these carbs etc., does not help in PCOS. If you have obesity or need to lose weight with PCOS then diet has to be planned accordingly. If you also have insulin resistance then diet has to be adjusted. At most the best advice that can given, generally speaking are

    1. 1. Eat food rich in fibers like brocolli, beans, peppers, berries, sweet potatoes etc.,
    2. 2. Eat food rich in protien – In non-vegetarion food, take fish and chicken compared to red meat. These are lean sources of protein. Vegetarians can take tofu, paneer, lentils etc.,
    3. 3. Take some good supplements that can specifically help in mensuration like doing seed cycling
    4. 4. Foods that reduce inflammation are good like berries, almonds, walnut, spinach etc.,

But remember, its one to know what to take and its another to plan how to take and how much to take based on body calorie needs and your goal. So more than knowing a list understand portions and how to incorporate good elements on daily basis..

Program like ours, Fabjoys, come with nutritional coaching support to help follow these diet based on your goals and help you manage PCOS. You may try us or similar programs. You can also take advice from nutritionist.

31

Are there are any specific foods that can help?

There is nothing like specific food for PCOS women. You can read more about this on “What is a good diet for PCOS”. But one technique that helps women for hormonal balance is called “Seed Cycling”. You can read more on this <here>.

32

Is there some specific food that needs to be avoided?

Yes.

Avoid Junk food, fatty food, deep fried food, refined flour and avoid non vegetarian food (eggs and fish can be taken as they are very healthy)

The idea behind avoiding these foods are, they will add to your body fat. PCOS with obesity is difficult to treat as opposed to PCOS without obesity

pcos exercises section

33

Does yoga really help with PCOS?

Absolutely. There are specific Yoga asanas that can stimulate different kind of hormones in the body . For PCOS women Yoga has been proven to be effective form of physical exercise.

Yoga stands out amongst the other forms of exercise, because in Yoga, you have asanas that are specifically designed to improve the health of each and every body part.

Read about PCOS Yoga Asanas here

34

Should I go to gym if i have PCOS ?

Many women with PCOS need to lose weight. To get regularise periods a 10% weight loss is typically enough for PCOS women. Weight loss is 70% nutrition and 30% physical exercise. If you have right nutrition, you can lose this 30% in gym or you can follow other physical exercise regimen and attain it. Consistency in doing physical exercise is more important. If you can do it by going to gym great, if you can do it at some other place, ensure that you do it.

35

How much exercises should I do everyday ?

It depends on the kind of exercises. 30 minutes of Yoga or 30 to 45 minutes of brisk walking everyday along with right nutrition should help you in weight loss and with PCOS. 

If you want to more active you take up activities like Running, Cardio exercises or sports like Badminton, Squash etc., 30 minutes of these will also give a very good overall workout.

skin pcos section

36

Why does PCOS cause Acne ?

Acne is a skin condition that occurs when your hair follicles become plugged with oil and dead skin cells. Few major reasons for having acne are

  1. 1. Excess oil production
  2. 2. Bacteria
  3. 3. Hair follicles clogged by oil and dead skin cells
  4. 4. Excess activity of a type of hormone (androgens)

Women with PCOS have in general excess of androgens and that is major cause of acne. Once hormones get balanced, acne can be cured for PCOS women.

37

Will excessive hair growth go away if PCOS is cured ?

Excessive hair growth happens because of hormonal imbalance in PCOS women. Once PCOS is controlled the hair that has already grown will not go away by itself. But 2 things will happen

  1. 1. New hair roots wont grow, so that way hair growth will reduce
  2. 2. In existing hair roots, hair growth will slow down

You have to resort to physical techniques like laser hair removal to remove hair in places that’s already there once PCOS is controlled.

38

I have hair fall with PCOS, what should I do ?

It must be ascertained if your hair fall is associated with PCOS or is a separate condition.

For eg, if you have PCOS associated with insulin resistance, hypothyroidism and irregular cycles ,  and hair fall, then treating PCOS will certain lt reduce hairfall

If you hairfall is due to conditions that are not associated with PCOS , like Anaemia, Dandruff, Dry scalp , then you will have to get that treated separately

pcos fertility

39

Can I get pregnant naturally even if I have PCOS / PCOD ?

Absolutely. About 80% of women can conceive naturally. First thing to do is to get PCOS under control. This can be done by addressing all the imbalances in right manner with medications, nutrition and physical exercises. This can be done in 12 – 18 weeks. Once PCOS is under control your ovulation will be regular and there is a good chance you can conceive naturally. It is important to address these in timely manner as side effects of PCOS will keep increasing as time progresses.

Fabjoys is one such online program that helps women manage PCOS naturally wiithout any harmful medications with right support for nutrition and physical exercises.

40

Is IVF the only way for PCOS women to get pregnant ?

No. About 80% of women can conceive naturally. Please refer to an answer above for more details.