When she was 18 years old, Sabrina A.K Shekhani, a fitness instructor, noticed hair on her chin, something she considered a minor irritant but nothing that couldn’t be ‘fixed’ at her local salon. It was only after she couldn’t shed her post-pregnancy weight that her doctor made the link between her hairy chin (hirsutism) and her weight troubles, and diagnosed her with Polycystic Ovarian Syndrome (PCOS). Her doctor warned her that if she didn’t do something about this soon, she was heading for an early menopause.

Sabrina was determined to tackle the problem: “Instead of letting PCOS wreak havoc in my life, I took charge of it, battling it head on. I stuck religiously to my diet plan, took my medicines and exercised regularly, making these things a part of my life. Exercise benefitted me so much that I ended up pursuing it professionally,” she says.

Today Sabrina is healthy and fit, and says that anybody who has PCOS, like her, shouldn’t be scared: while it can be overwhelming, the syndrome can be easily managed by regular exercise and a good health regimen.

Polycystic Ovarian Syndrome can cause a variety of health problems yet remains undiagnosed in most women who suffer from it

What is PCOS?

The syndrome, which is caused by a hormonal imbalance, can result in a myriad of issues like loss of scalp hair, obesity, hirsutism, oily skin, acne, mood swings, irregular menstrual cycles and reduced fertility. While it’s one of the most common hormonal disorders in Pakistan — it affects a staggering 20.7pc of women — and is the primary cause of infertility in women, research shows it also goes undiagnosed in more than 70pc of women suffering from it.

Teenagers and girls’ reluctance to talk about their bodies is one reason the syndrome can remain undetected for a long time. “Young girls consider it a taboo to talk about their menstrual irregularities, and if they are not close to a female member in their family they may not even realise what they are going through is abnormal,” says Dr Salman Kirmani, a paediatric endocrinologist at Aga Khan University Hospital. To tackle this issue, he says, it is important that girls are sensitised to what is normal and what is not, so they are able to detect abnormalities in their bodies.

According to Dr Kirmani, PCOS is probably caused by a combination of genetic and environmental factors. It tends to occur more commonly if there is a family history of the problem, more in twins than in other siblings, and is prevalent in certain ethnic groups such as South Asians. He adds that obesity might also be a culprit: the consumption of packaged food, fizzy drinks and a sedentary lifestyle may be contributing towards the spread of PCOS.

How to tackle PCOS

The backbone for the management of PCOS is weight loss; diet also plays a fundamental role. In addition, diet and exercise also plays a role in controlling the increased levels of insulin which women with PCOS tend to have.

Erum Jhumra, a registered dietician and nutrition therapist, recommends a strict sugar-free diet. “Primarily such women should not consume sugar or anything else that easily converts into sugar, juices [both packed and fresh] and excessive bad fats. But you cannot generalise the diet and portion sizes, as the syndrome exhibits dissimilar symptoms in different people, based on individual differences and the years the syndrome has been maturing undetected in the body,” she says.

Moreover, Jhumra says that weight should be lost methodically, aiming only to shed fat, while maintaining a healthy diet. She feels that following a good diet is something that should be encouraged from a young age and advises that parents should make sure their children eat balanced meals and avoid packaged food.

Low Vitamin D levels have also shown a correlation with the onset of PCOS, so getting plenty of sunshine is also a good idea.

While it’s one of the most common hormonal disorders in Pakistan — it affects a staggering 20.7pc of women — and is the primary cause of infertility in women, research shows it also goes undiagnosed in more than 70pc of women suffering from it.

Early diagnosis is the key

Timely detection and early management of the syndrome has many benefits, says Jhumra, as it saves the girl from innumerable physiological and psychological issues. “Ignoring and thinking that the issues will settle … is highly damaging and further complicates the problem, making it difficult to treat issues like fertility, when the girl is of age,” she adds.

Agreeing to this, Dr Kirmani says that early intervention and treatment of PCOS decreases metabolic risks and prevents long-term risk of diabetes and heart diseases. Moreover, if such menstrual irregularities are left untreated, it increases the risk of endometrial and uterine cancer for PCOS patients later in life.

Dr Kirmani also encourages young girls with menstrual irregularities to seek out medical advice. He points out that the United States’ National Institute of Heath states that girls may have irregular menstrual cycles for the first two years, but there are certain limits to it. Even within the first year after puberty, cycles shorter than 19 days or longer than 90 days are always abnormal and should be immediately checked by a qualified and experienced doctor.

Published in Dawn, Sunday Magazine, June 26th, 2016