September is globally recognised as PCOS awareness month, offering a chance to reflect on the day-to-day challenges women with the disorder face.

Over the past few decades, the field of medicine has undergone substantial advancements, thanks to the increased accessibility of technology and a wealth of resources for doctors and researchers.

There has been a notable increase in the discovery of treatment options, and the pace of ongoing testing and trials aimed at finding cures for various diseases has accelerated, surpassing what scientists could achieve but decades ago.

Thanks to modern medicine, the world is getting closer to cure diseases such as HIV/AIDS, different types of cancer and varying heart diseases.

However, the uncertainty surrounding certain disorders and illnesses prevail despite the available technologies and resources at our disposal.

One such famous example is the Polycystic Ovary Syndrome (PCOS), a disorder that has been challenging women’s medicine for many years.

PCOS is a complex hormonal disorder that affects an estimated 8-13% of women of reproductive age and was not discovered before the early 1990’s. Despite the disorder being more widespread in recent years, doctors are still unable to pinpoint the causes behind it and its origins remain unknown.

Dr. Nusrat Fazal, a senior Consultant Obstetrician and Gynecologist at Sidra Medicine in Qatar, says PCOS is a condition that can affect women’s immediate and long-term wellbeing, from diabetes to cardiovascular diseases.

“I would agree that PCOS is a complex hormonal disorder that does not have a single well-defined cause. It likely results from a combination of genetic environmental and lifestyle factors, and presents differently in different women,” Dr. Fazal told Doha News.

The complex disorder falls into numerous categories, depending on the symptoms women present — if they are lucky enough to consult a gynecologist.

Up to 70% of women with PCOS globally are undiagnosed, according to the World Health Organization (WHO).

Whilst some of the causes behind the delay in diagnosis and discovery of effective treatment for PCOS are attributed to gender bias in medicine, Dr. Fazal believes there has been a gradual shift in gender disparities in the medical world.

“Over the recent years’ inclusivity of more female conditions and subjects in research projects has improved recognition of many hidden despairs of women’s health. PCOS is one of them. It is extremely important to continue advocating for gender equity in healthcare and research,” the doctor noted.

Types and symptoms

Some of the common symptoms of PCOS include irregular menstrual cycles, ovarian cyst formation, weight gain, excess body hair and acne. The most common type of the condition that women are diagnosed with is insulin-resistant PCOS, which has the potential to lead to risk of diabetes.

The second most common type is pill-induced PCOS, which occurs once a woman stops consuming birth control pills, though its symptoms are temporary.

Inflammatory PCOS is the third most common type, during which women’s ovaries produce excess testosterone that leads to issues related to ovulation.

Regardless of the PCOS type, researchers over the years have discovered a number of mental health symptoms that women suffering from the hormonal disorder struggle with.

Women with PCOS often display anxiety levels, depressive feelings and psychological distress.

In Dr. Fazal’s view, PCOS diagnosis has improved and treatment plans have been individualised rather than remaining limited to the prescription of contraceptives, though treatment remains challenging.

“Simple contraceptive pills are not a definitive cure but can offer symptom control to some extent if given in appropriately selected cases. Menstrual regulation with contraceptive pills can help regulate the cycle to control symptoms and prevent the lining of the womb from over growing but can be counterproductive for fertility problems,” Dr. Fazal explained.

Myths vs. facts

With such an ambiguous disorder, it is only natural for myths to float around and create even more confusion for the women suffering from it.

Throughout her career, Dr. Fazal witnessed a number of myths surrounding PCOS that must be addressed by healthcare professionals. Here are some of them.

“All women with PCOS have ovarian cysts”

One of the most common misconceptions about the disorder is that all women with PCOS display cysts on their ovaries. This is not true, the cysts are often a feature but not the main source of diagnosis. 

“PCOS is characterised by a range of symptoms, including irregular menstrual cycles, elevated male hormones), and metabolic disturbances. While ovarian cysts are a feature of PCOS, they are not always present, and the condition is not solely defined by their presence,” Dr. Fazal explained.

The Sidra doctor also notes that some women can be asymptomatic or notice subtle symptoms.

“Women with PCOS are chronically infertile”

While PCOS has been described by WHO as “the commonest cause of anovulation and a leading cause of infertility” due to the lack of ovulation, one myth is that absolutely no woman with the disorder can ever conceive a child naturally.

“While PCOS can cause issues with sub-fertility, some women with PCOS can still conceive naturally. Some might require little help with medications[…]not all individuals have issues with fertility and some of them who do have can be easily treated with medications for ovulation induction or surgical drilling of the ovaries,” Dr. Fazal tells Doha News.

“All women with PCOS are overweight”

While PCOS can cause weight gain due to insulin resistance, women with lighter weight also struggle with the condition.

“PCOS can affect women of all body types, including those who are thin or of normal weight. While obesity is a common feature of PCOS and can exacerbate symptoms, not all women with PCOS are overweight,” the Qatar-based doctor said.

“Birth control pills are the cure“

Contraceptives have long been perceived by patients, and some doctors, as the one-size fits all type of treatment for PCOS. However, it is part of the treatment but not the permanent cure.

“While hormonal birth control is commonly prescribed to regulate menstrual cycles and manage some PCOS symptoms, it is not the only treatment option. PCOS treatment should be tailored to the individual’s specific symptoms and needs, and other medications and lifestyle changes may be recommended,” Dr. Fazal stressed.

Instead, Dr. Fazal recommends long-term management including lifestyle changes that gradually lead to visible results.

“Just lose weight”

Some of the most common reasons why women with PCOS give up on treatment is due to one sentence they would hear from doctors: “Just lose weight”. 

The words often discourage women from wanting to actively work in order to treat the hormonal condition, especially given the difficulty of losing weight while struggling with PCOS.

Weight loss can gradually occur upon consuming Metformin drugs that are often prescribed to patients with diabetes, but it is still merely one aspect of the long-term treatment.

“Weight management and working out is an important aspect of PCOS treatment but cannot guarantee complete cure. Weight loss however can improve symptoms related to insulin resistance. PCOS is a lifelong condition that often requires ongoing management,” Dr. Fazal noted.

PCOS still requires substantial medical clarity and remains a mystery within the realm of modern medicine, as women struggling with the disorder soldier on.

With the help of the internet, women are able to take on the mission to educate themselves about PCOS while speaking up about it to others with the same condition. 

Celebrities such as  Victoria Beckham, Lea Michele, Sasha Pieterse among many others have also joined the conversation on PCOS, proving that no woman is alone in her fight.

From a medical point of view, Dr. Fazal has one piece of advice that she wants to share with all women with PCOS.

“They should educate themselves to have lifestyle modifications towards balanced diet, regular exercise and stress management. Do not hesitate to seek mental health support if they are facing emotional issues. PCOS is a lifelong condition, you need to learn how to manage and keep it under control with minimal effects on your quality of life,” she told Doha News.