A PCOS primer: How women living with this hormonal condition can manage skin and weight

Around 30 percent of adolescent girls, at some stage in their reproductive life, grapple with painful symptoms of the endocrine disorder polycystic ovary syndrome (PCOS) -- most often, irregular periods and acne. "It is a multi-systemic disorder which means it not only affects the menstrual cycle but also affects other systems of the body. The cause is an imbalance between hormones called estrogen and progesterone," explains Dr. Anagha Chhatrapati, consultant - obstetrics and gynecology at Global Hospital.

What brings this hormonal condition about? "It is caused due to decreased metabolism in women. Women who have PCOS have increased levels of male hormones and are insulin-resistant. This makes it more difficult for the body to utilise the hormone insulin, which ideally converts sugars from foods into energy, leading to the build-up of insulin and sugar in the bloodstream," adds Dr. Manju Gupta, senior obstetrician and gynaecologist, Motherhood Hospital.

In India, prevalence of PCOS ranges from 3.7 to 22.5 per cent depending on the population studied and the criteria used for diagnosis, a medical study published in 2019 found.

Mid-Day.com spoke to experts to understand how the condition impacts weight and skin and how women can manage commonly occurring symptoms with dietary and lifestyle changes.

The impact of PCOS on weight and skin

"High androgen levels can cause unnatural body hair growth, acne, and irregular periods, and weight gain as well," states Gupta. Acne is a sign to watch for. PCOS-related acne often affects the lower face, including the jawline, chin, and upper neck, and typically it worsens around the time of periods. "While some women with PCOS have also experienced their cycle to become more regular as they get closer to menopause, their hormonal imbalance does not improve or change with age," the specialist adds.

According to Chhatrapati, contrary to conventional thinking that PCOS leads to weight gain, it is the other way round. "Excessive weight gain leads to accumulation of fat in the body, leading to increased amounts of hormone estrogen (E3), which leads to hormonal imbalance. Excessive estrogen causes anovulation and period irregularity. There is also insulin resistance leading to an increased risk of diabetes and abnormal lipid (cholesterol) profile. The insulin resistance seen in PCOS patients leads to non-utilisation of glucose, leading to lethargy. Lethargic patients avoid workouts leading to more weight gain, and the vicious cycle continues," says Chhatrapati.

Lifestyle and nutrition

The remedy for PCOS is having a healthy lifestyle, maintaining an ideal BMI, a diet high in protein and less in carbohydrates and including regular 45 minutes of aerobic exercise helps to reduce the severity of PCOS. "It is important to focus on root causes of PCOS and its symptoms as far as weight gain is concerned," says Lavleen Kaur, co-founder and head dietitian at Diet Insight. Below, she outlines actionable lifestyle and dietary tips along with superfoods that can help manage PCOS symptoms.

1. Do not take to trendy diets or starve yourself.
2. Eat at least three wholesome meals on time, and consume raw vegetables an hour before lunch.
3. Eat fresh and home-cooked meals, while avoiding sugar, refined, and processed foods.
4. Eating whole grains, enhancing strong protein, and eating more vegetables and fruits can help to reduce symptoms and maintain hormone levels. Rather than choosing refined oils, you can opt for virgin olive oil, coconut oil, mustard oil, etc.
5. Avoid using animal-based milk unless you know the source is pure and organic. You can have milk products such as cheese, curd, etc. If you wish to have milk products in tea or coffee, use plant-based milk like almond milk or soy milk.
6. Getting at least 7 to 8 hours of uninterrupted, sound sleep is crucial if you have skin issues related to PCOS. When you sleep, your body gets enough time to recover. You will also feel fresh and less stressed the next day.
7. Our body comes into touch with many toxins every day from foods, cosmetic items, cleaners, plastics and more. Although it is impossible to evade them all, it is necessary to avoid them as much as you can. Many of these are endocrine disruptors which means they conflict with your hormonal stability. This raises the chances of developing PCOS symptoms, and your hazard for developing heart disease, cancer, or diabetes.

Superfoods for managing PCOS

1. Fenugreek (methi) seed sprouts: Fenugreek seeds help in maintaining blood sugar levels in the body, especially in case of insulin resistance. So, use fenugreek sprouts by adding it in stuffing or tadkas for dals of sabzis, or you can also sprinkle the sprouts over your salads, although they are a bit bitterbut should be included in the diet.
2. Cinnamon (dalchini): Cinnamon helps control blood glucose levels because in most of thePCOS cases women are pre diabetic, so itcan be included in your diet in the form of cinnamon water or added to your herbal tea.
3. Raisins: These dry fruits are extremely beneficial for the PCOS women to suffice for the blood loss during irregular period cycles because they are rich in iron, especially black raisin, which is the ‘kaala munakka'. Have it soaked in water in the morning.
4. Dates: They are excellent sources of iron. Have them as such or in soaked form if you are having heavy period flow.
5. Jaggery balls: These small ladoos/balls help in regulation of period cycle along with taking care of the iron levels in the body. The ingredients used in this recipe are to ease out the menstrual pain and to induce periods, if one does not get them on time.

Caring for your skin

"PCOS is a spectrum not a disease. It can affect the skin, hair, hormones, and metabolism. PCOS may cause acne, open pores, increased oiliness of skin, acanthosis nigricans (a type of pigmentation on the face and folds of the body), extra facial hair called Hirsutism, hair loss, female pattern balding, dandruff, sticky scalps, and change in hair texture and frizziness," says Dr. Malavika Kohli, consultant dermatologist at Jaslok Hospital and Breach Candy Hospital. Below she shares 8 essential skincare tips to manage issues stemming from PCOS:

1. PCOS acne can be more inflamed, itchy and painful so a 3 percent or above Niacinamide containing gel with hyaluronic acid and zinc is very helpful keeping the breakouts calm and smoothened.
2. Keeping the skin bacteria free is important so cleansing the face twice a day and the scalp thrice a week helps to keep the bacteria count under control.
3. PCOS acne and sensitive skin will need paraben and perfume free products.
4. Women suffering from PCOS should avoid using a toner if they have sensitive skin. Micellar water is a good cleanser.
5. Mineral based makeup is better for acne prone skin.
6. Tinted sunscreens are useful in acne prone skin as they help as a cover up for blemishes too.
7. Silicone matte sunscreens are ideal as they are non-sticky, cover open pores, and can be used under makeup in acne prone skin.
8. Do not pop your pimples, instead get good medifacials, light and laser-based treatments. These help the pustules and breakouts to dry up, unclog the skin and prevent scarring.