Brown Girls and PCOS
I’ve mentioned before, I am the daughter of South Asian (includes Pakistan, India, Nepal, Sri Lanka,Maldives, Bhutan and Bangladesh) immigrants and practice in downtown Chicago. I proudly treat all races, religions and ethnicities. We all know representation matters and so does cultural sensitivity. Much of the South Asian diaspora live here in Chicago, so I have a high percentage of South Asians that I treat. Besides treating a lot of sexual pain and pelvic pain in this population do you know what I commonly treat? PCOS. Yes that’s right….
Polycystic Ovarian Syndrome.
So you’ve asked about it and I am here to answer. What does it mean? Kyar problem hai? (my broken Hindi/Urdu).
Well, first of all, did you know PCOS impacts about one in 10 reproductive age individuals born with uteri and ovaries? And among us brown girls the number is much higher! In one community-based study in the UK, 52% of South Asians in this category had PCOS, some estimate 1 in 5 in reproductive age in India are afflicted by this.
So, that explains why I see so much of it.
So, what is it?
It’s a constellation of symptoms that may present differently in different people.Basically, it results in a dysregulation of hormonal signals and communication between the brain and ovaries. Because genetics, environment and lifestyle are possible predispositions, as is metabolic syndrome and insulin resistance in South Asians, this combination of increased insulin and dysregulated ovarian function can result in:
- Cysts, cysts, cysts! A disrupted signal from brain to ovary which would usually signal follicular cyst (fluid-filled sac holding the egg) formation and ovulation. Follicle formation and eventual ovulation are disrupted. This can result in multiple small follicular cysts in the ovaries like this seen on ultrasound, giving it the so-called polycystic ovaries look.
- Watch your flo!!!!!
As this disruption leads to many small cysts but no release of egg or ovulation, this can lead to oligomenorrhea or missing or delayed periods. Classically, you can have multiple missed or delayed periods like maybe less than 8 a year and this can lead to a really heavy flow when it comes as well as subfertility or infertility. So, abnormal menses is usually seen.
- Hairy face, acne, and hair loss, oh My!
The ovaries also are responsible for some of your androgen or testosterone (classically thought of the male hormone) production and the ovaries in this case make too much of it. This can lead to acne, facial hair (hirsutism) or hair loss around the temporal area or in a male pattern. That’s right hirsutism. Facial hair is something most of us Have struggled with all of our life. Sometimes it’s pure ethnicity but sometimes it’s because of PCOS. In fact pre-pandemic, when I routinely entered threading salons, I would randomly start conversations with other Desi girl’s and guess what– a lot of them divulged issues about menstruation with me(happens all the time. The shit people tell a gynecologist in public is another topic of discussion).
- The Rotterdam criteria for diagnosis is 2 out of 3 of the above after ruling out other causes. That’s why you might have your blood drawn to rule out thyroid disease, prolactin disorders (which lead to abnormal bleeding ) or disorders of too much testosterone like a congenital adrenal hyperplasia.
Due to the impact of insulin resistance, some women have difficulty losing weight or gain too much weigh. They are also at risk for DM and heart disease (still number one killer of women).
On a side note…
You can ask your South Asian friends if they have any family members with heart disease or sudden death and most will answer a resounding yes!!!!! South Asians represent 60% of the worlds heart disease patients . Let that sink in. This is a different discussion for a different time but his is why some South Asians may not “look like the classic PCOS” patient. Some are lean but their blood pressure and cholesterol may tell a different story. Some studies have demonstrated it’s the increased visceral fat around our intestines, liver, or heart that predisposes us to heart disease.
That’s why some advocate for a different(lower) BMI measurement for overweight and obesity in South Asians. Additionally , the South Asian diet and acculturation process of incorporating more fast food, stress etc from immigration may contribute .
Another issue that we have to be vigilant about is the health of the lining of the uterus, or endometrium.
Due to the hormonal issue leading to abnormal bleeding some women may develop pathology of endometrium. So if you have not had a menstrual cycle in more than 6 months to a year due to PCOS and you are not on hormones, talk to your friendly neighborhood gynecologist. Additionally, some women with PCOS have more depression and anxiety, eating disorders and sexual dysfunction such as libido disorders. Again, please see your gyno.
Also, we as Brown girls have to be more vigilant. Some studies demonstrate that we experience more severe symptoms earlier! That means even young girls, for years after getting their period, maybe irregular or hairier or have more acne! Great right? And lets not forgot about checking our cholesterol and blood pressures along the way and making sure we are doing our best with diet and exercise because ultimately, we are at risk for more heart disease!!!!
But no fear, there are ways to treat you!
There is no one best method. Some people use birth control or hormones to regulate their cycle. Some use medications for acne. Some use laser hair removal for hirsutism. Some need augmentation of medications for ovulation when they are trying to conceive. Find a gynecologist you feel comfortable with and discuss all of your options and concerns. Don’t worry about , Log Kya Kahenge, what people say. Take charge of your menstrual and fertility issues without shame!!!!!