SEPTEMBER is World PCOS Awareness Month.

PCOS, or Polycystic Ovary Syndrome, is a very common condition. According to Cochrane Gynaecology and Fertility, it is characterized by:

• menstrual cycle problems, such as having irregular or no periods 
• high levels of testosterone or excessive hair growth
• polycystic ovaries, which contain fluid-filled sacs or follicles that surround the eggs

The organization PCOS Challenge: The National Polycystic Ovary Syndrome Association, describes PCOS as a serious genetic, hormone, metabolic, and reproductive disorder that is the leading cause of female infertility. OBYGN and Medical Aesthetician, Dr. Issa Matibag, M.D, DPOGS, states that some symptoms are the following:

• irregular menstruation
• hormonal acne
• excess hair on the face or other parts of the boy
• male-pattern baldness or hair thinning
• weight gain
• difficulty conceiving

PCOS Awareness Month was thus created to help improve the lives of those affected by this disorder, to help them overcome it, and to help prevent and reduce the risks for other diseases. 

The whole month is dedicated to increasing awareness about the disorder and treatment options for it, improving its diagnosis and treatment options, and promoting the need for further research and improved treatment and care options.

It also aims to acknowledge the struggles of those affected by PCOS, encouraging all institutions to make PCOS a public health priority.

To further shine a light on the disorder for this month, republicasia has spoken to two women living with PCOS, asking them how they treat it, how it affects them, and how they’ve managed to overcome it.

Living with PCOS

22-year-old Queenie Ashley Artita, a fourth-year student at the University of the Philippines Los Banos, was first diagnosed with PCOS while she was in the 12th grade. This was during the pandemic, specifically the first quarter of 2021.

Before this, she’d already noticed that her periods were often irregular, and a lot of the time she would experience severe dysmenorrhea.

In 2021, she was rushed to the hospital due to severe abdominal pain and had to undergo an ultrasound to see what was wrong. They discovered multiple cysts in her right ovaries and immediately was advised to undergo surgery. 

After this, she was diagnosed with ruptured ovarian cysts, and luckily, the doctors were able to remove all of the cysts in her right ovaries.

However, two years later at her annual check-up with her OB-GYN, they found out that she also had PCOS in her left ovaries.

“PCOS has changed so much in my life, especially with my physical appearance,” she shared.

She adds that she struggles with her weight the most, noting that it’s extremely difficult to lose weight when you have PCOS. Despite trying several different methods, she has yet to find one that’s effective.

“I am having a hard time losing weight and [am] constantly tired. I often have breakdowns and [am] emotionally unstable.”

Meanwhile, 23-year-old Elyana Faye Batungbacal, a first-year student at the University of Santo Tomas Faculty of Civil Law, was diagnosed in 2022. She said she would not get a period for six months, but once she started getting it, her period would come twice a month. 

She would also often experience bloating and weight gain despite rarely eating anything heavy. 

Like Artita, Batungbacal also struggles with weight loss. Without medication, her body also has difficulty regulating hormones like insulin and high cortisol.

“Physically, PCOS was more obvious with dark spots on my skin, like my underarms and bikini areas, as well as a lot of bloating in the face and belly,” she shared.

“Mentally and emotionally it made me feel bad because it made me feel bad. No matter how often I exercise or turn to other diets, my weight doesn’t change, and because of it, I used to be self-conscious about my looks.”

Treating PCOS

Batungbacal stated that she has a rough time with her PCOS treatment because it heavily affects her, both mentally and emotionally.

She said, “Whatever emotions I felt were magnified, and my anxiety was even more overwhelming.”

Matibag explains that PCOS has, in the past, been related to an increased risk for depression. Medications like the pill that are taken for PCOS may also cause mood swings for some.

To remedy this, Batungbacal started drinking supplements and switched to alternatives like oat milk instead of dairy to try to regulate her hormones without the use of a pill.

Since being diagnosed, she has made several changes to her lifestyle, such as sleeping properly and going on walks instead of high-intensity interval training (HIIT) as she finds the former more effective.  

Matibag notes that when it comes to workouts, the effectiveness of a workout depends on the person.

“This depends on the person. If you are someone who is starting, then yes, starting with lower-intensity exercises may be better,” she said.

“If you are someone who is already used to a higher intensity, then you can stay consistent with that. The secret is knowing what you can do and be consistent with [it].”

She adds that Zone 2 exercises are also helpful in activating the body’s fat-burning capacities. Included in this are exercises like walking, jogging, aerobics, swimming, and the like. Weight training is also effective as building muscle helps with one’s metabolism.

Artita faced similar problems during her initial diagnosis, with her doctor prescribing pills. While this worked fine with her menstruation, she gained unnecessary weight as a result.

To remedy this, she started doing low-intensity workouts such as walking, as well as lower-body workouts. She also tries to eat healthier foods with plenty of protein and fiber, lessens her processed sugar intake, and takes supplements like inositol and berberine.

Added to this, she tries her best to manage her stress levels, allowing herself to rest when necessary. She sleeps seven to eight hours each day and tries to maintain an active lifestyle.

Matibag, however, does explain that while a lot of patients with PCOS may be on the pill, the pills themselves do not cause weight gain. Factors like insulin resistance may be the cause.

She does confirm that PCOS patients with insulin resistance often have more cravings, increased appetite, and feelings of fatigue and tiredness, hence why they may tend to eat more or have less motivation to exercise given the excess insulin their body produces.

Common misconceptions

Given that there is still much research to be done to better understand PCOS, many misconceptions about it have started to spread. One, Artita notes, is that people with PCOS cannot have children. 

Matibag explains that you may still ovulate spontaneously, so there is still a need to use contraceptives even if you have PCOS. While it may be more difficult to get pregnant, with the proper guidance from an OBGYN, you can still achieve pregnancy.

Another is that people with PCOS are lazy and emotionally unstable.

“[I’d] like to think otherwise,” Artita stated. 

Batungbacal addressed the misconception that PCOS goes away when you lose weight, stating that there are also skinny women who have the disorder. 

For this, Matibag stated that even those with a normal BMI can have PCOS.

“Whilinsulin resistance may be higher in females who are overweight or obese and can perpetuate hyperandrogenism and irregular menses, other mechanisms like excessive luteinizing hormone (LH) secretion that lead to PCOS may come into play,” she explained.

Batungbacal also noted that many think that, when you have PCOS, you’re doomed forever, as it’s something that’s “uncurable” or “hopeless.” This, however, is far from the truth. 

Matibag also explains that pills do not cure PCOS, as some may think.

Artita also adds that PCOS is not a death sentence. 

She said: “PCOS affects your hormones but [it] does not necessarily make you incapable of doing things.”

She also states that some things that come with having PCOS, such as discoloration and hair growth, are perfectly normal.

Find what works best for you

To those with PCOS, Batungbacal explains that there are many ways to treat this disorder and regulate hormones. The solutions to this are rarely a one-size-fits-all type of ordeal, so it is important to consider all the factors and find what works best for you. 

Matibag states that the management of PCOS should be individualized according to the symptoms the patient represents. The first-line management should be lifestyle changes in the form of proper nutrition and exercise.

She notes that a weight loss of 5 to 10% in the next six months in those overweight or obese may also be helpful.

For those who struggle with hormonal acne, hirsutism or excessive hair growth, and other signs of androgen-excess, cyproterone acetate or Drospirenon-containing pills may be used to manage them.

To decrease the risk of endometrial hyperplasia or cancer, one can take pills that will help to shed the endometrium monthly.

Batungbacal also recommends that people diagnosed with PCOS do their research, particularly by reading credible medical journals.

“Given that PCOS isn’t necessarily a well-handled ailment, sometimes even doctors don’t have all the answers and lack some knowledge useful in treating it, and would usually just prescribe birth control and send you on your way,” she explained.

“You have to do your due diligence, but still consult what you researched with your doctor so they can guide you.”

To those with PCOS, Artita adds, “What you are feeling now is valid. Take your time to know yourself more and once you are ready to make progress, start from small steps. You are powerful. Control what you can, and let others be.”