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The first time I went to a gynaecologist was at the age of 20, and I’m not the only one. Those of us who are lucky enough to have healthy reproductive systems could put off visiting a gynaecologist till we were older and less embarrassed of and confused by our bodily processes. But, Head of Gynaecology at Lilavati Hospital Dr. Kiran S. Coelho tells me that 1 in 3 Indian women do not have that luxury because they suffer from Polycystic Ovary Syndrome (PCOD or PCOS).
20-year-old student Nairika Lodhi’s ordeal started early. “I got my period when I was 12. But I realised it was coming in intervals… Sometimes three months, sometimes four, sometimes five,” she tells me while listing the barrage of problems that followed: significant weight gain, excessive hair growth, and confidence issues. As Nairika describes her experience with PCOS, she sounds like a teenage version of Goddess Durga juggling doctors’ appointments, diets, and medications in her ten arms.
Nairika’s experiences aren’t isolated in the least. The prevalence of PCOS is on the rise, especially among women between the ages of 15 and 30 who start their period earlier than normal, says Dr. Coelho. Citing the younger generations’ heightened exposure to unhealthy lifestyles, she says, “There’s much more pressure in schools and jobs, so the hormonal balance between the hypothalamus, pituitary, and ovarian hormones gets altered.” Nayanika Mukherjee, a 20-year-old student from Kolkata, echoes a similar concern. She reports extreme lethargy and fatigue accompanying PCOS because of the strenuous demands of college life.
Dr. Coelho explains PCOS as a stress-induced hormonal imbalance that results in estrogen being poured into body fat not the bloodstream, where it’s needed to trigger the rupturing of eggs. Eggs ripen during ovulation, but don’t rupture, becoming cysts, she says. PCOS also includes Insulin resistance and a production of male hormones like testosterone.
It’s common for women with PCOS to report irregular menstrual cycles, but Ayesha Dutt, a 23-year-old artist from Kolkata, tells me of the opposite end of the spectrum– excessive bleeding. Ayesha says her period comes “24/7, 365 days a year,” unless she takes medications to stop it. She describes debilitating cramps, soaking through six or seven pads a day, low blood pressure, and fainting spells. Whether irregular or excessive, menstrual cycles are even known to disrupt moods, and Ayesha experiences increased anxiety and anger while menstruating. “It’s terrible. I hate feeling that way. People who love me understand, but it’s difficult because moodiness hinders my professional relationships,” she says. Nayanika also tells me of her experiences with mood swings, sudden emotionality, and irritation that she later realises is a symptom of PCOS.
A 2018 report by the Indian Fertility Society revealed that women with PCOS experience higher rates of anxiety and depression than the general population. Researches at Cardiff University’s Neuroscience and Mental Health Research Institute also found that women with PCOS were most likely to suffer from mental illnesses like depression and anxiety. The women interviewed in this story unfortunately concur.
Rujvi Mehta, a 22-year-old law student from Gujarat takes me through how excessive hair growth on her chin, cheeks, stomach, and back that impacted her self esteem and made her anxious to visit salons for hair removal. “Chin hair becomes hard. So it was very embarrassing,” she says. Nairika contextualises her poor mental health with years of body shaming and bullying from her peers in school who singled her out for her weight, acne, and hair fall. Ayesha too experienced initial feelings of disappointment when she was unable to lose weight.
A 2013 study conducted by The Iranian Journal of Reproductive Medicine (IJRM) found that women who suffer from irregular menstrual cycles are more dissatisfied with their bodies and have lower levels of self-esteem than those who don’t. So it’s unfortunately unsurprising to hear that Sarah Patil, a 20-year-old student in Mumbai, developed an eating disorder after she was diagnosed with PCOS. “I used to starve myself… I was borderline bulimic. I reached a point where I was harming myself,” she says recalling the countless nights she has cried herself to sleep. Nairika says her gaining 15kgs in six months triggered dangerous eating habits. “I started starving and purging... My skin became grey and brittle. My hair started falling out… My mother would sit with me for two hours after I ate to make sure I wouldn’t purge,” she tells me.
Dr. Coelho says, “Stress causes an unhealthy lifestyle, which results in obesity… Then, there is further stress and depression,” she says. What Dr. Coelho describes is a relentless cycle: hormonal imbalances triggering weight gain, anxiety, and PCOS that contributes to further hormonal imbalances that make living healthy a mammoth task.
Ayesha and Nairika both tell me of another unique struggle for women with PCOS: the inability to have a successful pregnancy. Ayesha says that the thought of needing to get pregnant by the age of 30 to have the best chance to deliver children is a huge source of anxiety because it feels like an unnecessary, self-imposed deadline. Nairika tells me that her doctor offered medication that would make her menstrual cycle more certain, “but he said, ‘If you want to be a mother, it’ll affect your chances,’” she says.
The same IJRM study found that women not only associate regular menstruation with the capacity to bear children, but also their feminine identity, which makes PCOS a condition that provokes deep insecurity and unhappiness with one’s self and body. Even excessive hair growth, especially facial hair, that challenges the conventions of femininity is a compounding problem. Rujvi tells me of her frustration at people pointing out specks of her chin hair and commenting, “What is that? It’s not normal, right?”
Forever mending the strained relationship with their bodies, fielding unsolicited opinions about their appearances, and attempting to maintain good mental health is only the tip of the PCOS iceberg. Women must also deal with numerous and exhausting trips to the doctor and expensive medication that can result in terrifying side effects. Nairika, who is also asthmatic, experienced pulmonary shock as a side effect to prescribed medication. Sarah says, “I’ve been to a lot of doctors and everyone says the same thing and gives the same medicine that works only temporarily.
Starting dialogue on PCOS in a country that’s reluctant to discuss menstruation and female hygiene is an uphill battle; and having to challenge patriarchal standards of feminine beauty while paying through the nose for expensive healthcare is an added burden. India’s PCOS problem has many faces– 1 in 3 to be precise– but the level of discourse on it is disproportionate. “Women are expected to endure so much already. We’re so used to silently working through all of this. I hope people realise how much effort it takes to get past body image issues, a stressful work life, not sleeping or eating properly.”
Regardless, Rujvi, Nayanika, Ayesha, Sarah, and Nairika all tell me of strong support systems, a now secure sense of self, and hope for an empathetic Indian society– things that aren’t medical solutions for PCOS, but make the fight more bearable and less lonely.
Feature image source: Sarah Patil and Ayesha Dutt.
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