Researchers in Kashmir aim to change the way PCOS is treated

Two latest studies by doctors at Government Medical College (GMC) Srinagar have revealed a link between psychiatric symptoms and poly-cystic ovarian syndrome (PCOS).

The studies are being seen as a valuable addition to existing literature regarding association of PCOS with psychiatric issues in women in Kashmir and could change the way doctors look at PCOS and mood disorders.

The studies, designed primarily by GMC’s psychiatry department, ‘Poly-cystic Ovary Syndrome in bipolar affective disorder: A hospital based study’ and ‘Prevalence of psychiatric disorders in patients with diagnosis of polycystic ovarian syndrome in Kashmir’, have established a strong link between mood-disorders and PCOS, the researchers involved in the studies said.

While talking about the work, Dr Sabreena Qadri, consultant and lead researcher of the hospital based study said, PCOS and mood & anxiety disorders are showing an increasing trend in urban young women with dual diagnosis.

The study found that 23 percent of patients with bipolar mood disorders had PCOS. Till now, doctors have been looking at psychiatric illnesses and PCOS separately. “We have been believing that because of the psycho-social impact of PCOS such as lowered self esteem, infertility and others, there is a psychiatric effect of PCOS,” Dr Sabreena said adding there was a greater association between the two than was being currently taken into account.

The second study carried out by the department has shown that 23 percent of PCOS patients had major depressive disorders as compared to just 7.5 percent of those women who did not have PCOS. Over 15 percent of PCOS affected women had panic orders, three times more than women not affected by it.

The other disorders also showed similar pattern. The study, published in Psychological Medicine in 2015, recommended screening and appropriate measures for psychiatric disorders as part of PCOS management. “The PCOS, if unmanaged, has devastating effect on the lives and well-being of women and must not be ignored by practitioners as a cosmetic issue,” said Dr Sabreena of GMC’s department of psychiatry, who was part of these studies. She urged doctors to employ multi-dimensional approach in treating patients diagnosed with PCOS or mood disorders.

“Lifestyle changes form the basis of PCOS management but we have evidence now that doctors need to look beyond the metabolic syndrome when evaluating such patients,” she said, adding most of the young women she studied were “erroneously” being diagnosed with borderline personality disorders, anxiety disorders, bipolar disorders and major depressive disorders to “fit them into current diagnostic systems”.

“We found that mood anxiety symptoms are very common in PCOS patient. Many a time the psychiatric symptoms predate the PCOS diagnosis and even signs and symptoms,” she said. “Thus,” the researcher asserted, “the association cannot be explained on basis of psychological burden or chance alone.

The pattern seems to be very similar and variations seem to be in severity only.” In view of the studies, the department of psychiatry has proposed a new term – Mood Anxiety Complex of Polycystic Ovary Syndrome (MAC-PCOS). “It is a distinct disorder and although shares features with all the mentioned psychiatric disorders, but has greater association with PCOS,” Dr Sabreena said. Dr Aakriti a postgraduate resident at IMHANS has been invited to present the findings and association at Royal College of Psychiatry this June, an honour very few have enjoyed in J&K. The aim of the studies and proposal was to recognise the common etiology of the epidemic of mood anxiety disorders and PCOS affecting females.

“If we could address the common factors that seem to have some link with both the disorders such as urban and sedentary lifestyle, reduced outdoor activities in childhood, changing eating patterns, loneliness and others, we could perhaps make some positive difference,” Dr Sabreena said. PCOS is a disorder affecting women where endocrine functions are disturbed, resulting in a variety of conditions, referred together as PCOS.

The common symptoms include weight gain, hirsuitism (male pattern hair growth), irregular cycles, acne. The conditions affect women in reproductive age and may adversely impact fertility.

Dr Ashraf Ganai, professor of endocrinology at SKIMS and a noted researcher on PCOS said that in Kashmir the presentation of PCOS was different than in metros like Delhi, although prevalence was similar.

“In Kashmir, obesity with PCOS is not as common as in Delhi. But we have girls who have more severe cosmetic affects such as hirsutism here,” he said. Apart from its cosmetic affects, women with PCOS have a higher risk of developing type-2 diabetes mellitus, cardiovascular diseases and have impaired glucose tolerance, he said.

Although no definite causes for PCOS have been defined yet, medical literature has linked it with imbalance of hormones such as testosterone, leutinising hormone, prolactin and resistance to insulin.

There is mounting evidence on link between lifestyle and PCOS. “If one has the genetic makeup that makes one vulnerable to have PCOS, urban, sedentary lifestyle seems to have a role in making it happen,” he said, adding he was currently studying PCOS in tribal women of Kashmir. “Interestingly, there is very low prevalence in comparison to people having an urban lifestyle…,” he said.