Always a skinny girl, Swati (name changed), a 25-year-old biochemist, started putting on weight in her early twenties. Chalking it down to a slowing metabolism, she didn’t think much of it. Until she missed her period. And missed it again in the following months. After visiting her gynecologist and undergoing an ultrasound exam, Swati was diagnosed with a polycystic ovarian syndrome or PCOS.
Metabolic Syndrome
Put simply, PCOS is a metabolic syndrome that manifests in women of childbearing age (between 15-30 years). Its external symptoms include irregular or no period for months, growth of excess facial and body hair, mild to severe acne, and weight gain. Internally, it’s characterized by increased levels of androgens (male hormones) in the body, resistance to insulin and/or multiple cysts (follicles containing immature eggs) on one or both ovaries.
Swati’s blood work bore this out. It confirmed high levels of androgens, leading to hirsutism (excess growth of hair on the female body), and above normal (>100mg/dL) fasting sugar levels, indicating insulin resistance. And Swati is far from alone. It is estimated that PCOS affects 1 in 5 women in India, compared with a global prevalence of 1 in 10.
Risk of development
Women with PCOS are at risk of developing type 2 diabetes, obesity, cardiovascular disorders (CVD) and infertility. And while research is yet to prove exactly why women develop this condition, lifestyle and genetics are considered to be major factors.
But here’s the thing—we don’t know what comes first.
Does weight gain, due to an unhealthy lifestyle, cause insulin resistance that, in turn, leads to the production of excess androgens and irregular menstrual cycles? Or does genetic predisposition to developing insulin resistance lead to a hormonal imbalance that causes women to miss their period and consequently put on weight?
The opinion is divided.
Dr. Padmaja Pepalla, for example, believes it is heavily lifestyle-related. Poor eating, sleeping and exercise habits, she says, lead to weight gain. Dr. Pepalla is a gynecologist at Padma Hospital in Vadodara.
Dr. Maya Hazra agrees that lifestyle plays a major role in the development of PCOS. However, she leans towards genetic predisposition as the primary cause. “There is a definite correlation with diabetes. I have seen women who have a family history (especially mother or maternal aunt) are extremely prone to developing insulin resistance themselves and consequently PCOS,” she says.
Diabetes, one of the most dangerous diseases
Dr. Hazra has been a practicing obstetrician and gynecologist (OB/GYN) in Vadodara for the past forty-five years. She has seen PCOS grow its claws over time, with her experiences leading her to believe it is a condition born of diabetes.
Both Pepalla and Hazra, however, are only making educated guesses. The reason could be both or neither, as research doesn’t clearly spell out the cause. This lack of clarity has led to contrasting opinions in the medical fraternity on how to treat a large population that is at risk of developing diabetes, obesity, and infertility.
But despite the uncertainty surrounding PCOS, there has been diagnosis and prescription overdrive. Indeed, in 2016, the global PCOS market was valued at $3.3 billion, according to US-based Grand View Research. By 2024, it is estimated to reach $5 billion—growing at a compound annual growth rate of 5%.
With the prevalence of PCOS in India higher than the global average, India’s own PCOS market is bound to be a significant contributor. One Mumbai-based pharma consultant The Ken spoke with conservatively pegged the healthcare and pharmaceuticals market for PCOS at $0.9 billion. The pharmaceuticals market, he opined, made up about a third of this.
On its own, this shouldn’t raise red flags. But there’s a problem—PCOS management is currently the Wild West. This inconsistency is fuelling the off-label use of many drugs available in the market. Off-label refers to the use of a drug for purposes other than what it was officially approved for. This poses its own concerns and challenges, and the trend shows no signs of slowing.