The Star (Nairobi)

11 February 2013

Kenya: Cysts - Every Young Girl's Nightmare and What Can Be Done

Polycystic Ovarian Syndrome (PCOS) is an imbalance of the female sex hormones, oestrogen and progesterone, and is typically characterized by the growth of cysts in the ovaries.

A female child is born with undeveloped eggs and they are stored in her ovaries. Once she hits puberty, hormones in her body trigger development of one egg into a fertilizable state every single month.

If it is not fertilized, then the body gets rid of it in what we colloquially call a period. With PCOS, the imbalance in hormones causes more than one egg to be developed and sometimes not to a fully fertilizable state. These half developed eggs grow into cysts and remain in the ovaries. Some PCOS patients can have as many as 14 cysts in one ovary.

Science is yet to identify the cause of PCOS. Jacqueline Nyamae is a 35-year-old lawyer who has been living with the syndorme since she was 21. 'I think there is a genetic link because my younger sister and one of my aunts also have PCOS.'

Dr Wanjiru Ndegwa, a gynecologist and fertility expert at the Kileleshwa Medical Centre, confirms Jacqueline's suspicions saying, 'doctors aren't sure where PCOS comes from but we do find that it runs in families so we think there is a genetic link. Lifestyle also plays big role. '

'I always had very heavy and irregular periods as a teenager. I was also a little bigger than my peers. When I moved to the UK for my law degree, something in the food there just changed my whole body, it was like a shutdown.

I put on weight, my period got even heavier, I got acne on my face, and then I started growing facial hair even though the hair on my head was falling off. I was unable to concentrate in school, it was really bad," said Jacqueline.

How did she turn things around? "I figured it out very recently. The hormonal imbalance makes you insulin resistant so the drugs that doctors prescribe are diabetic drugs.

I have tried several of these and they are really hard to take. It felt like my body was fighting them." She was put on a drug regimen that included Metamorphine, "that pill was a disaster. I almost lost my job. I could not concentrate, I had constant diarrhea so I lost so much weight. It was awful."

"My sister and I went for a Patrick Holford seminar and we got his book Balance Your Hormones. That is when I realised that something as simple as bad eating habits can destroy your life.

Food is the biggest thing to control and manage PCOS because it is all about keeping your blood sugar levels regular. That way you can decrease the insulin resistance and everything else normalises. I know when my system is off because I either get really cranky or I crave sugar.'

'Thanks to Balance your Hormones, I really understand my body and have learnt to control my moods and concentration, all through diet...avoid wheat, dairy, sugar, anything processed, caffeine and alcohol as much as possible. Recently I lost nine kilograms in six months without much exercise. I also have started practicing Bikram yoga and that helps because stress is another trigger."

Dr Ndegwa explains that hormones are what keep our body in a steady state, "some like the sex hormones instigate certain processes while others like simply balance sugar.

When something goes wrong then the whole system is thrown off and that is what PCOS does. The main symptom is insulin resistance so that the body does not respond to insulin which regulates blood sugar and this puts PCOS patients at risk for developing diabetes."

So what are the treatment options? Ndegwa says that PCOS is not treated, rather is it managed, "I urge my patients to get a healthier lifestyle - more exercise, less sugar and processed foods and also I ask them to eat a lot of fruit and vegetables.

Keeping a healthy weight is challenging with PCOS but it is very important so usually I recommend a nutritionist. We find that any weight loss makes a huge difference.

If the cysts are causing pain, immobility or infertility, then we perform surgery but this is a last resort because they will grow back. PCOS is the leading cause of infertility and we are seeing more of it as our lifestyles involve more fatty and processed foods.

"Regardless of age, we have to discuss fertility options so that they do not leave the decision to have children too late and find that they cannot. PCOS does not mean that the patient is infertile, just that they will probably have a harder time conceiving, as compared to most people," said Dr Ndegwa.

Dr Ndegwa is quick to add that while PCOS demands constant management it is in no way a death sentence, "patients eventually settle into their new and healthier lifestyles and go on to have the full lives they dreamt of."

Signs and Symptoms

Fewer than nine periods a year - your menstrual cycle should stabilise within two years of onset, so irregularity should be checked. Very light periods or very heavy flow, you should not have to change pad more than 3 or 4 times a day and the overnight one should last all night.

Hirsutism or abnormal hair growth - male pattern hair growth like facial hair or pubic hair in the shape of a diamond instead of a triangle.

Excessive thirst or eating

Weight gain or weight loss

Hair loss

Lack of concentration

Extreme moodiness, especially if related to missed meals.

Frequent urination

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