Discomfort during a period or a delayed period is considered a normal part of a woman’s reproductive life. However, dismissing it as just another ‘period pain’ would not be a wise thing to do as it may come with significant health issues linked with mental health, diabetes, and infertility.
Such painful periods could be a sign of Polycystic Ovary Syndrome (PCOS), which is common in India and an increasing number of women in the reproductive age are suffering from this hormonal disorder. They could also be associated with endometriosis, a disease in which tissue similar to the lining of the uterus grows outside the uterus.
As per reports, one in five women in India suffer from PCOS but this lifelong health condition is often dismissed as a routine issue that will go away on its own. In fact, the list of serious health issues that PCOS comes with is exhaustive. A recent study published in The Journal of Clinical Endocrinology and Metabolism says PCOS is associated with an eating disorder or bulimia. It shows that the risk of eating disorders is 50% higher among women with PCOS, regardless of their body mass index (BMI). Another study published in Neurology earlier this year, says it is also associated with potential cognitive issues in midlife. It says increasing evidence links cardiovascular risk factors, such as diabetes and hypertension, to accelerated cognitive ageing to PCOS.
The disorder is primarily known for its reproductive issues including oligomenorrhea (abnormal menstruation), hyperandrogenism (high levels of androgens or male hormones), and infertility. It is also associated with adverse metabolic features, including insulin resistance (IR) exacerbated by obesity, cardiovascular risk factors, including dyslipidemia, hypertension, and inflammation as well as mental health issues, including depression and anxiety.
A new study conducted by researchers from the Norwegian University of Science and Technology found that women with PCOS and obesity are more likely to have smaller babies in terms of birth weight, length, and head circumference. Research has also shown that, compared to 7% of women in the general population, 34% of women with PCOS experience depression and approximately 45% of them experience anxiety, compared to just 18% of those in the overall population. A study by researchers in Taiwan, published in Annals of Internal Medicine, earlier this year found that PCOS can also increase the likelihood of suicide attempts among women, even after adjusting for factors such as psychiatric disorders, other health conditions, and demographics.
Despite these health complications, experts say most women ignore PCOS symptoms and visit a doctor only when they face issues when planning to have a baby.
Endometriosis is another condition related to period pains in which women suffering from this disease are known to not get enough care worldwide simply because of the under-diagnosis of the disease, according to a Lancet study. The report says that it affects at least 10% of women of reproductive age worldwide, which spells out to approximately 247 million women. Several reports say that India alone represents 25% of the burden with an estimated 43 million women enduring the pain.
The Lancet report also notes that the poor care of the disease is attributed to the taboo around discussing menstrual pain and issues such as painful intercourse (a symptom of endometriosis) which leads to women ignoring the concerns altogether, not discussing it and resultantly either delaying its diagnosis or never seeking medical attention at all. If ignored for a long time, doctors say it can lead to infertility, damage to surrounding organs, persistent pelvic pain, gastrointestinal issues as well as mental health issues.
Warning signs
Doctors associate PCOS with menstrual irregularity, infertility, acne, hair loss on top, male-pattern baldness, and sides of the head, and excessive body hair typically seen on the upper lip, chin, sides of the face, and trunk. Obesity with skin darkening on the nape of the neck and folds is also seen. Other symptoms include polycystic ovaries (multiple small cysts on the ovaries visible on ultrasound), weight gain or difficulty losing weight, and sometimes infertility.
“The exact cause of PCOS is not known. Some studies say insulin resistance stimulates the production of androgens (male hormones). Mild inflammation in the ovaries of patients can cause the production of androgens,” says Dr Anshumala Shukla Kulkarni, head, minimally invasive gynaecology, gynaecology laparoscopic and robotic surgery, at Kokilaben Dhirubhai Ambani Hospital, Mumbai. She says genetics plays a major role in developing PCOS.
Talking about endometriosis, she says, it is a systemic inflammatory disease that is responsive to hormones. “It involves the growth of cells similar to the uterus lining (endometrium) in areas around the pelvis mainly, but can be found in the bowel, bladder, diaphragm, pleura, and nerves,” says Dr Kulkarni.
Women suffering from the condition have internal bleeding as the endometrial tissue has no outlet from the body. “Common symptoms of endometriosis include painful periods, heavy periods or bleeding between periods, pain during intercourse, bowel movements or urination, and infertility caused by scar tissue formation,” says Dr Anita Kant, chairman of OBG services and robotic surgery, Asian Hospital, Faridabad.
Dr Sameep Bhujbal, consultant, obstetrics and gynaecologist, at Jupiter Hospital in Pune, says that it can make it harder to get pregnant adding that it can start at a person’s first menstrual period and last until menopause. Talking about menstrual pain, Dr Bujbal also points out that while it typically causes painful periods, the pain may feel different from normal menstrual cramps.
“Not everyone experiences the same symptoms; some may only notice more intense period pain and heavier bleeding,” he says. The exact cause of endometriosis is not fully understood, but theories include retrograde menstruation, immune system disorders, and genetic predispositions, underscores Dr Tripti Raheja, lead consultant, obstetrics and gynaecology, at the CK Birla Hospital in Delhi.
Take care
Dr Raheja of CK Birla Hospital says that diagnosis of PCOS typically involves blood tests to check for hormone levels and an ultrasound to check for cysts on the ovaries. It is often based on the presence of at least two of the following criteria: irregular periods, elevated androgens, and polycystic ovaries.
The treatment includes hormonal birth control to regulate periods,
medications to manage insulin levels, and treatments for symptoms like acne and hair growth. Surgery for this is not recommended unless the patient is resistant to all medicines and desires fertility, explains Dr Kulkarni of Kokilaben hospital.
For endometriosis, the diagnosis involves pelvic exams, imaging tests like ultrasound or MRI, and often laparoscopy (a surgical procedure) to confirm the presence of endometrial tissue outside the uterus. For treatment, doctors may advise pain relief with medications, hormonal therapies to reduce or eliminate menstruation, as well as surgical options to remove endometrial tissue.
Experts say both the conditions cannot be prevented entirely as they are influenced by genetic and hormonal factors. However, certain lifestyle changes can help reduce the risks or manage the symptoms. They suggest eating a balanced diet with more fish, fruits, and vegetables while reducing dairy, carbs, and gluten, which can ease symptoms of endometriosis and PCOS.
Regular exercise, yoga, and mindfulness can also help manage pain and improve hormone balance. For any kind of supplements that may be beneficial, doctors advise against taking them on your own and consulting healthcare professionals beforehand.