At a time when modern science has made remarkable progress in treating diseases like cancer and HIV/AIDS, a common hormonal disorder remains undiagnosed affecting millions of women globally. Polycystic Ovary Syndrome (PCOS) is quietly emerging as a significant health concern, particularly among young women in Nepal. Once a rarely known disorder PCOS and its related term Polycystic Ovarian Disease (PCOD) are now emerging as significant health concerns. World Health Organization estimates 1 in 10 women suffer from PCOS, with a large proportion remaining undiagnosed. In Nepal, the situation is further complicated by limited research, awareness, social stigma surrounding menstrual health, and delayed medical consultation.
Changing lifestyles, rising stress levels, and limited awareness have contributed to a noticeable increase in cases. Preliminary diagnoses are often shrugged off and women mostly seek medical help during irregular menstrual cycles by which time the condition may have already progressed.
Understanding the Symptoms
Symptoms such as irregular periods or no periods, hair growth, heavy bleeding, acne, darkening of the skin, weight gain, depression, headache, mood swings, sleep-related disorder occur during PCOS and PCOD. However, these symptoms vary from person to person, often making early detection difficult leading to failure in recognising early stages warnings.
The main symptoms or the triad of the PCOS is menstrual irregularities, hormonal effects (such as unwanted facial hair or acne) and ultrasound reports. Apart from that, rapid weight gain which can't be controlled and metabolic problems can also be seen.Despite the visible signs, many women (about 70%) fail to recognize the PCOS in its early stage due to unawareness. About 33% of the women under 30 years of age get affected by this disorder. This disorder should not be taken as a menstrual problem only, as it can lead to serious problems like diabetes, heart disease and infertility if not treated at time. And when it becomes late to diagnose, complications may have already begun to develop.
PCOD can be rarely detected at an early age whereas symptoms of PCOS are visible since the start of puberty. Women with PCOD will have irregular periods rather than not having the periods. Likewise, obesity is more severe in PCOD than PCOS.
What not to do during silent period?
PCOS and PCOD: Clearing the Confusion?
In Nepal and India, the terms PCOS and PCOD are often used interchangeably, which leads to confusion among patients. However, medical experts clarify that while the two conditions are related, they are not identical.
PCOS is an endocrine hormonal disorder that causes ovulation to fail, male hormones to increase, and many small follicles or cysts to appear in the ovaries and without timely attention it can silently impact both physical and mental well-being. PCOS disorder is mainly characterized by hormonal imbalance that elevates the androgen levels often referred as male hormones. The imbalance disrupts the normal menstrual cycle leading to irregular or missed periods, forming the small cysts in the ovaries. PCOS doesn't have a single cause, it's a combination of genetic, lifestyle, and metabolic factors that disrupt hormones. It is mainly influenced by insulin resistance(50-70%), genetics (70%), obesity (80%), lifestyle factors like diet, exercise, sleep and stress (85%), all of which disrupts hormones and menstrual cycles. PCOS can be diagnosed using Rotterdam Criteria, if a woman has the following; Oligo/Anouvulation (71-85%), Hyperandrogenism (65-80%), or Polycystic ovaries (70-80%). In countries like Nepal, where reproductive health education is still far behind, these factors are worsened by lack of open discussion about menstruation health.
PCOD is a condition when the ovaries release many partially mature or immature eggs that turn into cysts. Every woman has two ovaries, one on either side of the uterus, and every month, ovaries release an egg alternately and also produce hormones like estrogen and progesterone in very few quantities.
Even if some women have known about these conditions, they get confused if PCOD and PCOS are the same. No doubt, both these conditions are related to the ovaries and menstrual problems and cause hormonal imbalance, irregularities in periods, and menstrual cycles. Still, they are different.
PCOS is commonly diagnosed using the Rotterdam Criteria, which requires at least two of the following conditions: irregular ovulation, elevated androgen levels, or the presence of polycystic ovaries on ultrasound.
The condition does not have a single cause. Instead, it is the result of a complex interaction between genetic predisposition and lifestyle factors. Increasing urbanization, sedentary behavior, unhealthy diets, and chronic stress are all contributing to the growing prevalence of PCOS among young women in Nepal.
Health Risks Beyond Menstruation
PCOS is often misunderstood as a menstrual irregularity, but it impacts the whole body. If left unmanaged, it can lead to serious long term complications including infertility, type two diabetes, high blood pressure, and cardiovascular diseases.
Beyond reproductive concerns, PCOS can also link to serious long term health risks, including infertility in 70–85% of cases and increasing the risk of gestational diabetes. It also raises the chances of type 2 diabetes by age 40, heart disease, high blood pressure, and mental health issues like anxiety and depression. Other serious risks include endometrial cancer, fatty liver, and sleep apnea. Early diagnosis and lifestyle management are essential to reduce these risks and maintain overall health.
What to do if you think you have PCOS or PCOD?
Despite many risks, medical experts suggest that it is manageable. Early diagnosis, lifestyle changes such as regular exercise and a balanced diet, and appropriate medical treatment can significantly reduce symptoms and improve quality of life. Awareness remains as the best to tackle the issues. Integrating PCOS education into school health programs, expanding community outreach, and using digital platforms to disseminate accurate information can play a crucial role in early prevention. Encouraging open discussions around menstrual and hormonal health can also help reduce stigma and promote timely healthcare seeking behavior.
Kathmandu Metropolitan City is currently working with Catalyst for Change Nepal in generating awareness on PCOS in all of its wards. By capacitating Female Community Health Volunteers from Urban Health Promotion Centers (UHPC), the organisation is addressing PCOS at the ground.
Kathmandu Metropolitan City, in collaboration with Catalyst for Change Nepal, is initiating awareness campaigns on PCOS across all wards. Through capacity building of Female Community Health Volunteers from Urban Health Promotion Centers (UHPC), the organization is strengthening early identification of PCOS. With early detection, awareness and timely intervention, women can improve their health and prevent long term complications associated with this silent yet significant disorder.
Bajracharya is Co-founder and Thapa is Program Associate at Catalyst for Change Nepal
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