Indian women at high risk of syndrome

Doctor researches reasons

POLYCYSTIC Ovarian Syndrome, one of the leading causes of impaired fertility, is more prevalent among Indian women of reproductive age than any other race group, but the reason remains unknown.

Dr Nitasha Magan, a specialist gynaecologist and obstetrician at Kingsway Hospital in Durban, said there were many theories on why Indian women were more prone to the condition.

PCOS was associated with metabolic ailments such as diabetes, hypertension and heart disease and these were more common in Indian women, she added. And the Indian diet and genetic factors could largely contribute to these conditions.

Magan, who graduated with a Master’s in medicine in obstetrics and gynaecology, conducted research for her dissertation – the first of its kind in the country – that focused on PCOS, which affects women, particularly Asians, around the world.

According to her research in 2010, PCOS is one of the most common endocrinopathies in women of reproductive age, with the prevalence estimated to be around 5 to 25 percent in the general population.

She said literature on the prevalence of the disease in black women was limited and this prompted her to embark on this study.

Participants were patients at the gynaecology, endocrine or fertility clinics at Inkosi Albert Luthuli Central Hospital between 2005 and 2009. In total 110 patients were analysed.

Magan found that, in keeping with international markers, PCOS was most prevalent among Indian patients, with 87 diagnosed with PCOS compared to 16 African, five coloured and two white patients.

Although the international findings indicated a similar pattern of the disease among the various race groups, she found that South African Indian women also presented with obesity, diabetes mellitus and an impaired glucose tolerance test.

She said the prevalence of obesity and diabetes in Durban women was higher than seen globally in women with PCOS.

Magan also found that none of the African patients had diabetes mellitus or hyperlipidaemia (when the concentration of triglycerides or cholesterol in the blood is too high).

She found that although there were no differences in the hormonal and clinical profile of South African Indian and African women with PCOS, there was a trend towards Indian women having a greater prevalence of glucose abnormalities than African women.

The incidence of PCOS was increasing, and many women did not know they had the condition until they wanted to fall pregnant, Magan told POST this week.

“Women should suspect they have the condition if they have increased weight, a thicker hair growth, acne and an irregular menstrual cycle. At first, no one thinks it is a problem. They think it’s normal until they go to a dermatologist or a gynaecologist.”

She said similarly, women who wanted to have children only found out they had the condition when they struggled to fall pregnant.

Magan added that most of the women battled to lose weight and were prone to develop diabetes, high blood pressure and heart disease. She said research showed the condition was growing rapidly.

Fertility specialist Dr Johan van Schouwenburg of Medfem Fertility Clinic in Johannesburg said about 10 percent of couples they treated had fertility problems.

He said the common problem with women with PCOS was insulin resistance, and after diagnoses there were standard treatments which included Metformin – a diabetes medicine sometimes used for lowering insulin and blood sugar levels.

It also regulates menstrual cycles, starts ovulation and lowers the risk of miscarriage in women with the condition.

Speaking about the problems women encountered when trying for a baby, Van Schouwenburg said that in the ovary, the follicle needed to grow to about 22cm before it ruptured for ovulation, but for those with PCOS, it grew to around 5cm then stopped and remained in the ovaries.

He said infertility was not the only problem. Patients could suffer with obesity, and the ovaries could start making more male sex hormones (androgens), which could result in ovulation stopping, acne breaking out, and the growth of extra facial and body hair.