March 1 marks the annual Endometriosis Awareness Day, a global initiative aimed at raising awareness and understanding of this chronic and often debilitating condition. Endometriosis affects an estimated 176 million women worldwide, causing symptoms such as severe pelvic pain, heavy periods, and infertility. Despite its prevalence, there is still a lack of knowledge and understanding surrounding this condition, leading to delayed diagnosis and inadequate treatment options.
One of the factors contributing to this knowledge gap is the link between endometriosis and other health issues, such as polycystic ovary syndrome (PCOS) and obesity. In honour of Endometriosis Awareness Day 2024, let's unpack this connection and understand how it impacts women struggling with infertility.
The link between PCOS, Obesity, and Infertility:
According to Dr Astha Dayal, Lead Consultant, Obstetrics & Gynaecology, CK Birla Hospital, Gurugram, PCOS or Polycystic Ovarian Disease is a kind of hormonal imbalance that involves hormones like insulin, testosterone and female hormones. So, there is a component of insulin resistance in PCOS and because of that, there is a higher chance of obesity in girls who have PCOS. If we say the incidence of PCOS is around 10-15% worldwide but in metropolitan cities, it is much higher. In my OPD I would say up to 25 to 30% of girls that I see could be having PCOD. Now, 80% of the girls who have PCO are overweight and 20% of them have thin PCOS.
There is a correlation between PCOS and obesity because PCO has a feature of insulin resistance so your quality of insulin is not good, whatever carbohydrates you are eating, you are not digesting them well and you have a tendency to put on weight and it is a very common symptom that girls with PCO, have a very easy weight gain, and they have a lot of difficulties, in losing weight, despite doing diet and exercise.
Now another problem with PCO is irregular cycles and that is because the egg formation or the ovulation is not very proper. So this is the reason for fertility issues in PCO and not everybody but about 30% of the girls with PCO do have a problem in conceiving easily. So they do have some subfertility but having said that, it is also relatively easier to treat because we know what the problem is and we know what medication would be helping out the girl who has a fertility issue.
Besides this obesity in itself is an independent risk factor for subfertility, which means that if you are overweight, you will have relatively a difficult time getting pregnant. So if you lose 10% of your body weight, it will improve your fertility. So this is how all these are interrelated. So if you have PCO and you are overweight, then if you lose weight, it will improve your PCOS and it will improve your fertility also. That is an advantage that people with overweight PCOS have that when they lose weight, all their problems get sorted. But in thin PCOS, it is relatively more difficult to treat them because in obese, just a lifestyle change can make a big difference in their treatment.
Endometriosis Awareness Day 2024 serves as a reminder that more needs to be done to raise awareness and understanding of this condition. With the link between PCOS, obesity, and infertility being established, healthcare professionals must address these factors in the diagnosis and treatment of endometriosis. It is also essential for women to prioritise their health, seek support, and advocate for themselves to break the cycle and improve their chances of fertility.
