Valley In Throes Of Lifestyle Diseases: ‘Conflict-Related Stress Has Triggered Hormonal Disorders In Women’

By: Syed Mohsin
Srinagar, Dec 8: With conflict-related mental strain becoming part of life in the Valley, doctors at Sher-e-Kashmir Institute of Medical Sciences (SKIMS) and the Government Medical College (GMC) Srinagar say the stress might be responsible for triggering polycystic ovary syndrome, one of the most common endocrine disorders in women of reproductive age.
Polycystic ovary syndrome is the most common hormonal disorder occurring in women during their reproductive years. It’s thought that 4 to 10 percent of women are suffering from the disorder. The prevalence of PCOS seems much higher in the Valley as compared to the rest of the country.
Polycystic ovarian syndrome is one of the leading causes of infertility. PCOS can occur anytime during the reproductive years. Due to its often vague presentation, the disease can take years to reach the diagnosis. Symptoms frequently start to show up soon after puberty.
The disorder originally described as cystic disease of the ovaries by Stein and Levanthal in 1935, is now considered to be associated with a barrage of endocrine and metabolic disturbances like hypertension, impaired glucose tolerance, type-2 diabetes mellitus, coronary artery disease, increased risk of endometrial and perhaps breast cancer. The usual manifestations of the disorder are menstrual disturbances, abnormal male pattern hair growth in women, severe acne vulgaris, obesity, infertility, irregular, few or absent menstrual periods, generally resulting from chronic lack of ovulation.
Doctors say Serum insulin, insulin resistance and homocysteine levels are significantly higher in subjects having PCOS. “In view of this link it is considered as mother of all life style disorders,” says Dr Muhammad Ashraf, Associate Professor Endocrinology at SKIMS. Dr Ashraf was earlier working on the subject in the All India Institute of Medical Sciences (AIIMS) New Delhi.
Dr Ashraf says the condition may be very common in Kashmir for multiple reasons. “Firstly Kashmiris take high caloric diet in the form of fat in non-vegetarian food, use lot of oil for cooking and are used to fast food culture in the light of sedentary lifestyle. This may also exaggerate obesity which is an essential accompaniment of the condition. Our data reflected the same as 60 percent of the affected girls are obese,” he said.
Secondly genetic predisposition also seems to be very important predictor of the condition possibly due to very high background of consanguinity. “Our data shows that 85 percent mothers, 80 percent sisters, 60 percent brothers and 50 percent fathers of a cohort of PSCOS girls had metabolic syndrome,” he said.
He said stress may be another important factor responsible for the high prevalence of the condition. The disturbance of hypothalamic-pituitary-gonadal axis may be occurring due to stressful life style. He says among 112 young and adolescent PCOS women studied at SKIMS, there has been high (65-70%) prevalence of psychiatric disorders. The study shows eight patients had Obsessive Compulsive Disorder, five had post traumatic stress order, 27 women were having MDD, four had mood disorder, nine had suicidal tendencies, 3 had mania, 18 had panic disorder, 20 patients had generalized anxiety disorder.
“We studied 175 girls (13-18 year) identified during country-wide survey of thyroid diseases in schools and we found PCOS phenotype was two to three fold common in chronic lymphocytic thyroiditis girls. This may point towards an autoimmune basis of the disorder mandating more research. This first time we show to World and this work was awarded first prize in AE-PCOS meet in San Francisco in 2008 but it needs further study to confirm,” he said.
According to Dr Ashraf healthy diets (fresh fruit, vegetables, low fat diet), exercise, weight maintenance are the main recommendations pending understanding the cause of disorder.
“Till now we were looking at stress as harbinger of mental health issues as PTSD, depression but now we are increasingly realizing that chronic conflict related stress has probably increased insulin resistance, cortisol levels,” says Dr Arshid Hussain, Consultant at Postgraduate Department of Psychiatry GMC Srinagar with research interest in metabolism and stress.
“We seem to be sitting on a metabolic spectrum disorder volcano ready to explode,” he goes on to add.
Dr Ashraf says the disorder is a good model to understand the origin and hence planning the therapy of both these disorders.“India being diabetic capital of the world, health planners need to focus on the metabolic syndrome and PCOS stage of this spectrum to prevent the occurrence of diabetes, otherwise our healthcare is going to crumble under the burden of diabetes and coronary artery disease alone,” he cautions.


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