When Shariq Masoodi, who heads endocrinology at Sher-i-Kashmir Institute of Medical Sciences – a premier hospital in Srinagar, consulted a woman who hadn’t been able to conceive a child after the five years of her marriage, he immediately pointed out the problem — a sedentary lifestyle.
Suffering from Polycystic Ovarian Syndrome (PCOS) and obesity, the 35-year-old woman had gone from one doctor to another for years and tried several treatments. Everything, however, failed.
Then, in 2019, Masoodi suggested that “she lose 10 per cent weight and opt for a healthy lifestyle”. “For years, she had been desperate for a child,” Masoodi recalled. “And months later, she conceived.”
A study conducted by the Department of Endocrinology and Metabolism at All India Institute of Medical Sciences (AIIMS), Delhi, shows that nearly a quarter of Indian women of childbearing age are suffering from PCOS.
PCOS, also known as Polycystic Ovarian Disease (PCOD), is a health problem caused by the imbalance of reproductive hormones in women due to several factors, including lack of physical activity, unhealthy eating habits, stress and depression. Sometimes, a family history of diabetes also results in conditions like weight gain, acne, hair fall, irregular periods, and even infertility or delayed pregnancies.
A lifestyle disease
In Kashmir’s society, women are often held responsible for being unable to bear a child, however, said Masoodi from his experience, women are responsible only forty per cent of the time. “The other 40 per cent of the time, men are responsible. 10 per cent of the time both of the men and women are responsible and the rest of 10 percent of the time, the reason remains completely unknown, called indeterminate infertility,” said Masoodi.
Among the commonest reasons found among women who are unable to conceive is anovulation, Masoodi said, a condition where a woman with PCOS skips ovulation, leading to infertility.
In this lifestyle disease, just like diabetes, hypertension, obesity, and fatty liver, there is increased insulin resistance in a woman’s body leading to an increase in testosterone, a male hormone, Masoodi said.
“Testosterone is essential for every woman but if it is more than normal, we call it hyperandrogenism,” Masoodi added. In an unmarried girl, it causes acne and irregular periods, he said, but among married women, “it causes infertility by anovulation.”
Masoodi said that every second patient that he receives nowadays has PCOS. “I feel there is a 50 per cent increase in the cases,” he said. “However, the treatment is not impossible.”
Masoodi suggests his patients start the treatment along with leading a healthy lifestyle at least for three months and reducing the weight. “Women with PCOS who are trying to conceive should start exercising at least five days a week or do a brisk walk of thirty minutes at least five days a week,” Masoodi added. “Next very important thing is to have at least eight hours of sleep every night.”
More awareness and proper education about the ovulation period and reproductive process can lead to an increased chance of fertility, Masoodi suggested.
‘A vicious circle’
Over the years, other than hormonal issues, Masoodi has seen his patients unable to conceive due to stress, anxiety, and depression. “Stress management is very important. Women need proper counselling because PCOS can cause infertility that, in turn, leads to stress,” he said. “Stress only worsens this problem more. This is a vicious circle.”
Zoya Mir, a counselling psychologist at the Institute of Mental Health and Neuro Sciences in Srinagar, a sedentary lifestyle along with a stressful scenario often causes issues in pregnancy. “PCOS is stress-induced and over the years it has become common in Kashmir,” she said.
In Kashmir, the decades-long conflict has worsened the chances of recreation or physical activities for women, leading to helplessness amongst them, said Mir. “Stress causes delayed periods. And before periods, women usually get premenstrual syndrome (PMS). If a woman is stressed she will have more pain and mood swings,” she added.
Years of continuous trauma and stress have led to an increased emotional burden for women, Mir told The Kashmir Walla. “I believe that trying to conceive in later years should not have been a problem but the lifestyle and the way women suffer in Kashmir is a problem,” she said.
Mir said conversion disorder is the most common amongst women in Kashmir due to women being unable to express their emotions. “Most of the women in Kashmir don’t even understand that they are not able to conceive because they are stressed,” she said. “So if she has a stressful life, she may conceive and then have a miscarriage because of the stressors around her.”
Over the years, Mir said that women have failed too in relating mental health with hormonal issues. “If stress is causing infertility, counselling sessions may decrease the stress and the chances of conceiving may actually increase,” said Mir.
This is the second part of the series ‘Kashmir’s infertility issues’ in Kashmir. You can read the first part here.