BEHIND THE visible symptoms of Polycystic Ovary Syndrome (PCOS) lies a systemic and metabolic crisis. Too often, women are left to navigate the perplexities of their symptoms on their own amid a system that often fails to look beyond the surface.
Globally, up to 13% of women aged 15–49 years old are affected by PCOS, including an estimated 4.5 million Filipinas. Despite its prevalence, 70% of cases remain undiagnosed.
As PCOS often goes undiagnosed, many women struggle to receive proper treatment due to the lack of information surrounding it and the variability of its symptoms.
Mixed signals
PCOS is a highly complex condition linked to the hypothalamus that disrupts the hormone regulation of the ovaries and other organs, leading to a cardiometabolic disease with significant physical, mental, and emotional impacts among women.
As pointed out by Grace Estanislao, MD, an obstetrician-gynecologist and Maternal-Fetal Medicine specialist, “Most people think [PCOS] is just irregular [menstruation], being overweight, mabuhok, and ma-pimple (hairy and prone to acne). It’s not just that, [those are] just what we readily see.”
Beyond the physical signs, she stressed how patients face a lifelong condition with far-reaching health risks for cardiovascular problems, endometrial cancer, diabetes, and reproductive issues, among others.
Due to variability in PCOS symptoms, candidates are evaluated using the Rotterdam criteria, which looks at three key symptoms: irregular menstrual cycle, signs of high testosterone levels, and detection of polycystic ovaries—two of which must be present to rule out other possible conditions.
With how diverse each case of PCOS is in different women, management treatments often require a multifaceted and personalized approach.
Dr. Estanislao explained that treatment plans often depend on the priorities of the patient, whether to address irregular cycles, manage diabetes, or prepare for pregnancy. Common medications prescribed include birth control pills to stabilize menstrual cycles and Metformin to address insulin resistance.
While medicines are available, Silliman University graduate Zeina Lubaton shared that a six-month prescription for a single medication can cost up to Php 3,000. For many women, these expenses can quickly add up, forcing them to delay treatment, skip doses, or seek alternative means of coping with their symptoms.
With this, Dr. Estanislao stressed that lifestyle changes, including a balanced diet and physical activity, remain central to managing PCOS—regardless of symptoms faced.
Body out of sync
The exact cause of PCOS remains unclear, but studies suggest that genetic and environmental factors increase the chances of its development.
A poor diet high in fats and sugar, along with chronic stress and a sedentary lifestyle, has been implicated as a precursor to PCOS while also worsening existing symptoms. For Lubaton and Niña Jumawid (3 BS HSc), stress exacerbates symptoms such as bouts of lethargy and brain fog, making PCOS harder to manage.
When stress takes a toll, Jumawid acknowledged the challenge in staying consistent with lifestyle changes, especially during exam seasons. She also cites difficulties in managing cravings for high-calorie food given the lack of healthy food options on-campus.
Lifestyle habits are not the only factors that predispose individuals to PCOS. Endocrine-disrupting chemicals (EDCs), which are natural or man-made chemicals found in everyday products, have also been linked to adverse health effects.
According to Dr. Estanislao, EDC exposure can trigger hormonal imbalances that contribute to PCOS development. As they mimic and interfere with the body’s natural hormones, these chemicals have a detrimental impact on fertility and other reproductive health issues. Despite this, EDCs are still commonly found in items such as shampoo, food packaging, sunscreens, and nonstick cookware.
Focusing only on visible signs of PCOS ignores the underlying factors that predispose women to PCOS. PCOS perception must then move past surface-level impressions so it is treated as a nuanced disorder rather than a fixed set of symptoms, shaped by the interplay between lifestyle, environment, and biological factors.
No single story
The ambiguity of PCOS development manifests differently in lived experiences. For many women, the first signs of PCOS are often normalized and dismissed. For instance, painful menstrual cramps are often brushed off as a “normal” part of the menstrual cycle. Such perceptions not only alienate and discredit the women who shoulder these experiences but also delay the provision of adequate and timely medical intervention.
In Jumawid’s case, she initially dismissed irregular periods, chronic fatigue, and a larger body frame as part of who she was. Moreover, her official diagnosis was also prolonged as she was considered a PCOS candidate for two years before receiving a confirmation when she was 19 years old.
For Lubaton, a three-month stretch between menstrual cycles led her to realize that she could no longer attribute cycle irregularities to stress or environmental factors. This realization prompted her to seek medical advice, resulting in a late diagnosis at 25 years old.
Though Lubaton’s doctor emphasized the severity of the condition early on, Jumawid felt that her doctor focused more on aesthetic concerns, particularly on acne breakouts and weight gain.
“I feel like if they had been more straightforward [about] what the health risks were, I would have felt the need to manage it more. It would have validated that what I was feeling was rooted in something medical instead of just […] a me problem,” Jumawid expounded.
Stereotypical depictions of PCOS symptoms and high healthcare costs further deter many from consulting a doctor, resulting in delays and underdiagnosis of the condition.
As such, Lubaton pointed out that conversations must pivot towards destigmatizing women’s sexual and reproductive health. “There should be no malice in trying to converse [about] reproductive health so that women are not afraid to seek help,” Lubaton said. By allowing open discussion, women will be empowered to advocate and prioritize their well-being.
Breaking the cycle
As a multifactorial disorder, PCOS response must shift from managing aesthetic impacts to the serious health risks it poses. This encompasses symptoms evident on the surface and the invisible manifestations that impede daily life.
For Dr. Estanislao, this begins with broadening the public understanding of PCOS beyond its physical symptoms. She added that education must also extend to healthcare providers and policymakers to ensure greater recognition and institutional support at the public health level.
Addressing PCOS effectively means reducing the stigma around reproductive healthcare and ensuring women can access the medical attention they need early.
Ultimately, there must be more women-centered healthcare systems that prioritize women in both providing and receiving care. Only by moving towards a holistic approach to healthcare, where all women’s experiences are represented, will the unique and diverse realities of all women struggling with PCOS be met.
