PCOS is a very common hormonal problem in females. In females with PCOS, male hormones (testosterone, androstenedione, DHEA) are increased. Ovaries are larger than normal and contain many small cysts (visible on sonography).

Symptoms are variable. Some may have very severe symptoms, while some of them have only mild symptoms. Usual symptoms are:

1. Excessive unwanted hair growth (over lips, chin, chest & back),
2. Irregular periods
3. Inability to get pregnant
4. Acne (pimples).

PCOS is diagnosed when you have 2 out of following (with normal TSH and prolactin levels)

1. Ovaries are larger than normal and contain many small cysts (visible on sonography).
2. Acne, excessive unwanted hair growth (over chin, lips, chest & back) or increased male hormone levels
3. Irregular periods

Treatment of PCOS depends on the symptoms. For obese woman with PCOS, diet & lifestyle modifications (for weight loss) are must. For treatment of irregular periods, hormonal pills (e.g. Yasmin, Diane-35, etc.) are required. For excessive hair growth/acne, hormonal pills with/without antiandrogens (spironolactone, finesteride, etc.) are required. Fertility management includes metformin, weight loss and ovulation inducing drugs.

Cosmetic therapy (laser hair removal, waxing, etc.) is useful for hirsuitism in PCOS. But, in majority of the patients hormonal pills are required to control hair growth.

Obese patients with PCOS are at risk of developing type 2 diabetes, hypertension, high cholesterol, metabolic syndrome, heart diseases & stroke in future. Hence, weight loss is must for these patients. Additionally, weight loss helps in improving the symptoms of PCOS (irregular periods, excessive unwanted hair growth, infertility, etc.) as well.

No. But as woman approaches menopause, symptoms of PCOS tend to improve in many patients.

Diabetes is a state with ‘increased blood sugar levels’, which can damage your kidney, eye, heart, nerves, etc. Pre-diabetes means you are at a higher risk of developing diabetes melitus.

Patients with mildly elevated sugars may not have any symptoms. Usual symptoms of diabetes are: frequency of urination, excessive thirst, increased/decreased appetite, weight loss, burning feet, and generalized weakness.

Diagnosis of diabetes is confirmed by fasting/ postprandial sugars or HbA1c. Fasting glucose 126 mg/dl or postprandial glucose >200 mg/dl or HbA1c >6.4% is called ‘Diabetes mellitus’. Fasting glucose 100-125 mg/dl or postprandial glucose 140-199 mg/dl or HbA1c 5.6-6.4% is called ‘Pre-Diabetes’.

HbA1c is a better reflection of sugar control than fasting or postprandial sugars, because it is an average of last 3 months blood glucose levels. Hence, every diabetic patient should do HbA1c testing at least 2-3 times per year.

Type 1 diabetes, type 2 diabetes, diabetes in pregnancy and other types. Majority (90-95%) of the patients with diabetes have Type 2 diabetes.

In Type 2 diabetes, sugar levels in blood can be controlled with oral drugs for many years and insulin is required in a few patients only. In Type 1 diabetes, insulin is always required for sugar control and stopping of insulin can lead to death.

Not directly. In fact, eating too much calories in form of carbohydrates/fat in presence of sedentary lifestyle (physical inactivity) can lead to obesity. Obesity leads to insulin resistance (inability of insulin to control sugars) and hence diabetes.

Those who are overweight or obese or have family member with diabetes are at risk for diabetes. Females with history of diabetes in pregnancy or PCOS (Polycycstic ovarian syndrome) are also at increased risk of developing diabetes. Diabetes can occur in anyone without any of these risk factors because we Indians are already at high risk of developing diabetes.

Uncontrolled diabetes can cause damage to eyes, kidney, and nerves. It can lead to stroke or heart diseases. It can also increase the risk of infections and diabetic foot problems. Hence, it is very important to control sugars.

No. But, sugars can be controlled with diet & lifestyle modifications without medicines in some patients with type 2 diabetes.

Sugars can be controlled with diet and lifestyle modifications (with weight loss) in some of the patients with type 2 diabetes. But, majority of the patients require medicines to control sugars.

No. Medicines used to treat diabetes don’t damage the kidney. But, uncontrolled diabetes can certainly damage the kidney and many other organs of the body.

Diet, exercise, and weight loss helps in controlling sugars. If you don’t follow diet, exercise, & weight loss, you will need higher dose of medicines to control sugars.

Physical activity is the most important aspect of management of diabetes. At least 30 minutes of walking/day is advisable. Avoid prolonged (>90 minutes) sitting. Avoid watching TV or using Laptops continuously for a long time. Exercise helps in controlling sugars and reducing weight. It also helps in lowering blood pressure and cholesterol levels and reducing the risk of heart disease or stroke.

Avoid: Sugar, sweets, butter, ghee, cheese, honey, bakery products (khari/ toast/ biscuits/bread/ pav/ pastries/cakes), potato, sweet potato, fried items, fastfood, junk food, packaged food, fruit juices, and oily foods.

Limit: Rice, roti, and wheat.

Prefer: Salads (cucumber/ tomato/ carrot/ onion/ cabbage/ capsicum), green leafy vegetables, pulses, sprouts, citrus fruits, and low fat milk.

Most of the fruits (except mango, banana, chikoo, & custard apple) are advisable in diabetes. At least 2-3 fruits per day are recommended. It is always better to eat whole fruit than fruit juice.

A patient with diabetes needs to be monitored for eye, kidney, & foot problems at least once in a year. Blood pressure should be measured at regular intervals. Lipid profile (cholesterol) should be done at least once in a year.

Fasting glucose < 130 mg/dl, postprandial glucose < 180 mg/dl, and HbA1c <7%.

There is nothing like ‘thyroid in blood’ and ‘thyroid in neck’. Every one of us has thyroid gland in the neck, which secretes thyroid hormones named ‘T3 & T4’ under the effect of a hormone named ‘TSH’ (which is produced from pituitary gland in brain). These hormones have wide range of functions and affect every organ of the body.

When production of T3 & T4 hormones from the thyroid gland is less than normal, it is called hypothyroidism. In this condition TSH is usually high with normal/low T3 & T4.

When production of T3 & T4 hormones from the thyroid gland is higher than normal, it is called hyperthyroidism. In this condition TSH is usually low with normal/high T3 & T4.

Dry skin, fatigue, lethargy, mood fluctuations, menstrual abnormalities, constipation, weight gain, increased sleepiness, excessive hair fall, etc.

Excessive sweating, palpitation, weight loss, frequency of stool, irritability, restlessness, menstrual abnormalities, lack of sleep, etc.

It is a complex disorders occurring as a result of autoimmunity because of genetic & environmental factors. Females are more likely to get thyroid disorder. Also, those with family history of thyroid disorder are at risk of developing thyroid disorder.

There is no relation with any particular type of food intake & autoimmune thyroid disorder. Iodine deficiency can lead to goiter. Individuals with iodine deficiency, who are eating raw vegetables (cauliflower/cabbage) in large quantities, can develop goiter (enlarged thyroid gland). Hence, it is advisable to eat it in cooked form than raw form. Other than that there are no food restrictions for a patient with hypothyroidism.

No. In majority of the cases, thyroid disorder is permanent and patient will require medicines for whole life. In very few cases, thyroid disorder is transient and patient needs medicines for few months only.

Untreated hypothyroidism can lead to heart diseases & increase in blood pressure/cholesterol levels. It can also lead to mood fluctuations & poor quality of life. Hence, it is very important to treat thyroid disorder.

Hypothyroidism is treated with a tablet which contains T4 hormone. The dose of the tablet should be adjusted based on TSH levels at regular intervals (at least 2-3 times per year). It should be taken in fasting. It should be taken at least 1 hour before tea/breakfast. It is always better to have 4 hour gap between thyroid medicines and any other medicines.

Treatment of hyperthyroidism is decreasing thyroid hormone levels to normal range. It can be achieved by medicines, radioiodine treatment or surgery. This should be treated aggressively by monitoring thyroid hormone level at regular intervals.

Obesity is the disorder with excessive accumulation of body fat. It occurs because of imbalance between calorie intake and calorie usage. Eating foods with high caloric intake (high fat/high carbohydrate) and lack of exercise/physical activity leads to obesity.

Measure your height in meter & weight in kg. Calculate your BMI (body mass index) = weight (kg) % height (meter) % height (meter). If your BMI is more than 23, you are overweight and if it is more than 25 you are obese.

Complications of obesity occur at much lower weights/BMI in Indians as compared to that in the western world. Hence, we Indians have to be much more careful about obesity and its future complications. Hence, there is an urgent need of awareness and willingness to fight obesity in general population

Untreated obesity can lead to diabetes, high cholesterol, hypertension, heart diseases and stroke. In addition it can increase the risk of some cancers. Hence, it should be treated as soon as possible.

Most important aspect of treating obesity is diet and lifestyle modifications. Total caloric intake has to be decreased by avoiding food items with high fat/high carbohydrate content. Caloric usage has to be increased by increasing physical activity/exercise. At least 30 minutes of walking/day is recommended.

Avoid: Sweets, butter, ghee, cheese, honey, bakery products (khari/ toast/ biscuits/bread/ pav/ pastries/cakes), potato, sweet potato, fried items, fastfood, junk food, packaged food, fruit juices, and oily foods.

Limit: Rice, roti, and wheat

Prefer: Salads (cucumber/ tomato/ carrot/ onion/ cabbage/ capsicum), green leafy vegetables, pulses, sprouts, citrus fruits, and low fat milk.

Medicines are indicated when BMI is >30 kg/m2 or >27kg/m2 with complications of obesity. Medicines work by reducing fat absorption (eg: orlistat) or by reducing appetite (eg: liraglutide).

Bariatric surgery is indicated in patients having BMI >40 kg/m2 or >35 kg/m2 with complications of obesity.

Puberty is the phase of life where boys or girls attain sexual maturity.

In girls, first sign of puberty is breast enlargement, followed by pubic hair development, menses & finally axillary hair development. In boys, first sign of puberty is testicular enlargement followed by pubic & axillary hair development. Bye the time, boys also develop beard and mustache.

Normal age of puberty onset is 8-13 years in girls and 9-14 years in boys.

Puberty onset before 8 years of age in girls & 9 years of age in boys is called early (precocious) puberty.

Absence of any signs of puberty till 13 years of age in girls and 14 years of age in boys is called delayed puberty.

Height spurt during puberty is because of sex hormones (testosterone in boys and estrogen in girls). Height spurt is one of the sign of puberty.

Early puberty can lead to decreased final height because of premature fusion of bones. In addition, early puberty can lead to psychosocial issues for a child or parents.

Yes. Hormonal treatment to stop the progression of puberty is available.

Yes. Treatment with testosterone (in boys) or estrogen (in girls) can lead to sexual maturation in those with delayed puberty.