The latest Indian National Family Health Survey (NFHS), published in December 2020, found that at least 60% of Kashmiri married women report one or more reproductive health problems, which is significantly higher in comparison to the national average of 40%.
Arjumand Shaheen | TwoCircles.net
SRINAGAR (J&K) — 21-year-old Henna from a town on the outskirts of capital Srinagar has lived in depression ever since she was diagnosed with Polycystic ovary syndrome (PCOS) at the age of sixteen.
Her parents asked her to remain silent about her diagnosis.“I was made to feel as if I had some serious disease and that my life had halted,” Henna, told TwoCircles.net. “My relatives used to gossip about how my life was not normal anymore.”
The silence enforced by her family around her illness was spawned by fear.
Henna said her mother would constantly tell her that if anyone gets to know about her having PCOS, her chances of getting married would be grim, as girls with this condition were perceived as infertile.
“Sometimes my mother introduces herself as the patient at the doctor’s clinic to the people enquiring,” Henna said.
“This has greatly impacted my mental health.”
Henna is one among several women (believed to be in thousands) in Kashmir, who suffer from PCOS, an endocrine disorder found in women in their reproductive age.Symptoms include hirsutism, acne, obesity, infertility, liver inflammation, diabetes, abnormal cholesterol, eating disorder, endometrial cancer and other cosmetic issues. Doctors from the region believe stress and anxiety are the major factors contributing to the rise of PCOS cases in Kashmir—where a low-intensity armed conflict has been raging on for the last three decades.
The latest Indian National Family Health Survey (NFHS), published in December 2020, found that “at least 60% of Kashmiri married women report one or more reproductive health problems, which is significantly higher in comparison to the national average of 40%.”
According to health experts, the last few years have witnessed a sharp increase in the cases of PCOS, infertility, spontaneous abortions and miscarriages among women, especially those who had underlying mental health issues.
Dr Aafia, a scientist at Sher-e-Kashmir Institute of Medical Sciences who has been researching PCOS among women in Kashmir, told TwoCircles.net that “the paradigm shift in lifestyle has led to the rise of PCOS among Kashmiri women.”
Besides consuming junk food and calories in high amounts, many other parameters like decrease in physical activity, anxiety are collectively responsible for the rise in PCOS here.”
However, according to a survey published in May 2020 by Ganie et al, 35.3% women qualified for diagnosis of PCOS in Kashmir using Rotterdam criteria while the prevalence of PCOS was 28.9% by NIH criteria and 34.3% by AE-PCOS criteria.
As per the study, the prevalence of PCOS is high among Kashmiri women and is probably the highest in a published series globally.
“PCOS is diagnosed using different criterias like Rotterdam, NIH PCOS criteria. The results and prevalence vary from criteria to criteria. So generalizing prevalence as per just one criteria is impossible,” Dr Aafia said.
Young girls like Henna, who have been diagnosed with PCOS, face multiple challenges due to pressures by family and society.
“We keep battling the challenges and changes that we experience due to PCOS. People around us, however, make our life worse,” Henna said.
These factors impacted Henna’s mental health. “Besides insomnia, I often get anxiety and panic attacks. Why can’t people give us space considering the pain we already experience due to PCOS?” asks Henna.
Different studies reveal that there are higher chances of psychiatric disorders in the patients with PCOS and the relationship between depression and polycystic ovarian syndrome (PCOS) is such that as many as 40% of women with PCOS experience depressive symptoms.
As per a study published in the journal Psychoneuroendocrinology, self harming behaviors were seven times higher among women with PCOS than those without the syndrome.
Dr Abdul Majid, head of post graduation department of Psychiatry, SKIMS Medical College Hospital, Srinagar, said, “Beyond the hormonal influences of PCOS that can contribute to depression, the difficulties and frustrations of managing the symptoms of PCOS can’t be overlooked.”
27-year-old Nida, a medical student from Pulwama district of Kashmir, suffered from PCOS for a brief period of time but the illness affected her mental health which took longer to heal.
She said she felt embarrassed when certain symptoms started appearing on her body.
“I had no idea about PCOS. I was not able to accept that I had grown hair on my face,” Nida said.
Besides anxiety attacks and mood swings, she said that she used to stay awake in bed and brood. It went on like this for months.
“The situation aggravated after I was diagnosed with clinical depression,” Nida said.
“Gradually I withdrew from people. I lost opportunities that came my way as I thought I wasn’t capable of doing anything. I was in a state of self-doubt,” she added.
Dr Majid said that symptoms of PCOS reduces motivation and increases feelings of worthlessness and low self-esteem. “Reduced emotional wellbeing can make it difficult to look after oneself, follow a healthy lifestyle and make the best decisions about one’s health,” he said.
He said that PCOS is increasingly becoming the leading cause of infertility among women of reproductive age in Kashmir.
Experts believe that PCOS may lead to infertility but it can also get better with time if treated at proper time and after following a certain lifestyle. “There are many women with PCOS who conceived and delivered successfully after the treatment,” Dr Aafia said
“Despite its increasing prevalence in our community, there is still less awareness among the women regarding the diagnosis and treatment,” she added.
Arjumand Shaheen is an independent journalist based in Srinagar, Kashmir. She covers human rights, gender, health and culture. She tweets at @UroojAndrabi