By Sadaf Ahsan
It was summer 2019. I was running errands.
It wasn’t a particularly warm day, but I felt so overheated and exhausted I was forced to take slower and slower steps, pausing to sit on a benchevery few blocks to rest. My stomach, too, had started to cramp so painfully that I stopped at a café to grab a cold drink and take a seat.
By the time I made it back to my apartment, I had to race to the bathroom. It wasn’t pretty. Was it because of what I ate and drank, or from sheer pain? I wasn’t sure, but at that moment, I realized it was time to see a digestive specialist about the stomach and gut issues that had been plaguing me for years.
Let’s rewind to the beginning. I’m a woman in her 30s who, for years, had been navigating a carousel of symptoms — chronic bloating, unpredictable digestion that veered between constipation and diarrhea, abdominal pain and what people politely call an “apron belly.” (Or more bluntly, a pouch of excess skin and fat that hangs over my lower stomach).
My stomach was the site of endless investigation.
Over about a decade, starting from the time I was 25 years old, I’d been grappling with stomach and gut issues. Different doctors had proposed different explanations. It could be stress. Maybe it was irritable bowel syndrome. Or, a possible food sensitivity. At various points, I was told by my family doctor, gynaecologists and dietitians to cut dairy, avoid gluten, eat less sugar and plain-old eat less in general.
“Just lose weight!” they said, as if that were both a diagnosis and treatment.
At every single appointment, my digestive system was treated as a stand-alone problem, something isolated from the rest of my body. But what I was experiencing wasn’t just a gut issue. It was hormonal. In the fall of 2024, I finally received the diagnosis that I had polycystic ovary syndrome (PCOS) after cysts were spotted on a transvaginal ultrasound by my family doctor after I insisted that my gynaecologist order the test.
By the time the diagnosis came, it felt less like news and more like validation. I had suspected I might have PCOS due to my infrequent periods, excessive body hair, fatigue and trouble losing weight, and those persistent stomach and gut problems. Finally, I had confirmation.
So, why does this finding of PCOS matter?
Perhaps it’s knowing that what seems like a digestive issue may not be, especially when it comes to “women’s diseases.” Research clearly shows women’s health is persistently misunderstood, underfunded and under-researched.
Take PCOS. The condition is one of the most common endocrine disorders that women of reproductive age live with today. It’s estimated to affect roughly 5 to 18 per cent of females globally, according to a 2022 Lancet study, with research indicating a high prevalence among South Asian women like myself. In Canada alone, as many as 1.4 million women may have PCOS. Despite its prevalence, diagnosis is notoriously slow and confusing. Up to 70 per cent of PCOS cases may go undiagnosed.
Emerging research has also begun to highlight the complex relationship between PCOS, insulin resistance and the gut microbiome. Studies suggest that people with PCOS often have altered gut bacteria, leading to systemic inflammation and changed hormone levels.
Others, meanwhile, have found that gut microbiota may regulate the synthesis of insulin, and affect androgen metabolism and follicle development, all key elements associated with PCOS.
The result can be symptoms that look a whole lot like digestive disorders, with bloating, abdominal discomfort, irregular bowel movements and food sensitivities. In other words, what appears to be a gut problem may actually be part of a broader hormonal and metabolic condition. When it comes to isolating what the problem is, though, the journey can be complex. For me, the path to a PCOS diagnosis wound through the waiting rooms and offices of physicians, gynaecologists, gastroenterologists, a dermatologist, naturopaths and a dietitian.
Olga Bougie, an associate professor at Temerty Faculty of Medicine’s Department of Obstetrics and Gynaecology, agrees that diagnosing PCOS can be tricky — and that she has encountered other patients who have had their symptoms misidentified. She says obtaining a diagnosis of PCOS means patients must meet two of three criteria: irregular or absent periods, ultrasound findings of polycystic ovaries and signs of high androgens.
“Patients with PCOS may experience many other concerns such as fatigue, digestive issues and mental health struggles,” says Bougie, who did not treat me, but treats hundreds of other patients with PCOS in her practice at Sinai Health.
During my many appointments, gut symptoms dominated the dialogue. Every conversation seemed to circle back to food. What had I eaten? What should I eliminate next? The implication was always that my body was reacting poorly to something I was putting into it — not that something deeper might be going on inside it.
The fragmentation of my symptoms obscured the bigger picture. Bloating became a digestive issue. Weight gain was the sign of a lifestyle issue. Irregular menstrual cycles were perceived as a gynaecological issue. Each symptom was managed individually rather than recognized as part of a pattern. For me, the result was years of confusion, as well as discomfort and pain. In hindsight, the clues were there. But they were scattered across specialties, each one treated as its own piece of the puzzle. The science is still evolving, but the broader lesson feels obvious: The body doesn’t operate in compartments.
Receiving a PCOS diagnosis didn’t magically solve everything. It didn’t make the symptoms disappear or erase the years spent chasing the wrong explanations. As of yet, no cure exists. But it did offer me something surprisingly powerful: a framework. Suddenly, the bloating, the weight changes, the digestive chaos and the hormonal symptoms weren’t isolated mysteries anymore, but pieces of the same story.
Which, for me, raises an uncomfortable question: How many other people are still being treated in fragments?