INTRODUCTION

The moment we hear someone we know just diagnosed with PCOD, it’s a gut-wrenching feeling. It’s something you wish your loved ones never have to go through. Unfortunately, as I have noticed this trend is only climbing & affecting more younger populations with each passing day.

All this got me thinking. What is a PCOD? How bad is it? Is there a way to prevent it? Or are we all resigned to the fate of rapidly increasing such disorders? So many questions to answer, so I am sharing my research and I hope it will add some value to your lives.

**This is not a medically accurate article. If you are experiencing any symptoms contact your doctor immediately.

WHAT IS PCOS / PCOD

Polycystic ovary syndrome (PCOS) is one of the most common endocrine and metabolic disorders in premenopausal/childbearing-age women. Heterogeneous by nature, PCOS is defined by a combination of signs and symptoms of androgen excess and ovarian dysfunction in the absence of other specific diagnoses. It causes a woman’s ovaries (the reproductive organs that produce and release eggs) to create excess male hormones leading to reproductive hormonal imbalance. As a result, people with PCOS often have erratic menstrual cycles, missed periods, and unpredictable ovulation. Small cysts may develop on ovaries (fluid-filled sacs) due to a lack of ovulation (anovulation). However, despite the name “polycystic,” it is not compulsory to have cysts on ovaries to have PCOS. PCOS is one of the most common causes of female infertility. It can also increase the risk of other health conditions. Healthcare providers can treat PCOS based on symptoms.

COMMONLY ASKED QUESTIONS

Who can get PCOS?

A woman can get PCOS at any time after puberty. Most women are diagnosed in their 20s or 30s when they are trying to get pregnant. Excess weight Obesity or any family history of PCOS increases the chance of getting PCOS.

How common is PCOS?

PCOS is very common — up to 15% of women of reproductive age have it.

Can I have PCOS but not have any symptoms?

Yes, it’s possible to have PCOS and not have any symptoms. Many women don’t even realize they have the condition until they have trouble getting pregnant or are gaining weight for unknown reasons. It’s also possible to have mild PCOS, where the symptoms are not severe enough to notice.

Can I prevent PCOS or its effects?

There is no proven way to prevent PCOS, but you can take small steps to reduce your symptoms. For example, eating nutritious foods, exercising regularly, and managing your weight can help you avoid the effects of PCOS.

Does polycystic ovarian syndrome ever go away?

The hormone changes caused by menopause may make PCOS go away, but not always. Sometimes the imbalance of hormones continues into menopause, meaning hormonal imbalance does not change with age. If symptoms are bothering or affecting the quality of life, then the healthcare provider can recommend symptomatic treatment.

CAUSES:

The exact cause of PCOS is unknown. Several factors also play a role in causing PCOS/PCOD:

• Hormonal etiology
• Genetic etiology
• Environmental etiology

Hormonal etiology

Women with PCOS have a hormonal imbalance that disrupts the menstrual cycle, ovulation, and possibly, conception. These hormones are like an intricate web and the function of the female reproductive system relies heavily on its balance. The hormones that play a role in PCOS are:

1. High levels of Androgens (like testosterone and androstenedione): They’re often called male hormones, but women have them too. Women with PCOS tend to have higher levels of androgens.

High androgen levels can lead to:

• Acne
• Excessive hair growth
• Weight gain
• Problems with ovulation can also cause small cysts in ovaries.

Causes for excess androgen production:

• Genes 
• Insulin Resistance
• Inflammation 

1. Insulin resistance:  Insulin is a hormone that the pancreas produces. It controls the way the body processes glucose (sugar) and uses it for energy. Insulin resistance means the body doesn’t process insulin correctly, leading to high glucose levels in the blood. When cells can’t use insulin properly its demand increases and more insulin is produced to compensate. Increased insulin levels cause the ovaries to make and release male hormones (androgens). This, in turn, suppresses ovulation and contributes to other symptoms of PCOS. Not all individuals with insulin resistance have elevated glucose or diabetes, but insulin resistance can lead to diabetes.
2. Elevated Luteinizing hormone (LH).
3. Elevated Gonadotropin–releasing hormone (GnRH)
4. Low Follicle-stimulating hormone (FSH).
5. High levels of Testosterone and Progesterone.

Genetic etiology 

Family history of PCOS is relatively common; however, familial links to PCOS are unclear. A lack of phenotypic information prevents a formal segregation analysis. Nonetheless, the current literature suggests that the clustering of PCOS in families resembles an autosomal dominant pattern.

Environmental etiology

PCOS is an emerging health problem during adolescence therefore promotion of healthy lifestyles and early interventions are required to prevent future morbidities including insulin resistance, type 2 diabetes, high cholesterol, high blood pressure, and heart disease. 

Can be exacerbated by:

• Poor dietary choices.
• Physical inactivity.
• Infectious agents and toxins may also play a role.

PCOS signs and symptoms are typically more severe with obesity. The reproductive and metabolic features of PCOS are sometimes reversible with lifestyle modifications such as weight loss and exercise. Being overweight also contributes to chronic low-grade inflammation indicated by high blood levels of C-reactive protein (CRP) and white blood cells.

SYMPTOMS:

PCOS is a syndrome disease defined by a group of signs (physical findings) and symptoms (patient complaints). Symptoms can vary from woman to woman. Some women start seeing symptoms around the time of their first period. Others only discover they have PCOS after they’ve gained a lot of weight or they’ve had trouble getting pregnant.

The most common symptoms of PCOS include:

• Irregular periods: Abnormal menstruation involves missing periods or not having a period at all. It may also involve heavy bleeding during periods.
• Abnormal hair growth: Excess facial hair and heavy hair growth on the arms, chest and abdomen (hirsutism). This affects up to 70% of women with PCOS.
• Acne: PCOS can cause acne, especially on the back, chest, and face. This acne may continue past the teenage years and may be difficult to treat.
• Obesity: About 80% of women with PCOS are overweight or have obesity, usually with extra weight around the waist, and have trouble losing weight.
• Darkening of the skin: Patches of dark skin, especially in the folds of your neck, armpits, groin (between the legs) and under the breasts. This is known as acanthosis nigricans.
• Cysts: Many women with PCOS have small pockets of fluid in their ovaries.
• Skin tags: Skin tags are little flaps of extra skin. They’re often found in the armpits or on the neck in women with PCOS.
• Male-pattern baldness or Thinning hair: People with PCOS may lose patches of hair on their heads or start to go bald.
• Infertility: PCOS is the most common cause of female infertility. Decreased frequency or lack of ovulation can result in not being able to conceive. Conception may take longer than in
• Pelvic pain
• Anxiety or depression
• Sleep apnea (when breathing stops for short periods of time while asleep)
• Cysts in the ovaries

COMPLICATIONS:

PCOS is also associated with the risk of developing the following Comorbidities/diseases:

• Hypertension (high blood pressure)
• High cholesterol
• Anxiety and depression
• Sleep apnea (when a person stops breathing periodically during sleep)
• Endometrial cancer (cancer caused by thickening of the lining of the uterus)
• Heart attack
• Diabetes
• Breast cancer

DIAGNOSIS:

In most cases, healthcare provider can diagnose PCOS after an examination. They may order blood tests or perform an ultrasound to help with the diagnosis.

Healthcare provider will:

• Talk to you about your symptoms and medical history.
• Ask about your family’s medical history.
• Take your weight and blood pressure.
• Perform a physical exam, looking specifically for excess facial hair, hair loss, acne, discolored skin and skin tags.
• Perform a pelvic exam to look for swollen ovaries or other growths in your uterus.
• Order blood tests to check hormone levels and glucose levels.
• Perform a pelvic ultrasound to look for cysts in your ovaries and check the thickness of the lining of your uterus.

Typically, you are be diagnosed with PCOS if you have at least two of the following:

• Irregular or missed periods. Some people with PCOS have very heavy bleeding when they do have a period.
• Signs of excess androgen such as acne or excessive hair growth. Or, a blood test confirming excess androgen levels.
• Cysts on one or both ovaries. Many people don’t develop cysts.

MANAGEMENT:

Treatment of PCOS is not curative and can’t be prevented, but early diagnosis and treatment helps to prevent long-term complications, such as infertility, metabolic syndrome, obesity, diabetes and heart disease. It varies from woman to woman, depending on specific symptoms. Treatment focuses on controlling symptoms and managing the condition to prevent complications.

Lifestyle modifications:

• Weight management through exerciseand healthy eating
• Getting enough sleep
• Managing stress

1.  Weight management:

Why Managing weight is required?

In case of PCOS, shedding just 10% of body weight can bring periods back to normal. 

• Weight loss can improve insulin sensitivity which will reduce risk of diabetes, heart disease, and other PCOS complications,
• Weight loss can also make you feel better. 
• Weight loss can also help in relieving some of the symptoms of polycystic ovary syndrome. 

Cause of weight gain in PCOS/PCOD: 

Because of Insulin resistance, high blood insulin levels increase the production of male hormones called androgens which triggers weight gain typically in the abdomen. That is where men tend to carry weight. So, instead of having a pear shape, women with PCOS have more of an apple shape. Abdominal fat is the most dangerous kind of fat. That’s because it is associated with an increased risk of heart disease and other health conditions.Losing weight will often help improve symptoms no matter what caused insulin resistance.

How to lose weight in PCOS/PCOD?

Healthy eating

Reduce Your Carb Intake

Research associates high levels of insulin with increased body fat and weight gain in the general population — and in women with PCOS. Lowering your carb consumption may help manage PCOS due to carbs’ impact on insulin levels. Approximately 70% of women with PCOS have insulin resistance. What’s more, a low-glycemic diet may benefit women with PCOS. The glycemic index (GI) is a measurement of how quickly a particular food raises blood sugar. In one study, women ate their normal diet for 12 weeks, followed by a low-GI diet for 12 weeks. Their measures of insulin sensitivity (how efficiently the body uses insulin) were significantly better during the low-GI phase.

Sugar is a carbohydrate and should be limited on a PCOS diet. When reading food labels, be sure to look for sugar’s various names, including:

• sucrose
• high fructose corn syrup
• dextrose

On a PCOS diet reduce consumption of beverages like soda and juice, which can be high in sugar. However, before removing a number of foods from diet, it’s best to speak with a doctor. They can recommend an eating plan that is right for you and your individual needs.

Get Plenty of Fiber

Because fiber helps to stay full after a meal, a high-fiber diet may improve weight loss in women with PCOS. A diet high in fiber may help reduce insulin resistance, body weight, and excess body fat. In one study, higher fiber intake was linked to lower insulin resistance, total body fat, and belly fat in women with PCOS — but not in women without PCOS. In another study in 57 women with this condition, higher fiber intake was associated with lower body weight.

Here are some examples of high fiber foods:

• cruciferous vegetables, like broccoli, cauliflower, and Brussels sprouts
• greens, including red leaf lettuce and arugula
• green and red peppers
• beans and lentils
• almonds
• berries
• sweet potatoes
• winter squash
• pumpkin

Eat Enough Protein

Higher protein intake may boost weight loss, especially for women with PCOS. 

Protein helps: 

• Stabilize blood sugar.
• Increases feelings of fullness after a meal.
• Also aid weight loss by reducing cravings, helping you burn more calories, and managing hunger hormones. 

In one study, 57 women with PCOS were given either a high-protein diet — more than 40% of calories from protein and 30% from fat — or a standard diet consisting of less than 15% protein and 30% fat. Women in the high-protein group lost an average of 9.7 pounds (4.4 kg) after 6 months — significantly more than those in the control group.

Protein-containing foods such as:

•  lean meats, poultry, and eggs, with meals and,
• Snacks to add fullness and help manage blood sugar levels 

Eat Healthy Fats

Having plenty of healthy fats in diet may help you feel more satisfied after meals, as well as tackle weight loss and other symptoms of PCOS. Eating more healthy fats may be beneficial for women with PCOS. In studies, higher fat intake is linked to reduced hunger and a greater loss of body fat. Combining a healthy fat with a protein source can further increase the filling effects of meals and snacks. In one study in 30 women with PCOS, a low-fat diet (55% carbs, 18% protein, 27% fat) was compared to a higher-fat diet (41% carb, 19% protein, 40% fat). After eight weeks, the higher-fat diet resulted in more fat loss — including belly fat — than the lower-fat diet, which also reduced lean body mass. In fact, although fats are rich in calories, adding healthy fats to meals can expand stomach volume and reduce hunger. This may help you to eat fewer calories throughout the day.

Healthy fats include foods high in omega-3 fatty acids:

• Fatty fish (salmon, mackerel, herring, sardines, and albacore tuna), 
• Seeds (flax seeds, chia seeds), 
• Oils (canola, olive, peanut,Coconut) and nuts (walnuts)
• Avocado and nut butters. 

Eat Fermented Foods

Healthy gut bacteria may play a role in metabolism and weight maintenance. Studies suggest that women with PCOS may have fewer healthy gut bacteria than women without this condition. Women with PCOS may have lower numbers of beneficial gut bacteria. Eating foods rich in probiotics or taking a probiotic supplement may support gut bacteria, thus aiding weight loss. Emerging research suggests that certain probiotic strains may have positive impacts on weight loss.

Foods high in probiotics — such as: 

• Yogurt, kefir, sauerkraut, and other fermented foods — may help increase the number of beneficial bacteria in your gut.
• You can also try taking a probiotic supplement to get the same results.

Limit Processed Foods or Refined carbohydrates

Another tip to lose weight with PCOS is to cut down on intake of certain unhealthy foods. Processed foods such as refined carbs and added sugars may raise blood sugar levels and increase risk of insulin resistance, which is linked to weight gain.

Women with PCOS may process sugar differently than women without it. Research shows that women with PCOS experience larger spikes in blood sugar and insulin levels after consuming the same amount of sugar as women without this condition. Studies indicate that minimally processed, real foods not only raise blood sugar less than highly processed foods but are also more satisfying.

Furthermore, experts recommend that women with PCOS limit their consumption of added sugars and refined carbs to manage symptoms and maintain a healthy body weight. Refined carbohydrates cause inflammation, exacerbate insulin resistance, and should be avoided or limited significantly. 

These include highly processed foods like:

• White bread
• Muffins
• Breakfast pastries
• Sugary desserts
• Anything made with white flour

Pasta noodles that list semolina, durum flour, or durum wheat flour as their first ingredient are high in carbohydrates and low in fiber. Pasta made from bean or lentil flour instead of wheat flour is a nutritious alternative.

Reduce Inflammation

Inflammation is body’s natural response to infection or injury. But chronic inflammation — which is common in women with PCOS — is linked to obesity. Sugar and processed foods may contribute to inflammation so eating a diet high in whole foods — especially fruits and vegetables — may safeguard against inflammation. Stopping consumption of inflammation-causing foods, like fries, margarine, and red or processed meats might help.

In one study, 16 women with PCOS who took a one-time dose of 75 grams of glucose — a particular type of sugar — had higher blood markers for inflammation, compared to women without this condition. 

Foods that help reduce inflammation include:

• A diet which is high in fruits, vegetables, whole grains, olive oil, and omega-3-rich foods, such as fatty fish (like salmon and sardines), Almonds and Walnuts. 
• Tomatoes
• Kale
• Spinach
• fruits, like blueberries and strawberries

Consider Supplements

Interactions between genetic factors and some nutrient deficiencies cause PCOS pathophysiology -related symptoms such as elevated Hcy levels, oxidative stress, hyperandrogenism, and hyperinsulinemia. In particular, deficiencies of vitamin D, bioflavonoids, Ca, chromium, NAC, probiotics, magnesium, zinc, and selenium are associated with IR. Therefore, the treatment of women with PCOS with these supplements provides improvement for hyperinsulinemia and increased insulin sensitivity. Inositol, vitamin A, carnitine, omega-3 fatty acids, and NAC supplements affect hyperandrogenism. Inositol and omega 3 supplementation in particular help the recovery of PCOS with regard to metabolic and reproductive parameters. Apart from that, vitamin B6, B12, and folic acid have beneficial effects on abnormal Hcy levels, and also vitamin E, α-linolenic acid, bioflavonoids, selenium, NAC, and MT supplements help to remove the oxidative stress of PCOS.

Practice Mindful Eating

Mindful eating helps promote awareness of internal eating cues and may promote weight loss. It may be especially helpful for women with PCOS, as they have often tried many diets and are three times more likely to have eating disorders. Mindful eating is one potential solution. It promotes an increased awareness of bodily cues, such as hunger and fullness. Mindfulness-based approaches to food may help address problematic eating behaviors — especially binge eating and emotional eating. What’s more, studies suggest that mindful eating practices may be linked to weight loss. 

• Listen to your body’s signals to decide when you are truly hungry and when you are satisfied.
• Drink at least 8 glasses of water daily.
• Choose calorie free beverages to limit extra calories.
• Keep a consistent eating schedule and aim to eat at least 3 meals around the same time every day. Skipping meals leads to overeating later.
• Monitor your portions sizes by using measuring cups or following the serving size on the food label.
• Try keeping a food journal to monitor your food choices
• Don’t Undereat: Long-term calorie restriction may slow down metabolism. Although calorie restriction is likely to lead to short-term weight loss, over time, the body adapts to this restriction by reducing the number of overall calories it burns, which can lead to weight regain. Eating too few calories can negatively impact hormones that control appetite as well. For example, in one study, restrictive dieting was found to modify the hormones leptin, peptide YY, cholecystokinin, insulin, and ghrelin, which increased appetite and led to weight gain. Instead of restricting calories, it may be best to focus on eating whole foods and cutting out unhealthy products. For example, a study of over 600 people suggested that eating more vegetables and whole foods — while reducing consumption of processed foods, refined grains, and added sugars — may help promote weight loss without restricting calories. Chronic calorie restriction may slow down your metabolism, possibly leading to weight gain. Instead of forcing yourself to eat less food, try to adopt a diet of whole, unprocessed foods to help with weight loss.

Exercise Regularly

Exercise is a well-known strategy to improve weight loss. Exercise and daily physical movement when coupled with a limited intake of refined carbohydrates can help reduce insulin resistance. Many experts agree that at least 150 minutes per week of exercise is ideal.

 In a 12-week study in which 16 women did 45–60 minutes of cardio 3 times per week, those with PCOS lost 2.3% body fat, compared to 6.4% in the control group. While women with PCOS lost less fat than those without this condition, the exercise regimen did result in loss of belly fat and improvements in insulin sensitivity.

Weight training has also been shown to aid women with PCOS. In one study, 45 women with PCOS did weight training 3 times weekly. After 4 months, they lost belly fat and gained lean body mass while reducing testosterone and blood sugar levels.

Summary Daily activity, low sugar intake, and a low-inflammation diet may also lead to weight loss. People may experience improved ovulation with weight loss. Both cardio and weight-training exercises may help women with PCOS drop body fat and improve insulin sensitivity.

Get Enough Sleep

Sleep is increasingly acknowledged as central to your health.

In PCOS, experiences of sleep disturbances, including excessive daytime sleepiness, sleep apnea, and insomnia may occur. Lack of sleep has been shown to increase the activity of hormones that drive hunger, such as ghrelin and cortisol, which may cause you to eat more throughout the day. In fact, insufficient sleep is associated with a higher risk of being overweight or obese. A review of 18 studies found that those who slept less than 5 hours per night were significantly more likely to be obese.

Furthermore, the study demonstrated that every hour of additional sleep per night was associated with a decrease in body mass index (BMI) of 0.35 kg per square meter. Additionally, studies have linked better-quality sleep to fat loss. In one study, healthy adults who slept less than 6 hours per night had a 12% higher risk of developing belly fat compared to those who slept 6–8 hours a night.

Relationship with food

Sleeping in a state of hunger or full stomach is harmful and should be avoided. It is recommended to have a gap of about 3 h between food consumption and sleep. Consumption of some foods such as milk and lettuce close to bedtime elevates sleep quality, whereas some foods such as cabbage and coriander disturbs the sleep. Sleeping soon after mealtime causes impaired digestion and produces bloat as well as sleep disorders. Ideally, an accepted sleep should be after waste disposal, this means that sleep should be after urination and defecation.

Duration

Sleep should have a normal duration. It is recommended to have 6–8 h of sleep in the night depending on the individual. Excessive wakefulness disrupts the work of different body organs, especially brain activity; it harms digestive power, and causes gastrointestinal disturbances. Loss of energy is another complication of poor sleep. On the other hand, excessive sleep has some complications such as weight gain and obesity.

Tips for improving sleep hygiene

1. Try to go to sleep and wake up at a regular time – this gets your body into a rhythm. Avoid disrupting the rhythm by sleeping in on the weekends.
2. The bedroom is only for sleep or sex. Avoid watching TV or reading in bed, otherwise your brain will associate being in bed with not sleeping.
3. Being active, exercising and going outdoors can improve quality of sleep.
4. People can differ in how much sleep they require, but most people need between 7-9 hours every night to function normally.
5. Avoid screens e.g. computer, phone late at night that emit blue light. This can make it harder to fall asleep. Glasses are available to block blue light, and some phones have a mode that turns off the blue light parts of the screen.
6. Avoid caffeinated beverages after early afternoon. The effects of some caffeinated beverages can last for many hours.

Summary Poor sleep is linked to obesity. Studies in healthy adults suggest that increasing your total time asleep can reduce body fat and promote weight loss.

Manage Your Stress

Because stress is a risk factor for weight gain, managing your stress can help manage your weight. The symptoms associated with PCOS can cause stress. Stress increases levels of cortisol, a hormone made by your adrenal glands. Chronically high cortisol levels are linked to insulin resistance and weight gain. Chronic stress also increases your risk of developing belly fat. In turn, belly fat increases inflammation, which triggers your body to make more cortisol — creating a vicious cycle.

Stress reduction techniques:

• Which help calm the mind and let you connect with your body, can help. These include yoga and meditation and spending time in nature can help lower cortisol levels.
• In addition, speaking with a therapist or another healthcare professional may be beneficial.
• Eating a PCOS-friendly diet and making some lifestyle changes may help improve mood and reduce some of the associated symptoms of PCOS.

Summary High cortisol levels from chronic stress are linked to insulin resistance and belly fat. Relieving stress through yoga, meditation, and time outdoors may help lower cortisol levels.

SUMMARY:

Losing weight can be a struggle for women with PCOS. A balanced diet — low in inflammatory foods like refined carbs and highly processed foods but rich in whole foods, protein, healthy fats, and fiber — may aid weight loss. Certain supplements may help as well. Lifestyle should also be taken into consideration. Regular exercise, stress management, and sleep are all important to weight loss. If you have PCOS and struggle losing weight, try out some of the tips above.

Pharmacologic treatments:

When a healthy diet and regular exercise aren’t enough, medications can make losing weight easier. Different drugs work in different ways. Your doctor will prescribe the medication they think will be the most successful for you. Options include:

• Hormonal birth control, including the pill, patch, shot, vaginal ring, and hormone intrauterine device (IUD)
  • Helps make the menstrual cycle more regular
  • Lowers the risk of endometrial cancer
  • Can improve acne and reduce excess hair growth

• Spironolactone (Aldactone): If birth control doesn’t stop hair growth after 6 months, your doctor may prescribe this drug. It lowers the level of a type of sex hormone called androgens. But you shouldn’t take it if you’re pregnant or plan to become pregnant, because it can cause birth defects.

• Anti-androgen medications such as spironolactone 
  • Can help with excess hair growth, acne, and scalp hair loss
  • Not approved by the Food and Drug Administration (FDA) to treat PCOS
  • May cause problems during pregnancy
• Metformin (Glucophage)
  • Can help lower insulin and androgen levels
  • Not approved by the Food and Drug Administration (FDA) to treat PCOS
• Prescription skin treatments or oral antibiotics for acne
  • Eflornithine HCl cream to slow hair growth in unwanted places
• Infertility medications
  • Clomiphene
  • Letrozole: usually used to treat breast cancer but can be effective in women with PCOS who want to conceive
  • Gonadotropin therapy (follicle-stimulating hormone [FSH] injections)

• Other options to improve your fertility are:

1. Surgery: A procedure called ovarian drilling might make your ovaries work better when ovulation medications don’t, but it’s being done less often than it used to. The doctor makes a small cut in your belly and uses a tool called a laparoscope with a needle to poke your ovary and wreck a small part of it. The procedure changes your hormone levels and may make it easier for you to ovulate.
2. In vitro fertilization, or IVF:With this procedure your egg is fertilized outside of your body and then placed back inside your uterus. This may be the best way to get pregnant when you have PCOS, but it can be expensive are used for metabolic derangements, such as anovulation, hirsutism, and menstrual irregularities.

• Orlistat (Alli, Xenical): This drug stops your body from digesting some of the fat in your food, so it may also improve your cholesterol levels.
• Excessive hair growth: Sometimes PCOS causes unwanted hair growth, which your doctor can treat with medications and hair removal methods, such as:

1. Depilatories:These are creams, gels, and lotions that break down the protein structure of hair so it falls out of the skin. 
2. Electrolysis or laser therapy:Electrolysis removes individual hairs with an electric current that destroys the root. Laser therapy destroys hair follicles. You’ll need several sessions, and though some hair may come back, it should be finer and less noticeable.