PCOD (Polycystic ovarian disease)

PCOD is a hormonal disorder causing enlarged ovaries with multiple small cysts on the outer surface of ovaries. It affects about 5 to 10% of women in their reproductive age.

Cause of PCOD

The cause of polycystic ovary syndrome isn’t well understood, but may involve a combination of genetic and environmental factors. There is evidence that genetics play a role. Several other factors also play a role in causing PCOS. 

Increased male hormones: There is higher levels of male hormones called androgens in PCOD patients which prevent the ovaries from releasing eggs (ovulation) and causes irregular menstrual cycles, infertility, weight gain, pimples and excessive hair growth in the body. If not treated in time, can lead to further health problems like diabetes, obesity, heart diseases, and high cholesterol.

Insulin resistance: Increased insulin levels cause the ovaries to make and release male hormone. Increased male hormone, in turn, suppress ovulation and contribute to other symptoms of PCOS.

What are the problems associated with PCOD?

• 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 face and back. 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, 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 multiple small cysts their ovaries.

• 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 is the cause of infertility.

How is PCOD diagnosed?

Your doctor will diagnose PCOD by: 

• Taking your medical history and symptoms.

• Taking your weight and blood pressure.

• Performing a physical examination, looking specifically for excess facial hair, acne, thick and discolored skin. 

• Doing blood tests to check hormone levels and blood sugar levels.

• Performing a pelvic ultrasound to look for cysts in your ovaries and check the thickness of the lining of your uterus.

Typically, you will 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 after a long time.

• Signs of excess male hormones such as acne or excessive hair growth or a blood test confirming excess androgen levels.

• Cysts on one or both ovaries. Many patients don’t develop cysts.

Treatment available for PCOD

Treatment depends on your symptoms, medical history and other health conditions, and if you want to get pregnant. Treatments can include medications, lifestyle changes or a combination of both.

If you do not plan to become pregnant, treatment options are:

• Hormonal pills: Options include oral contraceptive pills,  a vaginal ring or an intrauterine device (IUD). Hormonal birth control helps to regulate your menstrual cycle, improve acne and help with excess hair growth.

• Insulin sensitizers: Metformin is a drug used to treat diabetes. It works by helping your body process insulin. Once insulin is controlled, some people with PCOS see improvements in their menstrual cycles and infertility issues.

• Medications to block androgens: Some drugs can block the effect of androgens. This helps control acne or hair growth caused by PCOS.

• Lifestyle changes: Losing weight and eating less carbohydrates and fats in your diet can have a positive effect on insulin levels.

If you want to become pregnant, treatment options include:

• Medicines to induce ovulation: There are some good medications available to induce ovulation in women with PCOS. There are tablets and injections available for this. The clomiphene citrate and letrozole are used commonly and taken orally. In some cases, gonadotropins are given by injection.

• Surgery: A surgical procedure called ovarian drilling can trigger ovulation by removing tissues in the ovaries that are producing androgen hormones. This is rarely used now-a- days and can be considered if medical treatment fails to treat infertility.

• In vitro fertilization (IVF): This is an option for women with PCOS when medication doesn’t help with ovulation.

Is it possible to prevent PCOS or its effects?

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

Does polycystic ovarian syndrome ever go away after pregnancy and menopause?

The hormone changes caused by menopause may make your PCOS go away, but not always. If your symptoms bother you or affect your quality of life, talk to your doctor so they can recommend treating your symptoms.

Does PCOS increase risk for other disease?

PCOS has been shown to put you at a higher risk for several health conditions, including:

• Diabetes.

• High blood pressure.

• Cardiovascular disease.

• Endometrial hyperplasia.

• Endometrial cancer. 

• Depression and anxiety.

Talk to your doctor to make sure you understand the risks of developing these conditions.

How do I deal with symptoms of PCOS?

One of the best ways to cope with PCOS is to lose weight with healthy eating and regular exercise. Even a small amount of weight loss can affect hormone levels and help to regulate your menstrual cycle and ease your symptoms.

If excess hair growth or acne is hurting your confidence, cosmetic treatments or working with a dermatologist might be helpful.

Finally, if you are trying to conceive and have been diagnosed with PCOS, your gynaecologist can help you to get pregnant. 

Is polycystic ovarian syndrome genetic?

There is still a lot of research being done to understand the causes of PCOS. There is evidence that shows PCOS has a genetic or hereditary component.

Can I get pregnant if I have PCOS?

Yes, you can get pregnant if you have PCOS. PCOS can make it difficult to conceive naturally while also increasing your risk for certain pregnancy complications. There are many medications available for ovulation induction.