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Everything About PCOD

Polycystic Ovarian Syndrome (PCOS), is also known by other names; Polycystic Ovarian Disease and Stein Leventhal Syndrome. This is a fairly common disease that occurs in women who are at a reproductive age; they can bear children, roughly between the ages of fifteen to forty four. What is common amongst all cases of PCOD is erratic and irregular menstrual cycles and imbalances; higher levels of male hormone androgen. PCOD/PCOS gets its name because of the discovery of enlarged ovaries which contained many small cysts. The ovaries produce hormones called progesterone and estrogen which regulate menstrual cycles. However the ovaries produce yet another hormone: a male hormone called androgen even though in much smaller quantities. PCOD today is unfortunately a fairly common disease and yet some studies have shown that around seventy percent of women who had PCOd were not diagnosed.  

The ovaries release eggs (this process is called ovulation) and PCOD is a group of syndromes that affect the ovaries and ovulation. There are three main features: irregular/erratic menstrual cycles, cysts within the ovaries and high presence of male hormones. The word polycystic means many cysts but these cysts are in fact follicles they house an immature eggs that will never mature enough for ovulation and therefore will not be passed out. Estrogen and progesterone levels drop while androgen levels rise because of lack of ovulation. These extra or higher amounts of male hormones will halt or disrupt the menstrual cycles leading to women having fewer periods than normal.  

Causes of PCOD 

Experts are yet to ascertain the exact cause of PCOD but the excess androgen levels are more or less understood to trigger the condition. Some speculative causes are Genetic Predisposition- it seems to be a family occurrence, generation to generation.  

Insulin resistance: women with PCOS have intrinsic insulin resistance independent of the extent of obesity and magnitude of androgen concentrations. Even lean women with PCOS manifest insulin resistance. Increasing body mass index exacerbates insulin resistance. 

INFLAMMATION: Obesity is common among adolescent girls and adult women with PCOS. In response to nutrient excess adipocytes can enlarge. This adipocyte hypertrophy establishes a microenvironment characterized by hypoxia, inflammatory cytokine secretion and free fatty acid spill over. 

Symptoms of PCOD 

Some cases report symptoms were present upon the first period while other women find out they have PCOD in case they gain a lot of weight or face difficulties while trying to get pregnant. The most common symptoms are Irregular Periods: a lack of or insufficient ovulation stops the lining of the uterine from shedding every month.  

Heavier than usual bleeding: as the uterine lining doesn’t shed regularly, it builds up more body and when periods occur more bleeding occurs.  

Excess Hair Growth: more than seventy percent of women with PCOD have untoward hair growth on their face, back, belly, chest and other parts of the body.  

This could be the excessive male hormones.

Acne:  excess male hormones lead to acne breakouts on the face, chest, back and oilier skin.  

Weight Related: more than eighty percent of all women with PCOD are overweight or obese.  

Male Pattern Baldness: thinning and falling of of hair on the scalp  

Darkened Skin: dark patches and stretches can form on the skin in areas like the neck, under the breasts or in the groin area.  

Constant headaches are another reported symptom.  

What PCOD Causes in the Body? 

Infertility: in order to get pregnant, first a woman needs to ovulate. Irregular ovulation naturally causes difficulty in getting pregnant and PCOD is a leading cause of infertility among women.  

Metabolic Syndrome: more than eighty percent of women with PCOD are overweight; this coupled with PCOD leads to higher blood sugar and blood pressure, lower HDL and higher LDL: all these factors together are called metabolic syndrome. The chances of cardiovascular diseases, diabetes and stroke are higher due to these.  

Sleep Apnea: extremely difficult or stopped breathing while sleeping are characteristic of this. Sleep pane is found more commonly among overweight or obese women and those with PCOD.  

Endometrial Cancer: the uterine lining doesn’t shed and builds up due to irregular ovulation, this thickens the uterine lining which increases the risk of endometrial cancer.  

Depression: fluctuations in hormonal levels or hormonal changes play a role in dulling mood and mental being, causing negative feelings, anxiety and depression.  

Diagnosis of PCOD  

Higher androgen levels, cysts in the ovaries and irregular menstrual cycles; having two out of these three is enough for diagnosis. Related symptoms like excess hair or acne and being overweight can also be factored in. A pelvic examination can reveal further problems in the ovaries. Blood tests can help reveal higher male hormones in the body along with cholesterol, insulin and triglycerides which could cause heart issues or stroke. An ultrasound can be used to detect abnormal follicles or other problems in the ovaries.  

Treatment: being fit and healthy is the first step along with a balanced healthy diet. Other Options:  

Birth Control: having estrogen and progesterone in the form of pills, patches or vaginal rings can rebalance hormone levels and relieve symptoms.  

Metformin: is used for type 2 diabetes treatment can help remedy insulin levels and control PCOD. Coupled with a balanced diet and healthy weight maintenance these can work well.  

Clomiphene: a drug that helps in getting pregnant though it can lead to twin or multiple births.  

Hair removal pills or treatment can help with excessive unwanted weight.  

Surgery: ovarian drilling is the process through which tiny holes are made in the ovary using a laser or thinly heated needle: this helps facilitate and restore normal ovulation.  

Dr. Madhulika Sinha 
Senior Consultant 
Obstetrics and Gynaecology 

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