Obstetrics and Gynaecology | by CMRI | Published on 15/04/2020
Polycystic Ovarian Disease (PCOD) or commonly known as Polycystic Ovary Syndrome (PCOS) is a condition that affects the level of hormones in a woman of reproductive age. Generally, all human bodies need a certain balance of both ‘male’ and ‘female’ hormones, but in women who have PCOD/PCOS this balance is disturbed and there is more production of male hormones. In PCOD, many small sacs full of fluid tend to grow inside the ovaries. These sacs are follicles that contain an immature egg that never matures enough for ovulation. Due to a lack of ovulation, the hormone levels are altered, causing various problems.
Androgens: Most commonly found in hormones in men but also can be found in women. However, in women with PCOD, the level of hormones is higher than normal.
Insulin: This hormone is responsible for managing the level of blood sugar in the body. In women with PCOD, the way the hormone may not function effectively to counteract diabetes.
Progesterone: This hormone is responsible for periods and with PCOD, there is a shortage of this particular hormone in the body leading to irregularity in periods or no periods at all.
This tends to create a problem with the ovaries – there can be an irregularity in periods or no periods, the formation of a cyst, and in extreme cases infertility. Even if a woman suffering from PCOD gets pregnant, she is likely to have higher chances of miscarriage, preeclampsia, high blood pressure due to pregnancy, and premature delivery. There can also be several other problems such as excessive hair growth on the face and body, baldness, acne, and obesity.
Moreover, associated health risks include:
While the exact cause of PCOD is not known; however, it has been strongly linked to factors such as:
Genes: If someone in the family such as mother or sister is suffering from PCOD – there is a higher chance of the individual being affected by the condition.
Excess production of insulin in the body: Insulin is a hormone produced by the pancreas that helps the body use sugar from food for energy. When cells of the body are not able to use insulin appropriately, they demand more insulin, causing the pancreas to produce more insulin to compensate. This, in turn, leads to ovaries increasing the production of male hormones in the body – causing PCOD.
Low-grade inflammation: Low-grade inflammation has been linked to excess production of androgen – a hormone whose excess production triggers PCOD. Low-grade inflammation can be due to obesity.
That said, PCOD is a common problem and treatable if detected timely. Early diagnosis, and effective treatment aided with sustainable weight loss can help reduce long-term complications of PCOD.
The time when a woman starts experiencing PCOD symptoms varies significantly on the intensity of the condition. While some women experience symptoms during the first period, some others might not witness any symptoms until they have gained excessive weight or have trouble getting pregnant. It may take years for some women to diagnose their condition and get appropriate treatment.
Some of the common symptoms that can help with the diagnosis of PCOD are:
Problem with Periods: The most common and significant symptom of PCOD is irregularity or absence of periods. PCOD causes a lack of ovulation which prevents the lining of the uterus from shedding monthly, causing issues with periods such as irregular periods or absence of periods. A woman with PCOD gets less than eight periods yearly on average.
Heavy Menstrual Bleeding: Apart from problems with periods, women suffering from PCOD are also likely to experience heavy menstrual bleeding during periods. This happens because the uterine line builds up for a time longer than usual, causing excessive bleeding.
Excessive Hair Growth in Unwanted Areas: Another troubling symptom of PCOD that is easy to identify is excessive growth of hair in areas such as the face, breast, stomach, thumb, toes, back, etc. This condition is mainly referred to as ‘hirsutism’.
Hair Loss: Simultaneous to the excessive growth of hair in unwanted areas, women with PCOD, tend to experience extreme hair loss or thinning from the head. This symptom tends to intensify with age.
Weight Problems: Women with PCOD suffer from overweight issues; they either tend to be overweight or have a hard time losing weight. More than half of the women with PCOD are overweight or obese.
Acne or Oily Skin: Though these are general problems, this can indicate PCOD in some women. Hormonal changes triggered by PCOD tend to cause breakouts in the form of acne on the face, chest, and back. Moreover, due to the excessive production of male hormones caused by PCOD – the skin becomes oilier than usual.
Darkening of the Skin: In women suffering from PCOD, dark patches of skin can develop in the creases on the neck, in the groin, under the breasts, etc.
Headaches: Changes in hormonal levels caused due to PCOD can cause headaches in some women.
Infertility: Infertility or problems in getting pregnant can be an indication of PCOD.
Sleep Issues: Most women with PCOD tend to have trouble falling asleep – a disorder known as sleep apnea. Moreover, even after a restful sleep, these women tend to experience fatigue and feel tired all the time.
Two or more of these symptoms indicate that there may be a PCOD problem. Hence, it is better to be alert for symptoms so that effective medical help can be sought timely. Early diagnosis and treatment help to better manage the condition.
The treatment for PCOD will depend on condition-to-condition. Some women might experience symptoms that they would want to be treated individually and at a priority; such women experiencing issues with getting pregnant will seek PCOD treatment that helps them improve fertility, whereas women who experience acne and other skin issues might seek treatment to improve skin health and reduce acne breakouts. Hence, the treatment of PCOD depends on the goal of the patient. That said, PCOD cannot be permanently cured; it can only be treated to manage symptoms and improve health generally. That said, the primary treatment for PCOD is the adoption of a healthy lifestyle and habits, followed by medication.
The most effective ways to treat symptoms of PCOD are to eat well, eat healthily, and exercise regularly. Since most women with PCOD are overweight or obese, hence, losing some weight will ease symptoms of PCOD and also regularise periods, and manage sugar levels, and ovulation. Eating healthy is also another very critical constituent of managing PCOD. Avoiding high-fat, trans-fat, saturated-fat, high-sugar, and starchy foods helps to control weight and systematize blood sugar levels.
Several medications can be prescribed per case to normalize the hormonal level. For women not looking to get pregnant soon, birth control medication is the primary method to treat PCOD symptoms. More so, a skin patch, vaginal ring, shots, or an intrauterine hormonal device can be used to manage the condition. This method helps to regularise periods and also treat acne and excessive hair growth in unwanted areas. The birth control hormonal pills also reduce the risk of endometrial cancer. In cases, where the birth control pills do not help with hair growth, spironolactone may be prescribed after six months to reduce the androgens – the sex hormone. However, this can cause serious issues with pregnancy; hence it is to be taken only if there is no desire for pregnancy in the near future.
In other simple cases, hormone pills of progestin can help with symptoms such as irregular periods, acne and unwanted hair growth. But this will only work in cases, where the PCOC problem is not intense.
Additionally, metformin can help lower the insulin production in the body, which will aid weight loss and also prevent diabetes and increase chances of getting pregnant.
On the other hand, in the case where a healthy diet and exercise have not been able to reduce weight, doctors might suggest different drugs or in severe cases, even weight loss surgery to help manage weight and PCOD symptoms. Moreover, to tackle fertility, certain targeted drugs might be prescribed, and in rare cases, a surgery called ovarian drilling can be undertaken to improve ovulation and increase the chances of getting pregnant.
Overall, even though PCOD cannot be entirely cured, it can be very easily managed provided, it is detected timely, and appropriate treatment is received.