Polycystic Ovarian Disease (PCOD)

What is Polycystic Ovarian Disease (PCOD)?

PCOD (also known as Polycystic Ovary Syndrome or PCOS) is a condition affecting the ovaries that can produce symptoms related to a woman’s menstrual cycle, fertility, hormones, insulin production, heart, blood vessels and appearance.

PCOD is the most common hormonal reproductive problem in women of childbearing age. An estimated five to 10 percent of women of childbearing age have PCOD.

Women with PCOD have:

• High levels of male hormones (androgens)
• An irregular or no menstrual cycle
• Many small cysts (fluid-filled sacs) in their ovaries (although this may not always be the case)

What are the causes of Polycystic Ovarian Disease (PCOD)?

The exact cause of PCOD is not known. Women with PCOD frequently have a mother or sister with PCOD. But there is not yet enough evidence to say there is a genetic link to this disorder.

Many women with PCOD have a weight problem. So researchers are looking at the relationship between PCOD and the body’s ability to make insulin. Insulin is a hormone that regulates the change of sugar, starches, and other food into energy for the body’s use or for storage. Since some women with PCOD make too much insulin, it’s possible that the ovaries react by making too many male hormones, called androgens. This can lead to ovulation problems, excessive hair growth, weight gain and acne.

What are the symptoms of Polycystic Ovarian Disease (PCOD)?

These are some of the symptoms of PCOD. Various combinations of these symptoms can be seen in patients:

• Infrequent menstrual periods, absent menstrual periods, and/or irregular bleeding
• Infertility or inability to get pregnant because of not ovulating
• Increased growth of hair on the face, chest, stomach, back, thumbs, or toes
• Acne, oily skin, dandruff
• Pelvic pain
• Weight gain or obesity, usually carrying extra weight around the waist
• Type 2 diabetes
• High cholesterol
• High blood pressure
• Male-pattern baldness or thinning hair
• Patches of thickened and dark brown or black skin on the neck, arms, breasts, or thighs
• Skin tags or tiny excess flaps of skin in the armpits or neck area

How is Polycystic Ovarian Disease (PCOD) diagnosed?

There is no single test to diagnose PCOD. Diagnosis will reqire:

• A detailed medical history
• Physical examination
• Ultrasound
• Hormone levels
• Blood glucose levels

How is Polycystic Ovarian Disease (PCOD) treated?

Various treatment options are chosen based on the symptoms each patient is having and whether she wants to conceive or needs contraception. Below are some of the most commonly used treatments used for PCOD:

Birth control pills

Diabetes Medications: Metformin

Fertility Medications: Clomiphene (clomid) medication and gonadotropin injections can be used to stimulate the ovary to ovulate. PCOD patients are at increased risk for multiple births when using these medications. In vitro Fertilization (IVF) is sometimes recommended to control the chance of having triplets or more. Metformin can be taken with fertility medications and helps to make PCOD women ovulate on lower doses of medication.

Medicine for increased hair growth or extra male hormones: If a woman is not trying to get pregnant there are some other medicines that may reduce hair growth. Spironolactone is a blood pressure medicine that has been shown to decrease the male hormone’s effect on hair. Propecia, a medicine taken by men for hair loss, is another medication that blocks this effect. Both of these medicines can affect the development of a male foetus and should not be taken if pregnancy is possible. Other non-medical treatments such as electrolysis or laser hair removal are effective at getting rid of hair. A woman with PCOD can also take hormonal treatment to keep new hair from growing.

Surgery: Although it is not recommended as the first course of treatment, surgery called Ovarian Drilling is available to induce ovulation. The doctor makes a very small incision above or below the navel, and inserts a small instrument that acts like a telescope into the abdomen. This is called laparoscopy. The doctor then punctures the ovary with a small needle carrying an electric current to destroy a small portion of the ovary. This procedure carries a risk of developing scar tissue on the ovary. This surgery can lower male hormone levels and help with ovulation. These effects may only last a few months.

A healthy weight: Maintaining a healthy weight is another way women can help manage PCOD. Since obesity is common with PCOD, a healthy diet and physical activity help maintain a healthy weight, which will help the body lower glucose levels, use insulin more efficiently, and may help restore a normal period. Even loss of 10% of her body weight can help make a woman's cycle more regular.

What are the possible complications of Polycystic Ovarian Disease (PCOD)?

Women with PCOD can be at an increased risk for developing several other conditions. Irregular menstrual periods and the absence of ovulation cause women to produce the hormone estrogen, but not the hormone progesterone. Without progesterone, which causes the endometrium to shed each month as a menstrual period, the endometrium becomes thick, which can cause heavy bleeding or irregular bleeding. Eventually, this can lead to endometrial hyperplasia or cancer.

With PCOD are also at higher risk for:

• Diabetes
• High cholesterol
• High blood pressure
• Heart disease

Getting the symptoms under control at an earlier age may help to reduce this risk.