Dr. Vishakha Munjal

MBBS, MD (AIIMS), FICOG, DIP ENDOSCOPY (GERMANY)

Senior Consultant Gynecologist, Laparoscopic surgeon & Infertility

Specialist at Apollo Cradle & Spectra hospitals, New Delhi

 •       Polycystic Ovarian Disease (PCOD)/Polycystic Ovary syndrome (PCOS) is the commonest hormonal disorder faced by women of adolescent & reproductive age groups. With today’s changing lifestyle, women are increasingly facing problems of Obesity, PCOS & Infertility.

This disorder is termed PCOD when it is just confined to ovaries. The ovaries typically become bulky with multiple small cysts called follicles arranged at its periphery in a pearl string like manner. PCOD is typically diagnosed on Pelvic ultrasound.

It is termed PCOS, when apart from polycystic appearance of ovaries, there are associated systemic symptoms like Obesity, Menstrual irregularities, Infertility, Acne, increased facial hair, increased skin pigmentation, hair loss etc.

•       Why PCOS happens? – The reasons could be Genetic or Lifestyle related.  Genetically, women who have a family history of PCOS or Type 2 Diabetes or Obesity are more prone to develop PCOS. Also, women who have inactive lifestyle with bad eating habits are more prone to develop it .

•       What hormonal changes women with PCOS may have?

 1) Increased Androgen ( male hormone) levels which leads to Acne , excessive facial & body hair( Hisutism) , increased skin pigmentation especially at the nape of neck / underarms / groin (Acanthosis nigricans) & Hair loss etc.

2) Increased Insulin levels which leads to Obesity, menstrual disturbances & Infertility.

3) Imbalance in levels of reproductive hormones FSH & LH which leads to irregular periods & Infertility.

4) These women may also have increased levels of  Prolactin & Thyroid hormones which adds to the problem of Obesity, menstrual irregularities & Infertility.

•       What are the Investigations women with PCOS may be advised?                                                               The doctor may advice a Pelvic Ultrasound along with Hormone tests like FSH /LH / AMH / Serum Insulin / Blood Sugar/ Testosterone/ DHEAS/ TSH / Prolactin . These  tests are individualised by doctor according to age & symptoms.

•       When to seek medical advice:

1) If mothers of young adolescent girls see their daughters gaining weight along with irregular periods or Hirsutism or Acne, they must see a gynaecologist early.

2) Women who themselves have PCOS must be vigilant for their daughters right from an early age & encourage them for a healty lifestyle so that they don’t gain weight.

3) Women  diagnosed with PCOS must not delay marriage & childbirth

4) If a Woman diagnosed with PCOS , is facing difficulty in conception, she must see a gynaecologist early.

•       How can PCOS be treated?

 1) Weight loss by exercise & diet control is the best mantra for controlling PCOS  2)Women who have irregular periods & do not wish to conceive may be given cyclical Drospirenone containing oral contraceptive pills ( OCP) like Yasmin

3) Women with high Insulin levels maybe given Metformin or Myoinositol

5) Women with androgenic symptoms may be given Cyproterone containing OCPs like Diane35 & Spironolactone

6) Laser is a treatment option for Hirsutism

 7) Women with Infertility should see a Gynaecologist for possible treatment options like Ovulation Induction/ IUI/ IVF/Laparoscopy

•       What are the long term risks women with PCOS face?  

In the long run, women with PCOS are more prone to develop Type 2 Diabetes , Endometrial (uterine) cancer & Cardiovascular problems like high BP & abnormal Lipid profile.