Dr. (Professor) Syed Amin Tabish
PCOD (Polycystic Ovarian Disease) is mostly caused by a combination of hormonal imbalance and genetic tendencies. In a standard menstrual cycle, the two ovaries will alternately release mature, ready-to-be-fertilized eggs each month. PCOD is a medical condition in women, where the ovaries produce multiple immature eggs which, over time, become cysts on the ovaries. the hormones of a woman go out of balance which creates various symptoms, including the absence of ovulation, irregular menstrual cycle, difficulty conceiving, weight gain, acne, and hirsutism. PCOD, also known as PCOS (Polycystic Ovarian Syndrome), if left untreated, can lead to further health complications, like diabetes, obesity, heart diseases, and high cholesterol.
Ovaries are the reproductive organs of a female which control the menstrual cycle and the production of hormones like estrogen, progesterone, inhibin, relaxin etc. The accumulation of the eggs swells the ovary and makes it release large quantities of male hormone thus causing infertility.
PCOS (Polycystic Ovary Syndrome) is a metabolic disorder in which the woman affected by hormonal imbalance in their reproductive years. Due to increase level of male hormones females might skip menstrual periods, have irregular ovulation making it hard to get pregnant, get abnormal hair growth on the body and face simultaneously it can lead to heart disease and diabetes in long term. PCOD affects approximately 5- 10% of women in their childbearing ages (12 to 45-years). While the prevalence of PCOD differs, it affects around 9% to 22% of Indian women.
Genes, insulin resistance, and inflammation have all been linked to excess androgen production. Studies show that PCOS runs in families. It’s likely that many genes — not just one — contribute to the condition. There is a 50% possibility of getting PCOD among the women whose immediate female relatives suffer from PCOD.
Insulin resistance: Up to 70 percent of women with PCOS have insulin resistance, meaning that their cells can’t use insulin properly. Insulin is a hormone the pancreas produces to help the body use sugar from foods for energy. When cells can’t use insulin properly, the body’s demand for insulin increases. The pancreas makes more insulin to compensate. Extra insulin triggers the ovaries to produce more male hormones.
Obesity is a major cause of insulin resistance. Both obesity and insulin resistance can increase your risk for type 2 diabetes.
Inflammation: Women with PCOS often have increased levels of inflammation in their body. Being overweight can also contribute to inflammation. Studies have linked excess inflammation to higher androgen levels.
Weight: Sometimes, a higher weight may worsen insulin resistance and the symptoms of polycystic ovarian syndrome. Some women with PCOD report that they had never experienced symptoms such as menstrual irregularity or excessive hair growth and are a healthy weight. However, these symptoms only appear once they gain weight.
Your doctor would discuss your medical history and perform a physical examination to confirm the condition. They may then recommend
• A pelvic examination
• Blood tests to quantify hormone levels
• An ultrasound to check the appearance of your ovaries and the uterus
Studies also report that by the age of forty, approximately fifty per cent of women with PCOD would develop pre-diabetes or would already be diabetic, while many others would face infertility during their childbearing age.
A physical exam includes checking for signs of excess hair growth, insulin resistance and acne. Your doctor might then recommend:
• Pelvic exam
• Blood tests can measure hormone levels.
• Ultrasound can check the appearance of your ovaries and the thickness of the lining of your uterus.
• Regular checks of blood pressure, glucose tolerance, and cholesterol and triglyceride levels
• Screening for depression and anxiety
• Screening for obstructive sleep apnea
With PCOS, many small sacs of fluid develop along the outer edge of the ovary. These are called cysts. The small fluid-filled cysts contain immature eggs. These are called follicles. The follicles fail to regularly release eggs. A diagnosis of PCOS is made when you have at least two of these:
• Irregular periods
• Too much androgen
• Polycystic ovaries
Metabolic syndrome: Up to 80 percent of women with PCOS are overweight or have obesity. Both obesity and PCOS increase your risk for: high blood sugar, high blood pressure, low HDL “good” cholesterol, high LDL “bad” cholesterol. Together, these factors are called metabolic syndrome, and they increase the risk for: heart disease, diabetes, stroke, Sleep apnea (repeated pauses in breathing during the night, which interrupt sleep).
A multidisciplinary treatment approach for PCOD may include a gynaecologist, endocrinologist, dietician, infertility expert, and dermatologist.
One of the most practical ways to manage and keep your symptoms in check is proper weight management. Even if you can achieve 5% weight loss, it will make your treatment easy and more effective. Women who have PCOD must work out regularly and maintain a healthy lifestyle and diet. Make sure to cut on your carbohydrate and sugar and have more high fiberand high protein food.
To regulate your periods, your doctor might recommend:
• Combination birth control pills
• Progestin therapy
To help you ovulate so that you can become pregnant, your health care provider might recommend:
• Clomiphene. This oral anti-estrogen medication is taken during the first part of your menstrual cycle.
• Letrozole. This breast cancer treatment can work to stimulate the ovaries.
• Metformin. This medicine for type 2 diabetes that you take by mouth improves insulin resistance and lowers insulin levels. If you don't become pregnant using clomiphene, your provider might recommend adding metformin to help you ovulate. If you have prediabetes, metformin can slow the progression to type 2 diabetes and help with weight loss.
• Gonadotropins. These hormone medications are given by injection.
If needed, talk with your doctor about procedures that may help you become pregnant. For example, in vitro fertilization may be an option.
To reduce excessive hair growth or improve acne, your health care provider might recommend:
• Birth control pills. These pills decrease androgen production that can cause excessive hair growth and acne.
• Spironolactone (Aldactone).
• Eflornithine. This cream can slow facial hair growth.
• Hair removal
• Acne treatments
• In severe cases, may perform laparoscopic ovarian drilling, which would help trigger ovulation, that is the release of the egg from the ovaries.
Your first task is to reduce your Body Mass Index (BMI). Various types of exercises that you could consider are
• High-Intensity interval training (HIIT)
• Cardiovascular workouts
• Mind-body exercises
• Strength training
• Interval training
Early detection or diagnosis of PCOD will be constructive in relieving the symptoms as well as to reduce the complications involved.
20 minutes of moderate-intensity exercise at least five days a week can help women to lose weight. Losing weight with exercise also improves ovulation and insulin levels.
Your doctor may recommend weight loss through a low-calorie diet combined with moderate exercise activities. Even a modest reduction in your weight — for example, losing 5% of your body weight — might improve your condition. Losing weight may increase the effectiveness of medications your provider recommends for PCOS, and it can help with infertility.
Maintaining healthy body weight: BMI (body mass index) ranges from 18.5 - 24.9 considered as ideal and healthy for females, above than 30 considered as obese and not healthy. Maintaining healthy body weight or weight loss help in improving overall body cholesterol levels, reduce the risk of high blood pressure, heart disease, diabetes, maintaining ideal insulin levels and androgen levels that also restore ovulation phase in the menstrual cycle. Consult a dietitian for weight-loss pragramme to reach within a healthy BMI.
Limiting carbohydrate's consumption: If you have PCOD or PCOS follow a low-carb diet or complex carbohydrates diet that help in maintaining insulin levels. Eat fish, meat, eggs, vegetables that grow above ground and natural fats (like sunflower seeds, pumpkin seeds, sesame seeds and butter) and avoid sugar and starchy foods (like potatoes, bread, rice, pasta, and beans)
Treatment usually starts with lifestyle changes like weight loss, diet, and exercise. Losing just 5 to 10 percent of your body weight can help regulate your menstrual cycle. Do regular exercise and be active.
PCOS / PCOD problem in future
Polycystic Ovarian Syndrome is a prevalent hormonal disorder in women, yet it is one of the most underdiagnosed diseases. It adversely affects women at varying life stages, but unfortunately, half of the women with PCOS are unaware and ignorant about it. As it is a complex and multifaceted condition, it impacts women’s health and well-being in a multitude of ways. It is imperative to create awareness and emphasize prevention strategies.
Females those who are diagnosed with PCOD problem or PCOS should monitor their health on regular basis to avoid any complications in the future. If left untreated, PCOD problem in future can lead to type 2 diabetes, obesity and other mental issues due to hormonal imbalance whereas PCOS in future can have serious complications such as risk of hypertension, hyperglycaemia, endometrial cancer and pregnancy complications (premature birth / preeclampsia / miscarriage).
The best treatment for PCOD and PCOS will consist of on-time diagnosis and the appropriate treatment modalities can help to overcome the symptoms. Maintaining healthy lifestyle is equally important to treat hormonal imbalance and conditions related. Women with PCOD can get pregnant and complete pregnancy, this requires planning and follow-up consultation with gynaecologist to avoid any future complications.
The bottom line
Lifestyle interventions are the first treatments doctors recommend for PCOS, and they often work well. Birth control pills and the diabetes drug metformin can help bring back a normal menstrual cycle. Clomiphene and surgery improve fertility in women with PCOS. Hair removal medications can help women remove unwanted hair.
Weight loss can treat PCOS symptoms and improve the odds of getting pregnant. Diet and aerobic exercise are two effective ways to lose weight.
In both the conditions - PCOD vs PCOS, weight-loss, a healthy diet, avoiding junk foods, processed foods, regular exercise have shown effective results. Early diagnosis of the disease will help is treating the conditions.
Almost 10% of women in the world is suffering from PCOD. PCOS is a serious medical condition and is highly prevalent. Adolescent girls and women should consult a gynecologistin case of irregular menstrual cycles to know the exact reason behind it. Delays in the detection and treatment of PCOS can put people at higher risk of infertility, heart diseases, hypertension, endometrial cancer, and diabetes. Since it is a hormonal disease, one should avoid self-medication and consult a doctor for timely and correct treatment.
Dr. (Professor) Syed Amin Tabish
FRCP (London), FACP, FAMS, FRCP (Edin), MHA (AIIMS)
Postdoctoral Fellowship, Faculty of Medicine
University of Bristol (England)
Doctor of Education in Educational Leadership (USA)