1. Do you have irregular menstrual cycles ? A. Yes B. No
2. Are you obese with hair on upper lip and chin abdomen calf muscles. A. Yes B. No
3. Has your Gynecologist has informed you that you have PCOD. A. Yes B. No
Polycystic Ovarian Disease [PCOD]
POLYCYSTIC OVARIAN DISEASE (PCOD) is a condition where a women is usually (not always) obese with irregular menses and male like hair distribution on the body (upper lip, chin, abdomen, calf muscles, inner thighs). On sonography the ovary has many peripheral follicles and ovarian volume is increased. There are two hormones coming from the Pituitary gland (based at the base of the brain) FSH and LH, normally they are in 1: 1 proportion, In PCOD, LH is three times higher than FSH. Due to which a lot of follicles starts growing in the ovary,
In the ovary there are two types of cells surrounding the egg-
- 1) Theca cells outside
- 2) Granulosa cells inside around the oocyte
LH hormone acts on the Theca cells which produce male hormone TESTOSTERONE.
Normally testosterone is converted to ESTROGEN because of FSH acting on granulose cells.
In PCOD because LH is high Theca cells are more Testosterone produce by these cells cannot be converted to estrogen. This high circulating Testosterone produces obesity, male like features and failure of ovulation.
There is a genetic link between PCOD and Insulin resistance and many PCOD women have altered GTT (glucose tolerance test) and high circulating Insulin.
HOW DO WE MANAGE PCOD ?
PCOD is an inherited disorder and one has to live with it. The best treatment for any complaints of PCOD (Hirsutism, Obesity, Infertility.) is lifestyle management, like:
- 1) DIET which contain low carbohydrates , low fats and high proteins and fiber
- 2) EXERCISE this should be a resistance exercise like Weights, climbing.
Weight reduction is the first key to solve problems.
For Hirsutism (male like hair distribution) ANTI-ANDROGENS are prescribed.
For Weight gain: diet, exercise and Insulin sensitisers are given
For Ovulation Induction and Infertility Clomifene Citrate is the first drug tried. If this fails then Laproscopy and Hysteroscopy is done and Ovarian-drilling is done to remove excess Androgens from the Ovary.
40 % Patients will Spontaneously Ovulate.
- 1) If PCOD Drilling fails Ovulation can be induced with Gonadotrophins + IUI. This is injections of Hormones FSH and LH. There is a risk of Ovarian Hyperstimulation Syndrome when HCG Hormone is given for ovulation after growing folliclas with Hormones. ( FSH & LH )
In Ovarian Hyperstimulation Syndrome the blood vessels in the peritoneum or pleura starts leaking water from the blood. Abdomen gets distended, ovaries are enlarged there is fluid collection in the abdominal cavity ( Ascitis ). Sometimes excess of fluid can make respiration difficult. In this situation fluid has to be tapped (removed with a needle) If the fluid collects in pleura (a space around lungs) repeated tapping is required. Ovarian Hyperstimulation is self limiting condition, starts on day 5 after injection HCG and disappears in 7 days. If you conceive in this state, Hyperstimulation continues for 2 weeks.
- 2) If you fail to conceive with Gonadotrophins + IUI for 3 cycles the next line of treatement is IVF/ ICSI.
Pregnancy rates in PCOS patients undergoing IVF / ICSI are as high as 50 % hence it is worth taking a chance with IVF / ICSI. Chances of getting more eggs and Ovarian Hyperstimulation are high along with Twin Gestations. Embryo freezing for next cycles is highly recommended.
Polycystic Ovary Syndrome [PCOS]
Polycystic ovary syndrome (PCOS) is the most common hormonal disorder among women of reproductive age.
Infertility is one of the most common PCOS symptoms. Because the symptoms of PCOS are seemingly unrelated to one another, the condition is often overlooked and undiagnosed.
Polycystic ovary syndrome is a problem in which a womens hormones are out of balance. It can cause problems with your periods and make it difficult to get pregnant. PCOS also may cause unwanted changes in the way you look. If it isnt treated, over time it can lead to serious health problems like diabetes, hypertension also called metabolic syndrome.
PCOS is a syndrome disease defined by a collection of signs and symptoms. The symptoms of PCOS that one patient experiences can be very different from the symptoms of another patient. If you have two or more of the following symptoms, you need to have a thorough checkup to determine if you need PCOS treatment:
- - Irregular menstrual periods
- - Infertility
- - Male like hair distribution on the body(hirsutism)
- - Thinning hair on the scalp
- - Weight gain
- - Skin problems, including skin tags, darkening skin and acne
- - Polycystic ovaries on ultrasound.
Complications of PCOS
The common PCOS symptoms are difficult enough for most women, but some will experience further complications, including:
Diabetes, elevated insulin levels or insulin resistance
Heart and blood vessel problems
Each of these problems can be life threatening, which is why treatment for PCOS is so important.