Polycystic Ovarian Disease (PCOD): Causes, Symptoms, and Treatment

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What is Polycystic Ovarian Disease?

Polycystic Ovarian Disease (PCOD), also known as Polycystic Ovary syndrome (PCOS) is a very common condition affecting 5% to 10% of women in the age group 12–45 years. It is a problem in which a woman’s hormones are out of balance. It can cause problems with menstrual periods and make it difficult for her to conceive. The principal features include no ovulation, irregular periods, acne and hirsuitism. If not treated it can cause insulin resistant diabetes, obesity and high cholesterol leading to heart disease.

What causes Polycystic Ovarian Disease (PCOD)?

• Normally, the ovaries make female sex menhormones and a tiny amount of male sex hormones (androgens). These help regulate the normal development of eggs in the ovaries during each menstrual cycle.
• Polycystic ovary syndrome is related to an imbalance in these sex hormones. In PCOS, they start making slightly more androgens. This causes patients to stop ovulating, get pimples and grow extra facial and body hair.
• Follicles are sacs within the ovaries that contain eggs. Normally, one or more eggs are released during each menstrual cycle. This is called ovulation.
• In polycystic ovary syndrome, the eggs in these follicles do not mature and are not released from the ovaries. Instead, they can form very small cysts in the ovary, hence the name polycystic ovaries.
• PCOS seems to run in families, so the chance of having it is higher if other women in the family have PCOS, irregular periods, or diabetes

Common symptoms of PCOD/PCOS include:

• Acne
• Weight gain and trouble losing weight
• Extra hair on the face and body. Often women get thicker, darker facial hair and more hair on the chest, belly, and back.
• Thinning hair on the scalp
• Irregular periods. Often women with PCOS have fewer than nine periods a year. Some women have no periods others have very heavy bleeding
• Fertility problems. Many women who have PCOS have trouble getting pregnant (infertility)
• Depression

Investigations like blood sugar estimation, thyroid hormone tests, ultrasound of the abdomen and pelvis are done. Sometimes serum androgens, luteinising hormone and other hormone estimations may be ordered

Treatment

The medical treatment of PCOD/PCOS focuses on managing your individual concerns, such as infertility, hirsutism, acne or obesity.

• Lowering of blood glucose levels
• Restoration of fertility
• Treatment of hirsutism or acne
• Restoration of regular menstruation, and prevention of endometrial hyperplasia and endometrial cancer

Losing weight (which can be difficult) has been shown to help with diabetes, high blood pressure, and high cholesterol. Even a weight loss of 5% of total body weight has been shown to help with the imbalance of hormones and also with infertility.

Medications used to treat the abnormal hormones and menstrual cycles of polycystic ovary syndrome include:

• Birth control pills or progesterone pills help to make menstrual cycles more regular
• Metformin, a medication that increases the body's sensitivity to insulin, can improve the symptoms of PCOS and sometimes will cause the menstrual cycles to normalize. For some women, it can also help with weight loss.
• LH-releasing hormone (LHRH) analogs
• Treatment with clomiphene citrate causes the egg to mature and be released. Sometimes women need this or other fertility drugs to get pregnant.

Medications or other treatments for abnormal hair growth include:

• Birth control pills. It may take several months to begin noticing a difference.
• Anti-androgen medications, such as spironolactone and flutamide may be tried if birth control pills do not work.
• Eflornithine cream may slow the growth of unwanted facial hair in women.
• Hair removal using laser and nonlaser light sources damages individual hair follicles so they do not grow back. This can be expensive and multiple treatments are needed. Laser removal can be combined with other medicines and hormones.
• Pelvic laparoscopy to remove a section of the ovary or drill holes in the ovaries is sometimes done to treat the absence of ovulation (anovulation) and infertility. The effects are temporary.

Expectations (prognosis)

Women who have this condition can get pregnant with the right surgical or medical treatments. Pregnancies are usually normal.

PCOD/PCOS Complications

• Increased risk of endometrial cancer
• Infertility (early treatment of polycystic ovary disease can help prevent infertility or increase the chance of having a healthy pregnancy)
• Obesity-related (BMI over 30 and waist circumference greater than 35) conditions, such as high blood pressure, heart problems, and diabetes
• Possible increased risk of breast cancer