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PCOD/PCOS (polycystic ovarian disease/syndrome)

PCOS is the most common endocrinal disorder among women between the ages of 18 and 44. It affects approximately 5% to 10% of this age group. It is one of the commonest causes of infertility.

Patients have multiple small cysts in their ovaries that occur when the regular changes of a normal menstrual cycle are disrupted. The ovary is enlarged, and produces excessive androgen and estrogenic hormones.

In PCOS, there is elevated LH reversal of the LH/FSH ration as LH becomes higher than FSH. The low levels of FSH allow many follicles to develop but without ever maturing even one follicle. Thus, numerous follicles are present in ovaries and once they become ataractic they form cysts, hence the ovaries appear as polycystic. Since the follicles do not mature, they do not release the egg (ovulation). Ovulation can be induced with ovulation drugs [clomid & metformin], by gonadotropins or correction of insulin resistance. If not success go for IVF with Gonadotropins.

Polycystic ovary syndrome (PCOS), also called hyper-androgenic anovulation (HA), or Stein–Leventhal syndrome, is a syndrome of hormone imbalance in women. This syndrome associated with irregular or no menstrual periods, heavy periods, excess body and facial hair, male pattern hair loss, acne, pelvic pain, patches of thick, darker, velvety skin, skin tags, high cholesterol levels, exhaustion or lack of mental alertness, depression, anxiety, decreased sex drive, excess male hormones and trouble getting pregnant (infertility). Associated conditions also include type 2 Diabetes, Obesity, Obstructive Sleep Apnoea, Heart Diseases, Mood Disorders, and Endometrial Cancer.

PCOS is due to a combination of genetic and environmental factors, like obesity (no exercise), family history of PCOD. Diagnosis is based on two of three following findings: no ovulation, high androgen levels, and ovarian cysts (Ultrasound). Differential diagnosis (Other conditions produce similar same symptoms) adrenal hyperplasia, hypothyroidism, and hyperprolactinemia.

PCOS has no permanent cure. Treatment for PCOS involves lifestyle changes such as weight loss and exercise. Birth control pills are used to help in regularizing periods, excess hair, and acne. Metformin and anti-androgens are also useful. Efforts to improve fertility include weight loss for obese patients, and administration of clomiphene, or metformin. In vitro fertilization is used in few cases wherein the treatment is not effective.

Diagnosis

The diagnostic criteria are not definitive for PCOS. There are a few tests that help confirm insulin resistance such as a fasting insulin blood test and cholesterol panels [specifically triglycerides]. Testosterone, cortisol and DHEA should also be tested.

Not everyone with PCOS has polycystic ovaries (PCO), nor does everyone with ovarian cysts have PCOS;

Pelvic ultrasound is a major diagnostic tool, non-appearance of cysts does not confirm that one does not have PCOS.

The diagnosis is straight forward using the Rotterdam criteria, even when the syndrome is associated with a wide range of symptoms.

Management

The primary treatments for PCOS include lifestyle changes, reduced insulin strategies are more effective. medications, and surgery.

Diet

Where PCOS is associated with overweight or obesity, successful weight loss is the most effective method of restoring normal ovulation/menstruation, but many women find it very difficult to achieve and sustain significant weight loss.

Medications

Because there is no cure for PCOS, it needs to be managed to prevent problems. Treatment goals are based on your symptoms, whether or not you want to become pregnant and to lower your chances of getting heart disease and diabetes. Many women will need a combination of treatments to meet these goals.

Birth Control Pills: For women who do not want to be pregnant and still control menstrual cycles, reduce male hormone levels and help clear acne. The oral contraceptives increase sex hormone binding globulin production, which increases binding of free testosterone. This reduces the symptoms of hirsutism caused by high free testosterone and regulates return to normal menstrual periods. However symptoms return once the pill is stopped.

Diabetes medications: Metformin is a drug commonly used in type-2 Diabetes to reduce insulin resistance and is also used to treat insulin resistance seen in PCOS. It lowers the testosterone production and controls abnormal hair growth, supports ovarian function and return to normal ovulation. It will also decrease body mass index [BMI] and improve cholesterol levels.

Fertility medications: Lack of ovulation is usually seen in PCOS. This can be treated with the use of clomiphene citrate. Clomiphene citrate + Metformin is also used for ovulation stimulation. Another option is IVF with Gonadotropins treatment.

Surgery: Video assisted laparoscopic “ovarian drilling” often results in either resumption of spontaneous ovulation or ovulations after adjuvant treatment with medication for hormone imbalance/ insulin resistance (clomiphene or FSH). it is used on some women who do not respond to fertility medicines

Life style modifications: Many Women with PCOS are overweight or obese. Keeping a healthy weight by eating healthy foods and exercising is another way woman can manage PCOS. Even a 10 percent loss in body weight can restore a normal period and make a women’s cycle more regular

Other health risks in PCOS women: Women with PCOS have greater chances of developing several serious, life-threatening diseases, including type 2 diabetes, cardiovascular disease [CVD] and cancer. Getting your symptoms under control at an early stage can help to reduce the above complications.