PCOS and PCOD: Causes, Symptoms, & Treatment
PCOD or Polycystic Ovarian Disease is caused due to the imbalance of the reproductive hormones in the body that affects women in the age group between 15–44 years. It includes symptoms that are associated with the ovaries and the release of the egg by the ovaries. It is caused due to:-
- Cysts in the ovaries
- High levels of male hormones or androgens
- Irregular or skipped periods
In this condition, many small cysts grow inside the ovaries, hence the name “Polycystic”. These cysts contain an immature egg (an immature egg has no function and is not ready for fertilisation or to produce babies). These eggs never mature enough to trigger ovulation (release of the egg).
WHY MENSTRUAL CYCLES ARE NOT REGULAR IN PCOD?
As the egg is not released, it alters the level of female hormones. Estrogen and progesterone levels (female hormones) are lower than usual, while male hormones are higher than usual. This causes an imbalance between male and female hormones. Extra male hormones disrupt the menstrual cycle, so women with PCOD may get fewer periods than usual.
Causes of PCOD:
- Excess production of insulin: Insulin is a hormone that is produced by the pancreas to help the body use sugar from food to provide energy. This is how Insulin controls the blood sugar levels in the human body. When human cells become resistant to the action of insulin, the blood sugar level increases. As a result, the body produces an excessive amount of insulin to control this increase in blood sugar levels. An excessive production of insulin increases the production of androgens (male hormones which are very less in females). Increased androgen production causes difficulty for egg to mature and get ready for fertilisation.
- Excess male hormones: Overproduction of male hormones by the ovaries leads to irregular periods and impaired fertility. It also causes excessive growth of body hair (a condition known as hirsutism) and acne.
- Heredity: Certain genes may also cause PCOD in women. Studies show that PCOD is passed on from mothers to their daughters.
PCOD Symptoms:
Following are the most commonly reported symptoms in PCOD patients:
- Acne: Male hormones can make the skin more oily and cause acne or pimples on areas like the face, chest, and upper back.
- Darkening of skin: Dark patches of skin can be formed in the skin folds in body like neck, in the groin or genital regions, and under the breasts.
- Abnormal growth of hair on face and body
- Irregular menstrual cycle (Periods): A lack of ovulation or immature egg can cause delay or skipping of periods. Some studies show that women with PCOD get even lesser than eight periods a year.
- Heavy bleeding in periods
- Weight gain: Up to 80 percent of women with PCOD are overweight or obese as per the studies conducted.
- Hair loss: Hair on the scalp gets thinner and fall out.
- Headache: Hormonal changes can trigger headaches in some women.
- Skin tags: A skin tag is a small, soft, and skin-colored growth on skin (it looks like a mole but isn’t black in colour).
- Painful periods: Women with PCOD feel more pain during their menstrual cycles or periods.
PCOD Problems and Pregnancy:
PCOD interrupts the normal menstrual cycle and it may get difficult for a woman with PCOD to get pregnant. Between 70 to 80 percent of women with PCOD have problems getting pregnant. PCOD complications can also increase the risk for pregnancy complications like:-
- Miscarriage
- Ectopic pregnancy: A fertilized egg implanted outside of the uterus is an ectopic pregnancy.
- Gestational Diabetes: It is a form of diabetes that is diagnosed during pregnancy.
- Premature Birth: Women with PCOD are likely to deliver their baby prematurely as per the studies.
- Incompetent Cervix: Cervix is a canal like organ present outside the uterus. A growing baby puts continual pressure on a pregnant woman’s cervix. In rare cases, the pressure becomes too much for the cervix to handle. This will cause the cervix to open before the baby is ready to be born and may lead to the premature birth of the baby, which is called cervical insufficiency or an incompetent cervix.
- Placental Abruption: Placenta provides nutrients from mother to baby. Placenta completely or partially separates from the uterus before a baby is born sometimes in PCOD. This separation means the fetus cannot receive proper nutrients and oxygen.
- Preeclampsia: It is a condition marked by high blood pressure, and high protein levels in a woman’s urine.
- Eclampsia: It occurs when preeclampsia progresses and attacks the central nervous system, causing seizures. If left untreated, it can affect both mother and baby.
If there is a difficulty for a woman with PCOD in getting pregnant, using fertility treatments can improve ovulation. Losing weight and lowering blood sugar levels can improve the chances of having a healthy pregnancy.
Risk of complications due to PCOD at the time of pregnancy can be lowered by some of the following measures:-
- Achieving healthy weight before pregnancy
- Maintaining normal blood sugar levels before and during pregnancy
- Normal level of iron in the body
Diagnosis of PCOD:
- Blood tests: This is done to evaluate levels of male hormones. Levels of hormones produced by the thyroid gland such as THYROID STIMULATING HORMONE, T3 & T4 and may also be evaluated in order to exclude other causes of the symptoms.
- Ultrasound: It can be used to demonstrate the presence of cysts in the ovaries.
Treatment of PCOD:
LIFESTYLE MODIFICATION TO TREAT PCOD:
Treatment for PCOD usually starts with lifestyle changes like losing excessive weight, diet, and exercise:-
- PCOD and Weight Loss: Losing just 5 to 10 percent of body weight can help regulate the menstrual cycle and improve PCOD symptoms. Weight loss can also improve cholesterol levels, keep insulin levels in the normal range, and reduce heart disease and diabetes risks.
- PCOD Diet: A balanced diet is to be taken in order to maintain normal blood sugar levels.Studies comparing diets for PCOD have found that a low glycemic index (low-GI) diet that gets most carbohydrates from fruits, vegetables, and whole grains helps regulate the menstrual cycle better. The Glycemic Index (GI) determines how easily a food product can be converted into sugar and how easily it increases the sugar levels.
- PCOD and Exercises: A few studies have found that 30 minutes of moderate-intensity exercise at least three days a week can help women with PCOD lose weight. Losing weight with exercise also improves ovulation and insulin levels. Exercise is even more beneficial when combined with a healthy diet as it lowers the risks for diabetes and heart disease.
The treatment for PCOD helps in regular menstrual cycles, controlling abnormal uterine bleeding, controlling excess hair growth, management of associated conditions such as type 2 diabetes mellitus, Elevated level of Blood Pressure (Hypertension), Heart Diseases, Obesity, Elevated blood cholesterol levels, Insulin resistance, or improving the chances of pregnancy when desired.
- Met-Pco Care (Myo-Inositol) Tablet is a combination of five medicines. These medicines work by enhancing the body’s response to insulin and decreasing the levels of a harmful substance (homocysteine). This effect improves hormone balance and leads to more regular ovulation and menstrual cycles in PCOD which improve overall health. Met-Pco Care Tablet should be taken in the dose and duration as advised by your doctor. It is to be taken with food, preferably at the same time each day.
- Oral Contraceptives: Oral contraceptive pills (OCPs or birth control pills) are used in some women with PCOD to establish a regular menstrual cycle and to reduce the risk of endometrial hyperplasia and cancer by establishing regular menstrual periods For example: Desogestrel & Ethinyl Estradiol contraceptive pill. It contains a combination of two female hormones. While using Novelon for PCOS, periods become more regular, lighter, less painful menstruation and an improvement in pre-menstrual symptoms, like bloating, swelling or weight gain related to fluid retention is observed. It also improves acne and reduces oil secretion of skin.
- Metformin is a medicine used to treat Diabetes Mellitus ll. It can be used to treat PCOD by decreasing the levels of androgens and enhancing the sensitivity to the action of insulin. It enhances fertility. It has also been used to treat abnormal hair growth in individuals with PCOD.
- Spironolactone (Aldactone) is a diuretic (water pill) that can reverse the effects of excess production of male hormones such as acne and unwanted hair growth.
- Finasteride (Propecia) is a medicine that is taken by men to treat hair loss and can also block the effects of androgens on hair growth.
- Eflornithine (Vaniqa) is a medication that has been approved for reducing the growth of facial hair.
- Clomiphene (Clomid) can be used to induce ovulation (cause egg production and maturation) in women who desire to become pregnant.
SURGERY: Laparoscopic ovarian drilling (LOD) may be a treatment option for fertility problems associated with PCOD that do not respond to medication. Electrocautery or Laser is used to destroy the parts of the ovary. This surgery is not commonly used but it can be used as an option for women who are still not ovulating after losing weight and trying fertility medicines. Destroying the parts of the ovaries may restore regular ovulation cycles. As per the studies about 50 percent of the women can get pregnant after they have undergone the surgery.
PCOD remains undiagnosed due to a lack of awareness and taboo. It is always better to prevent than cure! :)
