POLYCYSTIC OVARIAN DISEASE (PCOD)
Are you having scanty irregular periods or prolonged cycle with heavy bleeding? having difficulty in losing weight or putting on weight despite of less intake? Is problem of acne, darkening of neck and underarms or excessive hair growth on face is disturbing you? or you are unable to conceive? If one of the answer to a above mentioned problems is yes; then see your doctor for excluding polycystic ovarian disease.
It is the most common metabolic hormone disease which is either missed or over diagnosed as we get incomplete information. I hope after reading this blog, you would know the current and future problems associated with it and how to deal with them. Here are answers to commonly asked questions about this disease.
What is polycystic ovarian disease?
It is a very common disease of hormone imbalance in females, with insulin resistance, a relative increase in androgenic (male like) LH (luetininzing hormone ) as compared to FSH (follicle stimulating hormone) and ultrasound showing small peripherally arranged multiple small cysts in ovaries.
What are the chances of having PCOD?
It usually affects 1 in 15 women, but nowadays its incidence is increasing, due to obesity resulting from poor dietary habits and sedentary life styles.
Is transmitted from one generation to other?
Yes, it is partly genetic but other factors like high carbohydrate diet, sedentary life style, thyroid disorders and family history of diabetes mellitus are associated with it.
What are the symptoms and signs of PCOD?
If you are having irregular scanty or prolonged periods, excessive weight gain or difficulty in losing weight ,excessive hair growth on face, chin or chest, hair fall, oily skin with acne, darkening of neck and armpits, depression, infertility or abortions then you should see your doctor for investigations, treatment and dealing with future complications of PCOD.
How disturbed FSH and LH affect egg formation?
Both of these hormones are released from brain and act on ovaries for release of estrogen and progesterone hormones. These are needed for making, maturing, releasing eggs from ovaries and maintaining a normal menstrual cycle. When there is imbalance of FSH and LH hormones, fertility declines, follicles containing eggs do not grow, mature or get released from ovaries, as a result small cysts form in ovaries, estrogen levels relatively increase as compared to progesterone and menstrual cycle gets disturbed.
How insulin resistance affects body?
The main defect in PCOD is insulin resistance in body, insulin is a hormone that picks glucose from blood and takes it into the cells like a truck carrying goods from street to the shop, if it is not present in adequate amount or inefficient (resistance) then glucose will remain in blood and will not enter the cells resulting in high blood sugar levels. This causes obesity, difficulty in losing weight, dark thick skin of neck and armpits (Acanthosis Nigricans), high cholesterol, and in later life diabetes and heart problems.
How high androgens affect body?
These hormones come from ovaries, small glands on kidneys called adrenals and fat. There are high levels of free testosterone levels in PCOD causing hair fall, excessive facial and body hair, irregular menses and infertility.
What are complications of PCOD?
If PCOD IS NOT treated then complications can occur:
- Type II diabetes, high blood pressure (PIH) and diabetes during pregnancy(gestational diabetes)
- Hypothyroidism
- Infertility
- Repeated abortions and premature deliveries
- Fatty liver with inflammation(cholestasis)
- Metabolic syndrome with high cholesterol, high sugar and blood pressure increasing chances of heart diseases
- Abnormal uterine bleeding and more chances of uterine lining (endometrial) cancers
What are blood tests for PCOD?
You should get your hormone levels in blood, preferably on day 1 to day 3 of periods, these are FSH, LH, TSH, Prolactin and if you are obese then blood sugar tests and fasting insulin levels, lipid profile are also done. If there is excessive hair growth then free testosterone level is checked.
What is the role of ultrasound?
It helps to diagnose typical necklace ring appearance of polycystic ovaries, it also helps in checking the thickness of lining of uterus and monitoring follicle size during fertility treatment.
What is the basic treatment for PCOD?
The treatment options are tailored in each patient considering age group, health problems and wish for getting pregnant. The goal is normalization of insulin sensitivity and controlling blood sugar levels, weight control, correcting hormone imbalance and improving ovarian fictional this can be done by life style modifications and medications.
How can insulin sensitivity be improved by medicines?
ALWAYS take medical advice before starting medicines for insulin resistance, as it can only be started after a detailed history, examination and lab results. Metformin (Glucophage) or other sugar lowering medicines reduce weight and blood sugar levels, improve insulin actions, reduce dosage of fertility drugs, and bring rapid results. It will also slow down onset of type II diabetes.
Myoinositol is also insulin sensitizer, it is a vitamin like substance found in organ meat, nuts, grains and fruits, also produced in body from glucose and it mediates action of insulin in body. If taken in diet or in supplements the blood sugar levels are controlled, fertility improves and hormone imbalance gets better.
What is medical treatment of menstrual problems in PCOD?
There are hormones preparations of oral contraceptive pills, contain estrogen plus progesterone or only progesterone tablets are given cyclically and regularly at a fixed time to regulate the cycle, reduce abnormal bleeding and protect lining of uterus (endometrium) from cancers. Oral contraceptives are given in less than 40 years needing contraception, but they are also given in a previous to control the ovaries before starting medicines for making eggs. Please note that progesterone pills are useful for patients wanting pregnancy or more than 40 years or if there is any contraindication for pills. Now progesterone loaded intrauterine device has been very effective in treating heavy bleeding during menses.
What are pregnancy treatments for PCOD?
The antiestrogen medicines like clomiphene or letrozoles are given from day 2 of cycle for 5 days, in resistant cases they are combined with injections of (gonadotrophins) FSH or FSH + LH to make follicles, the size of follicles is checked on day 10 of cycle by ultrasound, and if its more than 18mm then an injection for HCG (human chorionic gonadotrophins) is given to release the eggs.
What are treatment options for excessive hair growth on body?
Excessive hair can be removed by any local method but REMEMBER all methods would be ineffective till we treat the root cause of hormone imbalance. There is some oral contraceptive hormone (cyproterone acetate), some antiandrogenic drugs (Aldactone) which are helpful in decreasing androgen production and its action on skin. But Aldactone cause birth defects, you have to use extra contraceptive measures during their use.
How can we protect our heart in PCOD?
Obesity, high blood sugars and high cholesterol levels are damaging for heart and blood vessels. Weight reduction, regular exercise and lipid lowering drugs like Statins are really helpful for arresting the disease process.
How life style modification is effective in treating PCOD?
Try to lose weight by exercise, diet plans of minimal fat, low refined sugars, high fiber, complex carbohydrates and moderate amount of proteins. It will not only improve insulin sensitivity, decrease problems of PCOD, but also reduce dose of all treatment drugs and prevent complications.
PCOD is a treatable and manageable problem, proper guidance, education and precise treatment can improve insulin sensitivity, reduce androgens, restore fertility. We can save ourselves from different diseases and can have a better quality of life.
Dr. Ayesha Azam Khan
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