WHAT IS PCOD?

In PCOD the ovary is symmetrically enlarged and is riddled with small follicular cysts of about 0.5-1.0 cm in diameter. As many as 30 cysts may be seen at one time. PCOD is a hormone problem defined by the collection its symptoms.

WHAT CAUSES PCOD?

Poly Cystic Ovarian Disease (PCOD) is usually thought to be a lifetime female hormonal imbalance where maturing eggs fail to be expelled from the ovary, creating an ovary filled with immature follicles (somewhat misleadingly labeled "cysts"). The cysts then contribute to the hormonal imbalance…which causes more cysts… What causes this vicious cycle to start is not well understood, and probably varies from patient to patient: Insulin? Diet? Stress? Fat? Glandular & hormone problems? Are all implicated in the causation.

SYMPTOMS & SIGNSs

No two women are affected by PCOD in exactly the same way. The most common symptoms and indicators of PCOD are:

• Lack of periods, or extremely irregular periods - In a patient's words "I had perhaps 3 or 4 periods per year at random times except when I was prescribed tablets for withdrawal bleeding and my cycles were artificially regulated for one year. When I went off the drugs the irregularity came right back".
• Male body hair patterns - Scalp hair thinning, excess/ rich growth on face (upper lip and chin) & pubic region.
• Early development of breast buds.
• Male fat storage patterns -- Abdominal storage, rather than standard female pattern on thighs, hips and waist.
• If married, history of infertility, despite regular, unprotected intercourse as irregular ovulation reduces the odds of pregnancy each month.
• Mid cycle pain indicating painful ovulation – due to the enlargement and blockage of the surface of the ovaries.
• Positive Family History - A sister, mother or grandmother with similar symptom.
• Adult acne

HOW IS IT’S EXISTENCE CONFIRMED?

Investigations: (to confirm or rule out): A combination of classical history, close observation of patient and the following investigations are enough to confirm a case of PCOD

• FSH & LH levels with ratio - The levels of FSH & LH vary according to the stage of menstruation, but the ratio FSH-LH should always be < 2. In PCOD we see a ratio of around 4 and above.


• Pelvic Ultrasound - Ultrasound shows a honeycomb of partially developed follicles (eggs) coating the ovaries.

SO, PCOD MEANS INFERTILITY?

No, No. PCOD does not equal infertility. Some women with PCOD have no fertility problem at all. The stress of having such a long named condition may contribute more to infertility than PCOD itself.

In fact, a positive history in either mother or one of the grandmothers proves that fertility is possible. Infertility is just another possible symptom of PCOD. Just like all of the dozen or so possible symptoms, infertility may or may not be present. More than 80% of women with fertility problems caused by PCOD, properly treated and with patience, do bear a healthy child.

TREATMENT

General

Patients should be reassured and taught NOT to panic. Our support group on PCOD@JE will definitely a big help with Shabina Welde at the helm

Approach in girls/ women not wanting another pregnancy: Since the main problem here is anovulation, they have to be protected from continuous action of estrogen. These patients are given progesterone pills after not getting a natural cycle for 6 weeks from their last cycle. They are similarly followed up till they get married and/or want to conceive.

Approach to women desiring children

These patients are given pills that cause ovulation. Almost 70% of patients ovulate with this one course only. If Husband semen is normal and other causes like blocked tubes etc are ruled out with the couple understanding the importance of dates - pregnancy is the likely outcome.

If 3 cycles are not successful we wait for 3-mth period before embarking on next cycle of treatment.

After the family is complete, these patients are treated the same way, unmarried girls are treated.

A word of caution for them - since they can ovulate any time they are asked to take contraceptive precautions.

Surgery for PCOD

This surgery is not a permanent fix, it usually only straightens out the hormonal imbalance temporarily (perhaps one year). The downside of surgery is the risk that it could cause adhesions, which will reduce fertility until removed by another surgery, and the small risk of complete ovarian failure due to ovarian trauma.