Polycystic Ovary Disorder (PCOD): Causes, Symptoms & Treatment

Symptoms of PCOD/PCOS

Symptoms of PCOD can vary significantly among women, often impacting menstrual cycles and causing noticeable physical changes. Recognizing these signs is important for seeking timely medical advice.

• Menstrual Irregularities: Oligomenorrhea (infrequent periods) or amenorrhea (absence of periods) are common. These irregularities often signal an underlying hormonal imbalance.
• Ovarian Changes: Enlarged ovaries containing multiple small follicles (typically ≥ 12 follicles measuring 2-9 mm in diameter) are characteristic. These can be observed during transvaginal ultrasound.
• Increased Androgen Levels: Clinical or biochemical evidence of hyperandrogenism manifests as:
• Hirsutism: Excessive hair growth in a male-pattern distribution.
• Acne: Particularly inflammatory acne that is resistant to standard treatments.
• Androgenic Alopecia: Thinning of scalp hair.
• Metabolic Impact:
• Weight Gain: Central obesity is frequently observed.
• Insulin Resistance: Leading to hyperinsulinemia, which exacerbates hyperandrogenism.
• Insulin Resistance: A significant proportion of women with PCOD exhibit insulin resistance, which increases the risk of developing type 2 diabetes and cardiovascular diseases.

Causes and Risk Factors of PCOD

While the exact cause of PCOD is not fully known, several risk factors contribute to the development of this condition. Understanding these factors can help in prevention and management.

Genetic Predisposition:

• Family History: A positive family history of PCOD (mother or sister) significantly increases risk.
• Genetic Markers: Studies have identified several candidate genes, including those involved in steroidogenesis and insulin action.

Insulin Resistance:

• Mechanism: Insulin resistance leads to hyperinsulinemia, which stimulates ovarian androgen production.
• Clinical Implication: Screening for insulin resistance is crucial in PCOD management.

Low-Grade Inflammation:

• Role of Inflammation: Chronic low-grade inflammation is observed in many women with PCOD.
• Impact: Inflammatory markers (e.g., C-reactive protein) are often elevated.

Lifestyle Factors:

• Diet: Diets high in refined carbohydrates and saturated fats can exacerbate insulin resistance.
• Physical Activity: Lack of exercise contributes to obesity and insulin resistance.

Complications: Health Issues Caused by PCOD

If not managed properly, PCOD can lead to several serious health issues. Awareness of these complications is crucial for proactive management and overall well-being.

Pregnancy Complications:

• Gestational Diabetes: Increased risk due to pre-existing insulin resistance.
• Infertility: Anovulation is a primary cause of infertility in women with PCOD.
• Preeclampsia: Higher incidence in women with PCOD.
• Miscarriage: Increased risk, possibly linked to hormonal imbalances.
• Metabolic Syndrome: Characterized by a cluster of conditions:
• Hypertension: High blood pressure.
• Dyslipidemia: Abnormal lipid profile (high triglycerides, low HDL cholesterol).
• Central Obesity: Increased waist circumference.

Increased Risk of Diseases:

• Type 2 Diabetes: Due to chronic insulin resistance.
• Cardiovascular Disease: Linked to dyslipidemia, hypertension, and insulin resistance.

Mood Disorders and Cancer Risk:

• Anxiety and Depression: Higher prevalence in women with PCOD.
• Endometrial Cancer: Increased risk due to chronic anovulation and unopposed estrogen exposure.

PCOD vs. PCOS: Key Differences

While PCOD and PCOS are often used interchangeably, there are important distinctions. Understanding these differences is essential for appropriate diagnosis and treatment.

• PCOD Specifics: In PCOD, the ovaries release many immature or partially mature eggs, which over time develop into cysts. This is often a result of hormonal imbalances that are not as severe as in PCOS.
• PCOS Specifics: PCOS is a metabolic disorder characterized by more severe hyperandrogenism. The ovaries produce excessive androgens, leading to more pronounced symptoms and a higher risk of metabolic complications.

Severity Difference:

• PCOD: Often considered a milder condition, primarily affecting the ovaries.
• PCOS: A more severe and complex endocrine-metabolic disorder with systemic implications.

Implications for Treatment:

• PCOD: May be managed with lifestyle modifications and medications to regulate menstrual cycles.
• PCOS: Requires a comprehensive approach, often including medications to address insulin resistance, hyperandrogenism, and other metabolic issues.

Diagnosis: How is PCOD Identified?

Diagnosing PCOD involves a combination of medical history, physical examination, and various tests to accurately identify the condition.

• Medical History: A detailed medical history is essential, focusing on:
• Menstrual Patterns: Frequency, duration, and regularity of periods.
• Symptom Assessment: Presence of hirsutism, acne, and alopecia.
• Family History: Any history of PCOD or related conditions.

Physical Examination:

• BMI Calculation: To assess obesity.
• Waist Circumference: To evaluate central adiposity.
• Pelvic Exam: To check for enlarged ovaries, although this is less reliable than imaging.

Blood Tests:

• Hormone Levels: Measurement of androgens (testosterone, DHEAS), LH, FSH, and prolactin.
• Glucose Metabolism: Fasting glucose, oral glucose tolerance test (OGTT), and HbA1c to assess for insulin resistance and diabetes.
• Lipid Profile: To evaluate cardiovascular risk.

Ultrasound Imaging:

• Transvaginal Ultrasound: Preferred method to visualize ovarian morphology.
• Criteria: Presence of ≥ 12 follicles (2-9 mm) in each ovary and/or increased ovarian volume (>10 mL).

Ruling Out Other Conditions:

Differential Diagnosis: Exclude other causes of hyperandrogenism and ovulatory dysfunction, such as congenital adrenal hyperplasia, Cushing's syndrome, and androgen-secreting tumors.

Treatment Options for PCOD/PCOS

Managing PCOD requires a multifaceted approach, addressing symptoms and underlying hormonal imbalances through lifestyle changes and medical interventions.

Lifestyle Modifications:

• Dietary Changes: Low-glycemic index diet, reduced intake of saturated fats and refined carbohydrates.
• Weight Management: Even a 5-10% weight loss can significantly improve symptoms and metabolic parameters.
• Physical Activity: At least 150 minutes of moderate-intensity exercise per week.

Medications for Specific Symptoms:

• Oral Contraceptives: First-line treatment for regulating menstrual cycles and reducing androgen levels.
• Anti-androgens: Spironolactone, flutamide, or finasteride to treat hirsutism and acne.

Fertility Drugs:

• Clomiphene Citrate: First-line for ovulation induction.
• Letrozole: Aromatase inhibitor, increasingly used for ovulation induction.
• Gonadotropins: Reserved for cases refractory to clomiphene or letrozole.
• Restoring Hormonal Balance: The primary goal is to restore hormonal balance, improve insulin sensitivity, and mitigate long-term health risks.