PCOS / PCOD
Polycystic meaning many cysts - it is a disease which is characterized by multiple small cysts in the ovaries.
In this syndrome, due to hormonal imbalances the follicles fail to expel the ovum. This leads to the ovary getting filled with immature follicles, which are called cysts.
PCOD is also referred to as PCOS or polycystic ovarian syndrome because the signs and symptoms are very closely interrelated and associated with each other. The syndrome was originally reported by Stein and Leventhal. So it is also called Stein-Leventhal syndrome.
Every woman has a pair of ovaries. The ovaries have many follicles inside them. Every month, one of these follicles develops and matures to release an egg (or ovum). This is called ovulation. All this happens under the influence of hormones.
The ovary gets enlarged, and produces excessive amounts of three important hormones - estrogen, androgen and progesterone. So, affected women often have signs and symptoms of elevated androgen levels, menstrual irregularity, weight gain and abnormal hair growth on the face or body. They may even have amenorrhea (absence of periods).
The ovary gets enlarged, and produces excessive amounts of three important hormones - estrogen, androgen and progesterone. So, affected women often have signs and symptoms of elevated androgen levels, menstrual irregularity, weight gain and abnormal hair growth on the face or body. They may even have amenorrhea (absence of periods).
Causes of PCOD / PCOS
There is no definite cause that has been identified, but studies indicate that PCOD has a significant hereditary component. It is often found to run in the family.
- Patients with PCOD have persistently elevated levels of androgens and estrogen, which leads to anovulation (no ovulation). This further leads to enlargement of the ovaries, and in turn, excess of hormone production. It is a vicious cycle.
- Overactive adrenal glands can also produce excess androgens, and these may also contribute to PCOD. These women also have high levels of insulin in their blood, because their cells do not respond normally to insulin.
- Obesity is known to aggravate PCOD.
Symptoms of PCOD / PCOS
Some women do not show any signs or symptoms of PCOD. They may have regular menses and ovaries that look normal on an ultrasound scan, and still have PCOD.
Most women with PCOD display the following classic symptoms:
Menstrual irregularities:
- This is a common PCOD / PCOS symptoms. Due to excessive estrogen production, there is excessive growth of the uterine lining. This usually leads to very heavy uterine bleeding. The bleeding episodes may occur anytime, leading to menstrual irregularities. So there may be irregular and infrequent menstrual periods or no menstrual periods at all.
Hair and skin problems:
- Hair and skin problems are also common symptoms of PCOS / PCOD. When the ovaries enlarge, they produce excess androgen (male hormone) and estrogen. The excess androgen leads to increased hair growth, which is called hirsuitism. There may be excessive breakouts of acne. The patient may also have thickened, darkened areas of skin on the neck, groin or underarms.
Obesity:
- Most of women with PCOD are obese. Obesity tends to enhance abnormal estrogen and androgen production in this disorder, which only magnifies the problems of irregular bleeding and excessive hair-growth.
Symptoms related to insulin resistance:
- Insulin resistance is also a common PCOD / PCOS symptom. Most of PCOD patients are insulin resistant. This means that their cells do not respond normally to insulin. This if left untreated, leads to excess of un-utilized glucose in the body. So this causes Type II diabetes. There may be weight gain and high blood pressure also.
Infertility:
- In PCOD, as explained above, the follicles are not able to release the mature ova. So this, coupled with the fact that there is hormonal imbalance, contributes to infertility. PCOD is the cause of infertility in 20% of women who are unable to conceive.
Miscarriage:
- The hormonal imbalance in PCOD interferes with ovum development within the follicle and disrupts embryo implantation in the uterus. This leads to miscarriages.
PCOD / PCOS - Diagnosis
When a physician suspects that the patient is suffering from PCOD, he looks for typical symptoms like irregular menstrual cycle, hirsutism and obesity.
Patients with PCOD may not have all or any of these symptoms. So to confirm the diagnosis, Doctors may request for the following tests:
- Ultrasound scan, which may reveal enlarged ovaries and the presence of multiple cysts. Small cysts are generally seen along the periphery of the ovary.
- Blood tests are done to check the levels of hormones. A high level of LH (luteinising hormone) and elevated levels of androgen may indicate PCOD. LH is the hormone which is responsible for ovulation. So when the follicle is not able to release the ovum, the body secretes more of LH to stimulate ovulation. Blood is also tested for insulin and cholesterol levels.
- Diagnostic laparoscopy may be advised in patients where the physician suspects PCOD but there are no apparent symptoms except infertility or miscarriages.
PCOD / PCOS Treatment Options
Usually, patients consult their physician for cosmetic concerns like excessive hair growth, that the underlying problem is PCOD. Some may also report to the doctor because they are unable to conceive. Treatment of PCOD usually aims at inducing ovulation, correcting menstrual irregularities and stabilizing hormonal imbalance.
Conventional System
Metformin has become a leading treatment for PCOD, despite the fact that it has not been approved for this purpose. Metformin is an 'insulin sensitizing' drug commonly used in the treatment of diabetes. Since many patients of PCOD have insulin resistance, they usually end up having type II diabetes. So, they are given this drug. It reduces production of androgen and establishes ovulation.
Metformin is reported to affect kidney functioning and needs careful monitoring.
As part of PCOS treatment, sometimes a drug called clomiphene is combined with low doses of dexamethasone, a steroid which suppresses androgen production from the adrenal glands.
Clomiphene stimulates the ovaries to produce more ova, but there is a risk of multiple-pregnancy, on this therapy.
In some difficult cases, a newer anti-estrogencalled letrozole is used. This is the same drug which is used to treat breast cancer.
Doctors may also prescribe medicines to induce ovulation. Ovulation induction can often be difficult in patients with PCOD, since there is the risk that the patient may over-respond to the drugs, and produce too many follicles. This is called ovarian hyperstimulation syndrome (OHSS).
There are several medications that can block and reduce the effects of androgen. They include spironolactone, cyproterone acetate and flutamide. They all may have reported side-effects.
Laparoscopy is another PCOS / PCOD treatment option used lately for patients with PCOD. If the ovaries are quite enlarged, multiple holes are drilled through the thickened ovarian tissue. This helps to restore normal ovarian function and helps to induce ovulation. But, it is a very delicate surgery and can lead to severe consequences if the cortex of the ovary is destroyed. The cortex contains ova. So destruction of this area may cause infertility.
Homeopathy Treatment
Conventional System
Metformin has become a leading treatment for PCOD, despite the fact that it has not been approved for this purpose. Metformin is an 'insulin sensitizing' drug commonly used in the treatment of diabetes. Since many patients of PCOD have insulin resistance, they usually end up having type II diabetes. So, they are given this drug. It reduces production of androgen and establishes ovulation.
Metformin is reported to affect kidney functioning and needs careful monitoring.
As part of PCOS treatment, sometimes a drug called clomiphene is combined with low doses of dexamethasone, a steroid which suppresses androgen production from the adrenal glands.
Clomiphene stimulates the ovaries to produce more ova, but there is a risk of multiple-pregnancy, on this therapy.
In some difficult cases, a newer anti-estrogencalled letrozole is used. This is the same drug which is used to treat breast cancer.
Doctors may also prescribe medicines to induce ovulation. Ovulation induction can often be difficult in patients with PCOD, since there is the risk that the patient may over-respond to the drugs, and produce too many follicles. This is called ovarian hyperstimulation syndrome (OHSS).
There are several medications that can block and reduce the effects of androgen. They include spironolactone, cyproterone acetate and flutamide. They all may have reported side-effects.
Laparoscopy is another PCOS / PCOD treatment option used lately for patients with PCOD. If the ovaries are quite enlarged, multiple holes are drilled through the thickened ovarian tissue. This helps to restore normal ovarian function and helps to induce ovulation. But, it is a very delicate surgery and can lead to severe consequences if the cortex of the ovary is destroyed. The cortex contains ova. So destruction of this area may cause infertility.
Homeopathy Treatment
Homeopathy medicines works well in PCOD/PCOS. Regular homeopathy medicines helps to regulate menstrual cycle, controls obesity and helps to recover from infertility problems
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