Polycystic Ovarian Disease (PCOD)/Polycystic Ovarian Syndrome (PCOD/PCOS) is a hormonal disorder prevalent among women of childbearing age (15 to 44 years old). It is not a new condition. Its first symptoms were described in 1721 by an Italian physician Antonio Vallisneri. PCOD/PCOS is relatively common and found in up to 15% of women of reproductive age. Among them, 70% of cases usually remain undiagnosed. The good news is that with increasing awareness in the digital era now more & more people are seeking treatment for this condition and are able to lead a healthier life.
PCOD/PCOS refers to a group of symptoms affecting how the ovaries work including ovulation. This syndrome is characterized by:
Polycystic ovaries- Enlarged ovaries holding multiple cysts (small fluid-filled sacs) visible on an ultrasound. They contain a large number of cysts that are approximately up to 0.3 inches (8mm) in size.
Unusual higher-than-normal levels of androgens produced by the ovaries, adrenal glands and fat cells- cause excess facial or body hair growth, acne, and scalp hair loss
Infrequent, skipped, or prolonged menstrual periods and unpredictable ovulation.
The cysts are the partially formed follicles that contain an immature egg. These rarely grow to mature enough to stimulate ovulation. The lack of ovulation alters the level of hormones progesterone, estrogen, LH, and FSH which in turn disrupts the menstrual cycle. A diagnosis of PCOD/PCOS is confirmed if the patient experiences at least two of the above-mentioned symptoms. Those suffering from PCOD/PCOS can consider meeting one of the best gynaecologist in Mumbai, Juhu, Dr. Chaitali Mahajan Trivedi, MD (Obstetrics & Gynaecology) who has helped many women treat this condition in the last 1 decade of her practice. Currently, she practices at the renowned Nanavati Superspeciality Hospital in Mumbai.
Women have reproductive organs called ovaries that produce and release eggs. Normally, the ovaries produce progesterone and estrogen hormones which regulate the menstrual cycle, and a limited amount of male hormones called androgens. Every month, the ovaries release an egg to fertilize with the sperm, a process called ovulation. The pituitary gland in women produces Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH) to control ovulation. FSH triggers ovaries to produce underdeveloped sacs called follicles wherein eggs develop and LH stimulates the ovaries to release a mature egg.
PCOD/PCOS affects the functioning of a woman’s ovaries. Thus, PCOD/PCOS is a gender-biased condition that solely affects women.
There is no definite cause known for PCOD/PCOS. It is believed that high androgen levels prevent the ovaries from normally releasing eggs and producing the right levels of hormones. Genes, low-grade inflammation, and insulin resistance are all linked to an excess of androgens in the blood. There is evidence that women who are obese, overweight, or who have a family history of PCOD/PCOS are more likely to suffer from the same condition.
Insulin resistance: Insulin is a peptide hormone produced by the beta cell of Islets of Langerhans of the Pancreas. It is an anabolic substance that helps control blood sugar levels. Women with PCOD/PCOS are insulin resistant majorly because of obesity. Insulin resistance means the cells are not able to use insulin properly. When this happens, the body demands more insulin. To compensate, the pancreas produces more insulin. The excess insulin stimulates the ovaries to produce increased levels of male hormones.
Chronic Low-grade inflammation: PCOD/PCOS patients who are overweight tend to have inflammation in their bodies. This can be indicated in the blood tests that measure the levels of white blood cells and C-reactive proteins. Studies have linked this inflammation to high levels of androgens in the bloodstream.
The signs and symptoms of PCOD/PCOS often become apparent in females during puberty around their first menses. Other women can discover that they have PCOD/PCOS in response to substantial weight gain or when they’ve had difficulty getting pregnant.
The most familiar signs/symptoms of PCOD/PCOS include:
This involves erratic menstrual cycles, missing periods, or not having periods at all. It may also include pelvic pain and heavy blood flow during periods because uterine lining builds up for a longer period. Prolonged thickened lining of the uterus can increase the risk of endometrial cancer.
Excess hair growth (Hirsutism)
There is undesirable facial hair and more hair growth on body areas like the breast, back, abdomen, buttocks, and arms. This is seen in about 70% of PCOD/PCOS patients.
As PCOD/PCOS patients have high levels of androgens, these hormones trigger more sebum production. When the skin becomes oilier than normal, the chances of acne breakouts are more. The most common acne-prone areas are the chest, face, and upper back.
About 80% of women with PCOD/PCOS are overweight or obese and have issues in losing weight.
Dark skin patches can be noticed in folds or creases of the neck, groin, armpits, and under the breasts. This is a characteristic feature of a skin concern called acanthosis nigricans.
These are harmless or painless skin flaps or extra skin growths that appear on the skin surface. They’re often found in the neck region or armpits.
Scalp hair thinning or loss
Women with PCOD/PCOS may suffer from female pattern baldness also known as Female pattern hair loss (FPHL). Their hair may get thinner starting from the middle partition and excessively fall out.
Hormonal fluctuations can trigger headaches in some women with PCOD/PCOS.
PCOD/PCOS patients experience reduced frequency of egg release or lack of ovulation. As there is no egg to fertilize with the sperm, they have difficulty conceiving a child.
Due to hormonal changes and the symptoms such as undesirable hair growth, the patient can feel anxious and depressed or have mood swings.
Overweight women with PCOD/PCOS have interrupted sleep as the condition causes them to have breathing issues
PCOD/PCOS condition can be managed by treating symptoms. Dr. Chaitali Mahajan Trivedi, PCOD/PCOS expert in Mumbai, Juhu will plan out the treatment based on the patient’s symptoms, medical history, or other health issues, and if they want to get pregnant.
Birth control pills, shots, patches, intrauterine devices, or a vaginal ring can be used to regulate the menstrual cycle and treat acne and hirsutism. These contraceptives contain progestin and estrogen hormones that help restore normal hormonal levels. They help regulate ovulation and even protect the patient against endometrial cancer. This option is recommended only when the patient does not plan to become pregnant.
Mild oral antibiotics
These can help treat PCOD/PCOS acne.
These include drugs that block the effect of androgens and help reduce scalp hair loss or excess hair growth.
Some medications can help the patient ovulate such as oral estrogen medication (clomiphene), a drug taken for treatment of breast cancer, a drug for type-2 diabetes to improve insulin resistance, and injectable hormonal medication like gonadotropins. In-vitro fertilization (IVF) can be an option when medications don’t help and women with PCOD/PCOS want to become pregnant.
2. Lifestyle modification
The patient’s diet must include limited carbohydrates to have a positive effect on insulin levels. A low-glycaemic index diet where most carbohydrates are taken from fruits, vegetables, and whole grains is recommended rather than a regular weight loss diet.
Losing weight can decrease the levels of insulin and androgens and may even restore ovulation. Hence, the patients must actively participate in weight loss programs and regularly meet dieticians to help them reach their weight loss goals. Daily exercises can help keep weight under control, reduce blood cholesterol, and also decrease blood sugar levels to prevent diabetes and even risks of cardiovascular diseases.
To know about the PCOD/PCOS treatment in Mumbai, Juhu please feel free to speak to Dr. Chaitali Mahajan Trivedi at Nanavati Superspeciality Hospital.
Laparoscopic Ovarian Drilling
This is a rarely performed surgical approach performed in women with PCOD/PCOS to trigger ovulation. It is done only when infertility medications or lifestyle changes have failed.
In ovarian drilling, the surgeon first makes a small incision at the belly button to insert a small tube to inflate the belly. When the belly is filled with air, the surgeon inserts a laparoscope (a viewing tool) into the abdomen without causing damage to internal organs. This helps the surgeon view the cysts in the ovary in detail. Lastly, through the same incision or other small cuts made in the pelvic area, the surgeon inserts surgical tools to take drill or puncture the cysts in the ovarian tissues linked with high androgen levels. Electrocautery or laser can be used for this purpose.Dr. Chaitali Mahajan Trivedi is also an expert in genital rejuvenation, laparoscopy, hysteroscopy, sexology treatment, and improving female reproductive health.