PCOD Article

PCOD Article

Polycystic Ovarian Syndrome can lead to serious complications

Polycystic Ovarian Syndrome (PCOS) is a common and heterogeneous disorder in women’s reproductive age -, characterized by chronic anovulation and hyperandrogenism. It may manifest at any age, ranging from childhood in the form of premature puberty.

Among the teenagers, it is reflected through hirsuitism and menstrual abnormalities, while in early adulthood and middle life, PCOS could manifest in the form of infertility, glucose intolerance and at later stage through diabetes mellitus and cardiovascular disease.

Hyperinsulinemia has proved to be a key link in the generation of the symptoms of PCOS. Anovuulatory infertility is very common manifestation. The skin stigmata are induced by hyperinsulinemia. Most women with polycystic ovaries tend to be profoundly insulin resistant, and the resultant hyperinsulinemia increases the reproductive problems.

Regression of these symptoms may be achieved by reducing the hyperinsulinemia. As obesity exaggerates the expression of the symptoms induced by hyperinsulinemia, a low calorie diet and lifestyle change resulting in loss of weight for obese women with PCCOs is capable of reversing these symptoms. PCOS is a multiorgan disorder and can give rise to long – term potenttial health risks. Endometrial cancer remains one of the most serious potential complicattionns for women with polycystic ovarian syndrome if neglected.

Drugs that ameliorate insulin resistance and reduce circulating insulin levels could providde a new therapeutic modality for PCOS. Hence, it is necessary to identify this subset of women, who will response this therapy i.e., insulin-sensitizing agents.

Diagnosis

As per the finding of the latest researches, the syndrome of PCOD could surface either in the form of ultrasound appearance of polycystic ovaries, menstrual disturbances or with evidence of hyperadrogenism (acne hirsuitsm etc). Other causes of hyperandrogenism have been ruled out especially congenital adrenal hyperplasia. It is important thet 40 per cent of women have scanty periods, 85 per cent of women with hirsuitism and 100 percent of women presenting with severe acne have PCOD as their etiology. Skin complication can be in the form of acne, cystic acne on face, neck, back shoulders and hirsutism with excessive hair on face, body, upper lip, chin, neck abdomen, thinning of the head hair or male pattern balding. There is acanthosis nigricans, which is a discoloration or darkening of skin around neck, chin, under arms skin folds or skin tags. The incidence of impaired glucose tolerance amongst PCOD subject is high and 35 to 45 percent of them will have type II diabetes mellitus. A fasting glucose to fasting insulin ratio less then 4.5 is predictive of insulin resistance.

Management

The good treatment in obese PCOD should be weight loss by diet and exercise. Obesity is associated with central fat accumulation and an increased waist to hip ratio (WHR).

Over 5-10 per cent of the body weight, alone can improve the fundamental aspect of the endocrine system of PCOS and result in low xirculating Androgen levels and spontaneous resumption of menses.

The first line of treatment is still remains clomephene citrate (CC) in patient with PCOS and infertility. However about 20 to 30 percent of patients will be resistant to CC therapy. It is important to identify women who are clomiphene failure.

Diet and exercise followed by clomiphane citrate should be used for nonclomiphane-resistant PCOS women, Metformin may be included in a stepwise approach. Laparoscopic ovarian drilling can be considerd as an option in certain patien before gonadotropin therapy.

Use of insulin sensitizers

Like metformin in PCOS is now gold standarspecially in adolescent girl with menstrual problem of infertility. Laparoscopic ovarian drilling (LOD) is used as second line treatment after patient have proved resistant to metformin plus clomiphane or as a third line treatment after failed ovulation induction with gonadotropins. Laparoscopic ovarian drilling is a relative simple procedure performed by minimal access surgery.

Conclusion

The reduced rate of ovulation is directly associated with hyperinsulinemia and hence the initial focus in treatment should be control of insulin secretion and control of weight by diet and exercise. Insulin sensitizers do play an important of PCOD.

We running PCOD clinic at LIFECARE CENTRE have our 3000 Adolescent on our ruled out.

Devanshi

Simran Kaur

Nupur Sabharwal

Dureen

Ranjana

Sanya Suneja

Neha

Shweta

Viveka

Tanvi

Swati

Shruti Gupta

Disha Sharma