Are PCOS and PCOD the same? Women undergo various changes throughout their lifetime. It could be due to fluctuating hormonal levels, cyst formation, diminished ovarian reserve or even age-related decline in fertility. In fact, they face various health issues specifically related to ovaries, and among them, the most common condition is Polycystic Ovarian Syndrome (PCOS) or Polycystic ovarian disease(PCOD). People confuse these two conditions to be different. However, PCOD is the older terminology for PCOS.
In 1935, Stein and Leventhal, first described the polycystic ovary as a frequent cause of irregular cycles in women seeking fertility treatment. This condition was initially termed Polycystic Ovarian Disease (PCOD). However, a large group of women presented with symptoms of androgen excess like hirsutism, acne and greasy skin. Many women also had associated insulin resistance, excess insulin levels in blood and excess levels of cholesterol. As this condition had multi-systemic involvement, it was re-coined as Polycystic Ovarian Syndrome (PCOS).
Polycystic Ovarian Syndrome (PCOS)
Polycystic Ovarian Syndrome (PCOS) is the most common endocrine disorder affecting women of the reproductive age group. As per industry experts, the worldwide prevalence of PCOS is about 4-18 per cent. In fact, South Asian women are more predisposed. In India, the prevalence is approximately 3.7 - 22.5 per cent.
The exact cause of PCOS is uncertain, although there is increasing evidence for genetic factors. There is a high level of luteinizing hormone (LH), a hormone from the pituitary gland which plays a key role in the menstrual cycle and fertility. Persistently high levels of LH stimulate the production of excess androgen (male hormone).
PCOS is not just a hormonal disorder. It also encompasses the metabolic (insulin resistance), cardiovascular, dermatological and psychological conditions with which it is associated. These can have long-term consequences on the holistic well-being of women. In severe cases, PCOS significantly contributes to infertility. In fact, it accounts for 92- 95% of women attending in fertility clinics. It is a common notion that PCOS is more prevalent in obese women than in the case of lean people. However, it can affect 5% of lean women as well.
Clinical features of PCOS, in addition to biochemical disturbance, vary between individuals. The features commonly presented are irregular cycles, anovulation(no egg release from ovary), increased weight gain (overweight or obesity), features of hyper androgenism (acne, hirsutism or excessive hair on face and body, alopecia or hair loss, acanthosis nigrans or darkish discolouration of skin folds, insulin resistance causing diabetes mellitus and infertility. Dyslipidemia or derranged cholesterol levels is also a clinical feature.
Diagnosis of PCOS is by clinical features, ultrasound findings and hormonal levels. Ultrasound is the gold standard for diagnosis of PCOS. On Ultrasound examination of ovaries, many tiny cysts (water filled cavities) of 2-10mm size are seen at the periphery of ovary. Hence the condition is termed Polycystic Ovarian Syndrome. In fact, these are immature follicles or eggs in ovaries, not exactly cysts .
However, there can be another variant where polycystic ovaries on ultrasound without any clinical features, biochemical markers or metabolic syndrome. These women may not have any symptoms and can be completely normal.
What are the symptoms of PCOS?
- Acne or Oily skin
- Missed periods or irregular periods
- Ovaries that are large
- Weight gain
- Excess body hair
- Male pattern baldness
- Hair Thinning
- Infertility
Managing PCOS and PCOD
Management of PCOS depends on the clinical features, the severity of the syndrome and also expectations as well as fertility aspiration of the women. There is no 'one medicine' for the treatment of PCOS.
Adopting healthy lifestyle
Lifestyle modification with a nutritious diet, good physical activity and loss of at least 10% weight (in the case of overweight and obese women) are the general advice given to all PCOS women.
Regulation of menstrual cycles
Menstrual regulation in patients with irregular cycles can be achieved by hormonal medication either progesterone alone or a combination of oestrogen and progesterone. Sometimes, women can start getting regular cycles by reducing weight.
Dealing with infertility
Infertility management on the other hand needs thorough evaluation of the women. Depending on the severity and other associated conditions of infertility women, may need ovulation induction (medications for egg growth and release), surgical procedure called ovarian drilling or IVF. Supportive medicines like inositol, melatonin, arginine, leucine and co-enzyme Q can all also be tried.
Managing insulin levels
Insulin resistance specifically can be treated with metformin, an insulin sensitising drug. Metformin can also be used as a supportive medicine in infertility treatment. It can also prevent diabetes mellitus in pregnancy (gestational diabetes mellitus - GDM).
Treatment for skin issues
Acne, hirsutism and alopecia on the other hand can be treated with anti-testosterone medications called cyproterone acetate and spironolactone. You can consult a dermatologist for other measures like acne creams, retinol tablets and antibiotics.
Coping with facial hair and hair loss
Excessive facial hair can be treated with creams or laser hair reduction. However, hair loss needs further investigations to check for other vitamin and iron deficiencies. For dealing with hair loss and for regrowth of hair, various hair oils, creams and medications can be used.
Summing up!
PCOS has adverse effects on both short and long-term health. It can impact the body and even lead to infertility. While the clinical features and symptoms can be dealt with the needed precautionary measures, an overall change in lifestyle and diet is what is required. Furthermore, the females suffering from this condition and wanting to start a family should seek assistance from fertility specialists.
(This article is attributed to Dr. Varini N – Senior Consultant - Obstetrician & Gynaecologist, Milann Fertility & Birthing Hospital, Kumarapark, Bangalore)
(Disclaimer: The opinions expressed in this article are those of the author. They do not reflect the views of India TV)
