Polycystic Ovarian Disease!

Polycystic ovarian disease - It is a common female endocrine disorder occurring in reproductive age group from 15 to 45 years. It affects 1 in every 5 women. Insulin resistance is central to the pathogenesis of pcos and indians are known to have high prevalence of insulin resistence

Three main features of pcos:

• Irregular periods - Which means ovaries don’t regularly release eggs (ovulation)

• Excess androgen - High levels of male hormone in your body which may cause physical signs such as excess facial or body hair

• Polycystic ovaries - Your ovaries become enlarged and contains many fluid filled sacs which surround the egg (follicle)

If you have atleast two of these features you may be diagnosed of pcos

Signs and symptoms:

• Irregular or no periods
• Difficulty getting pregnant
• Excessive hair growth on face, chest, back
• Weight gain
• Hairloss from the scalp
• Oily skin or acne

Pcos is associated with an increased risk of developing metabolic problems like -

• Type 2 diabetes
• Hypertension
• High cholesterol 
• Heart disease
• High uric acid

What causes pcos?
Exact cause is not known, it may have a multifactorial cause like insulin resistance, hormonal imbalance, genetics

Resistance to insulin - Insulin is a hormone produced by the pancreas to control the amount of sugar in the blood. It helps to move glucose from blood to the cells where it is broken down to produce energy.
Insulin resistance means body’s tissues are resistance to the effects of insulin. The body therefore has to produce extra insulin to compensate.
High levels of insulin cause ovaries to produce too much testosterone, which interferes with the development of the follicles and prevents normal ovulation.
Insulin resistance can also lead to weight gain which can make pcos symptoms worse, because having excess fat causes the body to produce even more insulin

Hormone imbalance - Many women with pcos are found to have an imbalance in certain hormones that includes increased estrogen, decreased fsh, decreased progesterone, increased lh, increased testosterone, low levels of shbg, raised levels of prolactin. The exact reason is why these hormonal changes occur is not known. It’s been suggested that problem may start in the ovary itself, in other glands that produce these hormones or in the part of the brain that controls their production. The changes may also be caused by the resistance to insulin

Genetics - Sometimes pcos runs in families. 

Diagnosis -

• Hormonal evaluation
• Ultrasound scan
• Blood test to screen for diabetes and cholesterol

Treatment -
Pcos can’t be cured but the symptoms can be managed

Life style changes

• In overweight women by losing excess weight by exercise and healthy balanced diet
• Medication
• For irregular periods contraceptive pills to induce regular periods or induce period every 3-4 mnths to reduce long term risk of developing endometrial cancer
• Fertility problems:
• Short course of ovulation induction medication. If no response then ivf
• Metformin