PCOD / PCOS Problems:

Polycystic Ovarian Disease is a triad of “Amenorrhea, Obesity and Hirsutism” when observed the relation between the obesity & reproductive disorders. Also known as the ‘Stein-Leventhal Syndrome’ or ‘Hyper androgenic Anovulation’ is the most common endocrine ovarian disorder affecting 2 to 8 percentage women of reproductive age globally. Nowadays, referred as ‘Syndrome O’ i.e. Over nourishment, Overproduction of Insulin, Ovarian confusion and Ovulatory disruption. So, PCOD is called as ‘Polycystic Ovarian Syndrome (PCOS).

PCOS is a lifestyle disorder affecting 3 to 26 percentage of young girls in their reproductive age, wherein its diagnosis is difficult as it manifests as a spectrum of symptoms than a specific one. Mainly characterized by extreme irregular menstrual cycle in which ovulation may not occur.

Many women with this (PCOS) condition are obese and have a higher commonness of impaired glucose tolerance, type 2 diabetes and sleep apnea than is observed in the general population. They exhibit an adverse cardiovascular risk profile, characteristic of the cardio metabolic syndrome as suggested by a higher reported incidence of hypertension, dyslipidemia, visceral obesity, insulin resistance and hyperinsulinemia.

PCOS is diagnosed by gynecologists and is therefore important that there is a good understanding of the long-term implications of the diagnosis in order to offer a holistic approach to the disorder. The calculation of the prevalence of PCOS depends on the criteria used to define this syndrome. Symptoms of PCOS emerge insidiously and are coincident with changes that accompany normal pubertal development, subtle features may not be identified/realized in the early stages, which may lead to failure in identifying the disorder in young girls.

This PCOS problem occurs because of the lifestyle and environmental changes due to modernization. The signs of PCOS include excess of hair growth on the face / abdomen, acne, irregular or absent menstrual periods, failure of ovulation and reduced fertility. PCOS usually occur at or soon after puberty & is a lifelong situation / condition.

Identifications / Suggestions:

Identify the adolescent girls who are at major risk for PCOS; include

  • Missed / irregular / very light periods.
  • Ovaries which appear to be large and have cysts
  • Excess hair in the parts of chest, stomach and back
  • Oily skin or Acne
  • Male pattern baldness or thin hair happening
  • Infertility
  • Small pieces of excess skin on the armpits and neck (also called as skin tags)
  • Dark / thick skin patches on the back of neck / armpits and under breasts.

Risk factors of PCOS:

Cardiovascular Disease: Studies and collective reports suggest women with multiple cysts on their Ovaries were at the risk of heart disease, hence they should be regularly advised & monitored to consume less fat and cholesterol. PCOS is well known by endothelial dysfunction and resistance to vasodilating action of insulin. Increased risk of myocardial infarction in PCOS women than aged matched controls were also been reported.

Obesity: Observations / estimations show 50% of women with PCOS suffer obesity, classically presented in patients with upper body obesity which is associated with menstrual disturbances. Amplifies biochemical and clinical abnormalities of PCOS.

Infertility: Other complicating feature of PCOS is, ovulation and fertility with greater than 75 percentage of women with anovulation infertility, follicular arrest & impaired selection of dominant follicle, also risk of multiple pregnancy and treatment process is based on patient characteristics.

Complications of PCOS:

Endometrial cancer: A long term follows up of PCOS women found an increased risk of endometrial cancer. Few studies suggest women >50 years of age suffer with this cancer is 62.5% and those who are not suffering with this syndrome is 27.33%.

Complications in Pregnancy: Women with PCOS have risk of ‘Gestational diabetes, pre-eclampsia, pre-term labour, small for gestational age, pregnancy induced hypertension, spontaneous abortions, etc.

Sleep Apnoea: It’s been reported women with PCOS have increased sleep disordered breathing & daytime sleepiness.

Depression: There is a higher chances of depression in PCOS patients associated with higher BMI (body mass index) and greater insulin resistance. Besides, Dyslipidaemia, Metabolicsyndrome, Impaired Glucose Tolerance, Non-alcoholic steatohepatitis and higher levels of C-reactive protein, a disease marker for cardiovascular diseases are other probable risks involved.

Conclusions:

Results indicate that individual who suffer from PCOS should undergo proper diagnosis with the help of an experienced Gynecologist. However, the primary treatment is a healthy diet & regular exercise.

Under Investigation unmarried girls presented mainly with complaints of menstrual abnormalities like oligo and or hypomenorrhoea. Remaining other cases had isolated secondary amenorrhoea. But, in case of married girls the duration of married life was less than two years at the time of investigation.

Only ten percent women belonged to lean PCOS category. Eighty to eighty-five percent cases had Ultrasonographic and endocrinal evidence of PCOS.

Women who are oligomenorrhoeic and who do not have normal withdrawal bleeds should be investigated and send for consultation of gynecologist. Obesity worsens insulin resistance that may exacerbate this dysfunction.

Lifestyle changes or alterations will reduce the development of type 2 diabetes later stage in life.

Effects of hyperandrogenisation are among the most undesirable long-term consequences of PCOS when taken into account of its impact on a woman’s self-image perception and the subsequent psychological effects.