About PCOS-PCOD

According to the Indian Fertility Society, PCOS affects 3.7% to 22.5% (1.3-7.9 crore) of Indian women. If you are a woman with PCOS, you might face numerous social, physical, and emotional challenges. However, unfortunately, despite its significant impact, PCOS is not yet widely recognised as a major health issue.

It is crucial to focus on prevention and early detection of PCOS. This blog looks at the different types of PCOS, their symptoms, and treatment options. So, let’s go on a trip together to comprehend this problematic ailment.

What is PCOS?

Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder affecting women of reproductive age, caused by a combination of genetic and lifestyle factors. It is marked by irregular or absent periods, excess male hormones (androgens), and multiple small cysts on the ovaries. The condition often results from insulin resistance, which leads to increased insulin levels that stimulate the ovaries to produce more androgens, disrupting ovulation. 

Common symptoms include irregular periods, acne, weight gain, excessive hair growth (hirsutism), and infertility. Diagnosis is based on the presence of at least two of the following: irregular ovulation, high androgen levels, and polycystic ovaries seen on ultrasound. Though there is no cure, PCOS can be managed with lifestyle changes like healthy diet and exercise, along with medications such as birth control pills, anti-androgens, and insulin-sensitizing drugs. If untreated, PCOS can lead to complications such as type 2 diabetes, infertility, heart disease, and endometrial cancer.

Types of PCOD / PCOS

PCOS is often used interchangeably with Polycystic Ovary Syndrome (PCOS), though they have subtle differences. PCOS is considered a metabolic disorder with more severe symptoms and complications, while PCOS may be milder and more responsive to lifestyle changes.

There are several types of PCOS, which can also apply to PCOS, based on underlying causes and symptoms:

• Insulin-resistant PCOS: Most common type, characterized by the body's resistance to insulin, causing increased androgen levels.
• Lean PCOS: Occurs in women with normal or low body weight but with hormonal imbalances.
• Inflammatory PCOS: Marked by chronic low-grade inflammation exacerbating symptoms.
• Hidden-cause PCOS: Cause not clearly identified, possibly genetic or environmental.
• Pill-induced PCOS: Symptoms triggered by hormonal medications, reversible upon stopping.
• Adrenal PCOS: Excess androgen production from adrenal glands.
• Post-pregnancy PCOS: Develops after childbirth due to hormonal changes.

Signs and Symptoms of PCOD / PCOS

PCOD symptoms often begin around puberty but may develop later in life, especially with excess weight gain or lifestyle changes that affect hormonal balance. The severity and combination of symptoms can vary widely from person to person. Common signs and symptoms include:

• Irregular or Delayed Menstrual Periods : Women with PCOD may experience infrequent, irregular, or even absent periods—often fewer than nine periods per year. Cycles may be unpredictable, and menstruation may be unusually light or heavy. This is primarily due to disrupted ovulation.
• Difficulty Conceiving (Infertility) : Irregular ovulation or complete anovulation (lack of ovulation) can make it difficult to conceive. PCOD is one of the most common causes of ovulatory infertility.
• Excess Androgen Effects :
  Elevated levels of male hormones (androgens) can lead to:
  
  • Hirsutism – excessive hair growth on the face, chest, abdomen, or back
  • Acne – often severe and persistent
  • Male-pattern baldness or thinning hair, especially near the temples or crown
• Weight Gain or Difficulty Losing Weight : Many women with PCOD have a tendency to gain weight, particularly around the abdomen, and may struggle to lose it due to

PCOD / PCOS Causes

The exact cause of PCOD is multifactorial, involving genetic, hormonal, and environmental factors:

• Genetic predisposition: Family history increases risk; multiple genes likely involved.
• Insulin resistance: Present in about 70% of women with PCOD, leading to higher insulin levels that increase androgen production.
• Hormonal imbalance: Excess androgens disrupt normal ovulation.
• Chronic low-grade inflammation: Contributes to hormonal disturbances and insulin resistance.
• Environmental factors: Exposure to endocrine-disrupting chemicals (EDCs), pollutants, and lifestyle factors such as diet and obesity.
• Obesity: Worsens insulin resistance and symptoms but PCOD can also occur in lean women

PCOD / PCOS Risk Factors

• Family history of PCOD or PCOS
• Overweight or obesity
• Sedentary lifestyle and poor diet
• Early puberty onset
• Exposure to environmental pollutants and endocrine disruptors

PCOD / PCOS Complications

If untreated, PCOD can lead to several health issues:

• Infertility due to anovulation
• Increased risk of Type 2 diabetes and insulin resistance
• Metabolic syndrome: high blood pressure, abnormal cholesterol, cardiovascular disease risk
• Miscarriages and gestational diabetes during pregnancy
• Sleep apnea
• Endometrial hyperplasia and cancer due to prolonged unopposed estrogen exposure
• Mental health issues such as depression and anxiety
• Persistent acne and hirsutism
• Chronic liver inflammation.

PCOD / PCOS Diagnosis

There is no single test that definitively confirms PCOD. Instead, diagnosis is made through a comprehensive clinical evaluation and a combination of diagnostic tests. Doctors typically rely on criteria such as the Rotterdam criteria, which require the presence of at least two out of three key features: irregular ovulation, signs of excess androgens, and polycystic ovaries on ultrasound.

The diagnostic process generally includes:

1. Medical History and Physical Examination

• A detailed assessment of the patient’s menstrual cycle history—looking for irregular or absent periods.
• Evaluation of symptoms of androgen excess, such as acne, excessive hair growth (hirsutism), and scalp hair thinning.
• Body weight and BMI assessment, as weight gain or obesity is often associated with PCOD.
• Examination for signs of insulin resistance, such as acanthosis nigricans (darkened skin patches).

2. Pelvic Ultrasound

• A transvaginal or abdominal ultrasound is performed to check for:
  
  • The presence of multiple small ovarian follicles (commonly referred to as "cysts")
  • Enlarged ovaries or increased ovarian volume
• While the presence of cysts is not required for diagnosis, their appearance supports the condition when combined with other symptoms.

3. Blood Tests

• Hormonal blood tests are essential to evaluate:
  
  • Androgens (e.g., testosterone, DHEAS) – typically elevated in PCOD
  • LH (Luteinizing Hormone) and FSH (Follicle-Stimulating Hormone) – often an increased LH:FSH ratio is noted
  • Insulin and glucose levels – to assess for insulin resistance or prediabetes
  • Lipid profile – as women with PCOD may have elevated cholesterol or triglycerides

4. Exclusion of Other Conditions

Since many symptoms of PCOD overlap with other endocrine disorders, it’s important to rule out:

• Thyroid disorders (by testing TSH and free T4 levels)
• Hyperprolactinemia (high prolactin levels)
• Adrenal disorders, such as congenital adrenal hyperplasia or Cushing’s syndrome, by measuring cortisol or 17-hydroxyprogesterone

Diagnosis often follows criteria such as the Rotterdam criteria, requiring two of three features: irregular ovulation, hyperandrogenism, and polycystic ovaries on ultrasound.

PCOD / PCOS Treatment Management

Treatment aims to manage symptoms, regulate menstrual cycles, improve fertility, and reduce long-term risks:

• Lifestyle modifications: Weight loss through diet and exercise improves insulin sensitivity and hormone balance.
• Medications:
  • Hormonal contraceptives to regulate periods and reduce androgen effects
  • Metformin to improve insulin resistance
  • Anti-androgens for hirsutism and acne
  • Fertility treatments such as clomiphene citrate or letrozole for ovulation induction
• Management of complications: Diabetes screening, cardiovascular risk monitoring
• Supplements and alternative therapies: Some evidence supports vitamin D, inositols, and anti-inflammatory diets.
• Psychological support: For mental health issues related to PCOD.

Note: Medications are only advisable under Doctor’s consideration.

In some cases Minimal invasive procedures are required to treat complex PCOD.

Laparoscopic Ovarian Drilling is a minimally invasive surgical procedure used to treat women with PCOD who are not ovulating despite medication. Using laparoscopy for enhanced precision and depth perception, small holes are made in the ovary's surface MASSH MANAS with a laser or electrocautery to reduce androgen production and restore normal ovulation. It’s typically considered when other fertility treatments have failed.