Polycystic Ovaries Decoded

Every other day I get panic calls from girls, sometimes as young as 13, saying they have been ‘diagnosed’ with Polycystic Ovarian Disease (PCOD) or Polycystic Ovarian Syndrome (PCOS) and prescribed lifelong hormone treatment to ‘cure’ it. Now known as Polycystic Ovaries (PCO), the condition they have been ‘diagnosed’ for is indeed common, affecting almost 25 per cent of all women, but it is no longer considered a disease and is often overdiagnosed. A genetic predisposition is seen and environmental factors like diet and lifestyle may be involved, but the disorder is not fully understood. Ovaries secrete both male and female hormones under the influence of the hypothalamus and the pituitary gland, in the brain. In PCO, the level of male and female hormones is higher. A suboptimal insulin utilization and thyroid dysfunction may also be associated, producing a wide variety of symptoms. Symptoms include signs of excessive male hormones like acne, facial hair and weight gain or irregular periods. Some women may have problems conceiving.

Diagnosis

Two of the three features must be seen to make a diagnosis for PCO:

• Hormonal imbalance
• Irregular periods
• Showing ultrasound features of PCO

If you’ve been diagnosed, do not panic. You’re not ‘abnormal’ or ill. Any condition affecting a quarter of all women cannot really be called a disease. A majority of young women will need no medicines at all and a healthy balanced diet and regular exercise may keep you free of symptoms for years. Since it is a condition, rather than a disease, the aim of treatment is not to ‘cure’ but to treat the symptoms.

Symptoms and Their Treatment

• Cosmetic symptoms: These include acne, facial and body hair, dark patches in the underarms and obesity, which may sometimes require treatment with anti-male hormones—but their effect is temporary. They may arrest, but not reverse the changes already present. Local creams and laser therapy, which has become safer and cheaper in recent years, are often used.
• Menstrual irregularity: An easy way to treat it is with the oral contraceptive pill. Some pills contain anti-male hormone drugs and may also help women with cosmetic symptoms like facial hair.
• Weight issues: About a third of all women with PCO will be overweight. Weight management is always a challenge, but a balanced diet, low in fat and carbs, will help you drop weight. Even losing a few kilos corrects hormonal imbalance significantly. If you’re overweight, get your sugar levels checked. Exercise and seek expert diet management; only in extreme cases should bariatric surgery be considered. Metformin was earlier prescribed to reduce weight and treat infertility. Recent studies show it is not required unless the patient is also diabetic, in which case it is necessary to treat it.
• Fertility: Even those who have problems conceiving should be reassured as this is one cause of infertility which can be treated. With proper treatment, 90 per cent of women with PCO conceive. A judicious use of anti-oestrogen drugs like clomiphene, administered to make an egg, generally work. Severe cases may require hormone injections to induce ovulation. This should be carefully monitored with ultrasound and blood tests as high hormone levels can cause serious, life-threatening hyper-stimulation.
• Other health issues: PCO also has a bearing on long-term health as it may be associated with other hormonal disturbances such as abnormal sugars due to ineffective utilization of inulin (insulin resistance), thyroid dysfunction and other metabolic disturbances, which may increase the risk of diabetes and heart disease at a later age.

Dr Puneet Bedi is Consultant, Obstetrics and Gynaecology at the Indraprastha Apollo Hospital, New Delhi