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Polycystic Ovary Disease, widely known as PCOD or PCOS (Polycystic Ovary Syndrome) is an endocrine system disorder that affects women in their reproductive years. It is associated with increased androgen, multiple cysts in ovaries and anovulation. It is linked to endometrial hyperplasia. Another name of PCOS is Stein Leventhal Syndrome as these two scientists Stein and Leventhal describe the disease first. PCOS is also known for HAIR AN syndrome. HAIR – AN stands for Hyper Androgynism, Insulin Resistance and Acanthosis Nigricans. September is Polycystic Ovary Syndrome (PCOS) Awareness Month.
- Menstrual Irregularities – Oligomenorrhea occurs commonly. Menorrhagia (excess flow of blood at menstruation) can occur. Amenorrhoea ( lack of menstruation)
- Excess facial hair growth
- Acanthosis nigricans (a skin condition characterized by dark, velvety patches in body folds and creases)
- Obesity or Overweight
Rotterdam criteria used for PCOS diagnosis. It includes polycystic ovaries, ovulatory dysfunction, and excess androgen. Any two of these three features must be present to diagnose Polycystic Ovarian Syndrome. Cysts in ovaries are diagnosed by ultrasonography. Enlarge both ovaries in volume (>10 cubic cm) and peripherally arranged cysts (>12) are diagnostic features in USG. Serological test shows
- Normal or low FSH ( Follicular Stimulating Hormone)
- High LH ( Luteinizing Hormone)
- Elevated androstenedione (Male Sex Hormone)
- Elevated testosterone and reduced SHBG ( Sex Hormone Binding Globulin)
- Raised estrone and estradiol
- Elevated fasting insulin levels >25 Micro IU / ml
LONG TERM SEQUEL OF PCOS
PCOS must be treated early to prevent its complications. Untreated PCOS is a risk factor for developing diabetes mellitus in the future due to insulin resistance. The risk of developing endometrial carcinoma is also high due to the high estrogen level. Polycystic Ovarian Syndrome also causes dyslipidemia that may lead to hypertension and cardiovascular disease. PCOS patients have a high risk of developing preeclampsia (hypertension during pregnancy).
- For obese patients, weight reduction must be given as priority treatment. Regular exercise helps to weight reduction and ovulation induction.
- Metformin is very much beneficial for metabolic symptoms and glucose intolerance. Metformin also helps in weight reduction. Common side effects of Metformin are nausea, loose stool, vitamin B12 deficiency.
- For irregular periods oral combined pill (OCP) is beneficial when the patient is not willing to conceive.
- In the case of infertility with PCOS, ovulation induction is necessary. Clomiphene citrate is the first-line drug for ovulation induction. If Clomiphene fails, then Second-line drugs like Gonadotropins (low dose) used.
- Another treatment option for infertility is Aromatase inhibitor drugs like Letrozole, Anastrozole, Exemestane, etc.
- Hirsutism symptoms are treated with Antiandrogen drugs like Spiranoctone, Flutamide or Finasteride. Oral Spiranolactoen 25mg thrice daily is commonly used. Finasteride 5mg daily orally is also beneficial for hirsutism.
- Plenty of Dietary Fiber – Taking plenty of dietary fiber helps in reducing body weight and excess fat. It is also beneficial to reduce insulin resistance.
- Take protein-rich food – Eating healthy protein foods like egg, nuts, seafood is advised for PCOS patients.
- Avoid junk food – Avoiding junk food, Packaged food, fast food is very much essential for PCOS patients.
- Drink plenty of fluid – Proper and adequate fluid intake is beneficial. Drink Plenty of water, milk, low sugar fruit juice.