PCOD or PCOS
Monday, January 4th, 2010
PCOS and PCOD
Polycystic ovary syndrome (PCOS) or Polycystic ovary disease (PCOD) is a disease characterised by enlarged ovaries which contain multiple (poly) cysts (small sacs filled with fluid). PCOS is a health problem that can affect a woman’s menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearence. Women with PCOS have these characteristics:
? High levels of male hormones, also called androgens, that cause certain masculine changes in the body
? An irregular or no menstrual cycle
? May or may not have many small cysts in their ovaries. Cysts are fluid – filled sacs.
PCOS is the most common hormonal reproductive problem in women of childbearing age.
Patients suffering from polycystic ovarian disease (PCOS) have multiple small cysts in their ovaries ( the word poly means many). These cysts occur when the regular changes of a normal menstrual cycle are disrupted. The ovary is enlarged; and produces excessive amounts of androgen and estrogenic hormones. This excess, along with the absence of ovulation, may cause infertility. Other names for PCOS are polycystic ovary disease (PCOD) or the stein leven that syndrome.
An estimated five to ten percent of women of childbearing age have PCOS.
The ovaries are two small organs, one on each side of a woman’s uterus. A woman’s ovaries have follicles, which are tiny sacs filled with liquid that hold the eggs. These sacs are also called cysts. Each month about 20 eggs start to mature, but usually only one becomes dominant. As the one egg grows, the follicle accumulates fluid in it. When that egg matures, the follicle breaks open to release the egg so it can travel through the fallopian tube for fertilization. When the single egg leaves the follicle, ovulation takes place. In women with PCOS, the ovary doesn’t make all of the hormones it needs for any of the eggs to fully mature. They may start to grow and accumulate fluid. But no one egg becomes large enough. Instead, some may remain as cysts. Since no egg matures or is released, ovulation does not occur and the hormone progesterone is nor made. Without progesterone, a women’s menstrual cycle is irregular or absent. Also, the cysts produce male hormones, which continue to prevent ovulation.
These are some of the symptoms of PCOS:
? Infrequent menstrual periods, no menstrual periods, and / or irregular bleeding
? Infertility or inability to get pregnant because of not ovulating
? Increased growth of hair on the face, chest, stomach, back, thumbs, or toes
? Acne, oily skin, or dandruff
? Pelvic pain
? Weight gain or obesity, usually carrying extra weight around the waist
? Type 2 diabetes
? High cholesterol
? High blood pressure
? Male – pattern baldness or thinning hair
? Patches of thickened and dark brown or black skin on the neck, arms, breasts, or thighs
? Skin tags, or tiny excess flaps of skin in the ampits or neck area
? Sleep apnea, excessive snoring and breathing stops at times while asleep
? High levels of male hormones – a process called masculization or virilisation.
Causes
? Exact cause is not yet known.
? Could be heriditary. It is often transmitted from mother to daughter
? Obesity could be a cause, because fatty tissues are harmonally active and they produce estrogen which disrupts ovulation
? Graffian follicle is a mature follicle is the ovary prior to ovulation (follicle means – a small secretory cavity, sac or gland). Due to inadequate secretion of luteinizing hormone (released by pituitary gland, that stimulates ovulation), this Graffian follicles fail to ovulate and remain as multiple cysts is the ovary.
? Overactive adrenalin glands also produce excess androgens, which contribute to PCOS.
? High insulin levels is the blood.
Diagnosis
There is no single test to diagnose PCOS. Your doctor will take a medical history, perform a physical exam – possibly including an ultrasound, check your hormone levels, and measure glucose, or sugar levels, in the blood. If you are producing too many male hormones, the doctor will make sure it’s from PCOS. At the physical exam the doctor will want ot evaluate the areas of increased hair growth, so try to allow the natural hair growth for a few days before the visit. During a pelvic exam, the ovaries may be enlarged or swollen by the increased number of small cysts. This can be seen more easily by vaginal ultrasound, or screening, to examine the ovaries for cysts and the endometrium. The endomentrium is the lining of the uterus. The uterine lining may become thicker if there has not been a regular period. Blood tests are also very useful for making the diagnosis. Typically, blood levels of hormones reveal a high LH (luteinising hormone) level; and a normal FSH (follicle stimulating hormone) level (this is called a reversal of the LH: FSH ratio, which is normally 1:1); and elevated levels of androgens ( a high dehydroepiandrosterone sulphate (DHEA – S) level);
Treatment
Because there is no cure for PCOS, it needs to be managed to prevent problems. Treatments are based on the symptoms each patient is having and whether she wants to conceive or needs contraception. Below are descriptions of treatments used for PCOS.
Birth control pills. For women who don’t want to become pregnant, birth control pills can regulate menstrual cycles, reduce male hormone levels, and help to clear acne. However, the birth control pill does not cure PCOS. The menstrual cycle will become abnormal again if the pill is stopped. Women may also think about taking a pill that only has progesterone, to regulate the menstrual cycle and prevent endometrial problems. But progrsterone alone does not help reduce acne and hair growth.
Diabetes Medications. The medicine, Metformin, also called Glucophage, which is used to treat type 2 diabetes, also helps with PCOS symptoms. Metformin affects the way insulin regulates glucose and decreases the testosterone production. Abnormal hair growth will slow down and ovulation may return after a few months of use. These medications will not cause a person to become diabetic.
Fertility Medications. The main fertility problem for women with PCOS is the lack of ovulation. Even so, her husband’s sperm count should be checked and her tubes checked to make sure they are open before fertility medications are used. Clomiphene (clomid) medication and gonadotropin injections can be used to stimulate the ovary to ovulate. PCOS patients are at increased risk for miltiple births when using these medications. In vitro Fertilization (IVF) is sometimes recommended to control the chance of having triplets or more. Metformin can be taken with fertility medications and helps to make PCOS women ovulate on lower doses of medication.
Medicine for increased hair growth or extra male hormones. If a woman is not trying to get pregnant there are some other medicines that may reduce hair growth. Spironolactone is a blood pressure medicine that has been shown to decrease the male hormone’s effect on hair, Propecia, a medicie taken by men for hair loss, is another medication that blocks this effect. Both of these medicines can affect the development of a male foetus and should not be taken if pregnancy is possible. Other non – medical treatments such as electrolysis or laser hair removal are effective at getting rid of hair. A woman with PCOS can also take hormonal treatment to keep new hair from growing.
Surgery. Although it is not recommended as the first course of treatment, surgery called ovarian drilling is available to induce ovulation. The doctor makes a very small incision above or below the navel, and inserts a small instrument that acts like a telescope into the abdomen. This is called laparoscopy. The doctor then punctures the ovary with a small needle carrying an electric current to destroy a small portion of the ovary. This procedure carries a risk of developing scar tissue on the ovary. This surgery can lower male hormone levels and help with ovulation. But these effects may only last a few months. This treatment doesn’t help with increased hair growth and loss of scalp hair.
A healthy weight. Maintaining a healthy weight is another way women can help manage PCOS. Since obesity is common with PCOS, a healthy diet and physical activity help maintain a healthy weight, which will help the body lower glucose levels, use insulin more efficiently, and may help restore a normal period. Even loss of 10% her body weight can help make a woman’s cycle more regular. Increasing physical activities, Aerobic exercises, walking, Jogging. swimming are advised.
How does Polycystic Ovarian Syndrome (PCOS) affect a woman while pregnant?
There appears to be a higher rate of miscarriage, gestational diabetes, pregnancy – induced high blood pressure, and premature delivery in women with PCOS. Researchers are studying how the medicine, metformin, prevents or reduces the chances of having these problems while pregnant, in addition to looking at how the drug lowers male hormone levels and limits weight gain in women who are obese when they get pregnant.
Ayurveda
Ayurveda has excellent herbal medicines for all types of gynaecological problems from menarche to menopause. Herbal medicines, as good as Metformin, are available. These natually prepared medicines do not have side effects. Ayurveda’s herbal medicines for diabetes, also act well against PCOS., Potent herbal Ayurvedic medicines can improve ovaluation as effectively as clomiphene.
Ayurvedic medicines can control, Acne, hirsutism, Alopecia, Hyperandrogenism insulin resistance etc as well as any allopathic medicines.
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