Polycystic ovary is a multisystem endocrinopathy with features of oligomenorrhoea, non-ovulation, obesity and hirsutism. It is a disease common more among young women. Dr. Bhandari shares some useful information regarding the same with our readers.
INCIDENCE: About 2.2% to 26% adolescent female affected in India.
Cause: Generally PCOD are idiopathic in nature but there are certain factors responsible for development of PCOD such as change in lifestyle, diet and stress. The stress plays so much havoc for development of changes in ovaries. In reproductive age group females having so much stress in their life from adolescent to end of the reproductive life. They suppress their desires and live a stressful life. They are not safe because society does not allow them to live for themselves and that is the reason for hormonal or endocrinal changes which leads to PCOD. Most of the females have irregular periods.
In Married Females, the stress arises from:
Family stress
Females suffer from forced sexual relationship
Adaptation: sudden lifestyle changes
Work pressure
Depression & Anxiety
In Unmarried Females, the stress arises from;
Pressure of studies
Social pressure to follow all rules & regulation
Changes in lifestyle.
Broken relationship.
Lack of freedom
Other Causes:
l Genetic and familial environment factors (autosomal dominant inherited factors).
l CYP21 gene mutation.
l X-linked dominant mode of inheritance.
l Enhanced serine phosphorylation unification activity in the ovary (hyperandrogen)
l Insulin resistance.
l PCOS mothers can also cause PCOS in adolescent daughters.
Obesity is characterized as the condition when:
l Body mass index = 30 kg/m2.
l Waist line = 88 cm.
l Waist/hip ratio =0.85.
Endocrinological changes are as follows:
l Oestrone/E2 level rises.
l LH level is raised over 10 IU/ml.
l FSH level remains normal, but FSH/LH ratio falls.
l SHBG level falls due to hyperandrogenism.
l Testosterone and epi-androstenedione levels rise.
l Fasting blood glucose/fasting insulin<4.5 suggests insulin resistance.
l Triglyceride level .150 mg/dL-hyperlipidaemia HDL<50 mg/dL. Testosterone>2 ng/mL Free T .2.2 pg/mL (Normal level 0.2–0.8 ng/mL)
Normal androstenedione level is 1.3–1.5 ng/mL.
DHEA >700 ng/mL suggests adrenal tumor.
l Prolactin is mildly raised in 15% cases.
l Fasting insulin is more than 10 mIU/L in PCOS in most cases.
l Thyroid function tests may be abnormal (hypothyroidism).
l 17-a-hydroxyprogesterone in the follicular phase >300 ng/dL suggests adrenal hyperplasia due to 21-hydroxylase deficiency.
l Urinary cortisol <50μg/24 h.
Clinical Features:
l Oligomen¬orrhoea (87%)
l Amenorrhea (26%)
l Prolonged or heavy periods
l Hyperandrogenism appears in the form of acne (30%) and hirsutism
l Carbohydrate intolerance, diabetes and hypertension
l History of lifestyle, diet and smoking
l Acanthosis Nigra over the nape of the neck, axilla and below the breasts
l Obesity
l Infertility
The purpose of treatment is:
l To cure a woman with menstrual disorders
l To counsel her for adopt lifestyle changes
l To remove stress factor
l To treat infertility
l To treat hirsutism
l To prevent long-term effects of X syndrome in later life
Dietary Modifications are also required such as;
To be avoided: White bread, White potatoes, White flour, Spicy food, Oily food, Packed items, Sucrose and Fructose rich diet.
Foods which are rich in fiber and can be included are;
Green and red Peppers, Beans, Pumpkin, Radish, Turnips, Broccoli, Brussels, sprouts, Almonds Green leafy vegetables such as Spinach,
Cabbage, Berries, Fruits and Fish
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