Polycystic Ovarian Disease (PCOD) is one of the most common endocrine disorders in women of reproductive age. It is characterised by a state of hormonal imbalance, irregular ovulation, and the presence of multiple immature ovarian follicles. While the terms are used interchangeably with Polycystic Ovary Syndrome (PCOS), PCOD is considered a less severe form in which ovulation still occurs.
Polycystic ovary syndrome poses considerable metabolic, reproductive, and psychological implications for the affected women. This article provides an overview of Polycystic Ovarian Disease (PCOD) from a scientific perspective.
Pathophysiology of PCOD
The main cause of PCOD is hormonal imbalance, specifically an increase in androgen levels and insulin resistance.
In a regular menstrual cycle, one dominant follicle will develop and ovulate an egg during ovulation. In PCOD, multiple follicles will develop out to the pod into maturity, causing irregular ovulation.
These follicles will collect in the ovary, causing the characteristic polycystic ovary that can be seen in an ultrasound examination.
Insulin resistance is the main cause in most PCOD patients. High insulin levels will stimulate the ovaries to produce more androgen, leading to irregular ovulation and causing symptoms such as acne and hirsutism, making PCOD both a reproductive and a metabolic disorder.
Clinical Features and Symptoms
The clinical features of PCOD are nonspecific. Each case may manifest different clinical features, ranging from mild to severe.
Menstrual Irregularities
The most common presenting symptom of PCOD is menstrual irregularity. Patients may present with infrequent menstrual cycles, amenorrhea, or prolonged and heavy menstrual bleeding. This may increase the risk of endometrial hyperplasia if not properly managed.
Hyperandrogenism
Hyperandrogenic states are associated with dermatologic and cosmetic manifestations, including acne, hirsutism, and androgenetic alopecia. These manifestations may affect the patient’s psychosocial status.
Metabolic Disturbances
Patients with PCOD may also exhibit signs of metabolic disorders, including central adiposity, glucose intolerance, and lipid abnormalities. These abnormalities may be associated with insulin resistance, which may be seen in women who are of normal BMI. These abnormalities may increase the risk of developing type 2 diabetes and cardiovascular diseases.
Reproductive Concerns
Patients may also be infertile due to ovulatory disorders. However, ovulatory cycles may be reestablished if properly managed, allowing women to conceive.
Risk Factors
The aetiology of PCOD is complex, having both genetic and environmental components. Established risk factors include family history of PCOD or diabetes, sedentary lifestyle, excessive weight gain, especially central obesity, carbohydrate-rich diets, and psychosocial stress. These factors increase the risk of developing insulin resistance and hormonal imbalance, thereby promoting the manifestation of PCOD.
Diagnostic Evaluation
The diagnostic evaluation of PCOD is based upon clinical, laboratory, and imaging investigations. No single investigation is definitive for the diagnosis of PCOD.
Clinical Assessment
The clinical assessment of PCOD is based upon clinical history and physical examination. It involves an assessment of menstrual abnormalities, dermatological changes, fluctuations in weight, and signs of hyperandrogenism.
Laboratory Testing
Laboratory investigations may include the estimation of serum testosterone, luteinizing hormone, follicle-stimulating hormone, fasting glucose, fasting insulin, lipid profile, and thyroid function tests. These tests are useful for the assessment of hormonal imbalance.
Imaging
The ovaries are found to be enlarged with multiple small follicles on pelvic ultrasound. The appearance resembles a “string of pearls.” The imaging should be taken into account with clinical and biochemical parameters.
The differential diagnoses include thyroid disorders, hyperprolactinemia, and congenital adrenal hyperplasia. These diagnoses should be ruled out before diagnosing PCOD.
Management Approaches
The management approaches are individualised and are symptom-based. The first step towards managing PCOD is to restore menstrual regularity, improve metabolism, reduce hyperandrogenism, and maintain fertility.
Lifestyle modification is recommended as first-line treatment. A well-balanced diet with complex carbohydrates, proteins, dietary fibres, and fats can help manage insulin resistance. Reducing sugar and processed food products can help maintain metabolism.
Regular exercise, especially when it is a combination of aerobic exercises and resistance training, can improve insulin sensitivity and help in weight control. Studies indicate that even a small weight loss of 5-10% in overweight individuals can improve ovulatory function significantly.Sufficient sleep and stress management can also help in the maintenance of hormonal balance.
Pharmacological Management
When lifestyle modifications alone are not sufficient, pharmacological interventions may be required. Combined oral contraceptives can be used to regulate menstrual cycles and decrease androgen levels. Insulin sensitisers, such as metformin, can also be used to improve insulin sensitivity.
Anti-androgen medications can be used to improve dermatological symptoms, while ovulation induction agents can be used in fertility management. The choice of treatment should be individualised, taking into account the clinical presentation, the patient’s desires, and risk factors.
Psychological and Long-Term Considerations
Apart from the physical symptoms, the prevalence of anxiety, depression, and body image issues is also increased in women with PCOD. Therefore, a comprehensive approach towards the condition should also consider the psychological well-being of the affected.
The long-term consequences of untreated PCOD may result in type 2 diabetes, hypertension, lipid abnormalities, and endometrial disease. These consequences are significantly reduced in the presence of proper and long-term treatment.
Conclusion
Thus, PCOD is a condition that is endocrinally based but also encompasses reproductive and metabolic complications.The condition is a result of an interplay between hormone imbalances and insulin resistance.
Although the condition is chronic in nature, it is also highly manageable through proper and well-structured interventions. As a result, the hormonal and metabolic balance is well maintained in the long term in women with the condition.