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Understanding PCOD: A Comprehensive Guide

PCOD, or Polycystic Ovarian Disease, is a common hormonal disorder that affects women of reproductive age. It is characterized by:

  • Irregular or absent menstrual periods
  • Enlarged ovaries containing small cysts along the outer edges
  • Excess androgen (male hormone) production causes symptoms like facial hair growth, acne, etc.

PCOD is one of the leading causes of infertility among women. According to various studies, it affects 5-20% of women in the reproductive age group worldwide.

Signs and Symptoms of PCOD

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Source: elanhealthcare.ca

The common signs and symptoms of PCOD include:

  • Irregular, infrequent, or prolonged menstrual cycles – Women may have fewer than 8 cycles a year or have cycles more than 35 days apart.
  • Excess androgen levels – Higher male hormones can cause increased facial and body hair growth, severe acne, and male-pattern baldness.
  • Polycystic ovaries – Ultrasound reveals enlarged ovaries with small cysts around the periphery. The inner ovary may appear thickened.
  • Obesity – 50-80% of women with PCOD tend to be overweight or obese, especially with excess weight around the waist.
  • Skin tags – Small flaps of skin may appear on the neck, armpits, or groin.
  • Skin discoloration – Darkening of skin like acanthosis nigricans around neck, underarms, and groin.
  • Pelvic pain – Some women experience dull aches in the pelvis and heaviness in the abdomen.
  • Difficulty getting pregnant – PCOD is one of the top causes of female infertility.
  • Depression and mood swings – The hormonal imbalance can contribute to mood disorders.
  • Sleep apnea – This disorder may occur due to hormonal changes.
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Symptoms can begin soon after the start of periods or later in life. They often worsen around menopause when estrogen levels dip.

What Causes PCOD?

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source:nhassurance.com

The exact cause of PCOD is unknown, but several factors may contribute to the development of this condition:

  • Hormonal imbalances – PCOD results from excessive production of androgens like testosterone and DHEA by the ovaries and adrenal glands. Lower progesterone relative to estrogen levels also plays a role.
  • Insulin resistance – Insulin helps in energy storage and usage. About 50-70% of women with PCOD have higher insulin levels and insulin resistance.
  • Genetic factors – PCOS tends to run in families, so genes are likely involved. Daughters of women with PCOS have an elevated risk.
  • Inflammation – Women with PCOS show higher levels of inflammatory chemicals secreted by fat tissue, which furthers insulin resistance and androgen production.
  • Obesity – Excess fat increases androgen production, exacerbating PCOD symptoms.
  • Stress – Chronic stress leads to elevated androgens and cortisol changes that can worsen PCOS.

No single cause has been identified. The complex interplay between genetic, hormonal, and lifestyle factors leads to PCOD in susceptible women.

How is PCOD Diagnosed?

How is PCOD Diagnosed

There are no definitive tests for PCOD. Doctors make a diagnosis based on a combination of the following:

  • Medical history – Symptoms like irregular periods, severe acne, excess hair growth, fertility issues, etc.
  • Physical exam – Signs like skin tags, acne, hair growth patterns, and obesity. The pelvic exam notes any enlargement or tenderness of the ovaries.
  • Ultrasound – Imaging test reveals enlarged ovaries with peripheral cysts giving a ‘string of pearls’ appearance.
  • Blood tests – Elevated testosterone levels, DHEAS, LH/FSH ratio, prolactin, TSH, etc., can indicate PCOD.
  • Glucose tolerance test – For checking fasting blood sugar and insulin levels to detect insulin resistance.
  • Hormone tests – Low progesterone levels relative to estrogen may be seen.
  • Rotterdam criteria are widely used for diagnosis. You must have 2 out of 3 features:
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  1. Irregular periods or no periods for months
  2. Signs of excess androgens – acne, excess hair, etc.
  3. Polycystic ovaries on ultrasound

PCOD Treatment Options

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PCOD has no cure, but symptoms can be controlled and managed with lifestyle changes, medications, or surgery:

Lifestyle Changes

  • Weight loss – Losing even 5% of body weight can help restore normal periods and ovulation.
  • Healthy diet – Limit simple carbs, sugar, processed foods. Eat more fruits, vegetables, lean proteins, nuts, and whole grains.
  • Exercise – Do 30-60 minutes at least 5 days a week to improve insulin sensitivity.
  • Stress management – Try yoga, meditation, and counseling to lower stress hormones exacerbating PCOS.

Medications

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Several medications can be used to manage PCOD:

  • Birth control pills – Oral contraceptives containing estrogen/progestin can regulate menstrual cycles, curb excess hair growth and improve acne.
  • Anti-androgens – Spironolactone or flutamide tablets reduce excessive hair growth and clear up acne.
  • Metformin – This insulin-sensitizing drug can regulate menstruation by lowering testosterone levels and improving insulin resistance.
  • Clomiphene – This oral drug stimulates ovulation for improved fertility. Letrozole is also used for similar purposes.
  • Skin treatments – Creams like eflornithine can inhibit facial hair growth when combined with laser hair removal. Isotretinoin, anti-androgens, and topical retinoids help clear up severe acne.

Surgical Procedures

Surgery may sometimes be needed:

  • Ovarian drilling – Using diathermy, laser, or laparoscopy to destroy part of the ovary improves ovulation.
  • Hysterectomy – Removal of the uterus stops menstrual periods if other treatments fail. Done only in severe cases.
  • Bariatric surgery – This weight loss surgery in obese individuals may resume PCOS-related ovulation and menstruation.

PCOD Diet – What to Eat and Avoid

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Source: osmosis.org

Dietary changes, along with exercise, form the keystone of PCOD management. Here are some recommendations:

What to Eat

  • Protein – Eggs, lean meat, legumes, nuts, tofu. Proteins improve satiety and avoid blood sugar spikes.
  • Vegetables – Spinach, kale, tomatoes, carrots, and cruciferous vegetables like broccoli and cauliflower provide key nutrients missing in PCOS.
  • Fresh fruits – Berries, oranges, papaya, pomegranates, plums, and apples aid weight loss and provide antioxidants.
  • Whole grains – Brown rice, quinoa, oats, and whole wheat bread/cereal provide fiber to control blood sugar.
  • Healthy fats – Olive oil, coconut oil, avocado, nuts, seeds, and fatty fish provide good fats and vitamin E.
  • Dairy – Low-fat milk, yogurt, and cheese are good sources of protein and calcium, but avoid if intolerant.
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Foods to Avoid

  • Refined carbs – Limit foods like white rice, pasta, noodles, soda, pastries, and breakfast cereals with added sugar.
  • Sugar – Cut out table sugar, sugary drinks, juices, cakes, candy, and desserts to prevent blood sugar spikes.
  • Trans fats – Avoid fast foods, fried snacks, margarine, frozen meals, and processed foods containing hydrogenated oils.
  • Unhealthy fats – Limit intake of red meat, butter, lard, and tropical oils like palm and coconut oil, which are high in saturated fats.
  • Caffeine and alcohol – Excess intake stresses the body. Restrict to 1-2 cups of coffee and 1 drink per day.

Following a balanced low GI diet tailored to PCOS requirements aids weight loss, balances hormones restores ovulation, and regulates periods.

Also Read: Natural Aphrodisiacs: A Guide to Boosting Libido and Sexual Function

PCOS Weight Loss Tips

Weight management forms a vital part of PCOS treatment. Obesity exacerbates insulin resistance, inflammation, and androgen production, which worsens symptoms. Losing at least 5% of body weight can help reverse PCOD abnormalities. Useful tips include:

  • Set realistic goals of losing 1-2 lbs per week through diet and activity. Drastic cuts will only work short-term.
  • Track calories and food intake in a journal app, but don’t starve yourself. Consume 1200-1500 calories daily.
  • Exercise regularly by doing 60-90 minutes of brisk walking, swimming, strength training, or cardio most days. Yoga helps, too.
  • Eat 5-6 smaller meals spread throughout the day rather than 2-3 large meals to stabilize blood sugar.
  • Choose complex carbs that digest slowly over simple carbs like beans, oats, quinoa, bran cereals, etc.
  • Eat lean proteins like egg whites, chicken, fish, dairy, and nuts to improve satiety.
  • Avoid sugar, sodas, juices, processed foods, and snacks like chips, pastries, and fried foods.
  • Stay hydrated by drinking water, green tea, and adding lemon. Cut out sugary beverages.
  • Manage stress through meditation, massages, and counseling. High cortisol worsens PCOS symptoms.

With discipline and commitment to healthy eating and activity, it is possible to achieve long-term weight loss, which helps minimize PCOS effects.

PCOS and Fertility Issues

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PCOS is a common cause of infertility in women. About 70-80% of women with this condition have trouble getting pregnant. Reasons include:

  • No ovulation – Many follicles mature in the ovaries but fail to rupture and release an egg due to hormonal imbalances.
  • High androgen levels – Excess male hormones interfere with follicle growth and egg quality.
  • Insulin resistance – Raised insulin disrupts normal menstrual cycles and impairs egg development.
  • Obesity – Being overweight causes additional metabolic changes that suppress ovulation.
  • Inflammation – Elevated cytokines from fat cells disturb the menstrual cycle and ovulation.
  • Lining issues – The uterine lining may not thicken appropriately due to low progesterone and high estrogen.

Treatment aims to correct these abnormalities and promote natural ovulation and pregnancy. Options include:

  • Fertility drugs – Clomiphene and letrozole tablets stimulate follicle development and ovulation.
  • Metformin – The insulin-sensitizing effects promote ovulation.
  • Surgery – Laparoscopic ovarian drilling in selected cases can stimulate ovulation.
  • IVF – For women who don’t conceive naturally, in vitro fertilization provides the best chances.
  • Lifestyle changes – Losing weight, eating healthy, reducing stress, and limiting intensive workouts improve the chances of conception.

With individualized treatment, many women with PCOD successfully achieve pregnancy, although it may take longer.

Pregnancy with PCOS

Getting pregnant with PCOS may be difficult, but carrying a pregnancy to term is very possible. Some risks to note include:

Gestational diabetes – Insulin resistance increases the risk of gestational diabetes during pregnancy. Testing for high blood sugar should be done early.

Pregnancy-induced hypertension – Susceptibility to high blood pressure increases with PCOS. Monitoring BP is important.

Premature delivery – There is a higher risk of preterm birth and low birth weight babies than women without PCOS.

Miscarriage – PCOS elevates the chances of miscarriage slightly during the first trimester. Progesterone supplements may help.

Preeclampsia – General risk factors like obesity and hypertension can increase the odds of getting this dangerous complication.

Need for C-section – Vaginal delivery may be more difficult due to the possible large size of the baby.

However, with diligent prenatal care, the chances of a healthy pregnancy are quite positive with PCOS. Losing weight beforehand, controlling blood sugar and BP, taking supplements, and proactively monitoring for complications can lead to favorable outcomes.

PCOS in Perimenopause and Menopause

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source: sciencedirect.com

As women with PCOS enter perimenopause in their 40s and 50s, related symptoms may worsen before improving.

  • Worsening of symptoms – Estrogen levels fluctuate and drop during perimenopause. This can trigger an increase in androgens, elevating PCOS effects like facial hair growth, scalp hair loss, acne, etc.
  • Restart of periods – Women may suddenly get periods after months of absent cycles due to hormone shifts.
  • Worsening insulin resistance – Blood sugars rise as estrogen drops.
  • Weight gain – Declining estrogen reduces metabolic rate, promoting weight gain and exacerbating PCOS problems.
  • Mood issues – Hormonal changes can heighten anxiety, depression, and irritability.
  • Sleep issues – Night sweats and hot flashes may also disrupt sleep.
  • Vaginal dryness – Lower estrogen affects lubrication causing painful intercourse.

However, as menopause sets in and cycles cease permanently, PCOS symptoms tend to stabilize as hormone levels equalize. However, metabolic issues like diabetes risk may persist and need monitoring. Healthy lifestyle habits become particularly essential during this transition.

Long-Term Outlook with PCOS

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With diligent management, women can lead normal and healthy lives with PCOS. But it is wise to have periodic follow-ups and monitoring for potential complications:

  • Yearly screening for prediabetes and type 2 diabetes from age 30 onwards or earlier if overweight.
  • Checking blood pressure and cholesterol at regular intervals.
  • Getting thyroid tests done as thyroid issues often accompany PCOS.
  • Yearly full-body skin checkups to screen for melanoma and other skin cancers if skin tags or discoloration are present.
  • Monitoring for uterine cancer signs like abnormal bleeding after menopause.
  • Checking vitamin D levels and supplementing if deficient.
  • Screening for sleep apnea with tests or using home sleep monitors.
  • Having regular eye exams as retinal changes and cataracts are more common.
  • Scheduling routine mammograms as recommended after age 40 or earlier if needed.

With healthy habits, screenings, and weight management, risks are significantly reduced, and women can thrive with PCOS.

When to See a Doctor

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Consult your gynecologist if you experience:

  • No periods by age 15 or absent cycles for over 3 months
  • Excessive facial or body hair, severe acne
  • Scalp hair loss or thinning hair
  • Obesity, especially abdominal weight gain
  • Fertility issues and trouble conceiving
  • Chronic pelvic pain
  • Signs of insulin resistance – skin tags, meal fatigue, etc.
  • Worsening anxiety or depression
  • Snoring or waking up gasping for air
  • Sleep problems and chronic fatigue

Timely evaluation, diagnosis, and treatment of PCOS can help avoid long-term complications like diabetes, infertility, endometrial cancer, and mood disorders.

Conclusion

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PCOS is a common but complex endocrine condition in women of childbearing age. The exact causes are still unclear, but the interaction of genetic, hormonal, and metabolic factors underlies the development of this syndrome.

Hallmarks of PCOD include ovarian cysts, irregular periods, signs of androgen excess like excess facial and body hair, obesity, and fertility problems.

If necessary, symptoms can be well controlled with lifestyle interventions, medications, supplements, and surgery. Losing weight remains key for improving hormonal imbalances and insulin resistance.

Perimenopausal worsening of symptoms generally stabilizes after menopause. However, metabolic issues may persist and need ongoing monitoring. Close follow-up and active management are vital for the long-term health of women with PCOS.

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