Friday, February 29, 2008

Polycystic Ovary Syndrome PCOS

PCOD is a female hormonal imbalance where maturing eggs fail to be expelled from the ovary, creating an ovary filled with immature follicles. The cysts then contribute to the hormonal imbalance, which causes more cysts and enlarged ovaries. Polycystic ovary disease is characterized by anovulation (no formation of egg) irrespective of periods (regular or irregular or absent) and hyperandrogenism (elevated serum testosterone and androgen). Also women with PCOD who conceive have a higher rate of early foetal loss than women without PCOD.
PCOD women have fewer chances to conceive, compared to normal women who ovulate every month. Normal women get 12chances in a year to conceive. But PCOD women hardly get 3-4 chances due to delayed periods.
Relative causes of PCOD
PCOD does run in families. Several genes contribute to the pathogenesis of PCOD. Many of these genes are related to insulin resistance with elevated fasting blood insulin levels. The high levels of androgenic hormones interfere with the pituitary ovarian axis, leading to increased LH levels, anovulation, amenorrhea and infertility.
Young diabetic women treated with insulin are at special risk of PCOD. The amount of insulin injected by insulin-dependent or insulin-requiring diabetics is far in excess of what the body produces naturally.
Obesity is a common part of PCOD and many of these women are also insulin-resistant. When a woman is insulin-resistant, her fat cell does not respond normally to the insulin in the blood stream. Weight gain in itself can result from high serum insulin levels.
Symptoms of PCOD
The most common symptoms of PCOD are
Irregular and infrequent menstrual periods or no menstrual periods at all;
Infrequent or no ovulation with increased serum levels of male hormones - testosterone;
Inability to get pregnant within one year of unprotected sexual intercourse;
Weight gain or obesity;
Diabetes, over-production of insulin with abnormal lipid levels and high blood pressure;
Excess growth of hair on the face, chest, stomach in male pattern (hirsutism) and male-pattern baldness or thinning of hair;Acne, oily skin or dandruff;
Patches of thickened and dark brown or black skin on the neck, groin, underarms, or skin folds;
Skin tags, or tiny excess flaps of skin in the armpits or neck area;
Male fat storage patterns - abdominal storage rather than standard female pattern on thighs, hips and waist; and Mid-cycle pain indicating painful ovulation - due to the enlargement and blockage of the surface of the ovaries;
Consequences of PCOD
Hyperinsulinemia in PCOD has also been associated with high blood pressure and increased clot formation and appears to be a major risk factor for the development of heart disease, stroke and type-II diabetes
Women with irregular cycles need to have other conditions ruled out, such as anorexia, stress or exercise-induced problems with the menstrual cycle, other hormonal problems such as thyroid disease or medication problems.
The general consequences of PCOD are:Menstrual irregularities - Constant oestrogen production stimulates growth of the uterine lining which usually induces very heavy uterine bleeding. The bleeding episodes may occur after long gaps of time (oligomenorrhea) or, for some women, not at all (amenorrhea). Irregular periods are a nuisance and suggest some hormonal disorder or risk of endometrial thickening.
Impaired Fertility- Another consequence of incomplete follicular development is a lack of regular ovulation. Irregular ovulation usually means that pregnancy is more difficult to achieve. Similarly, if ovulation is not taking place, it is not possible to conceive.
Miscarriage - While miscarriage seems an unfortunate chance event for most couples, it is clear that women with PCOD may be at increased risk of early foetal loss. The hormonal environment in PCOD may interfere with egg development within the follicle and disrupt embryo implantation within the uterus.
Hair and skin problems - Androgen (male hormone) is a byproduct of the ovaries. In PCOD, the production of androgen, such as testosterone, is excessive, which causes abnormally increased hair growth and contributes to acne formation. The assessment of excessive hair growth (or hirsutism) may be difficult.
Obesity - About 50 per cent of women with PCOD are obese. Obesity tends to enhance abnormal estrogen and androgen production in this disorder, which only magnifies the problems of irregular bleeding and excessive hair growth.
More important, the long-term effects of unopposed oestrogen place women with the syndrome at considerable risk for endometrial cancer or breast cancer.
Diagnosis of PCOD - The signs of PCOD are ovaries slightly enlarged and may contain 10 or more small cysts located at the periphery of the ovary, which have led to polycystic ovaries. The size of these cysts is generally less than 8 mm and can usually be detected by ultrasound examination. Pelvic and physical examination, ultra sound scanning, blood tests to measure hormone, insulin and cholesterol levels will also help. Height and weight will be noted along with any increase in facial or body hair or loss of scalp hair, acne and discoloration of the skin under the arms, breasts and in the groin. Elevated androgen levels or testosterone confirms the diagnosis.
General treatment for PCOD
Mostly patients take treatment for cosmetic ailments like obesity, unwanted hair growth or acne. They will not mind the underlying delayed and heavy periods which is to be treated first. Medical treatment should be given to correct irregular menstruation, eradicate excessive hair growth or achieve pregnancy.
Because there is no cure for PCOD in Allopathy, it concentrates on ways of management to prevent further problems. The treatment can be as:
Medication: To induce a menstrual period and restore normal cycles, birth control pills are used. It regulates menstruation, reduces androgen levels and helps to clear acne. The method of treatment depends on the severity of the symptoms and whether the patient is trying to get pregnant or not. If not trying to conceive, then they are treated with hormones, including the birth control pill. If trying to become pregnant, fertility drugs and other treatments are necessary.
Getting normal can be tried:
1) Eating a balanced diet low in carbohydrates and maintaining a healthy weight can help lessen the symptoms of PCOD.2) Regular exercise helps weight loss and also helps the body in reducing blood glucose levels. Aerobic activities such as walking, jogging or swimming are advised. With reduction of weight and reduction in insulin resistance, regular periods will mostly resume. It is not always possible to promise a woman who has achieved ideal body weight and who continues with exercise that she may have regular ovulation.3) For reducing excess body and facial hair, bleaching, removal by waxing or a hair removal cream can be used. For permanent facial hair removal, electrolysis is done.
Treatment of PCOD for the infertile patient will usually focus on ovulation inducting. They induce ovulation with fertility drugs. Sometimes fertility drugs may induce risk of multiple pregnancies.
Surgery: Doctors used to perform ovarian surgery called wedge re-section to help patients with PCOD to ovulate. A recent treatment option uses laparoscopy to treat patients with PCOD. During operative laparoscopy, a laser is used to drill multiple holes through the thickened ovarian capsule. When wedge re-section or drilling is used, there is risk of inducing adhesions around the ovary. As a result of these, surgeries are used as the last resort.
Related
Naomi Campbell fine after cyst operationThe Sun, UK - Feb 27, 2008
Polycystic Ovary Syndrome (PCOS) – where there are several cysts – is a more serious condition associated with hormonal abnormalities. ...

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