By Dr.Lakshmi.R.Lakshman MD; M Tech, Asst.Professor, Dept. of Gynecology, AIMS, Kochi
Present day lifestyle, food habits, environmental exposure to toxins along with hereditary predisposition for metabolic syndrome (obesity, hyperlipidemia, diabetes and hypertension) and stress has contributed to the common problem faced by today’s female population – PCOD.
About 7-10 % of all the females have this problem. The symptoms are irregularity/absence of menstrual periods, scanty menstruation, acne, male pattern of hair growth, fronto-temporal hair loss, central obesity and glucose intolerance.
PCOD needs to be treated early due to the immediate and delayed consequences like:
1) Inconvenience of abnormal and irregular periods
2) Cosmetic concern of male pattern of hair growth and acne
3) Infertility
4) Frequent abortion
5) Diabetes during pregnancy (harmful even to the intellectual development of fetus)
6) Obesity
7) Hyperlipedemia, coronary artery disease and early stroke
8) Cancer of endometrium, breast and ovary
9) Early menopause
10) Early agening
PCOD should not be neglected just because it is a common and minor hormonal imbalance. It should rather be considered as a life-long concern.
It needs to be treated at the earliest so as to control the disease process than letting the disease to gain control. With early diagnosis and proper management, the harmful effects are minimized.
How does PCOD occur?
Cysts in the ovary are not a disease but a symptom of some metabolic derangement in the cellular level present in each one of the cells in the body and not just among the ovarian cells. The core pathology lies in the insulin receptor and signaling pathways in cellular metabolism which leads to glucose intolerance. The excess insulin will derange the LH: FSH ratio (hormones secreted in the brain). LH along with insulin will make the ovarian wall (theca cell) hypertrophied and prevents the follicle from ovulating. This finally leads to cyst formation. Sometimes the same pathogenesis may occur even without the appearance of the cyst. Acne, male pattern of hair growth, obesity, milk like secretion from nipples, hair fall etc may be a forerunner. Other conditions like tumors in the brain like prolactinoma and late appearance of adrenal hyperplasia should be ruled out. Not only obese, but some lean persons also can develop PCOD.
Along with detailed history taking like menstrual history, personal history, lifestyle history, food history etc, from a Modern medicine perspective, practical wisdom from Indian system of medicine and medical astrological inputs could be taken into account. An individualized dietary and exercise prescription along with an appropriate drug prescription combined with psychosocial support (including appropriate stress management techniques), pre-conception fertility advice etc are very important in managing PCOD.
Even after completion of the family, it is very important to continue the management of the basic metabolic derangement to prevent obesity, provide better cosmetic effect, prevent coronary artery disease, stroke, diabetes, hypertension, cancer of uterus and ovary, early agening, premature menopause and osteoporosis.
