THIRUVANANTHAPURAM: Polycystic ovarian disease, or PCOD, is the most common endocrine disorder affecting about five to 10 per cent of women in the reproductive age group. The condition arises when a woman’s level of the sex hormones estrogen and progesterone are out of balance. It is also the most common cause of ovulatory dysfunction in women.
Although the clinical expression varies widely, the syndrome is classically described as hyperandrogenism, ovulatory dysfunction or polycystic ovaries. It is often associated with psychological impairments, including depression and other mood disorders and metabolic derangements, chiefly insulin resistance and compensatory hyperinsulinaemia, which is recognized as a major factor responsible for altered androgen production and metabolism. Most women with PCOS are also overweight or obese, further enhancing androgen secretion while impairing metabolism and reproductive functions.
Women with polycystic ovaries often have an excess amount of the male hormones- testosterone and androstenedione which results in high testosterone levels in the blood. This leads to increased facial and body hair growth in such women, a condition called as hirsutism.
The primary treatment of anovulatory infertility in PCOD is weight loss through lifestyle modification. Menstrual function was shown to be improved by 5% to 10% reduction in body weight. No one diet has proved to be beneficial than others. The important factor is calorie restriction. Studies have shown no significant difference in outcomes between different hypocaloric diets. Routine exercise is also very important in the reproductive health of women with PCOS.
Other lifestyle factors such as excessive caffeine intake, alcohol consumption, and smoking should also be addressed. Once patients have achieved weight loss, they are encouraged to maintain this in the long term and to have normal weight gain during pregnancy. Obesity contributes to poor obstetric outcome (increased risk of spontaneous abortion and preterm labour) and also increases maternal complications, including gestational hypertension, gestational diabetes mellitus, thromboembolism, and wound infection.
In those PCO women who fail to achieve ovulation and pregnancy with lifestyle modification alone are managed with medications. The first line treatment of ovulation induction in women with PCOS has been a drug named Clomiphene citrate. In those PCO women who do not respond to Clomiphene citrate, ovulation induction has been tried with gonadotropin injections along with several adjunctive treatments.
Laparoscopic ovarian drilling is also an alternative to those women with PCOS who have clomiphene resistance. In vitro fertilization remains the last option for conception in women with PCOS whodo not respond to ovulation induction agents.
The various permutations and combinations of these pharmacologic agents may have either no response on ovulation or may lead to an explosive response, so it is important to strike a balance where optimal effect of these drugs could be extracted without the eminent risks.
-Dr.Sneha Ann Abraham KIMS Hospital