Polycystic Ovarian Disease

POLYCYSTIC OVARIAN DISEASE: THE RISING TREND

Dr Nupur GuptaConsultant & Unit Head, Dept of Obstetrics & Gynecology

WHAT IS PCOS?

A health problem that can affect a woman’s • Menstrual cycle,• Ability to have children• Hormones• Heart• Blood Vessels &• Appearance

INCIDENCE

• Affects 5 to 10% of females

• 20 to 30% have ultrasound appearance

Most common hormonal

disorder in women of

reproductive age

AGE GROUP

• Adolescent age (pubertal)

• Reproductive age

CAUSE: HORMONAL IMBALANCE

• Not completely understood

• Family History (genetic – 50%, 40% if sister,

10% if mother)

• Hyperinsulinaemia

• The ovaries make more androgens than

normal

SYMPTOMS

Vary from woman to woman

• Irregular menstrual cycles (amenorrhoea

25%, oligomenorrhoea 85%,

hypomenorrhoea)

• Difficulty in conception 50%

• Weight gain 40%

• Unwanted hair growth

• Acne

DIAGNOSIS

• CLINICAL

• ULTRASOUND – multiple tiny ovarian cysts

(STRING OF PEARLS)

• BIOCHEMICAL (blood tests) – hormones (LH

FSH, Testosterone, DHEAS, Glucose tolerance

test)

• ASSOCIATED TESTS - thyroid, prolactin, lipid

profile

PCOD & INSULIN RESISTANCE

• High insulin levels – high androgens

• Hyperinsulinemia

• Insulin resistance

PCOD & HYPERANDROGENISM

SERUM TESTOSTERONE & DHEAS

• Acne, oily skin, seborrhoea

• Hirsutism – upper lip, side bran, chin, chest,

abdomen, back & inner thigh

• Thinning of hair, Male pattern baldness

• Irregular or absent ovulation

• Dark patches of skin (neck, armpit & groin)

PCOD & WEIGHT GAIN

• Increase in abdominal fat as in males

• Apple figure (waist hip ratio)

• Rise in BMI

LONGTERM SIDE EFFECTS

• Metabolic Syndrome (risk of type 2

diabetes, hypertension, hyperlipidaemia,

heart disease)

• Increased risk of sleep apnoea

• Increased risk of endometrial hyperplasia &

uterine cancer

• Increased risk of depression

MANAGEMENT

• Lifestyle modification

• Drug therapy – hormones, insulin sensitisers

• Symptomatic treatment for acne, hair

growth, menstrual dysfunction

• Surgical management

COUNSELING IN PCOD

• Regarding endocrine problems

• Metabolic problems

• Fertility

• Risk of multiple pregnancy & its

complications

• Long term sequealae

TREATMENT GOALS

Depends on age & need

• Adolescent

• Newly married, not planning conception

• Married planning conception

• Secondary infertility

• Family complete

• Perimenopausal & Menopausal

LIFESTYLE MANAGEMENT

• Weight control

• Healthy Diet

• Regular exercise & physical activity

PCOS DIETARY GOALS

Consume More Foods

• Rich in

carbohydrates (50%)

• MUFA

• Fiber

• Omega 3

• Low Glycemic Index

Reduce

• Total Caloric intake

• Saturated Fats

(<10%)

• Cholesterol

HAIR TREATMENT

• Temporary – epilation, electrolysis, waxing,

shaving

• Permanent - Laser

WEIGHT LOSS & MENSTRUAL CYCLES

If 7% weight loss & 30 to 60 min of moderate physical activity

• Spontaneous menses

Free androgen Free insulin Free testosterone

SHBG

WEIGHT LOSS & FERTILITY

• In overweight anovulatory women

• Weight loss 6 Kg

• Resumption of ovulation 92%

• Pregnancy rate 85%

• Decrease in insulin & testosterone levels

HOW TO COPE WITH EMOTIONAL ASPECTS OF PCOS?

Don’t feel embarrassed

Don’t be depressed

Early diagnosis and treatment helps

prevent long-term complications, such

as infertility, metabolic syndrome, obesity,

diabetes & heart disease.

IS THERE A CURE FOR PCOS? CAN IT BE PREVENTED?

ThanksThanks

NEVER LOSE HOPENEVER LOSE HOPE

To consult Dr Nupur Gupta

Consultant & Unit Head, Dept of Obstetrics &

Gynecology

Call 0124-4585555

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