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9/11/2018 Fight Against Polycystic Ovary Syndrome (Pcos/pcod)
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Fight Against Polycystic Ovary

Syndrome (Pcos/pcod)
Dr.Subhendu Buzarbaruah
Gynecologist/Obstetrician
17
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14  2018
February,  
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Polycystic ovary syndrome (PCOS) or polycystic ovary disease (PCOD) is a probl

which a woman's hormones are out of balance. It can cause problems with you
periods and make it difficult to get pregnant. PCOS also may cause unwanted c
in the way you look. If it isn't treated, over time it can lead to other health prob
such as diabetes and heart disease. Most women with PCOS grow many small c
their ovaries. That is why it is called PCOS. The cysts are not harmful but lead to
hormone imbalances. Early diagnosis and treatment can help control the sympt
and prevent long-term problems.
The cause of PCOS is still puzzling. PCOS is thought to arise from a combination
familial and environmental factors that interact to cause the characteristic men
and metabolic disturbances. It is now accepted that PCOS is caused by several f
partly genetic, but the studies about the gene responsible for PCOS is still ongo
Although not frequent, this disease is also known to occur in men and this gene
predisposition may be expressed as premature balding.
The underlying
17 mechanism by which PCOS affects the body is by insulin resista
Thi i id i i h hi h B d M
https://www.practo.com/healthfeed/fight-against-polycystic-ovary-syndrome-pcos-pcod-32116/post I d (BMI) [BMI i 2/15
This is most evident in women with a high Body Mass Index (BMI). [BMI is meas
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dividing the weight (in Kg) of a person by the square of the height (in meters).
example, if the weight of a patient is 56 kg and the height is 1.6 m, then the BM
be 56/1.6x1.6=21.8. Ranges for BMI are usually defined as underweight (<19), n
weight (19.1-24.9) and obese (>30)]. In spite of insulin resistance in peripheral s
e.g. fat tissue, the ovary remains sensitive to insulin. The action of insulin on th
leads to a decrease in the production of sex hormone binding globulin which re
increased free testosterone (a male hormone).
Clinical sign symptoms:
The symptoms frequently begin at puberty although in many women the syndr
not fully expressed until later in their reproductive years.
Menstrual disturbances: Women with PCOS usually presents with

oligomenorrhoea (reduced menstrual bleeding), amenorrhoea (absence of
menstrual bleeding), prolonged erratic menstrual bleeding. Nearly 90% wo
with oligomenorrhoea have features of PCOS on Ultrasound. However, th
features of PCOS are present only in 30% of women who presents with
amenorrhoea.
Hirsutism, acne and alopecia: Increased facial and body hair (hirsutism) is
the most common presenting symptoms. About three-quarters of women
present with acne have PCO on ultrasound. Alopecia and more specifically
pattern baldness have been less commonly reported in women with PCOS
17
Recurrent miscarriage: polycystic ovaries have been identified as being
associated with recurrent miscarriage.
Metabolic: The metabolic aspect of PCOS is obesity and insulin resistance.
distribution of fat in women with PCOS results in an increased waist: hip r
and is frequently associated with greater insulin resistance than if fat is
distributed predominantly in the lower body segment. Some patients may
present with acanthosis nigricans (a feathering pigmented area of tissue in
neck and axillary regions); this is now recognized as a non-specific marker
moderate to severe insulin resistance. Hypersecretion of insulin results in o
secretions of androgen leading to hirsutism and menstrual disturbance.
Diagnosis:
Diagnosis of PCO is primarily by abdominal ultrasound. In ultrasonography, a pa

with PCO should have at least one of the following: increased ovarian area (>5.5
or volume (>11 mL) and/or presence of ≥12 follicles measuring 2 to 9 mm in dia
PCOS can also be diagnosed by measuring the level of several hormones in the
17
Treatment:
The mainstay of treatment of PCOS still remains in “diet and exercise” and grea
emphasis needs to be placed on lifestyle factors. The obesity epidemic may unm
more women with PCOS in the future. Weight reduction in a woman with PCO
often return her to the other end of the spectrum with ovulatory cycles and im
hirsutism. An asymptomatic non-obese woman who is diagnosed with PCO on
ultrasound should be counselled about the advisability of maintaining a normal
the future.
Weight loss: The increasing proportions of obesity in modern society will mean
more women will present with the symptoms of PCOS as an excess of body fat
accentuates insulin resistance and its associated clinical sequelae. Obese wome
PCOS almost inevitably have the stigmata of hirsutism, acne and irregular or ab
ovulation/menstruation. Being overweight makes treatment less effective and
efficient. Weight loss improves ovarian function and reverses some of the assoc
hormonal abnormalities. For these reasons, weight loss should be the first line o
treatment in women with PCOS who are overweight and wish to conceive.
17
Lifestyle factors in the management of PCOS:
Alteration of the environmental components of this condition is fundam

to the management of the condition and that pharmaceutical treatment
used after adequate counselling and action relating to lifestyle alteration.
Attention to weight loss altered diet and exercise are important aspects to
discuss with the patient as well as stopping smoking and improving psycho
attitudes.
Obesity is a costly and increasingly prevalent condition. A study published
noted medical journal Lancet says India is just behind US and China in this
hazard list of top 10 countries with the highest number of obese people. F
excess of the normal can lead to menstrual abnormality, infertility, miscar
and difficulties in performing assisted reproduction.
Weight loss induces menstrual regulation in a proportion of women with o
and anovulation. It was shown that a reduction in the blood level of male
hormone androgen with dieting and associated return of menstrual cycles
calorie restriction with a subsequent 5% or greater weight loss led to chan
insulin and Menstruation. Even women with the cause of infertility not rela
anovulation (such as tubal blockage or male partner with low sperm count
showed dramatic improvements in assisted reproduction pregnancies.
This lifestyle modification is put into practice for 6 months. If there is the
of periods, pregnancy etc, no further medical treatment is required. If diso
persists after 6 months, medical treatment may be offered.
17
Diet for PCOS
A moderate protein, high carbohydrate low fat and intake diet (15:55:30) or a
moderate protein, moderate carbohydrate and low-fat diet (30:40:30) with a
restricted caloric input is the standard recommended diet in most countries.
Concomitant exercise is essential for weight maintenance and contributes to re
stress and improves the sense of well-being. Weight loss is maintained more
effectively when a low-fat diet is followed over longer periods of time. A dietary
protocol advocating a moderate increase in protein and a concomitant reductio
dietary carbohydrate also helps. Furthermore, altering the type of carbohydrate
a lower glycemic index (The glycemic index (GI) is a ranking of carbohydrates on
scale from 0 to 100 according to the extent to which they raise blood sugar lev
after eating) helps to prevent obesity. World Health Organization (WHO) and F
and Agriculture Organisation (FAO) recommended that people in industrialized
countries base their diets on low-GI foods in order to prevent the most commo
diseases of affluence, such as coronary heart disease, diabetes and obesity. Hig
protein diets are more likely to reduce intake, increase subjective satiety and de
hunger compared to high carbohydrate diet. Weight loss may be more substan
the short term but is no better in other diets in the longer term. Weight loss w
result from a decrease in energy intake or increase in energy expenditure and th
should be the key approach. Women participating in a weight loss program hav
shown that return of ovulation coincides with a reduction in insulin resistance a
in central adiposity.
Lifestyle modification suggested for treatment of PCOS in overweight wome

include:
Moderate exercise (≥ 30 min/day)

Dietary modification (Fat ≤30% daily intake)
For weight loss, establish an energy deficit of 500 to 1000 kcal/day
17
Behavior modification, reduction of stress, increased well-being
Behavior modification, reduction of stress, increased well being
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Combination of dietary and behavioural therapy and increased physical
 act
Smoking cessation and to stop alcohol consumption
Moderate caffeine consumption
Group interaction/intervention to provide support
Social support by physician, family, spouse, and peers
Avoidance of “crash diets” and short-term weight loss
Minor roles for drugs involved in weight loss
Avoidance of aggressive surgical approaches for majority
Adaptation of weight loss programs to meet individual needs
17
Menstrual irregularities:
Menstrual irregularity secondary to ovulatory disturbance (anovulation) is a sig

acute clinical problem in PCOS. If untreated chronic anovulation is associated w
increased risk for endometrial carcinoma. Treatments include birth control pills
regularize periods. A medication called metformin also helps to improve menstr
irregularities/anovulation. Metformin may offer additional protection, by reduc
insulin resistance, which has been associated with an increased risk of endomet
carcinoma.
Hirsutism:
Anti-male hormone therapy is a successful treatment for symptoms of hirsutism

including acne. Antibiotic also is useful for the management of acne. Anti-male
hormones are prescribed with a low-dose contraceptive in order to induce regu
withdrawal bleeding.
For patients who are infertile due to PCOS, clomiphene citrate is generally use
induction of ovulation. Ovulation occurred in 70-80% of cases and pregnancy re
in 30-40%17
cases. Another medical treatment that is increasingly used for ovulat
ind ction is metformin an ins lin sensiti ing agent the most commonl prescr
https://www.practo.com/healthfeed/fight-against-polycystic-ovary-syndrome-pcos-pcod-32116/post
9/15
induction is metformin, an insulin-sensitizing agent, the most commonly prescr
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oral medication  as a
for hyperglycemia. A decrease in insulin levels results and
consequence, a lowering of circulating total and free androgen levels with an
improvement of clinical sequelae of the increased male hormone.
Summary:
PCOS is a subject that continues to be debated amongst the medical and scient
community. Over the past 60 years, tremendous advances have been made in
diagnosis and management. It is one of the most common endocrine disorders
the future, the focus on management is likely to be the prevention of the long-
sequelae associated with insulin resistance.
References:
1. Polycystic Ovary Syndrome, Second Edition, Edited by Gabor Kovacs and R

Norman, Cambridge University Press 2007
2. http://www.glycemicindex.com/about.php; The University of Sydney.
3. http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm
4. Michael T. Sheehan, MD. Polycystic Ovarian Syndrome: Diagnosis and
Management. Clin Med Res. 2004 Feb; 2(1): 13–27.
5. http://www.webmd.com/women/tc/polycystic-ovary-syndrome-pcos-topic
overview#1
6. http://www.mayoclinic.org/diseases-conditions/pcos/basics/definition/con
20028841
PCOS Obesity Infertility Ovarian Disorders PCOD / PCOS Weight Control
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9/11/2018 Fight Against Polycystic Ovary Syndrome (Pcos/pcod)

For Clinics & Hospitals  Login / Sign Up

Fight Against Polycystic Ovary

Clinical sign symptoms:

Menstrual disturbances: Women with PCOS usually presents with

Diagnosis of PCO is primarily by abdominal ultrasound. In ultrasonography, a pa

Alteration of the environmental components of this condition is fundam

Diet for PCOS

Lifestyle modification suggested for treatment of PCOS in overweight wome

Moderate exercise (≥ 30 min/day)

Menstrual irregularity secondary to ovulatory disturbance (anovulation) is a sig

Anti-male hormone therapy is a successful treatment for symptoms of hirsutism

1. Polycystic Ovary Syndrome, Second Edition, Edited by Gabor Kovacs and R

PCOS Obesity Infertility Ovarian Disorders PCOD / PCOS Weight Control

Secrets to Whiter and Brighter Teeth

How to Protect Your Skin From Pollution?

7 Tips To Reduce Acidity

All You Wanted to Know About Diabetes: A Scientific Elucidation

52 Effortless Ways to Lose Weight

Is Stress Affecting Your Conjugal Life?

Looking for a Gynecologist/Obstetrician?

Pcos or polycystic ovary syndrome

Polycystic ovary syndrome (PCOS)

Polycystic ovary syndrome

Health query on your mind?

Ask a doctor for free

RECOM M ENDED FOR YOU

Want That v Shape or Hour Glass?

6 Myths and Facts About Weight Loss

Side Effects Of Artificial Sweetner On Your Health

7 Ways to Naturally Lose Weight

Diet And Exercise - What To Choose?

Copyright © 2018, Practo. All rights reserved.

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