POLYCYSTIC OVARY SYNDROME
(PCOS, PCOD)
What is Polycystic Ovarian Syndrome (PCOS)?
PCOS is a health problem that can affect a woman’s menstrual
cycle, fertility, hormones, insulin production, heart, blood vessels, and
appearance. Women with PCOS have these characteristics:
- high levels of male hormones, also
called androgens
- an irregular or no menstrual cycle
- May or may not have many small
cysts in their ovaries. Cysts are fluid-filled sacs.
PCOS is the most common hormonal reproductive problem in women
of childbearing age.
Causes of Polycystic Ovarian Syndrome (PCOS)
- No one knows the exact cause of
PCOS.
- Women with PCOS frequently have a
mother or sister with PCOS. But there is not yet enough evidence to say
there is a genetic link to this disorder.
- Many women with PCOS have a weight
problem. So researchers are looking at the relationship between PCOS and
the body’s ability to make insulin.
- Insulin is a hormone that
regulates the change of sugar, starches, and other food into energy for
the body’s use or for storage. Since some women with PCOS make too much
insulin, it’s possible that the ovaries react by making too many male
hormones, called androgens. This can lead to acne, excessive hair growth,
weight gain, and ovulation problems.
Why do women with Polycystic
Ovarian Syndrome (PCOS) have trouble with their menstrual cycle?
The ovaries are two small organs, one on each side of a woman's
uterus. A woman's ovaries have follicles, which are tiny sacs filled with
liquid that hold the eggs. These sacs are also called cysts. Each month about
20 eggs start to mature, but usually only one becomes dominant. As the one egg
grows, the follicle accumulates fluid in it. When that egg matures, the
follicle breaks open to release the egg so it can travel through the fallopian
tube for fertilization. When the single egg leaves the follicle, ovulation
takes place.
In women with PCOS, the ovary doesn't make all of the hormones
it needs for any of the eggs to fully mature. They may start to grow and
accumulate fluid. But no one egg becomes large enough. Instead, some may remain
as cysts. Since no egg matures or is released, ovulation does not occur and the
hormone progesterone is not made. Without progesterone, a woman’s menstrual
cycle is irregular or absent. Also, the cysts produce male hormones, which
continue to prevent ovulation.
Symptoms of Polycystic Ovarian Syndrome (PCOS)
These are some of the symptoms of PCOS:
- infrequent menstrual periods, no
menstrual periods, and/or irregular bleeding
- infertility or inability to get
pregnant because of not ovulating
- increased growth of hair on the
face, chest, stomach, back, thumbs, or toes
- acne, oily skin, or dandruff
- pelvic pain
- weight gain or obesity, usually
carrying extra weight around the waist
- type 2 diabetes
- high cholesterol
- high blood pressure
- male-pattern baldness or thinning
hair
- patches of thickened and dark
brown or black skin on the neck, arms, breasts, or thighs
- skin tags, or tiny excess flaps of
skin in the armpits or neck area
- sleep apnoea? excessive snoring and
breathing stops at times while asleep
Diagnosis of Polycystic
Ovarian Syndrome (PCOS)
There is no single test to diagnose PCOS.
¬ Ultrasound, Hormone tests,
¬ Measuring blood glucose,
or sugar levels
¬ Increased hair growth, so
try to allow the natural hair growth for a few days before the visit.
¬ Irregular period.
How is Polycystic Ovarian
Syndrome (PCOS) treated in Alloapthy method?
Treatments are based on the symptoms each patient is having and
whether she wants to conceive or needs contraception. Below are descriptions of
treatments used for PCOS.
Birth control pills.
¬ For women who don’t want
to become pregnant, birth control pills can regulate menstrual cycles, reduce
male hormone levels, and help to clear acne. However, the birth control pill
does not cure PCOS. The menstrual cycle will become abnormal again if the pill
is stopped. Women may also think about taking a pill that only has
progesterone, like Provera, to regulate the menstrual cycle and prevent
endometrial problems. But progesterone alone does not help reduce acne and hair
growth.
Diabetes Medications.
¬ The medicine, Metformin,
also called Glucophage, which is used to treat type 2 diabetes, also helps with
PCOS symptoms. Metformin affects the way insulin regulates glucose and
decreases the testosterone production. Abnormal hair growth will slow down and
ovulation may return after a few months of use. These medications will not
cause a person to become diabetic.
Fertility Medications.
¬ The main fertility
problem for women with PCOS is the lack of ovulation. Even so, her husband’s
sperm count should be checked and her tubes checked to make sure they are open
before fertility medications are used. Clomiphene (clomid) medication and
gonadotropin injections can be used to stimulate the ovary to ovulate. PCOS
patients are at increased risk for multiple births when using these
medications. In vitro Fertilization (IVF) is sometimes recommended to control
the chance of having triplets or more. Metformin can be taken with fertility
medications and helps to make PCOS women ovulate on lower doses of medication.
Medicine for increased hair growth or extra male hormones.
¬ If a woman is not trying
to get pregnant there are some other medicines that may reduce hair growth.
Spironolactone is a blood pressure medicine that has been shown to decrease the
male hormone’s effect on hair. Propecia, a medicine taken by men for hair loss,
is another medication that blocks this effect. Both of these medicines can
affect the development of a male foetus and should not be taken if pregnancy is
possible. Other non-medical treatments such as electrolysis or laser hair
removal are effective at getting rid of hair. A woman with PCOS can also take
hormonal treatment to keep new hair from growing.
Surgery.
¬ Although it is not recommended
as the first course of treatment, surgery called ovarian drilling is available
to induce ovulation. The doctor makes a very small incision above or below the
navel, and inserts a small instrument that acts like a telescope into the
abdomen. This is called laparoscopy. The doctor then punctures the ovary with a
small needle carrying an electric current to destroy a small portion of the
ovary. This procedure carries a risk of developing scar tissue on the ovary.
This surgery can lower male hormone levels and help with ovulation. But these
effects may only last a few months. This treatment doesn't help with increased
hair growth and loss of scalp hair.
A healthy weight.
¬ Maintaining a healthy
weight is another way women can help manage PCOS. Since obesity is common with
PCOS, a healthy diet and physical activity help maintain a healthy weight,
which will help the body lower glucose levels, use insulin more efficiently,
and may help restore a normal period. Even loss of 10% of her body weight can
help make a woman's cycle more regular.
How does Polycystic
Ovarian Syndrome (PCOS) affect a woman while pregnant?
There appears to be a higher rate of miscarriage, gestational
diabetes, pregnancy-induced high blood pressure, and premature delivery in
women with PCOS. Researchers are studying how the medicine, metformin, prevents
or reduces the chances of having these problems while pregnant, in addition to
looking at how the drug lowers male hormone levels and limits weight gain in
women who are obese when they get pregnant.
Note: No one yet knows if metformin is safe for pregnant women.
Because the drug crosses the placenta, doctors are concerned that the baby
could be affected by the drug. Research is ongoing.
Does Polycystic Ovarian
Syndrome (PCOS) put women at risk for other conditions?
Women with PCOS can be at an increased risk for developing
several other conditions. Irregular menstrual periods and the absence of
ovulation cause women to produce the hormone estrogen, but not the hormone
progesterone. Without progesterone, which causes the endometrium to shed each
month as a menstrual period, the endometrium becomes thick, which can cause
heavy bleeding or irregular bleeding. Eventually, this can lead to endometrial
hyperplasia or cancer. Women with PCOS are also at higher risk for diabetes,
high cholesterol, high blood pressure, and heart disease. Getting the symptoms
under control at an earlier age may help to reduce this risk.
Does Polycystic Ovarian
Syndrome (PCOS) change at menopause?
Researchers are looking at how male hormone levels change as
women with PCOS grow older. They think that as women reach menopause, ovarian
function changes and the menstrual cycle may become more normal. But even with
falling male hormone levels, excessive hair growth continues, and male pattern
baldness or thinning hair gets worse after menopause.
Homeopathy Treatment for PCOD
Homeopathy methods of treatment based on symptoms similarity of
the patients. According the symptoms doctor will select the medicines.
Homeopathy medicines act well in PCOD/PCOS without side effects
What is PCOD ( polycystic ovarian disease) ?
Patients
suffering from polycystic ovarian disease ( PCOD ) have multiple small cysts in
their ovaries ( the word poly means many). These cysts occur when the regular
changes of a normal menstrual cycle are disrupted. The ovary is enlarged; and
produces excessive amounts of androgen and estrogenic hormones. This excess,
along with the absence of ovulation, may cause infertility. Other names for
PCOD are polycystic ovarian syndrome (PCOS) or the Stein-Leventhal syndrome.
How is PCOD diagnosed ?
PCOD can be easy to diagnose
in some patients. The typical medical history is that of irregular menstrual
cycles, which are unpredictable and can be very heavy ; and the need to take
hormonal tablets (progestins) to induce a period. Patients suffering from PCOD
are often obese and may have hirsutism , (excessive facial and body hair) as a
result of the high androgen levels. However, remember that not all patients
with PCOD will have all or any of these symptoms.
This
diagnosis can be confirmed by vaginal ultrasound, which shows that both the
ovaries are enlarged; the bright central stroma is increased ; and there are
multiple small cysts in the ovaries. These cysts are usually arranged in the
form of a necklace along the periphery of the ovary. ( It is important that
your doctor be able to differentiate multicystic ovaries from polycystic
ovaries. )
Blood
tests are also very useful for making the diagnosis. Typically, blood levels of
hormones reveal a high LH ( luteinising hormone) level; and a normal FSH
( follicle stimulating hormone) level ( this is called a reversal of the LH :
FSH ratio, which is normally 1:1); and elevated levels of androgens ( a high dehydroepiandrosterone
sulphate ( DHEA-S) level) ;
We
don't really understand what causes PCOD, though we do know that it has a
significant hereditary component, and is often transmitted from mother to
daughter . We also know that the characteristic polycystic ovary emerges when a
state of anovulation persists for a length of time. Patients with PCO have
persistently elevated levels of androgens and estrogens, which set up a vicious
cycle. Obesity can aggravate PCOD because fatty tissues are hormonally active
and they produce estrogen which disrupts ovulation . Overactive adrenal glands
can also produce excess androgens, and these may also contribute to PCOD. These
women also have insulin resistance ( high levels of insulin in their blood,
because their cells do not respond normally to insulin).
While some women with PCOD will have all the classic symptoms
and signs, many have what we call "occult PCOD". This means that they
may be thin, have regular periods , no hirsutism and normal looking ovaries on
ultrasound, but still have PCOD. This problem is detected only when these
patients are superovulated, at which time they over-respond by producing a
large number of follicles.
Interestingly, many of these patients present with recurrent
pregnancy loss ( recurrent miscarriages) , and often their doctor does not make
the correct diagnosis for them.
How is PCOD treated ?
Treatment of PCOD for the infertile patient will usually focus on inducing
ovulation to help them conceive.
Weight loss: For many
patients with PCOD, weight loss is an effective treatment - but of course, this
is easier said than done! Look for a permanent weight loss plan - and referral
to a dietitian or a weight control clinic may be helpful. Crash diets are
usually not effective.
Increasing
physical activity is an important step in losing weight. Aerobic activities
such as walking, jogging or swimming are advised. Try to find a partner to do
this with, so that you can help each other to keep going.
How can ovulation be induced in patients with PCOD ?
Ovulation Induction: The drug of first choice for women with PCOD today is metformin
( this medicine is also used for treating patients with diabetes. ) Doctors
have now learned that many patients with PCOD also have insulin resistance – a
condition similar to that found in diabetics, in that they have raised levels
of insulin in their blood ( hyperinsulinemia) , and their response to insulin
is blunted. This is why some patients with PCOD who do not respond to
clomiphene are treated with antidiabetic drugs, such as metformin and
troglitazone. Studies have shown that these drugs improve their fertility by
reversing their endocrine abnormality and improving their ovulatory response.
In
the past, the drug of first choice used to be clomiphene; this may be combined
with low-doses of dexamethasone, a steroid which suppresses androgen production
from the adrenal glands. Just taking clomiphene is not enough , and you need to
be monitored ( usually with ultrasound scans) to determine if the clomiphene is
helping you to ovulate or not. The doctor may have to progressively increase
the dose till he finds the right dose for you. If clomiphene does not work, a
newer anti-estrogen called letrozole ( which is also used for treating women
with breast cancer) can be used. Clomiphene resistant PCO women may need
ovulation induction with HMG ( gonadotropins). Some doctors prefer to use pure
FSH for inducing ovulation in PCOD patients because they have abnormally high
levels of LH.
Ovulation
induction can often be difficult in patients with PCOD , since there is the
risk that the patient may over-respond to the drugs, and produce too many
follicles, which is why the risk of ovarian hyperstimulation syndrome ( OHSS)
and multiple pregnancy is often increased in patients with PCOD. The doctor has
to find just the right dose of HMG ( called the threshold value ) in order to
induce maturation and release of a single , or only a few follicles , and this
can sometimes be very tricky.
Difficult
patients may also need a combination of a GnRH analog (to stop the abnormal
release of FSH and LH from the pituitary) and HMG to induce ovulation
successfully.
How is surgery used to treat patients with PCOD ?
Surgery: A recent
treatment option uses laparoscopy to treat patients with PCOD. During operative
laparoscopy, a laser or cautery is used to drill multiple holes through the
thickened ovarian capsule. This procedure is called laparoscopic ovarian
cauterisation or ovarian drilling or LEOS ( laparoscopic electrocauterisation
of ovarian stroma) . This should be reserved for women with PCOD who have large
ovaries with increased stroma on ultrasound scanning. Destroying the abnormal
ovarian tissue helps to restore normal ovarian function and helps to induce
ovulation. For young patients with PCO ovaries on ultrasound, if clomiphene
fails to achieve a pregnancy in 4 months time, we usually advise laparoscopic
surgery as the next treatment option. This is because LEOS helps us to
correct the underlying problem; and about 80% of patients will have regular
cycles after undergoing this surgery, of which 50% will conceive in a year’s time,
without having to take further medication or treatment. Having regular cycles
without having to take medicines each month can be very reassuring to these
patients !
The
skill of the surgeon plays a key role in determining the outcome of the surgery
. It is important that the surgeon selectively destroy only the stroma, and NOT
the cortex. The cortex of the ovary contains the eggs, and if this damaged,
then ovarian function is jeopardised, so that the surgery may actually end up
causing infertility ! An additional risk of this surgery is that it can induce
adhesion formation, if not performed competently.
In
the past, doctors used to perform ovarian surgery called wedge resection to
help patients with PCOD to ovulate. The removal of the abnormal ovarian tissue
in the wedge breaks the vicious cycle of PCOD, helping ovulation to occur .
While wedge resection used to be a popular treatment option, the risk of
inducing adhesions around the ovary as a result of this surgery has led to the
operation being used as a last resort.
For
patients who do not respond to the above measures, ovulation induction plus intrauterine
insemination is the next step.
How is IVF used for treating patients with PCOD ?
If 3 cycles
of IUI have failed, then IVF is the best treatment option for patients with
PCOD. However, many IVF clinics have little experience in superovulating these
women, and they often mess up their superovulation. Because these women grow so
many eggs in response to the HMG injections used for superovulation, and
because doctors are very worried about the risk of ovarian hyperstimulation,
they often end up triggering egg collection with HCG when the eggs are
immature. They consequently get lots of eggs, but since most of these are
immature, fertilisation rates and pregnancy rates are very poor.
PCOD / PCOS Homeopathy Treatment
Symptomatic Homeopathy works well for PCOD / PCOS, So its good to
consult a experienced Homeopathy physician without any hesitation.
Whom to contact for PCOD / PCOS Treatment
Dr.Senthil
Kumar Treats many cases of PCOD / PCOS, In his medical professional experience with successful results.
Many patients get relief after taking treatment from Dr.Senthil Kumar.
Dr.Senthil Kumar visits Chennai at Vivekanantha Homeopathy Clinic, Velachery,
Chennai 42. To get appointment please call 9786901830, +91 94430 54168 or mail
to consult.ur.dr@gmail.com,
For
more details & Consultation Feel free to contact us.
Vivekanantha Clinic Consultation Champers
at
Chennai:- 9786901830
Panruti:- 9443054168
Pondicherry:- 9865212055 (Camp)
For appointment please Call us or Mail Us
For appointment: SMS your Name -Age – Mobile Number - Problem in Single word -
date and day - Place of appointment (Eg: Rajini – 30 - 99xxxxxxx0 – PCOD / PCOS, – 21st Oct, Sunday -
Chennai ), You will receive Appointment details through SMS
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