PCOD - Polycystic Ovarian Disease

Hello friends,

Main Dr Surekha Jain gynaecologist and obstetrician pichhle 40 saal se Shalimar Bagh mein practice karti hoon.

Aaj ham baat karenge ek bimari PCOD jiska aapne bohot logon se naam suna hoga, isko PCOS bhi kehte hain aur jaisa ki naam se pata chalta hai ismein bohot sari bimariyan include hoti hai ye apne aap mein sirf ek bimari nahin hai ye PCOD aurat ke jivan mein ek health ko affect karne wali bohot badi syndrome hai jismein aur jyadatar ye child-bearing age mein hota hai matlab ki 20 se 40 sal tak ki umra mein ye women ki health ko bohot tarah se effect karta hai, sabse pehla uske periods ko irregular karta hai, irregular aur flow kam karta hai, 2ndly agar patient married hai, agar female to uski fertility pe impact dalta hai, pregnant hone mein mushkil hoti hai, teesra insulin production pe affect padta hai jisse patient diabetic ho sakti hai, chautha hormonal level ka imbalance karta hai jo female hormones hoti hai estrogen, progesterone unka balance karta hai aur last mein ye patient ke blood vessels aur blood pressure pe bhi affect kar sakta hai jisse ki lambe samay me use badi-badi bimariyan ho sakti hai aur aapke appearance ko affect kar sakta hai jisse ki anchahe baal, acne ye sab aate hain.

Ab aapke paas ek sawal aata hai ki kab aapko yeh mehsoos hona chahiye ki mujhe shayad PCOD ho sakta hai aur mujhe doctor ke pass jana chahiye? to ismein se agar jo-jo baten main apko bata rahi hoon ismein se koi bhi apko lakshan lage to aap ko doctor ke pass jana chahiye.

Sabse pehla agar aapke periods abhi recently aise hone lage ki flow kam hota hai pehle saat din hota tha ab do din hi hota hai aur kam hota hai aur bich ka interval badh gaya hai, har mahine ki jagah 2 mahine, 3 mahine, 4 mahine yahan tak ki 6 mahine tak bhi period nahi aate hain to aapko sochna chahiye ki aapko kuch problem hai.

Dusra agar aapko anchahe baal dikhai dete hain jaise ki upper lip, chin aur side burns, shoulders, lower back, front of chest yahan pe aapko baal dikhai dete hain jo ki normally female ko nahin hone chahiye, suddenly aapke baal girne shuru ho jaate hain aur scalp mein jagah-jagah patches ban jaate hain jahan per ki hair nahin ho or ya aapko face par acne aate hain bohot jyada muhase aate hain jo ki period aane se pehle jyada badh jaate hain aur agar aap married hai aur aap conceive karne mein problem arahi hai aapko pregnancy nahi ho rahi hai ye sab karno se aap ko doctor ke pass jana chahiye.

Yadi aap doctor ke pass jaati hai to wo kaise approach karenge? Sabse pehle aapko ye diagnosis banane ke liye ki aap PCOD ho ya nahi, aapki history lenge, history mein wo kya-kya lenge? poochenge aapka weight gain hua Kya recently, kya aapke parivar mein aapke maa-baap kisi ko sugar hain? Kya ki bahen-maa ya koi bhi aapke blood relation ki female ko polycystic ovarian syndrome raha hai? History lene ke baad wo fir aapki jaanch karenge, aap se puchenge ki aapko kya-kya problem hai, aap jab bataoge uske baad aap ki jaanch karenge jaanch karne mein sabse pahle aapka BMI nikalenge. BMI nikaalne ka matlab hota hai weight divided by height in metre square is BMI, BMI aapko ye bataega ki aap healthy weight ho, aap overweight ho ya aap obese hoya very obese ho kyunki overweight hone ke chances PCOD main bohot jyada hote hain.

BMI nikaalne se wo aapko guide kar payenge, secondly fir wo aapka hair pattern dekhenge ki aapko kahi anchahe baal hai kya unko dekhne ke baad fir wo aapka, agar aap married hain to aapka internal checkup bhi karna chahenge ps karke dekhnge, aapki ovary size mein badi lagti hai ya aapke abdomen mein jyada fat hai aur fir insulin resistance ke sign dekhenge, insulin resistance ke sign hote hain acanthosis nigricans iska matlab hota hai ki aapka nape of neck yahan per blackish skin ho jaaye or hard thick skin ho jaaye iske alava jo pressure points hai jaise elbows hai jahan per aap pressure lagakar baithte hain wo hiisa bhi kala aur thick ho jata hai, iske alava agar aake pet per bohot jyada charbi hai to wo bhi ek sign hota hai ki aapko insulin resistance hai.

Sare examination karne ke bad fir wo aapke kuch blood test karenge, blood test aur ultrasonography karenge, blood test main aata hai ek simple aapka hemogram, blood sugar uske alawa aapka fasting insulin aur aapke FSH, LSH. Jo aapke female hormones hai serum estrogen aur FSH, LSH ke alava aapke kuch test karenge jo ye bata sakte hain kya aapke sharir mein male hormones jyada hai kya, kyunki kuch male hormones sab females mein hote hain lekin ek limit ke baad agar wo badh jaaye to wo problems khadi karte hain. last mein thyroid test aur prolactin test bhi karenge kyunki hypothyroidism aur prolactin hormone ka jyada hona bhi isi tarhan ke symptoms paida kar sakta hai, jaise ki period kam aana, weight gain hona aur ye sab signs bhi dikha sakta hai to isliye rule out karna padega iske alava kuch tumors hote hain, jaise ovary ke tumor hai, adrenal ek gland hota hai kidney ke upper uske tumors hai wo bhi is tarah ke hormones nikaalte hain Jo ye saare symptoms jo humne PCOD ke discuss kiye hai usmein bhi aa sakte hain to in sabko bhi hamen rule out karna hai.

To ham male hormones test karte hain jaise serum testosterone, DHEA-S, 17 alpha hydroxyprogesterone, SHBG etc .. last mein agar aap unmarried hai to aapka abdomen se ultrasound hoga, agar aapka married hain to transvaginal sonography is the best wo ye bataegi ki kya aapki ovary normal size se badi hai Kya? aur agar badi hai to kya unke jo ande ban rahe hain wo unki periphery pe lage hue hain sare aur nikalte nahi hai, iske alava uski jo outer layer hai wo thick hai ye sab ultrasound mein dikh jata hai aur basically polycystic ovary mein yahi problem hoti hai har mahine anda banta hai lekin shed nahi hota aur collect ho jata hai periphery pe aur ek mala si banaa leta hai isko ham pearl neck appearance bhi kehte hain jaise ki ek moti ki mala hoti hai, is tarah se ban jata hai ye saare test aap ke doctor karenge.

First ek bar humne diagnosis bana liya patient ka ki usko PCOD hai to hamare jahan mein ek sawal aur bhi hai ki uska karan kya hai? PCOD ka koi karan nahi hai abhi tak koi aisa nahi hai ki koi virus, bacteria ya koi karan hamen samajh mein aata hai sirf genetic problem samajh mein aati hai genetic matlab agar aapke parivar mein aap ki maa-bahen ya koi blood relation ko PCOD hua hai to aapko bhi jyada chances hai, iske alava kuch logon ne yeh coincidence paaya hai ki agar ladki premature hui hai ya birth weight uska bohot kam raha hai to uske chances hai ki later life mein PCOD develop karegi, humne causes jaan liye ab ham ultimately treatment per aate hain.

Treatment jab ham shuru karna chahenge most important jo hai wo hai reduction of weight and lifestyle changes. Agar aap apne existing weight ka 5 ya 10% weight bhi reduce karte hai to aapki bohot sari problem bina doctor ki bhi solve ho jayengi, aap ko doctor ke pass nahi jana padega so mind you reduction of weight is very important. Ab baki ke treatment ki baat hai ki kya aapko chahiye aur kya jaruri doctor ko lagta hai us hisab se treatment diya jayega agar aapke periods irregular hai aur koi problem nahi hai to periods regular karne ke liye oral contraceptive pills di jaati hai jo har mahine mein 21 din khani hoti hai aur 21 din ke baad period aa jata hai fir paanchve din se shuru karte hain isliye har mahine period aane lagta hai aur hamen PCOD patient mein saal mein kam se kam char bar period jarur hona chahiye nahi to patient ko uterine cancer ke chances badh jaate hain. Period regular karne ke baad, second baat aati hai agar aapko male pattern ke hair hai jyada ya aapki voice mein change hai ya baal gir rahe hain ya acne hain, in patients ko bhi ham oral contraceptive pills dete hain lekin wo dete hain jinme ek dawai aisi bhi ho jo male hormone ko kam karti hai aisi contraceptive pills bhi aati hai jin mein ye dawai hoti hai, iske alava agar bohot jyada hair hai aapko kahin baar bohot jyada hair patient ko hote hain to usmein ham alag se dawai bhi add karte hain jo male hormones ko kam karti hai. Abh agar jitni apki hair growth aa chuke hai wo nahi htaayi ja sakti sirf further growth roki ja sakti hai uske liye aap jo existing hair hai unke liye to aap vahi sab kar sakti hai jaise ki waxing karana, laser se hair remove karana, kuch creams bhi aati hai jo growth kam karti hai wo bhi doctor aapko likhkar de sakta hai. Teesra agar aapko insulin resistance aati hai to insulin sensitizers drugs di jaati hai jaise ki metformin hai, myo-inositol, D-chiro inositol hai etc. this is doctor’s will. Last mein agar aap overweight hai to aapko kis dietician ki bhi help leni pad sakti hai weight reduce karne ke liye, agar aap morbidly obese hai ya aur aisi drugs bhi khaani pad sakti hai jinse aapka kam ho jaaye weight.

Ab patient agar married hai aur wo infertile hai us patient ko in sabh ke alava hamen aisi drugs bhi deni padti hai jo har mahine unka anda bane aur gire jisse ki wo pregnant ho sake ye sab bhi doctor aapko dekh ke aapke hisab se bataenge, kahi conditions aisi hoti hai koi bhi cheez kaam nahi karti to surgical treatment bhi karna padta hai ovaries ka usse ham ovarian drilling bhi kehte hain laparoscopically ovarian drilling karke patient ko cure kar sakte hain ye short mein sara ho gaya, ab log long term precaution kya hote hain agar patient ki PCOD theek nahin karen aur wo chalta rahe to kya kya problem lambe samay mein usko ayengi to PCOD ka matlab hai ki anda girta nahi hai to progesterone jo dusri hormone anda banne ke baad nahin aati aur pehli hormone estrogen excess main ho jaati hai, excessive estrogen hi aapke period ko delay karti hain, agar lambhe samay tak estrogen Jyada rehti hai to uterus ke andar ki layer jyada badh jaati hai jisko hum hyperplasia kehte hai aur lambe samay tak agar treat nahi karen to yeh hyperplasia endometrial cancer mein badal sakta hai.

To patient Jake ultimately endometrial cancer develop kar sakti hai isliye treatment jaroori hai, dusra kyunki ismein insulin resistance hota hai to patient ko long-term mein jakar diabetes type 2 ho sakti hai aur ismein dyslipidemia hota hai heart, blood vessels aur hypertension yeh sab affected ho sakte hain aapko cardiovascular problem ho sakti hai, like stroke, thrombolysis many things, so ultimately aapko ye baat ab acche se samajh mein agai hai ki once you are aware of any symptom which is you feel ki PCOD ho sakta hai to doctor ke pass jayen, proper, diagnosis, treatment management karayen.

All said and done, last mein main aapko yahi kehna chahti hoon ki PCOD jo syndrome hai Isko aap totally cure nahi kar sakte ismein sirf jo symptoms dominating hai ya aapko life mein trouble de rahe hain unko manage kar sakte hain unko treat kar sakte hain, aap khud iske liye help kar sakti hain apna weight reduction karke, apni lifestyle badal kar ke. Doctor isko totally cure nahi kar sakta yeh specially young mothers, young ladkiyon ki mothers ko bhi samajhna hai kyunki agar ham 6 mahine tak period regular karte hain aur dawai band karte hain to fir problem ajaati hai firse wahi hone lag jata hai to ham cure nahi kar sakte that is the most important message. So friends ab mujhe umeed hai ki apko PCOD ke bare mein karan, kaise-keise usko samjh sakte hain aap, kab doctor ke pass jana hai yeh sab aapko samajh mein aaya hoga aur aap iska labh utha payenge.

Thank you very much