Polycystic Ovarian Syndrome (PCOS)

Good morning, I’m Dr Nidhi Agarwal, I am a consultant gynaecologist, based in Gurgaon. Now today I’ll speak on Polycystic Ovarian Disease that is PCOD which is very common in women in recent years.

PCOD actually occurs in young women. They usually present to us with irregularity with their periods. The ovaries in PCOD patients actually become bigger and denser. As the name suggests, ‘poly’ means many that is many cysts are formed in the ovaries. This lady usually presents with a disruption in the normal menstrual cycle.

Now, what happens in a normal lady who menstruates every month?

There is one egg which is selected by nature which increases in size, and when it becomes bigger and appropriate in size, it is ruptured in the ovary which is then taken up by the Fallopian tube. And if it doesn’t meet the sperm and pregnancy doesn’t occur, then the lady menstruates. This should happen monthly up to 35 days. In PCOD patients, this natural selection of the egg every month doesn’t occur. Instead, many small cysts are formed in the ovaries. So that is why there are many cysts formed in the ovaries, and then the patient does not have normal periods. That is why we say it a Polycystic Ovarian Disease.

Now how does a patient of PCOD present to us?

A patient of PCOD, if she is a young girl in her teens or in the early twenties, she usually comes to us saying that she is not having her monthly periods. She menstruates at one and a half months, two months, two and a half months, and when she menstruates, she usually has excessive bleeding with clots. If a lady is in her late twenties and has got married, and she is not able to conceive, then also the patient presents with the problem in conceiving. Also, there is usually an excess of hormones produced by the ovaries, that is an excess of estrogen as well as androgen which is the male hormones. The lady usually presents with male like pattern of hair growth that is hair growth on her chin on her face, around the nipples of her breasts, in her lower abdomen, especially over her thighs and she says that along with excessive hair growth, she has developed excessive acne and things also appear all over her scalp. These are basically because of an excess of androgens, which are the male hormones. This change in the hormonal value occurs because of Polycystic Ovarian Disease. Also, very often, patients come to us saying that she is gaining weight excessively. A patient comes and says that in the last 5 months, I have gained 10 kgs of weight. So patients usually present to us with symptoms of insulin resistance, in which there is overweight. Now, PCOD has actually become very common and patients who are as small as 11-12 years of age come to me, young girls presenting with PCOD. And the incidence is very very very high; 1 out of 10 women are now having PCOD.

See, there are three criteria which are very important. As I have told you, first is a presentation, that the lady is not ovulating, that is the egg which is formed every month is not released. Instead, multiple eggs multiple cysts form which we call in their ovaries. So, if the ultrasound shows that they are polycystic ovaries if the patient presents to us with less ovulation, or anovulation which we say which occurs when the patient is not having her regular periods, or there are signs of excess androgen that is male hormone with features of hirsutism. Then, out of these three, if two criteria are there in the lady someone is having PCOD.

Very often patients ask me, ‘Why do we, why am I suffering from PCOD?’ So if you ask me, there is no one particular cause which I can see, that this is the reason you have got. There are so many factors, it could be just genetic- your mother or sister has been suffering from PCOD, then your chances of having PCOD are always higher. There could just be low-grade information in her ovaries, which has disturbed the ovaries to an extent that it is releasing more of male hormones, making them bigger in size and that is causing the ovaries not to ovulate. Or it could just be because of obesity and high insulin levels. Again, because of high insulin in the body, it puts stress on the ovaries and they don’t ovulate.

So there are so many causes, you have to investigate the patient, there are a lot of investigations that have to be done and we can come to a diagnosis, it is possible. So, I’ll just conclude by saying that PCOD is very very common nowadays.

If you are having problems with your menstrual cycle, if you are gaining weight abnormally, if you have excessive hair growth anywhere which is not expected in females, face acne or hair loss, please do see us, see your local gynecologist, so if there is any problem, it can be sorted out in time. I’m Dr Nidhi as I already told you, I am based in Gurgaon, and you can contact me for any queries for PCOD or its treatment at LivWell clinic which is at Galleria Market and also you can contact me through Lybrate.

Thank you.