|
|
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 it 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.
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. Typically, blood levels of hormones reveal elevated levels of androgens (a high dehydroepiandrosterone sulphate (DHEA-S) level); a high LH level; and a normal FSH level.
Fig 1. A schematic, comparing a polycystic ovary with a normal ovary.
We don't really understand what causes PCOD. However, we do 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.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
