Polycystic ovarian disease – Symptoms, Treatments, and Complications

PCOD and PCOS are mostly confused and are thought to be the same. But they are two different conditions.

Polycystic ovarian disease occurs when the ovaries produce a large number of immature or partially mature eggs. Polycystic ovarian syndrome (PCOS) is a metabolic disorder, a severe form of PCOD, in which the ovaries stop producing eggs resulting in anovulation.

This article highlights the causes, symptoms, treatment and prevention of PCOD.

What is PCOD? 

PCOD, abbreviated as Polycystic Ovarian Disease, is a medical condition in which the woman’s ovaries produce a lot of immature or partially mature eggs. These immature eggs develop into cysts in the ovaries over time. 

As a result, the ovaries enlarge and secrete an excessive amount of male hormones called androgens. This results in irregular menstrual cycles, infertility, hair loss and abnormal weight gain. PCOD can primarily be managed through diet and lifestyle changes.

Causes of PCOD

PCOD’s cause is unclear. However, there is a link between PCOD and low-grade inflammation, excessive production of male hormones (Hyperandrogenism), excess insulin and genetics. 

In addition, PCOD is exacerbated by early menarche and an unhealthy lifestyle.

Poor lifestyle  

The rising prevalence of PCOD in young adults can be directly associated with a sedentary lifestyle and a lack of nutritious food. 

Inactivity, weight gain and obesity contribute to metabolic imbalances such as insulin resistance, causing PCOD.

Obesity  

According to an NCBI article, obesity is a predisposing factor for polycystic ovary disease. 

However, there are also mechanisms which prove the development of PCOD can contribute to further weight gain and impede efforts to establish effective weight-loss programmes.

Stress  

Negative thoughts and stress cause disruptions in the endocrine system, causing hormonal imbalance, potentially leading to PCOD. 

An article published in the Journal of Human Reproductive Sciences states that stress is essential in the pathogenesis of many diseases and is a commonly overlooked cause of reproductive dysfunction.

Hormonal imbalance 

Excess insulin levels in the body may increase androgen production (a male hormone that is very low in females), causing ovulation problems. 

The ovaries produce abnormally elevated levels of androgen hormones, which can cause acne and hirsutism (increased hair growth on the face and body).

Symptoms of PCOD

The signs and symptoms of PCOD usually appear during the first menstrual cycle of puberty. PCOD may also develop later in life due to weight gain over time.

Irregular periods  

Some women with PCOD have regular periods. Most often, the high levels of androgens and too much insulin in their bodies can disrupt many women’s monthly ovulation and menstrual cycle.

These women are more likely to experience irregular periods or complete period cessation. 

Difficulty getting pregnant  

If PCOD is under control, getting pregnant is not a problem. 

It is said that people with PCOD have a limited ovarian capacity, making it challenging to produce healthy eggs. 

The hormonal imbalance disrupts egg growth. The release of these eggs from the ovaries (ovulation) is also hampered, making pregnancy difficult.

Due to this, they are advised to have children as soon as possible because increased age reduces the quality of the eggs. 

Hirsutism

Hirsutism is the excessive hair growth in females. The most common cause of hirsutism is polycystic ovary disease (PCOD), in which the ovaries produce an excess of androgens. 

Hirsutism is characterised by coarse, dark hair on the face, back, chest, abdomen, upper arms, or legs.

Weight gain

Insulin resistance is the usual cause of weight gain in polycystic ovary disease women. They struggle to lose weight due to hormonal imbalances, inflammation and insulin resistance. 

Thinning hair  

PCOS hair thinning or hair loss is caused by increased androgen in the body. Excess androgens also cause hair thinning on the scalp. However, there is no complete baldness as seen in men.

Oily skin  

When estrogen levels are too high, the skin becomes extremely dry, and the sebaceous glands respond by secreting an excessive amount of oil to compensate. This is why oily skin is often noticed in PCOD women.

In the body, testosterone and dehydroepiandrosterone (DHEA) combine to form another androgen known as Dihydrotestosterone (DHT). This DHT is responsible for the increase in sebum in the sebaceous glands, which causes acne.

Treatments for PCOD

The cure for PCOD is yet to be discovered. Lifestyle changes are the most commonly suggested treatment. A multidisciplinary approach involving a gynaecologist, dietitian, endocrinologist, dermatologist and infertility expert is also required.

Weight loss 

Maintaining proper weight is the most effective way to control and manage PCOD. Even a slight weight loss can significantly affect the treatment of the disease. 

Weight loss can improve reproductive aspects, such as regulating the menstrual cycle and assisting with ovulation and metabolic factors like insulin sensitivity. It may also help to improve the PCOD symptoms.

Diet

Eating a healthy diet makes a huge difference in the symptoms of PCOD. 

Patients suffering from PCOD are advised to consume a lot of protein and fibre. Sugars, fat and carbohydrates should also be limited in the diet.

A proper diet will keep the blood sugar levels stable and help maintain a healthy weight. 

The following foods can be included in the diet.

• Unprocessed and natural food
• Green leafy vegetables like spinach
• Fibre-rich foods
• Cruciferous vegetables like broccoli
• Legumes
• Nuts
• Fish
• Whole wheat
• Low-fat dairy

Exercise  

Lowering the BMI for PCOD is best done with the help of exercises. Being physically active is equally important as a weight loss diet. 

A minimum of 30 minutes of physical activity per day is advisable for best results. There are several types of exercises to consider, which includes

• High-intensity Interval Training (HIIT) – Sprint, jump squats, lunges, burpees
• Cardio workouts – Walking, cycling, jogging, swimming
• Mind-body exercises – Yoga, tai chi
• Strength training – Squats, push-ups, tricep dips
• Core strength exercises – Forearm plank, butterfly sit-up.

Complications of PCOD

Infertility 

Ovulation issues are typically the root cause of infertility in women with PCOD. Ovulation may not occur when there is an increase in testosterone production or if the ovarian follicles are immature.

Even if ovulation occurs, a hormonal imbalance may prevent the uterine lining from properly developing to allow for implantation.

Menstruation and ovulation can be irregular due to hormonal imbalance. Unpredictable and irregular menstrual cycles can also make pregnancy difficult.

Hypertension 

According to an article titled ‘Ovarian Hypertension: Polycystic Ovary Syndrome’, PCOS is characterised by several metabolic derangements that may contribute to hypertension and cardiovascular disease development. 

Patients with PCOS who have a hyperandrogenic phenotype are exposed to many cardiometabolic risk factors that increase their risk of developing hypertension. 

Excess androgen in PCOS may also directly affect the vascular properties of arterial walls involved in the atherogenic process.

Abnormal uterine bleeding 

PCOD-related irregular uterine bleeding is usually due to a lack of ovulation. The spongy uterine lining, known as endometrium, thickens due to excess estrogen. 

When an excess of this hormone is not balanced by the monthly production of progesterone from the ovary that usually follows ovulation, abnormal uterine bleeding occurs.

Type 2 Diabetes

Women with PCOD are mostly insulin resistant. Their bodies can produce insulin but not effectively use it, increasing their risk of type 2 Diabetes.

Preterm labour and premature birth

An article titled “Polycystic ovary syndrome and extremely preterm birth: A nationwide register-based study” states that women with PCOS were more than twice as likely as women without the condition to have a preterm birth with spontaneous onset. 

It is also said that women with PCOS are also more likely to require a caesarean section because their babies may be larger than expected for their gestational age (LGA).

Babies born to PCOS mothers are more likely to die during delivery and be admitted to a neonatal intensive care unit.

Metabolic syndrome 

According to an article titled ‘Metabolic dysfunction in polycystic ovary syndrome ‘, PCOS is associated with metabolic disorders such as obesity and insulin resistance.

Sedentary lifestyles and poor dietary habits are the primary factors that may contribute to obesity and insulin resistance, worsening the metabolic and reproductive abnormalities due to PCOS. 

Diagnosis of PCOD

While no specific test exists to confirm PCOD, a doctor will question about the medical history, eating and drinking habits, and any prescription or over-the-counter medications the person is on. They may also conduct a physical exam to confirm the condition.

Pelvic examinations 

Pelvic examination is conducted to examine the reproductive organs for cysts, abnormalities or growth. 

A doctor or health care practitioner will insert two fingers into the vagina and press on the belly to feel for cysts on the ovaries during the pelvic exam.

Blood tests  

Blood tests to diagnose PCOD will help understand the hormone levels. These include the following:

• Fasting lipid profile – which includes
• Total cholesterol
• High-density lipoprotein (HDL)
• Triglyceride levels 
• Low-density lipoprotein (LDL) levels 
• Glucose tolerance tests

The best tests for hyperandrogenism (high androgen levels) are blood tests for

• Testosterone 
• Free androgen index (FAI)

Imaging tests 

An ultrasound imaging test is done to determine the size of the ovaries, the uterine lining and cysts in the ovaries. It clearly shows the enlarged ovaries and multiple cysts on its walls.

Prevention of PCOD

Small steps can mitigate the symptoms of PCOD. Eating nutritious foods, being physically active and controlling the weight are a few ways to help prevent the effects of PCOD.

Avoid processed food 

Processed foods must be avoided as they contain high levels of sodium and unhealthy fats, resulting in unwanted weight gain and worsening PCOD symptoms.

Balanced carb  

A balanced carbohydrate and protein diet helps maintain blood sugar and hormone levels in check in PCOD women.

Eat iron-rich foods  

Research suggests that iron-rich foods reduce the occurrence of ovulatory infertility. 

Iron-rich foods, such as green vegetables and fruits, as well as fortified products, should be included in the diet. Foods high in vitamin C aid in iron absorption. 

Iron deficiency is also common in PCOD women due to excess bleeding, which can result in anaemia. Therefore, consuming foods rich in iron can help prevent PCOD.

Eat magnesium-rich foods  

Magnesium is one of the most vital minerals for hormone balance. 

Magnesium-rich foods such as cashews, almonds, bananas, and spinach can be included in the diet to prevent PCOD. 

Magnesium also helps in the maintenance of insulin levels and promotes restful sleep.

Cut down on caffeine

Coffee is a stimulant that raises insulin levels, and excessive caffeine consumption lowers fertility rates. Caffeine stimulates the body by increasing estrogen levels which causes hormonal imbalance.

Daily exercises

Exercise, paired with a healthy diet, is the most effective way to lose weight. Exercises like brisk walking, jogging, swimming and cycling can help PCOD. 

It is said to improve insulin sensitivity, lowering the risk of cardiovascular disease and type 2 Diabetes. 

Exercising regularly lowers estrogen levels in the body. Weight loss through exercise improves ovulation and insulin levels. 

Women with PCOD are more likely to suffer from mental illnesses like depression. Even 30 minutes of exercise per day can have a positive effect on mood and help to manage negative thoughts.

Adequate sleep

Adequate sleep of at least 7 – 8 hours a day is vital for every individual’s good health. It can also prevent PCOD.

Women with PCOD may suffer from sleep problems such as sleep apnea, insomnia and excessive daytime sleepiness. Obesity has been associated with a lack of sleep. 

According to research, getting enough sleep can help reduce weight and body fat. 

When to see a doctor? 

Women with PCOS may have no periods, irregular periods or extremely long periods. They may also have one or more of the following symptoms:

• Acne
• Hirsutism
• Acanthosis nigricans – patches of thick, dark skin that appear on the neck or groyne.
• Having difficulty getting pregnant (infertility)
• Weight gain (Abdominal obesity)

Consulting a doctor is necessary if any of the above symptoms are noticed.

Conclusion  

PCOD is a lifelong condition. Though there is no definitive cure or treatment, it can be managed and controlled in various ways. The best way to treat PCOD is to make diet and lifestyle modifications.

PCOD symptoms and severity vary from woman to woman, so there is no one-size-fits-all approach to treating this condition. Most long-term complications associated with PCOD can be avoided by eating well and staying active.

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