Articles on ovary

PCOS Is More Than a Hormonal Disorder

Dr. Neelam Nath Bhatia, General Physician
PCOS-Poly Cystic Ovarian Syndrome or POCD-Polycystic Ovarian Disease means presence of tiny water filled balloons on the ovaries. Ovaries have developing follicles in women from puberty to menopause. A baby girl is borne with a numbers of them but they start maturing at puberty, few per cycle. Not every egg she is carrying gets ripe in each cycle & this is the way the capability of reproducing is protected in a woman.Few follicles develop & rupture per cycle, egg is released which travels towards uterus for implantation. Uterus has made arrangements to receive the mature egg for conception. In case no conception takes place, the lining is shed for 5 days in the form of periods.The size of follicles in Indian women is about 20 mm or 2 cms but some women may do have a size larger than this but it is never more than 2.5 cms.What is a Cyst? Cyst is a balloon with clear water like transparent substance.If Cysts are present in ovaries , it is a disease or a Lifestyle Disorder?Cyst in ovaries can be a big follicle that did not rupture on day 14- Ovulation time or it can be due to other reasons not known to us,  but the affected woman gets diagnosed by an Ultrasound.She has symptoms of irregular periods, delayed cycles with less blood and obesity, acne on face, black patches here and there, hair loss, hirsutism (hair on face), risk of getting type 2 diabetes and heart disease, thyroid disease being on the low side and infertility / and if she conceives risk of a complicated pregnancy with high BP, swellings and pre eclamptic changes.Her blood levels are high  for SteroidsTestosterone hormoneFollicle stimulating hormoneFasting blood sugar is high but herHDL-the good cholesterol is low CRP-C reactive protein is high-it is an indicator of inflammation and infection Anywhere in the body.Doctors usually prescribe a 21 day course of low hormone oral contraceptive pills, even to young girls who do not need it to prevent conception. Metformin medicine given to Type 2 Diabetics is also prescribed.But OCs / Hormone therapy does carry side effects like making periods more irregular than before, break through bleeding, weight gain, nausea, mood swings among others. PCOS can also be considered a lifestyle disorder:Correct it by modifying lifestyle byReduce the weight by taking no sugar, minimal salt, no bad fats like burgers, pizzas and street food, packed food rich in salt and fats as salt is a preservative and fats add to the taste.Do yoga and meditation Reduce stress but do enjoy the fruitful result oriented stress as it boosts the good cholesterol, Exercise regularly but according to constitution and tolerance.Eat as much as possible-every seasonalfruits and vegetables, at least 5 types with 5 different colours.Even borderline low thyroid becomes normal without giving extra thyroid hormones as tablets (eltroxin has lots of side effects like palpitations and high end personality who wants to be always on the go!)Take a glass of warm water with juice oflemon + a spoon of honey added to it, every day in the morning on emptystomach. This helps to reduce weight, bring down levels of blood sugar andcholesterol.Apple cider vinegar if taken with juice/water /honey helps also.Treat PCOD minus hormones & sugar lowering medicine metformin

Things You Should Know About Polycystic Ovary Syndrome (Pcos)

Dr. Jyotsna Gupta, Gynecologist/Obstetrician
What is Polycystic Ovarian Disease (PCOD) or Polycystic Ovary Syndrome (PCOS)?Polycystic ovary syndrome (PCOS) is a health problem that can affect a woman's:Menstrual cycleAbility to have childrenAppearanceHormonesBlood vesselsHeartWith PCOS/PCOD women typically have:High levels of 'androgens.' These are sometimes called male hormones, though females also make them.Many small cysts (fluid-filled sacs) in their ovariesMissed or irregular periods (monthly bleeding)What causes PCOS? The cause of PCOS is unknown. But most experts think that several factors, including genetics, could play a role. Women with PCOS are more likely to have a mother or sister with PCOS.A main underlying problem with PCOS is a hormonal imbalance. In women with PCOS, the ovaries make more androgens than normal. Androgens are male hormones that females also make. High levels of these hormones affect the development and release of eggs during ovulation.High androgen levels can lead to:AcneExcessive hair growthWeight gainProblems with ovulation How many women have PCOS? Between 1 in 10 and 1 in 20 women of childbearing age has PCOS. It can occur in girls as young as 11 years old. What are the symptoms of PCOD or PCOS? The symptoms of PCOS can vary from woman to woman. Some of the polycystic ovary syndrome symptoms include:Infrequent, absent, and/or irregular menstrual periodsInfertility (not able to get pregnant) because of not ovulating. In fact, PCOS is the most common cause of female infertility.Increased hair growth on the face, chest, stomach, back, thumbs, or toesMale-pattern baldness or thinning hairCysts on the ovariesAcne, oily skin, or dandruffWeight gain or obesity, usually with extra weight around the waistSkin tags — excess flaps of skin in the armpits or neck areaPelvic painAnxiety or depressionPatches of skin on the neck, arms, breasts, or thighs that are thick and dark brown or blackSleep apnea — when breathing stops for short periods of time while asleepHow do I know if I have PCOS? There is no single test to diagnose PCOS. Your doctor will take the following steps to find out if you have PCOS or if something else is causing your symptoms.Medical history. Your doctor will ask about your menstrual periods, weight changes, and other symptoms.Physical exam. Your doctor will want to measure your blood pressure, body mass index (BMI), and waist size. He or she also will check the areas of increased hair growth. You should try to allow the natural hair to grow for a few days before the visit.Pelvic exam. Your doctor might want to check to see if your ovaries are enlarged or swollen by the increased number of small cysts.Blood tests. Your doctor may check the androgen hormone and glucose (sugar) levels in your blood.Ultrasound (sonogram). Your doctor may perform a test that uses sound waves to take pictures of the pelvic area. It might be used to examine your ovaries for cysts and check the endometrium (lining of the womb). This lining may become thicker if your periods are not regular.How is PCOS treated?Because there is no cure for PCOS, it needs to be managed to prevent problems. Treatment goals are based on your symptoms, whether or not you want to become pregnant, and lowering your chances of getting heart disease and diabetes. Many women will need a combination of treatments to meet these goals. Some treatments for PCOS include:Lifestyle modification. Many women with PCOS are overweight or obese, which can cause health problems. You can help manage your PCOS by eating healthy and exercising to keep your weight at a healthy level. Healthy eating tips include:Limiting processed foods and foods with added sugarsAdding more whole-grain products, fruits, vegetables, and lean meats to your dietThis helps to lower blood glucose (sugar) levels, improve the body's use of insulin, and normalize hormone levels in your body. Even a 10 percent loss in body weight can restore a normal period and make your cycle more regular.Birth control pills. For women who don't want to get pregnant, birth control pills can:Control menstrual cyclesReduce male hormone levelsHelp to clear acneFertility medications. Lack of ovulation is usually the reason for fertility problems in women with PCOS. Several medications that stimulate ovulation can help women with PCOS become pregnant. Even so, other reasons for infertility in both the woman and man should be ruled out before fertility medications are used.Another option is in vitro fertilization (IVF). IVF offers the best chance of becoming pregnant in any given cycle. It also gives doctors better control over the chance of multiple births. But, IVF is very costly.Surgery. "Ovarian drilling" is a surgery that may increase the chance of ovulation. It’s sometimes used when a woman does not respond to fertility medicines. This surgery can lower male hormone levels and help with ovulation. But, these effects may only last a few months.Medicine for increased hair growth or extra male hormones. Medicines called anti-androgens may reduce hair growth and clear acne. Anti-androgens are often combined with birth control pills. These medications should not be taken if you are trying to become pregnant.Before taking any Medicines tell your doctor if you are pregnant or plan to become pregnant. Do not breastfeed while taking this medicine.Other options include:Cream to reduce facial hairLaser hair removal or electrolysis to remove hairHormonal treatment to keep new hair from growingDoes PCOS change at menopause?Yes and no. PCOS affects many systems in the body. So, many symptoms may persist even though ovarian function and hormone levels change as a woman nears menopause. For instance, excessive hair growth continues, and male-pattern baldness or thinning hair gets worse after menopause. Also, the risks of complications (health problems) from PCOS, such as heart attack, stroke, and diabetes, increase as a woman gets older.Polycystic ovary syndrome and pregnancy- How does PCOS affect a woman while pregnant?Women with PCOS appear to have higher rates of:MiscarriagePremature deliveryPregnancy-induced high blood pressureGestational diabetesDoes PCOS put women at risk for other health problems?Women with PCOS have greater chances of developing several serious health conditions. Recent studies found that:Women with PCOS can have diabetes or pre-diabetes at early age.Women with PCOS are at greater risk of having high blood pressure.Women with PCOS can develop sleep apnea. This is when breathing stops for short periods of time during sleep.Women with PCOS may also develop anxiety and depression. It is important to talk to your doctor about treatment for these mental health conditions.Irregular menstrual periods and the lack of ovulation cause women to produce the hormone estrogen, but not the hormone progesterone. Progesterone causes the endometrium (lining of the womb) to shed each month as a menstrual period. Without progesterone, the endometrium becomes thick, which can cause heavy or irregular bleeding. Over time, this can lead to endometrial hyperplasia, when the lining grows too much, and cancer.I have PCOS. What can I do to prevent complications?If you have PCOS, get your symptoms under control at an earlier age to help reduce your chances of having complications like diabetes and heart disease. Talk to your doctor about treating all your symptoms, rather than focusing on just one aspect of your PCOS, such as problems getting pregnant. Also, talk to your doctor about getting tested for diabetes regularly. Other steps you can take to lower your chances of health problems include:Eating rightExercisingNot smokingHow can I cope with the emotional effects of PCOS?Having PCOS can be difficult. You may feel:Embarrassed by your appearanceWorried about being able to get pregnantDepressedManaging PCOS (Diet and Exercise)Following lifestyle and diet modifications can help manage PCOS symptoms to an extent-Frequently have small meals (5-6 times a day) without fail.Drink a lot of water (8-10 glasses)Try to consume 2-3 servings of fruits and vegetables every day.Stick to a high fibre diet (wholegrains/fruits/vegetables)Give preference to home cooked meals.Add brightly colored and white vegetables to your diet. They have high anti-oxidants.Food to avoid- Fried/packaged/processed foodsFoods with high glycemic index​Exercises suggested- Work out at least 5 times every week for at least 30 minutesRunning, swimming, yogaStrengthening exercises​Even if you don't lose weight, exercise in PCOS helps to improve things like- insulin sensitivity, frequency of ovulation, cholesterol, body composition.Getting treatment for PCOS can help with these concerns and help boost your self-esteem. It is advised that you should consult gynecologist who can help you based on your symptoms and requirements to manage PCOD/PCOS. 

Getting Pregnant With Polycystic Ovaries (Pcos)

Mr. Preshanthan M S
“From embarrassing visible signs like chin hair and acne, to more worrying ones like missed or irregular periods, polycystic ovary syndrome can affect your health, leading to diabetes, infertility and even cancer. Dr.Samundi Sankari, Chief Consultant - Srushti Fertility Centre Chennai tells you how to spot the symptoms of this sometimes silent disease”SYMPTOMSPCOS is untreatable, but can be managed. Irregular menstrual cycles and difficulty conceiving are among the most common symptoms, the result of ovarian follicles that fail to mature fully and to release eggs. Affected women often have enlarged ovaries and prolonged bleeding during menses. The hormone imbalances is characterised by the distinctive symptoms such as irregular periods, Excess facial hair and thinning and falling of hair, weight gain, oily and acne prone skin, pigmentation - around neck, armpit or thighs, Infertility and Insulin resistance-diabetes. The healthiest, most effective long-term method of managing PCOS is to live a healthy lifestyle: proper diet, accompanied by regular exercise, regularizing healthy sleep pattern and effectively managing stress could help normalize the body metabolism and reduce potential risks of PCOS such as Infertility and Diabetes.“LOSING WEIGHT REDUCES YOUR INSULIN LEVELS, RESULTING IN LOWER TESTOSTERONE LEVELS, WHICH IN TURN IMPROVES FERTILITY AND REDUCES VISIBLE SYMPTOMS SUCH AS EXCESSIVE HAIR GROWTH AND ACNE”PCOS AND INFERTILITYPCOS has a direct impact on your fertility and ability to conceive. In recent years, there has been increase in incidence where woman who underwent infertility treatment at Srushti were diagnosed with PCOS, but most of them had their other fertility factors as normal. About 30% of women who took treatment where able to conceive naturally with just lifestyle modifications. Half of the women with irregular periods conceived with ovulation induction, follicular monitoring and timed sexual intercourse or Intra Uterine Insemination (IUI). Women who had severe PCOS were treated with laparoscopic ovarian drilling and  most of them were able to conceive naturally post treatment and others conceived through Assisted Reproductive Techniques such as In Vitro Fertilization (IVF).Dr Samundi Sankari says many women won’t have any symptoms while having PCOS. Huge number of PCOS patients, particularly women in their early or late 20’s who come to me only when they have fertility issues. We advise women in the reproductive age group to visit their gynaecologist at least once a year, regardless of whether they have any symptoms or complaints.

Polycystic Ovary Syndrome | PCOD - Yes, Diet Can Help!

Ms. Ankita Gupta Sehgal, Dietitian/Nutritionist
PCOD or Polycystic Ovarian Disease, as the name suggests is a medical condition in which clusters of small sized cysts are formed in the ovaries. These cysts are fluid-filled and contain immature eggs. This disease usually occurs in the reproductive age of women, due to the hormonal imbalance. The female body starts producing more male sex hormone ‘androgen,’ due to which the normal menstrual cycles get disrupted. Though the cause of PCOD is not very clear, it is presumed that combination of genetic and environmental factors play a role. Risk factors are obesity, lack of physical activity/ sedentary lifestyle and family history of someone with the condition. Even a 10 percent loss in body weight can help lessen the symptoms of PCOD which in turn help in restoring a normal period and  regular cycle. Symptoms1. Hirsutism - Excessive hair growth on the face and body2. Weight gain - especially around the waist 3. Acne or oily skin4. Anxiety and depression 5. Irregular menstrual cycle or missed period6. Difficulty in conception as it affects fertility. 7. Thinning hair on the scalp. PCOD can further complicate health and can lead to diabetes and uterine cancer. Though several medications like Birth control pills, androgen blocking medications, insulin sensitising medications etc are used for the treatment, one of the best treatments for PCOD is a healthy lifestyle - a healthy diet with regular exercise. How can Diet help in PCOD / PCOSDietary considerations1.  Avoid dairy products.  Milk contains many hormones and chemicals given to the animals in the form of injections for the purpose of lactation, which when ingested by the PCOD patients can upset their hormonal balance and aggravate the symptoms.2.  Avoid saturated and trans fat.  These fats can increase your cholesterol levels and add more calories leading to weight gain. As PCOD patients are already at a risk of heart disease and diabetes, the saturated or trans fat can be additional risk factors. Avoid red meat, processed and fried foods.3.  Avoid high Glycemic Index ( GI ) foods as they shoot up your sugar levels quickly. These include refined flour, pasta, cookies, rice, potatoes, sweets or sweeteners, juices, etc.4.  Increase fiber intake. Have whole fruits, whole grains, beans, lentils, bran, barley, quinoa, almonds, walnuts, flaxseeds, leafy vegetables, etc. in your diet to increase the fiber content as it will keep you full for longer period and not let you gain weight.5. Have high protein and low carb diet. High protein diet is beneficial in losing weight. Add good sources of protein such as lean meat, poultry, fish, yogurt, beans, lentils, etc. Try to eat carbohydrate with protein, as protein helps to regulate the sugar spike resulting from carbohydrate intake. 6.  Add more fruits and vegetables in your diet, as they contain more antioxidants, which is very important to reduce the oxidative stress. They are the rich sources of all the minerals and vitamins. Vitamin B and folic acid in particular play an important role in managing PCOD symptoms. Try to eat fruits with skin rather than juices.7. Add healthy fats - Try to add more omega-3, omega-6 sources in your diet like olive or canola oil, nuts and seeds, fish. 8. Limit processed foods and foods with added sugars. Even a 10 percent loss in body weight can restore a normal period and make your cycle more regular. Though PCOD cannot be cured completely, but making some changes in your diet and regular exercise can be very helpful in managing the PCOD symptoms.

PCOS Has Become as Common as Common Cold These Days

Dr. Geetanjali, Dietitian/Nutritionist
Polycystic Ovary Syndrome (PCOS) has become as common as common cold these days. It affects at least one in every ten women ageing towards puberty. PCOS is an aftermath of a hormonal imbalance in women wherein the testosterone levels shoots up in the body causing an array of symptomatic reactions.A woman with PCOS is prone to weight gain, pelvic pain, acne, depression and irregular menstrual cycles. But that’s only as far as the horror factors go. Firstly, like I have mentioned before, PCOS has become indescribably common among women of a certain age these days. Secondly, with a treatment, proper diet and exercise schedule, PCOS is quite curable.Here are a few tips and tricks for you to keep in mind and compile them with your treatment to stay several steps ahead of PCOS.PCOS and Weight gain Between PCOS and body weight, it’s a long, enticing affair that takes place. PCOS makes it difficult for the body to use insulin; a hormone that is responsible for converting food starch into energy. As a result, your body becomes insulin resistant, and stores up the energy as fat instead of burning it out. High insulin levels make it a troublesome affair to maintain a manageable weight.Diet tips that work wonders with PCOS Carbohydrates are one of those food components that really make your insulin levels tick. But not all carbs are the bad guys. It’s the simple carbs that you need to watch out for. Even if you gulp down foods with the same amount of carbohydrate, the effect they will have on your insulin level will vary depending on the type of carb that you have consumed. So, it helps to stay wide awake every time you go grocery shopping. Make a few necessary tweaks to your grocery list and consumption pattern, and before you know your PCOS will be an ancient thing in the past. Next time you go to the departmental store, make sure you pick whole grains over multi-grains. You could switch from cornflakes to wheat flakes or oatmeal as far as breakfast is concerned. Here’s another small fix you can pull. Swap your white bread with its brown counterpart and do the same with your rice. It’s always more advisable (and beneficial) to eat whole fruits instead of drinking canned juices. And, most importantly let not those ‘fat-free’ levels laugh it off at you; they are secretly loaded with a truck full of sugar.To further fine tune your PCOS diet; build up on smart snacking habits. Open a packet of unsalted peanuts rather than salted potato chips. Having a tantrum with the sweet tooth? Smoothen it out with tidbits of dark chocolate.  Rely on water (and water alone) to quench your thirst.  Choose this essential and harmless liquid to curb down your soda and soft drink pangs entirely. Eating a little consciously can take you a long way to get rid of PCOS. Top up your dietary efforts with your regular exercise alongside your treatment, and there’s no reason why your hormones won’t fall into place along with your life

PCOD and Diet

Ms. Silky Mahajan, Dietitian/Nutritionist
Polycystic ovarian disease (PCOD) have multiple small cysts in their ovaries. 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.Causes of PCOD: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 an ovulation 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).Treatment:Weight Loss Diet for PCODIn case of PCod,Carbohydrate loading is very important to improve insulin sensitivity.Whey protein Avoid High Glycemic Index foodsInclude Green Leafy Vegetables & FruitsEssential Fats:Not all fat is bad and healthy fats are essential for your PCOS diet.Essential fatty acids are really important for maintaining the cell wall, which allows nutrients in, and toxins out. They are also vital for hormone balance, weight management and fertility.These healthy fats are found in nuts and seeds, oily fish, avocado and olive oil so be sure to incorporate those into your  diet.            6. Adequate Quantity of Vitamin B and MagnesiumPhysical ActivityWhilst diet is hugely important aspect to tackling PCOS, we must not forget other lifestyle changes that will help to overcome PCOS and it’s symptoms.Exercise regularlyManage stress levelsShare the burden and get good support from your family and friends.Look after yourself and pamper yourself. We need to reclaim our womanhood and femininity so a little bit of TLC is definitely in order.There is no magical formula that’s going to make us all better. However, by making these diet and lifestyle changes now, we can manage our symptoms and improve our health.

Pcod: Is It a Disease?

Dr. Radhika Wagh, Gynecologist/Obstetrician
“Poly Cystic Ovarian Disease” is a hormonal disorder where instead of one mature follicle; multiple immature follicles are formed in the ovaries. These are seen as small collections of fluid (follicles or cysts) in an ultrasound examination. The term definitely has the word Disease but this is not a Disease, it is an alteration in the body. It’s a body that is functioning in a different pattern.It is seen in the Reproductive age of a female common between the age group of 16-34.What causes PCOD?   The exact cause of this condition is unknown. But its presence is usually seen in obese constitutions, having lifestyles & habits that tend to cause weight gain. It also has genetic association.How to identify?It mainly deranges ovulation, causes either late ovulation or no ovulation. Whichever the case, leads to Irregularity of Periods. There is a difficulty to conceive for those who want to. So, it’s one of the main causes of Infertility. It also causes Obesity & Insulin resistance which may lead to Diabetes. We usually find the Waist to Hip ratio of such females equal to or more than 1.How to deal with it??Now, this is the important part. Management of this condition differs from person to person.Ovulation is deranged which means conceiving a pregnancy is tough. But if you’re an unmarried girl who has nothing to do with pregnancy, why bother. What difference is it going to make in your life if you skip a period or two (provided you are sure that you aren’t pregnant). Course of hormonal medicines will regularize your periods but this condition repeats itself once these medicines are stopped. Just prevent weight gain as that worsens this condition,or if you already are overweight then losing weight should reverse this condition.Yes, for someone who wants to plan a pregnancy treatment will really help. But the treatment should be aimed towards getting pregnant & not regularize periods. Ideally pregnancy itself is the best treatment of this condition. Post child birth this condition gets self-corrected in many of the females.To sum it up, PCOD is not a disease it’s a different type of body. Different not abnormal.

Polycysticovarian Disease (Pcod) Part 1

Dr. Hema Jajoo, Gynecologist/Obstetrician
Polycystic ovary syndrome (PCOS) is a hormonal disorder with over production of male harmone (Androgen) and insulin resistance (Insulin resistance is a condition in which the body produces insulin but does not use it effectively which again lead to horm onal imbalance) that causes verities of symptoms like irregular menstrual periods, overweight ,obesity, hirsuitism (excessive hair growth all over body), acne etc. Incidence-  The condition occurs in about 5 to 10 percent of female population of developed countries .Much higher incidence is reportedin india 3.7 to 22.5% and In Indian adolescents it is 9.13 to 36%..Cause of PCOD- The cause of polycystic ovary syndrome (PCOS)is not fully understood, but genetics may be a factor. PCOS can be passed down from either your mother's or father's side. PCOS problems are caused by hormonal changes. One hormone change triggers another,which changes another.How PCOS patients presents-Menstrual irregularities- is the commonest problem PCOD patients present with. This can be in the form of scanty menses, prolonged menstrual cycles, prolonged and heavy menses or absent menses.Weight gain and obesity- Because of hormonal imbalances most women gradually gain weight. There are few women or adolescents who do not gain weight. They are known as Lean PCOS.Male-pattern hair growth ( hirsutism is the excessive growth of thick,dark terminal hair in women where hair growth is normally absent) may be seen on the upper lip, chin, neck, side burn area, chest, upper or lower abdomen, upper arm, and inner thigh.Pimples- (Acne) is a skin condition that causes oily skin and blockages in hair follicles.Mostly occurs on face, but sometimes may be seen on back and upper chestInfertility - Many women with PCOS do not ovulate regularly, and it may take these women longer to become pregnant. An infertility evaluation is often recommended after 6 to 12 months of trying to become pregnant.Metabolic syndrome- Many patients with polycystic ovary syndrome (PCOS) also have features of the metabolic syndrome,including insulin resistance, Diabetes, obesity, and dyslipidemia (abnorma lLipid profile), suggesting an increased risk for cardiovascular disease( CVD ).Risk Factors for PCOSEarly or late Menarche- age of first menses.Obesity.Family History of PCOS ,irregular periods or Diabetes.Sedentary and improper life style.Long term sequel of PCOD-They are at high risk of developing Diabetes.High blood pressure, high cholesterol and heart diseases.Obesity.High risk of developing uterine cancer (endometrial cancer) due to unopposed action of Oestrogen harmone.Thyroid Disorders( Hypothyroidism)Sleep apnea — Sleep apnea is a condition that causes brief spells where breathing stops (apnea )during sleep. Patients with this problem often experience fatigue and daytime sleepiness.Depression and Anxiety.PCOS DIAGNOSISWhen patient goes to a doctor with any of the above mentioned symptoms then doctor takes full history, ask for other symptoms and examines thoroughly and then may advice certain tests to confirm the diagnosis.There is no single test for diagnosing polycystic ovary syndrome (PCOS). You may be diagnosed with PCOS based upon your symptoms, blood tests, and a physical examination. Expert groups have determined that a woman must have two out ofthree ( Rotterdam criteria ) of the following to be diagnosed with PCOS:Irregular menstrual periods caused by anovulation or irregular ovulation.Evidence of elevated male harmone (Testesterone) levels. The evidence can be based upon signs (excess hair growth, acne, or male-pattern balding) .Polycystic ovaries on pelvic ultrasound.- it shows enlarged ovary with multiple cysts. This is seen in almost 30% of cases.In women with moderate to severe hirsutism (excess hair growth), blood tests for testosterone and Indehydroepiandrosterone sulfate (DHEA-S) may be recommended.TSH and Prolactin harmones should also bed one as Hypothyroidism and or Hyperprolactinimia  may be associated with PCOS.If PCOS is confirmed, blood glucose and cholesterol testing are usually performed. Anoral glucose tolerance test is the best way to diagnose prediabetes and/or diabetes.Adolescent PCOS In adolescents, presence of oligomenorrhea (scanty menses) or amenorrhea (absent menses) beyond two years of menarche should be considered an early clinical sign of PCOS, followed by (Rotterdam criteria ) of adults for diagnosis of PCOS as mentioned above.Minimal diagnosis of PCOS in adolescents should include 5 tests- Serum total testosterone (cut off 60 ng/dL) Oral glucose tolerance test (OGTT) zero, two hours after 75 gm glucose load.Serum 17– hydroxy progesterone (assessed at 8 am)Serum TSH Serum and prolactin levels MANAGEMENT OF PATIENTS WITH PCOSBoth pharmacological and non-pharmacological management strategies are crucial in the overall management of PCOS. Usually treatment depends upon the symptoms for which patient comes. As PCOS can not be cured permanently, long term treatment plans should be given to manage her bothering symptoms and also to prevent long term sequeli. Treatment- usually depend upon the symptoms for which patient has come. But life style modification forms the main stay of treatment. Regular exercise,a healthy diet ,weight control, and not smoking are all important parts of treatment for polycystic ovary syndrome (PCOS)Physical activity- In adults and adolescents with PCOS, daily strict physical activity sessions for at least 30min/day or 150min/ week are recommended.Weight loss — Weight loss is one of the most effective approaches for managing insulinabnormalities, irregular menstrual periods, and other symptoms of PCOS. Forexample, many overweight women with PCOS who lose 5 to 10 percent of their bodyweight notice that their periods become more regular. Weight loss can often beachieved with a program of diet and exercise.Diet -it is recommended to follow calorie restricted diet (low carbohydrate and fat,high protein diet)There are a number of options available to treat obesity. These options are identical to those recommended for women without PCOS and include diet and exercise, weight loss medications (although their use is limited), and weight loss surgery. Weight loss surgery may be an option for severely obese women with PCOS. Women can lose significant of weight after surgery, which can restore normal menstrual cycles, reduce high androgen levels and hirsutism, and reduce the risk of type 2 diabetes. Oral contraceptives — Oral contraceptives (OCs; with combined estrogen and progestin) are the most commonly used treatment for regulating menstrual periods in women with polycystic ovary syndrome (PCOS). OCs protect the woman from endometrial (uterine) hyperplasia or cancer by inducing a monthly menstrual period. OCs are also effective for treating hirsutism and acne. Women with PCOS occasionally ovulate, and oral contraceptives are useful in providing protection from pregnancy. Although an OC allows for bleeding once per month, this does not mean that the PCOS is“cured,  irregular cycles generally return when the OC is stopped. Oral contraceptives decrease the body's production of male harmone ( androgens). Anti-androgen drugs (such as spironolactone) decrease the effect of androgens. These treatments can be used in combination to reduce and slow hair growth. Oral contraceptives and anti-androgens can alsoreduce acne. Metformin — Metformin is used to decrease insulin resistance in these patients. It improves the effectiveness of insulin produced by the body. It was developed as a treatmentfor type 2 diabetes but may be recommended for women with PCOS with obesity and insulin resistance.If a woman does not have regular menstrual cycles, the first-line treatment is a hormonal method of birth control, such as birth control pills. If the woman can not take birth control pills, one alternative is to take metformin; a progestinis usually recommended periodically to have withdrawal bleeding in addition to metformin, for six months or until menstrual cycles are regular.Metformin may help with weight loss. Although metformin is not a weight-loss drug, some studies have shown that women with PCOS who are on a low-calorie diet lose more weight when metformin is added. If metformin is used, it is essential that diet and exercise are also part of the recommended regimen because the weight that is lost in the early phase of metformin treatment may be regained over time.Treatment of infertility — If tests determine that lack of ovulation is the cause of infertility, several treatment options are available.These treatments work best in women who are not obese.The primary treatment for women who are unable to become pregnant and who have PCOS is weight loss. Even a modest amount of weight loss may allow the woman to begin ovulating normally. In addition, weight loss can improve the effectiveness of other infertility treatments. Ovulation inducing drugs (like clomiphene etc)  are also used in conjunction with Matformin. Your doctor will discuss with you about it.Prevention-  (PCOS) cannot be prevented. But early diagnosis and treatment helps prevent long-term complications, such as infertility, metabolic syndrome, obesity, diabetes, and heart disease. 

Infertility Factors in Males and Females

Dr. Kaushal Kadam, Gynecologist/Obstetrician
In medical terms, infertility is referred to as a woman’s inability to conceive, even after a year of unprotected intercourse. Although infertility is considered to be a concern often associated with women, not many people know that male-related infertility accounts for one-third of the cases. Studies also indicate that the infertility cause remains unidentified in 25% of couples planning to have a baby.Here are some common and not-so-common factors of female and male infertility:Infertility in WomenCommon Factors·      Tubal Disease – damage or blockage of the Fallopian tubes.·      Ovulatory dysfunction or an ovulation – egg is not released from the ovary every month.·      Endometriosis – affects the function of the Fallopian tubes, uterus and ovaries.·      Uterine or cervical abnormalities – abnormalities in the shape or cavity of the uterus or problems with the opening/closing of the cervix.·      Gynecological problems - previous ectopic pregnancy or more than one miscarriage.Less Common Factors·      Premature menopause·      Use of medications that induce temporary infertility·      Polycystic Ovary Syndrome (PCOS)·      Absence of menstruationInfertility in MenCommon Factors·      Low sperm count or quality·      Problems with the delivery of sperm·      Erectile dysfunction·      Premature ejaculationLess Common Factors·      Inflammation of testes (Orchitis)·      Blocked testicle(s)·      Any drug treatment or exposure to chemotherapy, saunas or hot tubsSome common factors which can lead to infertility issues in both men and women are:·      Genetic abnormalities·      Lifestyle factors such as being overweight, stress, smoking, drugs or contact with/ingestion of harmful chemicals.·      Medical conditions like diabetes, epilepsy and thyroid (mostly in women).·      Age-related infertility - though it affects females more (after the age of 35), males suffer from it too.Medical tests could help to determine the actual cause of infertility, and artificial treatment options available to the couple thereafter.