Introduction
Polycystic Ovarian Disease (PCOD), also known as Polycystic Ovary Syndrome (PCOS), is one of the most common endocrine disorders affecting women of reproductive age. It is characterized by chronic anovulation, hyperandrogenism, and polycystic ovarian morphology. The condition has significant reproductive, metabolic, and psychological implications.DefinitionPCOD is a heterogeneous disorder involving ovarian dysfunction and hormonal imbalance, leading to irregular ovulation, excess androgen production, and multiple small cysts in the ovaries.Diagnostic CriteriaThe most widely accepted criteria are the Rotterdam Criteria (2003). Diagnosis requires any two of the following three:Oligo-ovulation or anovulationClinical or biochemical hyperandrogenismPolycystic ovaries on ultrasound (≥12 follicles 2–9 mm or ovarian volume >10 cm³)Other causes (thyroid dysfunction, hyperprolactinemia, CAH, Cushing’s syndrome, androgen-secreting tumors) must be excluded.EtiopathogenesisPCOD is multifactorial and involves:1. Insulin ResistancePresent in ~50–70% of casesHyperinsulinemia increases ovarian androgen productionDecreases SHBG → increases free testosterone2. HyperandrogenismExcess LH stimulates theca cellsIncreased testosterone → hirsutism, acne3. Genetic FactorsFamilial clustering common4. Environmental FactorsObesitySedentary lifestyleClinical FeaturesMenstrual IrregularitiesOligomenorrheaAmenorrheaDysfunctional uterine bleedingHyperandrogenic FeaturesHirsutismAcneAndrogenic alopeciaMetabolic FeaturesObesity (central)Acanthosis nigricansImpaired glucose toleranceReproductive IssuesInfertility (anovulatory)Recurrent pregnancy lossInvestigationsHormonal ProfileLH/FSH ratio (>2:1 in many cases)Increased total/free testosteroneElevated DHEAS (sometimes)Fasting insulinMetabolic ScreeningOGTTLipid profileImagingTransvaginal ultrasound → “String of pearls” appearanceComplicationsReproductiveInfertilityEndometrial hyperplasiaEndometrial carcinomaMetabolicType 2 Diabetes MellitusDyslipidemiaCardiovascular diseasePsychologicalAnxietyDepressionLow self-esteemManagementManagement is symptom-based and individualized.1. Lifestyle Modification (First-line)Weight reduction (5–10% improves ovulation)Diet + exercise2. Menstrual RegulationCombined oral contraceptive pillsCyclic progesterone3. Treatment of HirsutismOCPsSpironolactone4. Insulin SensitizersMetformin5. Infertility TreatmentFirst-line: LetrozoleClomiphene citrateGonadotropinsLaparoscopic ovarian drillingLong-Term Follow-UpAnnual glucose screeningLipid profile monitoringEndometrial surveillance in chronic anovulationConclusionPCOD is a chronic endocrine disorder with reproductive and metabolic consequences. Early diagnosis and lifestyle intervention are crucial in preventing long-term complications. A multidisciplinary approach involving gynecologists, endocrinologists, nutritionists, and mental health professionals ensures optimal management.