Treatment of Polycystic Ovary Syndrome

Polycystic Ovary Disease
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Polycystic Ovary Disease
Introduction
Polycystic Ovarian Syndrome (Polycystic Ovary Disease) is a sum set of symptoms which occurs in women, due to hormonal imbalances. In this condition the women fail to ovulate and is marked by a decrease in frequency of menstrual cycles or a loss of menstruation. This condition is also referred as hyperandrogenic anovulation. However, women with PCOD can also present with heavy periods, male secondary sexual features or hiruitism (excess body and facial hair), may complain of pelvic pain and difficulty in conception. The risk of PCOD is increased by type -2 diabetes mellitus, obesity, mood disorders, and endometrial cancer. In this condition numerous fluid-filled cysts appear in the ovaries (Legro et al., 2013).
Literature Review
One out of every woman and one out of twenty women of childbearing age suffers from the condition of PCOD. In the United States itself, 5 million women are affected with PCOD. PCOD affects all women who have reached puberty and also below puberty, as early as 11 years old. PCOD is believed to be caused by genetic and environmental factors. PCOD is believed to be an autosomal dominant trait, as the gene for the disease is present in autosomes (Legro et al., 2013).
The risk factors for PCOD include obesity and inadequate physical activity. The diagnosis of PCOD is based on anovulation (loss of menstrual cycle), presence of fluid-filled cysts in the ovaries (detected by ultrasonography), and presence of high androgen levels.

In this disease, the ovaries are filled with fluid sacs called follicles or cysts (Legro et al., 2013).
Under normal condition, the ovary produces appropriate hormones for expulsion of the ovum (ovulation). However, in PCOD such fluid-filled sacs or cysts inhibit the production of progesterone. Progesterone pulse is necessary for maintaining the normal rhythm of the menstrual cycle. On the other hand, in PCOD there is an absence of aromatase enzyme, which leads to overproduction of androgen (male sex hormone). Aromatase converts androgen to the female sex hormones estrogens and progesterone. Therefore, decreased progesterone and increased androgen leads to male features and anovulation (Legro et al., 2013).
Treatment of PCOD is conservative in nature. The major non-pharmacological interventions include lifestyle modifications. PCOD is strongly correlated to obesity and decreased physical activity, and therefore diet restriction and consumption of healthy diet should be encouraged. Women suffering from PCOD should take foods, with low glycemic index and at the same time must consume whole grains based cereals, fruits, vegetables and lean meat. The goal of PCOD management would be to reduce the comorbid conditions, like diabetes or obesity (Legro et al., 2013).
Birth control pills may be administered to alleviate the symptoms of PCOD. Such pills are hormonal preparations containing estrogens and progesterone. Supplementation of estrogens and progesterone may help to normalize the menstrual cycle, and may alleviate anovulation. Anti-diabetic medications like clomiphene and metformin are administered to initiate the menstrual cycle. Clomiphene alone or in combination has been shown to stimulate ovulation (Legro et al., 2013).
Synthesis of Literature
Treatment and management of PCOD remain a medical dilemma. Although symptomatic relief of PCOD has been achieved, there should be interventions to prevent the formation of cysts or pharmacological agents must be researched to decrease the number of cysts, which may lead to effective ovulation. This is because treatment with anti-diabetic drugs like metformin may lead to lactic acidosis in the blood that leads to side effects. Moreover, hyperacidity and headaches are common with such anti-diabetic drugs. Further, women should maintain a healthy dietary pattern and should routinely engage in physical activity (Cassina et al., 2014).
References
Cassina M, Donà M, Di Gianantonio E, Litta P, & Clementi M (2014). “First-trimester exposure to metformin and risk of birth defects: a systematic review and meta-analysis”. Hum. Reprod. Update 20 (5): 656
Legro, RS; Arslanian, SA; Ehrmann, DA; Hoeger, KM; Murad, MH; Pasquali, R; & Welt, CK; Endocrine, Society (2013). “Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline.”.The Journal of clinical endocrinology and metabolism 98 (12), 4565–92