Polycystic Ovarian Disease (PCOD) is a common condition affecting 5% of women. The disorder appears to be increasing especially in young and teenagers perhaps related to more sedentary life and eating habits leading to obesity.

In this condition the ovary stops cyclic maturation of follicles (Water filled sacs containing egg) leading to anovulation or non production of mature eggs. This leads to increased production of male hormones and unbalanced production of estrogen which is the principal female hormone. There is also absence of progesterone, the hormone which comes only after ovulation and balances the side effects of increased estrogen production. Clinically these changes are manifested as :

1. Menstrual irregularity : This may range from short irregularcycles, having menstrual bleeding which stops only with medicines or abnormally delayed or absent menses.
2. Obesity :  increased weight is both a cause and an effect often PCOD
3. Hirsutism : Increased hair growth on face and other parts of the body due to increased male hormones.
4. Polycystic appearance of ovaries. These are small egg containing sacs which increase in size but do not attain full maturation and thus enlarge the ovary and give it its classical look. These are not tumors or growth and do not require operation for removal.
5. If the condition remains untreated the risk of developing type 2 diabetes, heart problems is greatly increased.
6. Infertility : Since there is no ovulation or timely egg release infertility is the most common problem.

Diagnosis depends mainly on ultrasound appearance of ovaries, anovulation and features of increased male hormones. Blood tests are only helpful to find out any association thyroid disorder, diabetes or increased prolactin secretions.

Treatment depends on the goal. If infertility is the main concern then induction of ovulation with ovulation triggering medicines can help. Clomiphene is a simple and inexpensive medicine which is successful in 50-60 % of cases. In other cases injections may be required to stimulate ovulation. Treatment with these injections is costly and requires highly experienced medical expertise for monitoring. Another drug metformin which is used to treat diabetes is also helpful in improving PCOD. In severe cases an operation of laparoscopic ovarian drilling can sometimes restore ovulation. IVF or test tube technique can also help if all other treatments fail.

If infertility is not immediately important as in young unmarried girls or in women who have completed their families other medicines can be given. Oral contraceptives regularize the menstrual cycle, reduce hair growth and control hormones. Other medicines can be combined to reduce hair growth.

Therapy other than medicines Weight reduction is the single most important lifestyle change which can help to restore and correct PCOD. Almost 60-70 % of PCOD women are obese. If they look back they can usually relate their problems to the period when their weight started increasing. The earlier the weight is controlled, sooner the problem may be corrected.

PCOD is a very common problem and has a lot of psychological and social impact on a women?s life. Fortunately the treatment is possible and life style changes and medicinal therapy can really improve life. I shall discuss weight reducing strategies in my next topic.