Have you been putting on weight lately? Have you noticed facial hair growth? Do you have irregular periods? You could have Polycystic Ovarian Disease (PCOD)! PCOD is a disease effecting approximately 6% of females in their thirties during the reproductive years of life with considerable variation in the symptoms of the disease. Anovulation, hyperandrogenism and cystic ovaries characterize PCOD.

Typical symptoms of PCOD are those of menstrual irregularities such as few or sporadic menstrual periods 3 to 6 times a year, rarely no periods and occasional heavy periods. The ovaries in PCOD have an increase of thecal cells which produce androgens causing hyperandrogenism and the following symptoms: hirsutism (coarse facial, chin and upper lip hair growth); virilizing signs like lowering of the voice, enlargement of the clitoris, and male pattern baldness; severe acne, skin tags, discoloration of the skin of the neck, groin and underarms with warty or velvety skin growths; and obesity. The long-term effect of the androgens produce metabolic syndrome where the patient in addition to obesity may have high blood pressure, high blood triglycerides, low HDL cholesterol and high blood glucose and/or diabetes mellitus. The symptoms may include headaches, increased appetite and thirst and increased urination.
The basic aim in the treatment of PCOD is to relieve the symptoms of hyperandrogenism and infertility and to institute lifestyle changes. Lifestyle changes are the most important part of treatment. Health care providers, endocrinologists and gynecologists alike recommend exercise and weight loss to reduce androgen effects before prescribing any medication. The following lifestyle changes will aid in weight reduction, decrease the risk cardiovascular disease, elevated HDL levels, modify metabolic syndrome risks, and alleviate or prevent diabetes:
-Weight reduction by 10% is recommended

-Suggest a 1,000-calorie reduction (a low fat, low calorie diet) to lose weight

-Increase physical activity of moderate intensity for 30 minutes five times per week

-Reduce saturated dietary fats and eliminate trans fats

-Increase dietary fiber to 15 gm/day

-Increase plant sterols to 2gm/day

-Smoking cessation

If this is not effective or if symptoms are severe, your health care provider may provide oral contraceptive pills (OCPs), which will reduce Luteinizing Hormone (LH) and the production of androgens. The anti-androgen spironolactone can also be given to inhibit the effects of androgen and to lower blood pressure. ACE inhibitors have also been prescribed to lower blood pressure. If diabetes has been diagnosed of if you are glucose intolerant, metformin can reduce the incidence of diabetes but is not as good as life style changes. Statins can be used to decrease LDL-cholesterol. OCPs with spironolactone may help in hair restoration from baldness. OCPs usually improve inflammatory acne, but if symptoms are severe, an antibiotic may be prescribed or a topical medication like isotretinoin may be given. Electrolysis or depilatory creams and/or laser treatments can be used to remove unwanted hair. Laser treatments should not be used on dark skinned people, because skin pigmentation loss. Complaints of infertility are treated with Clomiphene citrate; aromatase inhibitors or FSH may be prescribed to induce ovulation.

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