PCOD (Hormonal Issues & Menstrual Irregularities)

What is PCOD ( polycystic ovarian disease)?

Patients suffering from a polycystic ovarian disease (PCOD) have multiple small cysts in their ovaries (the word poly means many). The ovary is enlarged and produces excessive amounts of androgen. Patients suffering from PCOD are often obese and may have hirsutism, (excessive facial and body hair) as a result of the high androgen levels. Excessive androgen levels may also cause excessive acne on face and sometimes back. 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.

PCO can affect young girls and women in age group 15 – 35 years.

How is PCOS diagnosed?


Polycystic Ovarian Syndrome can be easy to diagnose in some patients. The typical medical history is that of irregular menstrual cycles, which are unpredictable and can be heavy or very light; and the need to take hormonal tablets (progestins) to induce a period.

Nearly 50% of women with PCO may find it difficult to conceive when they plan conception.

However, remember that not all patients with PCOD will have all or any of these symptoms.

Some women may have only ultrasound findings suggestive of PCO but are totally asymptomatic

This diagnosis can be confirmed by vaginal ultrasound, which shows that both the ovaries are enlarged; the bright central stroma is increased, and there are multiple small cysts in the ovaries. These cysts are usually arranged in the form of a necklace along the periphery of the ovary. ( It is important that your doctor be able to differentiate multicystic ovaries from polycystic ovaries. )

Girls or women with PCO have insulin resistance in their body and since insulin helps to regulate blood sugar levels; there is also a diabetic tendency in these women.


Treatment of PCOS is totally tailored to the symptoms and requirements of a woman or young girl and therefore will vary from person to person. Also in the same person treatment may change over the years. For instance, you may need hormonal pills as a young girl/women to treat the problem of irregular periods, acne or excessive hair but in later years when you plan a conception, hormones will have to stop and nee you may need medication for egg formation to help you conceive.

the main story of managing PCOS at a time is weight control by lifestyle changes- exercise and diet control (of course easier said than done), counselling, support and guidance from your doctor will help you a long way in helping you to achieve your goal.

Weight loss:

For many patients with PCOD, weight loss is an effective treatment – but of course, this is easier said than done! Look for a permanent weight loss plan – and referral to a dietitian or a weight control clinic may be helpful. Crash diets are usually not effective and not a good idea at all.

Ovulation Induction:

The drug of the first choice for women with PCOD today is metformin ( this medicine is also used for treating patients with diabetes. ) Doctors have now learned that many patients with PCOD also have insulin resistance – a condition similar to that found in diabetics, in that they have raised levels of insulin in their blood ( hyperinsulinemia) , and their response to insulin is blunted. This is why some patients with PCOD who do not respond to clomiphene are treated with antidiabetic drugs, such as metformin and troglitazone. Studies have shown that these drugs improve their fertility by reversing their endocrine abnormality and improving their ovulatory response.


A recent treatment option uses laparoscopy to treat patients with PCOD. During operative laparoscopy, a laser or cautery is used to drill multiple holes through the thickened ovarian capsule. This procedure is called laparoscopic ovarian cauterisation or ovarian drilling or LEOS ( laparoscopic electrocauterisation of ovarian stroma) . This should be reserved for women with PCOD who have large ovaries with increased stroma on ultrasound scanning. Destroying the abnormal ovarian tissue helps to restore normal ovarian function and helps to induce ovulation. For young patients with PCO ovaries on ultrasound, if clomiphene fails to achieve a pregnancy in 4 months time, we usually advise laparoscopic surgery as the next treatment option.


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How is IVF used for treating patients with PCOD ?

currently available treatment options, successful treatment of the infertility is usually possible in the majority of patients with PCOD

If up to 6 cycles of treatment have failed, then IVF is the best treatment option for patients with PCOD. However, many IVF clinics have little experience in superovulating these women, and they often mess up their superovulation. Because these women grow so many eggs in response to the HMG injections used for superovulation, and because doctors are very worried about the risk of ovarian hyperstimulation syndrome ( OHSS), they often end up triggering egg collection with HCG when the eggs are immature. They consequently get lots of eggs, but since most of these are immature, fertilization rates and pregnancy rates are very poor. Because we have extensive experience in dealing with women with PCOD (which is now very common in India), we do a much better job at getting these women to grow many mature eggs. Also, because we carefully and meticulously flush each and every follicle at the time of egg collection, the risk of PCOD patients developing ovarian hyperstimulation in our clinic has been virtually zero over the years.