Polycystic Ovarian
Disease (PCOD) is a complex endocrine disorder characterized by excessive androgen
production by the ovaries and adrenal glands, leading to menstrual abnormalities,
hirsutism, obesity, and polycystic ovaries.
Etiopathogenesis
- Unknown / Idiopathic
- Hypothalamic Dysfunction
- Androgen Excess
- Chronic Anovulation
- Obesity & Insulin
Resistance
Long-Term Consequences
- Hypertension (HTN)
- Diabetes Mellitus (DM)
- Endometrial Hyperplasia
& Cancer
- Dyslipidemia
Pathology
of PCOD
- Ovaries Enlarged (2-5 times
normal size)
- Increased Stroma &
Thickened Capsule
- White Pearly Capsule
- Multiple Follicular Cysts in
Ovarian Cortex
- Histological Features:
- Thickened Tunica
Albuginea
- Theca Cell Hyperplasia
Clinical
Features of PCOD
1.
Menstrual Abnormalities
o Oligomenorrhea
(Infrequent menstruation)
o Amenorrhea
(Absent menstruation)
o Dysfunctional Uterine Bleeding (DUB)
2.
Hyperandrogenism (Excess Androgen
Production)
o Hirsutism (Excess facial & body hair)
o Acne & Oily Skin
o Male-Pattern Baldness (Androgenic Alopecia)
3.
Metabolic Features
o Obesity & Weight Gain
o Insulin Resistance & Acanthosis Nigricans (Dark patches on skin folds)
4.
Infertility
o Chronic Anovulation & Follicular Dysfunction
Diagnosis of PCOD
1. Clinical Examination
- Bilateral Enlarged Ovaries on Bimanual Examination
- Signs of Hyperandrogenism
(Hirsutism, Acne, Baldness)
2. Hormonal Assays
- LH:FSH Ratio >2:1
(Increased LH, Low-Normal FSH)
- Serum Testosterone
(Elevated)
- Insulin Levels (Increased in
Insulin Resistance Cases)
3. Imaging Studies
- Pelvic Ultrasound (USG) – Ovaries Show "String of Pearls" Appearance
Treatment & Management
1. General Measures
- Weight Reduction (Diet
Control & Regular Exercise)
- Vitamin Supplementation
2. Medical Management
- Oral Contraceptive Pills
(OCPs) – For 6 months to regulate cycles
- Anti-Androgen Therapy
(Cyproterone Acetate, Spironolactone)
- Metformin – For Insulin
Resistance
3. Ovulation Induction (For Infertility Treatment)
- Clomiphene Citrate
(First-line therapy for ovulation induction)
- Gonadotropins (FSH, hMG
Injections)
4. Surgical Treatment
- Endoscopic Ovarian
Cauterization
(For Resistant PCOD Cases)
- Laparoscopic Ovarian
Drilling (Laser Vaporization or Cyst Drainage)
- Oophorectomy (Surgical Removal of Ovaries in Severe Cases)
1.
Irregular or absent menstrual
cycles
2.
Excessive facial and body hair
(hirsutism) due to high androgens
3.
Weight gain, especially around
the abdomen
4.
Acne and oily skin
5.
Infertility due to anovulation
1. Pulsatilla
Indications:
- Suppressed or delayed menses
due to hormonal imbalance
- Irregular menstruation,
often scanty and painful
Keynote Symptoms:
- Menses irregular, delayed, or
suppressed.
- Symptoms constantly changing and
unpredictable.
- Weepy mood, needs emotional support.
- Better in open air, worse in warm
rooms.
- Craving for rich and fatty foods.
2. Sepia
Indications:
- Hormonal imbalance leading
to irregular menses and infertility
- PCOD with excessive hair
growth (hirsutism)
Keynote Symptoms:
- Irregular periods with dark, scanty
flow.
- Bearing-down sensation in the pelvis.
- Aversion to sex and irritability.
- Feels exhausted and indifferent to
loved ones.
- Worse from cold and better from exercise.
3. Calcarea Carbonica
Indications:
- PCOD with excessive weight
gain and sluggish metabolism
- Delayed, heavy, and
prolonged menstrual flow
Keynote Symptoms:
- Weight gain despite normal eating
habits.
- Profuse, long-lasting periods with
fatigue.
- Cold intolerance and excessive
sweating on the head.
- Anxiety about health and fear of
failure.
- Craving for eggs and indigestible things.
4. Natrum Muriaticum
Indications:
- PCOD with suppressed
emotions and menstrual irregularities
- Weight gain with excessive
salt cravings
Keynote Symptoms:
- Menses irregular, late, and scanty.
- Severe headaches before menstruation.
- Craves salty foods and dislikes
sympathy.
- Dry lips, excessive thirst, and sun
sensitivity.
- Worse in the sun, better near the sea.
5. Lycopodium
Indications:
- PCOD with bloating,
digestive issues, and right-sided ovarian cysts
- Hormonal imbalance leading
to hair loss and excessive facial hair
Keynote Symptoms:
- Irregular cycles with scanty flow.
- Right-sided ovarian cysts or pain.
- Bloating, gas, and digestive problems.
- Weakness in the afternoon, craving for
sweets.
- Lack of confidence but highly
intelligent.
