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CONTROL RATHER THAN CURE

CONTROL RATHER THAN CURE

CONTROL RATHER THAN CURE

  ALL OU NEED TO KNOW ABOUT PCOD and ITS SYMPTOMS

PCOD is caused by complex interactions of genetic, epigenetic and environmental factors and is an epidemic in developing countries.

It was not a common site to see a young man in a hospital complex with a grim expression and a woman in his arms well after midnight. It was his shirt that I noticed first. It was stained bright red.

A night out got them more than they had bargained for. They landed in the hospital with a profusely bleeding post-coital tear. Though both of them were shocked by the turn of events it was the girl who needed blood and surgery to recover from the shock.

As I came out of the operation theatre, I remembered the restless boyfriend waiting outside. In all fairness, he deserved an explanation.  Considering the preceding events, I fumbled with the dos and don’ts. I got interrupted just in time.

“I hope her PCOD will not bleed her like this again.”

I reeled. PCOD and a night of passion? Seriously!

This was not the first time that people had used PCOD to suit their purposes. It is everywhere these days. From the bulging waistline to the hair on her chin, from the absent periods to her mood swings, from the acne to her poor performance in exams-it is the very fashionable punching bag.

Sometime ago, I met an overweight girl who had promised to lose weight. I could see no trace of that even six months later. But she stood unfazed.

‘I have POD’.

‘So?’

‘Both my parents are also diabetic.’

She cribbed, biting into a hot samosa.

‘Have you started running, exercising?’

‘I just don’t have time!’

Sounds like a cliché but it was not the genes that run in the family but the fact that nobody runs in the family.

India is rapidly becoming the diabetic capital of the world. PCOD is just the tip of the iceberg, a by-product of our faulty diet and lifestyle.

PCOD, meaning Polycystic Ovarian Disease is actually a syndrome(PCOS), a collection of symptoms comprising of irregular cycles, androgen excess (acne an abnormal hair) and polycystic ovaries detectable in ultrasounds.

It starts during adolescence but unfortunately is not easily and always diagnosed during this period. Caused by a complex interaction of genetic, epigenetic and environmental factors, PCOD is an epidemic in developing countries.

About 20% of women at reproductive age demonstrate the ultrasound picture of polycystic ovaries. Additionally, about 5-10% have clinical or biochemical signs of anovulation and androgen excess.

In majority of cases, the diagnosis is clinical. The hormonal analysis is supportive and not a prerequisite for diagnosis. The oral glucose tolerance tolerance test remains a gold standard for diagnosing insulin resistance, which is the main patho-physiology for PCOD.

Patients are generally overweight with scanty or overdue menses. The central players are obesity and insulin resistance. The ovary starts producing more male harmones(androgens) than female harmones. Hence women suffering from PCOD undergo a male pattern of obesity, scanty and irregular menses, more acne, and excessive hair growth on the face and body and sometimes male pattern of baldness too.

Every cycle sees the growth of a follicle but the abnormal hormonal milieu retards it and prevents ovulation or release of the egg. Hence multiple follicles are seen arrested in various stages of maturation. Apart from producing the characteristic polycystic appearance, they start producing more androgens-aggravating the situation.

This can cause difficulty in conceiving too.

Broadly speaking, the ovary is the victim rather than the villain. A polycystic ovary is crying out loud, sending a warning that the person has reached the first step that may lead to diabetes.

It’s a ‘Disaster in the making’ in a country already reeling under the curse of malnutrition.

Obese people have more fat cells which produce more estrogen compounding the already bad genetic predisposition. Lifestyle regulation is the only thing that can prevent the disease from reaching a pinnacle of disaster.

POS is one of the possible outcomes of peripubertal obesity. Prevention of peripubertal obesity is the first line of prevention of PCOS. It’s a startling fat that in urban cities more than 1 in 4 children are overweight or obese.

Obesity impacts almost every aspect of health, starting with mental health and extending to every system in the body.

We can’t change our genes so how do we bell the cat? No treatment is a panacea because treatments are generally directed at symptoms and not at the symptoms and not at the syndrome itself.

Life-style modifications are the mainstay treatment. Let’s beat the iron while it is hot. Adolesence is a period of inculcating good habits too. Diet modification,weight loss, exercise, psycho-social support, cessation of smoking are the pillars for change. A loss of only 5% in weight is associated with marked improvement.

Drugs like metformin, chiro-inositol and other insulin sensitizing agents cause definite improvement.

OCPs (Oral contraceptive pills), Anti-androgens, fertility improving agents all have been shown to be effective in addressing the specific problem in PCOD, such as regulating cycles, acne and hirsutism.

Absence of evidence of evidence is not always evidence of absence.

Phytomedicines (soybean, legumes, herbal agents) are frontiers we need to work upon. Studies show that they improve insulin sensitivity.

PCOS is an entity with a long life span, requiring “control” rather than “cure”. Therapies change with stag of life .

Extensive efforts should be made to fully investigate in order to make therapy more successful nd o delay the serious long-term effects of the disease on the patient’s health.

Management of PCOS should start by early intervention in high risk peripubertal kids by prevention of obesity. Prevention of peripubertal obesity is vital and lies in achieving the equilibrium of energy balance.

Multi-faceted, large-scale interventions for prevention are recommended by dietary modification, increased physical activity, decreased sedentary activity and behavior modification.

We are facing two interlinked epidemics (Peri- pubertal obesity and PCOD) which affect a large scale of population and also affects their reproductive future.

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drjolly

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