Less Facial Hair

Video on PCOD

WHAT IS PCOD

Introduction: The full form of PCOD is polycystic ovarian disease. In this disease when ultrasound of ovary is done it is studded with multiple small cyst that is why this disease is called polycystic disease.

What is Menstruation ?

The brain receives stimulation from the environment in the form of nutrition, stress, emotion, light, smell, sound etc. This stimulation results in secretion of a hormone called gonadotropin (L.H. & F.S.H). Gonadotropin stimulates the ovaries to secrete female hormones oestrogen (Estradol) and progesterone. These hormones stimulate the uterus lining to prepare it for menstruation. Normal menstruation consists of blood, secretions, and disintegrating uterus lining.

Before discussing other detail about PCOD, I’ll like to let you know about what is the normal physiology of menstruation. In normal female there are lacs of immature egg (ovarian) follicle lying in dormant state in the ovary. During the normal menstrual cycle on third day of cycle approximately 30 egg follicles starts maturing finally one of them will mature to full stage to form mature egg. When all the hormones are normal then one out of all maturing egg follicle is selected for further maturation & rest all shrink & atrophy. Finally this selected egg follicle passes through various stages of development & finally matures into a completely developed egg called ovum.  Then egg is released out of the ovary (i.e. ovulation). Once the ovum is released ovary starts secreting progesterone for next 10 days. This progesterone hormone leads to strengthening of walls of blood vessel of endometrium. After 10 days of egg release i.e. ovulation, the production of progesterone hormone from ovary ceases. Thus the sudden deficiency of progesterone hormone leads to weakening of the linings of endometrial blood vessels which ultimately shrink & stop supplying blood to endometrium i.e. inner uterine lining. Thus in nut shell the production of estrogen from ovary lads to formation of inner lining of the uterus during menstrual cycle, where as production of progesterone from ovary after the ovulation leads to maintenance of this uterine lining. The menstrual bleeding occurs due to shedding of uterine inner lining i.e. endometrium due to disruption of its blood supply because of sudden deficiency of progesterone because of stoppage of its production from ovary. Thus if no ovulation occurs, there will not be any cyclical exposure of progesterone resulting in absence of regular menstrual bleeding.

The full form of PCOD is polycystic ovarian disease. In this disease when ultrasound of ovary is done it is studded with multiple small cyst that is why this disease is called polycystic disease. These cysts are not real cyst but they are immature egg follicle. These multiple partially developed eggs looks like multiple cyst.

WHY THIS OCCURS

In this disease there is formation of more than normal amount of male hormones as testosterone & Androstenidione from the ovary in that patients due to various causes mentioned below. For your information normally also ovary makes some amount of male hormone even in normal females. But in this disease the amount of secretion of male hormone increases due to various defects as absence  of ovulation, appearances of hair growth over face.. The various causes of this excess male hormone formation from ovary is as follows.

1)      PRIMARY PCOD: In this the ovary has inherent defect in structure & functions due to its defective development since birth so that it start making little more male hormone (testosterone & Androstenidione,free testosterone from ovary or 17 –oh progesterone & DHEAS from the adrenal glan) than normal females. This little extra male hormone suppresses the maturation of egg in ovary. Thus multiple immature egg are present in ovary in every cycle (these immature look like cyst on ultrasound, but in real sense they are not cyst) but none of the immature follicle completes the maturity to fully developed eggs. Thus ovulation does not take place. Once there is no ovulation that leads to deficiency of progesterone hormone resulting into absent periods.

2)      Secondary PCOD: due to weight gain  & stress, hypothyroidism (HighTSH), High Prolactin, high 17 OH Progesterone high DHEAS. Thus resulting into late periods.

NORMAL VARITION PCOD: Remember in aproximately 20% normal women also if ultrasound done may show PCOD like ultrasound picture. Thus only showing pcod on ultrasound does not makes you hormone abnormal. To call this as abnormal, you must have atleast two thing out of three main features as I have enumerated below. PCOD is a condition of ovarian dysfunction in which there is main feature of increased male hormone secretion from ovary on blood testing or because these male hormone increments occurs in such a tinyamount and may be varying also meaning in one cycle there may be increased blood level of male hormone whereas in next cycle hormone level may be absolutely jormal thus apparent clinical feature of increasd male hormone activity will taken as eveidence for increased male hormone seretion from the ovay such as increased amount of unwanted facial hair or body hair, resistant acne or excessive hair fall in women without any obvious cause this is called ovarian  hyperandrogenism

Second feature is polycystic ovary (PCOD)  on ultrasound.

Third main feature is late period due to inhibition of egg formation by increased male hormone in ovary. Which is manifested either by late period or absence of ovuation i.e. egg release on serial ultrasonography starting from day 8 of menstrual cycle. ( this test is call Follicular monitoring or ovulation studies)

Thus if your male hormone total testosterone , free testosterone and androstenidione, 17-oh progesterone DHEAS and Insuin is normal and your period is coming on normal time then you’re your pcod on ultrasound has no significance.

What laboratory tests are recommended for (Menstrual irregularity) abnormal bleeding ?

Blood tests for assessment of hormones secretion (LH, FSH, Testosterone, Prolactin, Free testosterone, Androstenidione, DHEAS, ESTRADIOL, 17-OH Progesterone Thyroid tests DHT, and Insulin fasting and PP etc.)  .

Ultrasonography provides valuable information on the size of the uterus, thickness of the uterus lining, ovaries and any tumour in the reproductive organs.

                                                TREATMENT

1.) FOR UNWANTED  FACIAL HAIR:  

a.)    Cyproterone Acetate

b.)    Ethinostriadol

c.)    Finasteride

d.)    Dutasteride

e.)    Ketoconazole

f.)     Flutamide

g.)    LASER TREATMENT :Permanent cure for the facial hair is LASER TREATMENT at good laser centre.

h.)    I.P.L.

i.)      ELOS

j.)      DOUBLE SQUARE PULSE THERAPY

k.)    IPULSE

            2.) FOR late periods :

                a) Medroxyprogesterone

3)      Weight Reduction

4)      Regular Isometric exercises

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