Why do I have PCOD?

Polycystic ovarian Disease (PCOD) is considered to be the most common endocrine disorder in women of reproductive age.

The earliest reports of the disorder in 1935 by Stein & Levanthal described PCOD as a cystic disease of the ovaries.

Today, it encompasses a broad set of endocrine and metabolic disturbances though it is characterized by the presence of excessive amounts of male sex hormones or androgens in the body and ovulatory dysfunction.

How it develops

Most often, PCOD symptoms first appear in adolescence, but it is common for symptoms to not appear before women are in their mid-twenties. PCOD can present itself in different ways in different women, and not all symptoms may be seen in every woman. Women developing PCOD may notice some or all of the following signs as the disorder progresses:

1. Hirsutism or excessive hair on face, chest, abdomen.
2. Acne
3. Hair loss or thinning of scalp hair
4. Polycystic ovaries
5. Obesity/weight gain
6. Infertility or reduced fertility
7. Irregular periods
8. Insulin resistance

Prevalence

The PCOD condition was not clearly understood for a long time till the 1900s. In 1900, National Institutes of Health (NIH) worked to outline a definition of PCOS and criteria that would enable efficient diagnosis. The NIH criteria were used as a standard by clinicians and researchers till 2003, when a workshop in Rotterdam, Netherlands developed new diagnostic criteria, called the Rotterdam Criteria. This was followed by the AE-PCOS Criteria in 2006 proposed by the Androgen Excess (AE) and PCOS Society.

The estimated prevalence among women of reproductive age is estimated to be 5-10 percent. Under the Rotterdam-2003 criteria, this estimate is likely to rise up to 10 percent. In India, there is a shortage of research data to provide accurate estimates of PCOD prevalence in the country.

Due to the diverse parameters that are involved in defining PCOD, studies based on one or two criteria may not capture the entire clinical spectrum of the disorder. However, here are the results of some studies on PCOD:

1. A community-based study published in 2012 calculated the prevalence of PCOD in young women aged between 18 and 25 in north India. The study calculated the occurrence of PCOS in that age group to be 3.7 percent, using NIH criteria.
2. Insulin resistance most commonly accompanies PCOD. The same study also states that given the high prevalence of insulin resistance among Indian population, the chances of PCOD also run high in India. Another study has shown greater insulin resistance in women from south India with reproductive abnormalities.
3. A 2011 study on adolescent girls aged between 15 and 18 in Andhra Pradesh (Nagarthana et al) found PCOD to be prevalent among 9.13 percent Indian female population, drawing attention to the importance of early diagnosis.
4. A 2004 genetic analysis study OF Indian women showed a trend towards high cholesterol levels in women with PCOD. The study also showed a greater link between obesity and increased cholesterol, compared to high testosterone levels and cholesterol.
5. A 2001 clinical and ultrasound study on how ethnicity impacted PCOD showed Indian women had higher insulin responses as compared to more Caucasian backgrounds (Williamson et al.). PCOD characteristics remained same in obese women across ethnicities. Further, south-Asian women in UK showed higher rates of PCOD than native women.

PCOD facts and information:

1. PCOD was first reported in 1935 as Stein-Leventhal syndrome.
2. PCOD is neither population-specific nor restricted to a particular age group. (Eggers et al, 2007)
3. PCOD increases the risk to many metabolic, reproductive and endocrinal disorders like obesity, insulin resistance (IR), premature arteriosclerosis, type-2 diabetes mellitus, and endometrial cancer.
4. PCOD is the leading cause of an ovulatory infertility in premenopausal women.
5. Genetic factors are thought to play a role in development of the disorder, and PCOD follows a complex genetic trait similar to that of obesity and type-2 diabetes. A family history of PCOD can be considered as a risk factor to developing the disorder.
6. Environmental factors like nutrition (fat and carbohydrate consumption), activity levels, peripubertal stress, hormone exposure, and obesity are also linked to development of PCOD.
7. Studies show that a high-fat, low-fibre intake is a factor that favours the onset of obesity (obesity can by itself cause irregular menstrual periods and increase the chances of PCOD).
8. A high-fat, low-fibre diet is also linked to increasing androgen hormones in women.
9. One of the earliest signs of PCOD in young women is acne.
10. More than 50 percent of women with PCOD have insulin resistance.
11. PCOD increases the risk of complications during pregnancy, like miscarriage, gestational diabetes, preeclampsia, premature birth, caesarean delivery, and high blood pressure.
12. Lifestyle changes, including weight loss are known to improve the metabolic, physiological and psychological aspects of PCOD.
13. Women with PCOD are at higher risk of developing chronic conditions like type 2 diabetes and heart disease.