Can PCOD be Cured? A Helpline for Infertile Couples

PCOD - Polycystic Ovarian Disease is one of the general causes of infertility. Patients with PCOD have irregular periods, and this can cause considerable distress. The good news is that you can to learn to manage it yourself. PCOD is one of the commoner causes of infertility. It's a chronic disease, which patients need to learn to manage them; sadly, lots of patients with PCOD are very confused. They seem to understand very little about their own problem and I think this is partly because their doctors are very confused themselves and do not take the time and trouble to teach patients about their disease. Patients with PCOD have irregular periods; and they know that their irregular periods also mean that they will be infertile. How the irregular periods cause infertility is something they are not clear about. They also know that they have a "hormonal imbalance" - but are clueless about which hormones are not in balance. Because they miss their periods every month, many of them go to the doctor regularly so that he can prescribe medications for them to take in order to induce a period. While many know that the medicine the doctor prescribes is progesterone, they are very scared to take this for themselves on their own. For one thing, most patients are scared to self-medicate; and they are worried about the side effects of these hormones.

Why do women with PCOD have trouble with their menstrual cycle and fertility?

The ovaries, where a woman’s eggs are produced, have tiny fluid-filled sacs called follicles or cysts. As the egg grows, the follicle builds up fluid. When the egg matures, the follicle breaks open, the egg is released, and the egg travels through the fallopian tube to the uterus (womb) for fertilization. This is called ovulation.

In women with PCOD, the ovary doesn't make all of the hormones it needs for an egg to fully mature. The follicles may start to grow and build up fluid but ovulation does not occur. Instead, some follicles may remain as cysts. For these reasons, ovulation does not occur and the hormone progesterone is not made. Without progesterone, a woman's menstrual cycle is irregular or absent. Plus, the ovaries make male hormones, which also prevent ovulation.

Does PCOD change at menopause?

Yes and no. PCOD affects many systems in the body. So, many symptoms may persist even though ovarian function and hormone levels change as a woman nears menopause. For instance, excessive hair growth continues, and male-pattern baldness or thinning hair gets worse after menopause. Also, the risks of complications (health problems) from PCOD, such as heart attack, stroke, and diabetes, increase as a woman gets older.

Some basic principles which every PCOD patient needs to learn 

·         Firstly, you should plan to get 12 periods every year. There's no point in waiting week after week for the period to come on its own - you are just wasting time and adding to your anxiety levels. Every time you miss your period, you are hopeful that you are pregnant at last - and when the pregnancy test comes back as negative, you get depressed and disheartened again. Why break your heart every month - you need to be proactive.

·         Having irregular periods reduces your fertility. It also messes up the quality your life; and it also also impairs your health.

·         Why waste time waiting for the period to come when it's so easy and safe to induce one? Unfortunately, many patients are scared to self-medicate because of ignorance.

·         All you need to do is to take a 5-day course of a natural hormone called progesterone.

·         Many women are scared of hormones. They are worried that these hormones will make them fat or cause side effects. Please remember that this is a natural hormone which you are taking only because your own ovaries are not behaving themselves and producing this important hormone. It's very similar to managing diabetes. Just like a diabetic needs to take insulin to keep his blood sugar under control, you need to take the progesterone every month to induce a period. The good news is that it's not an injection - and you need to take it for only 5 days every month.

·         Every time you miss your period, do a pregnancy test to confirm you are not pregnant. Many doctors routinely prescribe during pregnancy to provide luteal phase hormonal support. Don't forget that progesterone is a natural hormone which is produced during pregnancy and as the name suggests, it supports gestation; If you take it inadvertently during your pregnancy, you will not harm your baby and in fact if you do not get a withdrawal bleed after taking this course of tablets, one possibility your doctor will need to rule out is a pregnancy.

What are the symptoms of PCOD?

The symptoms of PCOD can vary from woman to woman. Some of the symptoms of PCOD include:

·         Infertility (not able to get pregnant) because of not ovulating. In fact, PCOD is the most common cause of female infertility.

·         Infrequent, absent, and/or irregular menstrual periods

·         Increased hair growth on the face, chest, stomach, back, thumbs, or toes

·         Cysts on the ovaries

·         Acne, oily skin, or dandruff

·         Weight gain or obesity, usually with extra weight around the waist

·         Male-pattern baldness or thinning hair

·         Patches of skin on the neck, arms, breasts, or thighs that are thick and dark brown or black

·         Skin tags — excess flaps of skin in the armpits or neck area

·         Pelvic pain

·         Anxiety or depression

·         Sleep apnea — when breathing stops for short periods of time while asleep

How do I know if I have PCOD?

There is no single test to diagnose PCOD. Your doctor will take the following steps to find out if you have PCOD or if something else is causing your symptoms.

·         Medical history: Your doctor will ask about your menstrual periods, weight changes, and other symptoms.

·         Physical exam: Your doctor will want to measure your blood pressure, body mass index (BMI), and waist size. He or she also will check the areas of increased hair growth. You should try to allow the natural hair to grow for a few days before the visit.

·         Pelvic exam: Your doctor might want to check to see if your ovaries are enlarged or swollen by the increased number of small cysts.

·         Blood tests: Your doctor may check the androgen hormone and glucose (sugar) levels in your blood.

·         Vaginal ultrasound:  Your doctor may perform a test that uses sound waves to take pictures of the pelvic area. It might be used to examine your ovaries for cysts and check the endometrium -lining of the womb. This lining may become thicker if your periods are not regular.

How does PCOD affect a woman while pregnant?

Women with PCOD appear to have higher rates of:

·         Miscarriage

·         Gestational diabetes

·         Pregnancy-induced high blood pressure (preeclampsia)

·         Premature delivery

·         Babies born to women with PCOD have a higher risk of spending time in a neonatal intensive care unit or of dying before, during, or shortly after birth. Most of the time, these problems occur in multiple-birth babies (twins, triplets).

Researchers are studying whether the diabetes medicine metformin can prevent or reduce the chances of having problems while pregnant. Metformin also lowers male hormone levels and limits weight gain in women who are obese when they get pregnant. It does not appear to cause major birth defects or other problems in pregnant women. But, there have only been a few studies of metformin use in pregnant women to confirm its safety. Talk to your doctor about taking metformin if you are pregnant or are trying to become pregnant. Also, metformin is passed through breast milk. Talk with your doctor about metformin use if you are a nursing mother.

Does PCOD put women at risk for other health problems?

Women with PCOD have greater chances of developing several serious health conditions, including life-threatening diseases. Recent studies found that more than 50 percent of women with PCOD will have diabetes or pre-diabetes before the age of 40.

·         The risk of heart attack is 4 to 7 times higher in women with PCOD than women of the same age without PCOD.

·         Women with PCOD are at greater risk of having high blood pressure.

·         Women with PCOD have high levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol.

·         Women with PCOD can develop sleep apnea. This is when breathing stops for short periods of time during sleep.

·         Women with PCOD may also develop anxiety and depression. It is important to talk to your doctor about treatment for these mental health conditions.

Women with PCOD are also at risk for endometrial cancer. Irregular menstrual periods and the lack of ovulation cause women to produce the hormone estrogen, but not the hormone progesterone. Progesterone causes the endometrium (lining of the womb) to shed each month as a menstrual period. Without progesterone, the endometrium becomes thick, which can cause heavy or irregular bleeding. Over time, this can lead to endometrial hyperplasia, when the lining grows too much, and cancer. 

I have PCOD. What can I do to prevent complications?

If you have PCOD, get your symptoms under control at an earlier age to help reduce your chances of having complications like diabetes and heart disease. Talk to your doctor about treating all your symptoms, rather than focusing on just one aspect of your PCOD, such as problems getting pregnant. Also, talk to your doctor about getting tested for diabetes regularly. Other steps you can take to lower your chances of health problems include:

·         Eating right

·         Exercising

·         Not smoking

How can I cope with the emotional effects of PCOD?

Having PCOD can be difficult. You may feel

·         Embarrassed by your appearance

·         Worried about being able to get pregnant

·         Depressed

Getting treatment for PCOD can help with these concerns and help boost your self-esteem. You may also want to look for support groups in your area or online to help you deal with the emotional effects of PCOD. You are not alone and there are resources available for women with PCOD.

How to Manage your PCOD

It is important that a broad approach be used to treat and manage PCOD.

Lifestyle changes and Healthy eating

The good news is that PCOD can generally be treated with lifestyle changes that lead to good health. Studies show, that improving food and eating patterns, increasing exercise and losing some weight if necessary, can reduce insulin resistance, improve PCOD symptoms, help prevent long-term problems and reduce the use of medications. The main aims are to reduce both insulin resistance and insulin secretion and avoid excessive energy intake where weight is a concern. Food is an important part of culture, lifestyle and celebrations. Healthy eating is an essential part of PCOD management but this doesn’t mean following strict diets. Instead try small, sustainable changes that become a part of a normal lifestyle. What you can do

1. Eat regular meals

Spreading food more evenly over the day helps to prevent large swings in blood sugar, insulin and hunger levels. Eat regular meals and snacks when you need them over the day and avoid overeating later in the day. Eating more often doesn’t mean eating too much though.

2. Have a healthy variety of foods each day. This includes:

·         Eat plenty of fruits, salads and vegetables

·         These foods are high in fiber and vitamins and not too high in kilojoules. They should make up about half your plate at a main meal and be one of the first choices for snacks. Be careful with juices though as they can be high in sugar and kilojoules.

·         Wholegrain cereals

·         Choose wholegrain breads and breakfast cereals and keep serving sizes of rice and pasta to about one cup cooked at a time. Avoid too many extra biscuits, muffins and cakes so your intake of energy from starch and sugars (carbohydrate) is not too high.

·         The Glycemic Index is a ranking of foods with carbohydrate (sugar and starch) based on their effect on blood sugar (glucose) levels. Low G.I. foods have a number of benefits for PCOD. To find out more consult a dietitian.

·         Avoid large quantities of carbohydrate at any one meal, even from low GI foods (e.g. large serves of pasta or rice) – moderation is the key!

·         Include a moderate protein intake

·         Lean protein choices include meat, chicken, fish, eggs, dairy, nuts, legumes or soy foods and are an important part of the day’s nutrition as they contain minerals like iron, zinc and calcium. Protein also adds to the feeling of fullness when eating which may help with weight loss.

·         Healthy fats in small amounts

·         The type of fat eaten is important so choose monounsaturated fats and omega 3 essential fatty acids in moderation and avoid saturated fats. To do this, use small amounts of olive oil or canola oil in cooking and monounsaturated spreads instead of butter, use low fat dairy foods and include fish regularly. Check the labels on food for saturated fat levels.

3. Limit high fat, high sugar foods

Foods containing a lot of fat and sugar produce excess kilojoules (calories), contribute to weight gain and higher insulin levels and often don’t contain much nutrition. However, low fat, low sugar does not mean any fat, no sugar; The best approach is commonsense moderation and avoiding extremes in intake of any foods.

4. Pay attention to eating habits, not just food

People eat for many reasons such as pleasure, boredom, loneliness, stress or simply out of habit. This eating can be a concern if it leads to a less healthy food intake than needed. Rather than dieting, reducing this ‘non hungry’ eating is the best way to maintain a healthy weight. Serving sizes of food have also generally increased in recent years leading to many people becoming used to eating too much at a time. In this case experiment with smaller serving sizes and be careful not to overeat when eating out socially.

Physical Exercise and PCOD

Exercise is an essential part of managing PCOD. Regular physical activity can reduce insulin levels, increase the metabolic rate of the body, improve mood and energy levels and help maintain a healthy weight. Research has shown that people who exercise regularly, even if they are overweight or have a family history of diabetes, have less risk of developing diabetes or cardiovascular disease. Be active every day and then at least three to four times a week aim for 30 to 45 minutes of more vigorous exercise. A balanced mix of activities that include aerobic, resistance and flexibility/stretching exercises will give the best results. Variety is also important – if you are getting bored, it is time to try something new

·         Aiming for about 10,000 steps a day is an easy way to measure and assess general physical activity.

·         Put a limit to time watching television or in front of a computer. If you have a job where you sit for much of the day, get up and move around regularly.

·         Keep walking faster or further so your fitness keeps improving

·         Use the stairs instead of taking the lift, or park the car a bit further from the shops rather than the closest spot

·         Make time to take up a sport again you have enjoyed in the past

·         Make sure you have the right shoes and clothes