This story is about Polly, who has suffered and dealt with PCOD ever since she achieved menarche. When Polly was born to her lovely parents Asha and Sunil, she was a healthy baby who weighed 3 kilograms. Polly was a very special baby as she was born to her parents after 5 years of marriage and thousands of prayers. She was well fed, pampered and always showered with love by her doting parents. As Polly grew older, she began enjoying junk food and consequently became heavier than most of the children in her class. When she celebrated her 11th birthday, her mother noticed that she had already started developing breasts and her face exhibited traces of acne. Concerned about premature menarche (onset of early puberty), her mother brought her to me. I realised that her mother’s concerns were justified and Polly needed counselling. Polly and her parents were counselled about the need for a healthy diet and the importance of exercise.
I wish Polly had heeded my advice, because three years later, she was brought back to me with complaints of severe bleeding during menstruation and irregular and delayed periods. She had begun getting her periods at the age of 12 years. She had to be started on hormonal pills to control the heavy menstrual bleeding and the ultrasound confirmed that she had Polycystic Ovarian Disease or PCOD.
Her mother asked me several questions:
What is Polycystic Ovarian Disease?
Polycystic ovary disease (PCOD) is a common health problem that can affect teen girls and young women. It can cause irregular menstrual cycles, make periods heavier, or even make periods stop.
What Causes Polycystic Ovarian Disease?
The exact cause is not known, but we do know that it is caused by a hormonal imbalance of oestrogen, progesterone, testosterone and insulin. PCOD is often found to be hereditary.
What Is Wrong With the Hormones?
In girls, the ovaries make the hormones oestrogen and progesterone as well as small amounts of male hormones known as androgens. These hormones regulate a girl’s menstrual cycle and ovulation (when the egg is released). In girls with PCOD, the ovaries make higher than normal amounts of androgens and their bodies arrest the functioning of the insulin hormone. Too much insulin also signals the ovaries to release extra male hormones.
How Does This Disturbed Balance of Hormones Affect Periods?
The higher amounts of androgen due to PCOD can interfere with egg development and release. Instead of the eggs maturing, sometimes cysts (little sacs filled with liquid) develop. Then, instead of an egg being released during ovulation as in a normal period, the cysts build up in the ovaries. Polycystic ovaries can become enlarged. Girls with PCOD usually do not ovulate or release an egg each month. Effectively, many have irregular or missed periods.
Why Do Women With PCOD Use OC Pills?
These pills expose the lining to the progesterone hormone in quantities sufficient to ensure that it stays thin and healthy. Moreover, these pills also serve to lower the quantity of androgen in a girl’s system, often helping to resolve hair and skin problems.
Are There Any Other Complications of PCOD?
Imbalanced hormone levels can cause changes in a girl’s entire body, not just her ovaries.
Weight gain, obesity or difficulty maintaining a normal weight, especially when the extra weight is concentrated around the waist.
A condition called hirsutism, where a girl grows extra hair on her face, chest, abdomen, nipple area, or back (a little of this is normal for most girls, though).
Thinning hair on the head (alopecia).
Acne and clogged pores.
Darkened, thickened skin around the neck, armpits, or breasts (this is called acanthosis nigricans).
High blood pressure, high cholesterol, or diabetes mellitus (high blood sugar levels).
Difficulty in conceiving or infertility.
Our dear Polly was put on a low carbohydrate diet for weight loss, an exercise schedule, and pills in a bid to reclaim the regularity of her periods. She lost weight and started experiencing regular menstrual cycles too.
But as her studies and other commitments took priority, her relationship with exercise became strained. She gradually regained all the weight she had lost and started having irregular cycles again. She ignored regular treatment and occasionally took tablets to stimulate her periods. By now, Polly was 24 years old and her parents were thinking of getting her married. She had gained weight, had mild hirsutism and was menstruating hardly 4 or 5 times a year. She visited me again and we restarted a treatment like the one she’d undergone before. However, her ovaries had become resistant and were not responding to the treatment.
As a result, she was also advised to think about fertility immediately after marriage as her eggs were not growing in the best way. When she did get married, despite her best effort, she was unable to conceive naturally even after trying for 4 years.