PCOS or PCOD? Most people don’t even know!

‘Is it PCOD or PCOS?’ Most people don’t even know about these two terms, so talking about the difference between them is altogether a different thing. In this article, you will be reading about PCOS and PCOD, their differences, symptoms, societal take on them, diagnosis, risks and treatments. Societal take will also give you an idea regarding the myths and taboos for the same. Syndrome (PCOS)/Disease (PCOD) causes the formation of follicle cysts in the ovaries. It also results in the excessive secretion of androgen (male steroid hormones), which causes several unusual changes in a female’s body.

Can you guess the age when adolescence had hit you? As a millennial, you would say somewhere between thirteen to nineteen, and if you are a post-millennial (i.e. born after 1997) you would say ten to sixteen, am I right? Will it surprise you if I say that today children as young as seven years old have started showing signs of puberty and adolescence changes. Our lifestyle has deeply affected this cycle of hormonal changes. For some females, their menopause is starting in their 30's itself. So it's safe to say that we are living in a very unreliable biological age.

If you'll google the rise of these two terms then you will find statements like ‘One in every ten women in India have PCOS’ or ‘One in every five women in India have PCOS’, but rarely a statement about PCOD will pop up on your screen. We will come back to it later, but if PCOS (and also PCOD) is so common then why aren't we hearing about it? No Instagram posts, hashtags or movements? It is because they are related to periods and pregnancy, which are often taken as a shy topic in our country. Polycystic Ovary Syndrome (PCOS) and Polycystic Ovary Disease (PCOD), females all over the world are facing this problem.
People who have an idea about it use these names interchangeably but one shouldn't. Even in many magazines and blogs, you will see no distinction has been made between them, and it is wrong.

Meaning
PCOS as read above is a syndrome in which several cysts (sacs filled with liquids) start growing on both the ovaries of women. They are large and often made out of immature eggs and other secretions. Due to this, girls face problems in having periods. Sometimes they don’t have them at all or otherwise, they are delayed and unreliable. This usually gets identified in teenagers, almost at the first period itself. While, PCOD, on the other hand, has similar implications on ovary but they are minor in nature. Smaller sacs are formed on ovaries, which can go back by three months (change in lifestyle needed) and are also less in number. In PCOD periods are normal, sometimes delayed. It gets detected when a woman of childbearing age isn't able to conceive.

Effects
Apart from cysts formation, ovaries start secreting androgen. Androgen is a male steroid hormone, even in normal conditions ovaries secrete it but in much less proportion. Estrogen is a female steroid hormone which is by default more important for women, but in this case androgens are secreted far more than estrogen. This results in various unusual changes in a female.
Symptoms
PCOS has a number of symptoms which include:

Obesity
Irregular periods
No periods at all
Excess Facial Hair
Baldness
Patches on nape or elbows
Axillary Hair
Body Odor
Fatigue
Sleep-related problems
Depression/anxiety
Mood Swings
Headache

A woman can have many or most of these symptoms, the signs will be visible with the start of puberty itself. The most common sign is irregular periods/no periods.
PCOD has similar symptoms with some major differences:
It’s rare to be detected at an early age.
Periods are irregular rather than none at all.
Heaving bleeding; as periods are irregular so there’s a buildup on the uterine wall.
Obesity is observed to be severe in PCOD than PCOS.
(Note: You can notice that many of male-related symptoms are effects of high androgen only)
Current Scenario (Society)
Doctors and researchers are still finding the cause of this condition, one widely accepted factor of it is genetics. It's an observation that any female going through PCOS or PCOD has a family history of either. Lately, awareness programs have been started and females are now speaking about it.
In India, very few people know about it. Mainly they are from urban area, and most of them know it because:
They are gynecologists (or in medical field)
Females who are experiencing it (or have)
Family and friends of the above females.
In rural parts, talking about periods is also a taboo so such disease is a long shot.

Diagnosis
There is no specific test that can be used to diagnose PCOS or PCOD, there’s not even any kind of widespread agreement on what the diagnostic criteria should be. This is because the signs and symptoms for this are very common and similar to other types of diseases, so it takes experience and judgement of the doctor to state and diagnose it. Gynecologists typically evaluate a combination of clinical findings such as your signs and symptoms, medical and family history, physical exam as well as laboratory test results, to help them to make a diagnosis. Before a PCOS/PCOD diagnosis is made, some tests are done to rule out other possible causes of similar symptoms. For example, adrenal or ovarian tumours or overgrowth in adrenal tissue called adrenal hyperplasia can also cause an overproduction of male hormones in women.
A pelvic ultrasound (transvaginal and/or pelvic/abdominal) is used to evaluate enlarged ovaries. In PCOS, the ovaries maybe 1.5 to 3 times larger than normal and characteristically have 12 or more follicles per ovary measuring 2 to 9 mm in diameter. In PCOD, the ovaries may not appear large but they will have follicles around 5 to 6 per ovary which will be relatively smaller. Often the cysts are lined up on the surface of the ovaries forming the appearance of a 'pearl necklace'. The follicles tend to be small and immature, thus never reaching full development. These changes have been recorded in more than 90% of women with PCOS, but they are also found in up to 25% of women without PCOS symptoms.

Risks
Infertility- PCOD causes infertility as it reduces the frequency of ovulation in the body, in PCOS female might not be able to conceive at all even after following lifestyle changes.
Diabetes- PCOS/PCOD causes insulin resistance in the body leading to diabetes.
Heart Disease- Both increases the blood pressure in the body leading to vulnerability towards heart problems.
Endometrial Cancer- Because there is delayed ovulation, the body experiences a thickening of the endometrium, the inner lining of the uterus. This increases the odds of getting endometrial cancer. (Low in PCOD, high in PCOS)
Depression- Hormonal imbalance can cause depression, mood swing, anxiety and changed behaviour in women. Even a diagnosis of it can depress or deeply saddened a female.

Treatments
There is no cure for PCOS and it does not go away on its own. Treatment of it is only aimed at reducing the symptoms and preventing further complications. Several options are available for this, and the choice depends upon the type of the individual woman's symptoms and their severity, also her desire to become pregnant. This include:
Diet, exercise, and maintaining healthy body weight, these lifestyle changes are recommended to help in decreasing insulin resistance. Weight reduction also decreases testosterone, insulin, and LH levels. Regular exercise and healthy foods will help in maintaining lower blood pressure and cholesterol as well as can improve sleep apnea problems. Ceasing to smoke cigarettes and use of other tobacco products may help in lowering androgen levels.
Various drugs may be prescribed to treat insulin resistance and diabetes, some may also help to regulate menstrual periods and encourage ovulation.
Waxing, shaving, depilatory, and electrolysis or laser treatments can be used to remove excess facial and body hair.
Antibiotics or retinoic acids may be used to treat acne.
Oral contraceptives may be prescribed to help normalize menstrual periods.

PCOD in many cases have been treated completely but it always leaves chances to grow back. Its treatments are:
The simple and most effective way to treat it is accepting healthy lifestyle changes. All the changes suggested above shall be followed will be for the same reasons.
Birth control pills for controlling periods, but on doctor recommendation only. Hormonal medications to check androgen levels, but on doctor recommendation only.

Homoeopathy may not promise a complete cure of the problem (PCOD/PCOS). But the approach of the treatment is holistic and can assist in preventing any further deterioration of health due to the problem. Homoeopathic remedies work on correcting hormonal imbalances, regularizing ovulation, restoring menstrual normalcy. Some proponents of homoeopathy also claim that it helps in dissolving the cysts to eliminate the need for hormone therapy and surgery that promise complete cure from the condition.

It’s tough luck for a female with PCOS conceiving and delivering a normal child, but consultation with gynaecologists can always be made to check for new advancements in technology. For PCOD it’s relatively easy if healthy lifestyles are followed. At last, females should remember and make other females realise that all types of diseases are harmful to us and we should talk about them. Consulting a professional (gynaecologist in this case) with your problem is a normal and necessary thing to do.
(Note: If you find any changes in your cycle do consult a doctor.)

Author Bio:
Dr. Priya Banerjee
(M.D. (obs. & GYN.)
Have been practicing for fifteen years, an online consultant with Femicure [https://www.femicure.com/], along with it, have written medical articles and blogs for 10 years. Also an infertility specialist with IVF, IUI, ICSI, and infertility related surgeries.