Polycystic Ovarian Disease from childhood to adult life

The Polycystic Ovarian Disease (PCOD) has been associated with infertility, acne, hirsutism (increased amount of hairs) and obesity. The exact mechanism of this ovarian malfunction is still uncertain. It is however of multifactorial origin and inheritance seems to be important increasing the frequency of symptoms among 1^st degree relatives. The PCO women have a characteristic android type of body structure, fat deposited on the belly, short neck and flat small breast. The definite diagnosis is based on ultrasonographic findings. The ovaries are larger than usual and carry large follicles situated around the ovary which look like necklace, falsely called cysts. Actually these follicles are very precious since they contain oocytes with the potential to be fertilized. However, their abnormal function results to high prolactin and testosterone, low estradiol levels and failure of progesterone production. Most of these patients fail to ovulate between 2 – 6 months leading to subfertility. In addition the chronic exposure of endometrium to unopposed estrogens increases the risk of endometrial cancer at the age of 50-60.

The risk for diabetes type II and hypertension is also increased later in life. Hence it is of primary importance that the patient understands the severity of the disease and future complications in order to accept and follow obediently the preventive therapy provided. Reduction of body weight and physical exercise (like aerobics) most of the times help to regulate the period once a month. In cases that there is no response or body mass index is high then oral contraceptives or progesterone tabs 14 days per month or ovarian drilling will definitely improve and maintain regular periods. The patients that did not receive any preventive therapy to regulate their periods are considered high risk individuals to develop later in their life high blood pressure, diabetes and endometrial cancer. Hence they should be examined every 6 months with 2 hourly post prandial blood glucose checks, HgA1c test, and transvaginal ultrasound for measuring the endometrial thickness and activity. Infertility cases are usually treated with gonadotropin hormones for induction of ovulation. There women with normal body weight but with abnormal menstrual cycle and PCO characteristics in the ultrasound. The preventive treatment is equally important in these patients. The PCOD probably is evident since childhood but symptoms and oligo-ovulation expressed during adolescence and adult life. That’s another vital reason to encourage obese little girls to lose weight and exercise daily as a preventive measure to PCOD.