Polycystic Ovarian

Disorder
Stein-Leventhal Disease
-Meher Shivie Choudhry
Figure 1.1 Polycystic Ovary
 Biology Research Paper
Polycystic Ovarian Disorder

1.What is PCOD?
Polycystic Ovarian Disease (PCOD) is a very common condition affecting 5% to
10% of women in the age group 12–45 years. It is a problem in which a woman’s
hormones are out of balance. It can cause problems with menstrual periods and
make it difficult for her to conceive. The principal features include no ovulation,
irregular periods, acne and hirsuitism. If not treated it can cause insulin resistant
diabetes, obesity and high cholesterol leading to heart disease.
PCOD is a disease characterized by multiple (‘poly’) cysts (small sacs filled with
fluid) in the ovaries.
It is also known as PCOS (Polycystic Ovarian Syndrome) or Stein-Leventhal
Syndrome.

2.Why I chose this topic:

I chose this topic because I myself have been diagnosed with PCOD and I thought
that choosing this topic to research on would actually help me know more about
my own symptoms and how to tackle them. Learning more about PCOD would
make me more aware and more responsible and let me take better care of my
health.
Figure 3.1 Hormonal Changes in Normal Menstrual Cycle
3.Causes of PCOD:
PCOS problems are caused by hormone changes hormonal imbalance. One
hormone change triggers another, which changes another.

3.1 Raised levels of Testosterone – Androgens or "male hormones," although all

women make small amounts of androgens...Higher than normal
androgen levels in women can prevent the ovaries from releasing an egg
(ovulation) during each menstrual cycle. Excess androgen produced by the
theca cells of the ovaries, due either to hyperinsulinemia or increased
luteinizing hormone (LH) levels.

3.2 Raised levels of Luteinising Hormone (LH) – Due to increased production

from the anterior pituitary. This stimulates ovulation but may have an
abnormal effect on the ovaries if levels are too high.

3.3 low levels of Sex Hormone-Binding Globulin (SHBG) – A protein in the blood,
which binds to testosterone and reduces the effect of testosterone.

3.4 Raised levels of Prolactin - Hormone that stimulates the breast glands to
produce milk during pregnancy.

3.5 High levels of Insulin (a hormone that helps convert sugars and starches into
energy) If you have insulin resistance, your ability to use insulin effectively is
impaired, and also your pancreas has to secrete more insulin to make glucose
available to cells (so, hyperinsulinaemia) Excess insulin might also affect the
ovaries by increasing androgen production, which may interfere with the
ovaries' ability to ovulate.

3.6 A significant hereditary component, if your mother or sister has PCOS, you're
more likely to have it.

3.7 If you're overweight, your chances of developing it are greater. As weight

gain increases insulin resistance. Fatty tissues are hormonally active and they
produce estrogen which disrupts ovulation
Periods & fertility Hair & skin Mental & emotional Sleep
health
No periods or periods Excess facial Mood changes Sleep apnoea (a
that are: and/or body hair sleep disorder in
irregular (hirsutism) Depression which abnormal
infrequent pauses of
heavy Acne on the face Anxiety breathing occur
and/or body during sleep)
Immature ovarian
eggs that do not Scalp hair loss
ovulate (alopecia)

Multiple cysts on the Darkened skin

ovaries patches
(acanthosis
Difficulty becoming nigricans)
pregnant

Table 4.1 Common Symptoms of PCOD

Figure 4.2 Frequency of Infertility in

PCOD and non-PCOD Affected Women
4.Symptoms of PCOD:
PCOD symptoms present in many different ways. Some women will have only
some, or mild symptoms, whereas others will have severe symptoms.

Many of the symptoms of PCOS are caused by high levels of androgens

circulating in your body, causing 'hyperandrogenism'. Androgens are also called
'male' hormones, and the main one is testosterone. All women produce small
amounts of androgens in body tissues including the ovaries and the adrenal
glands. High levels of androgens can prevent ovulation and affect the menstrual
cycle.

The hormone insulin is also thought to be an important part of the development

of PCOS. Insulin is needed in the body for control of blood sugar, and 'insulin
resistance' is thought to be a key part of the development of PCOS. Insulin
resistance means that some parts of the body are 'resistant' to insulin, meaning
that more insulin than usual is needed to keep blood sugar in the normal range.
This means that insulin levels are often high or the body doesn't respond
normally to insulin. This in turn can affect the function of the ovaries, including
hormone and egg production.

4.1 Periods
Although some women with PCOS have regular periods, high levels of androgens
and also the hormone insulin can disrupt the monthly cycle of ovulation (when
eggs are released) and menstruation.

If you have PCOS, your periods may be 'irregular' or stop altogether. In some
girls PCOS is a cause of periods failing to commence. The average menstrual cycle
is 28 days with one ovulation, but anywhere between 21 and 35 days is
considered 'normal'. An 'irregular' period cycle is defined as either:
Eight or less menstrual cycles per year
Menstrual cycles longer than 35 days.

As menstrual cycles lengthen, ovulation may stop entirely or only occur

occasionally. Some women with PCOS also experience heavier or lighter bleeding
during their cycle.

4.2 Excess hair (Hirsutism)

Hirsutism is excess hair on the face and body due to high levels of androgens
stimulating the hair follicles. This excess hair is thicker and darker. The hair
typically grows in areas where it is more usual for men to grow hair such as the
sideburn region, chin, upper lip, around the nipples, lower abdomen, chest and
thighs.

Up to 60% of women with PCOS have hirsutism. Women with PCOS from ethnic
groups prone to darker body hair (eg Sri Lankan, Indian and Mediterranean
populations) often find they are more severely affected by hirsutism.
Figure 4.3 Psychological Symptoms connected to PCOD
4.3 Hair loss (Alopecia)
For some women with PCOS, the high level of androgens causes hair loss or
thinning of the scalp hair in a 'male-like' pattern: a receding frontal hair line and
thinning on top of the scalp.

4.4 Acne
If you have PCOS, the higher level of androgens can increase the size of the oil
production glands on the skin, which can lead to increased acne. Acne is common
in adolescence, but young women with PCOS also tend to have more severe acne.

4.5 Reduced Fertility

High levels of androgens and high insulin levels can affect the menstrual cycle
and prevent ovulation (the release of a mature egg from the ovary). Ovulation
can stop completely, or it can occur irregularly. This can make it more difficult
for women with PCOS to conceive naturally, and some women can also have a
greater risk of miscarriage. However, this does not mean that all women with
PCOS are infertile.
Many women with PCOS have children without the need for medical infertility
treatment. Others may require medical assistance. But overall, women with
PCOD have the same number of children as women without PCOD.

As being overweight can increase fertility problems, it is important to exercise

regularly to maintain a healthy weight and/or prevent weight gain. For those
who are overweight, even weight loss of 5-10% will improve fertility.

4.6 Psychological effects

Depression and anxiety are common symptoms of PCOD. About 29% of women
with PCOD have depression compared to around 7% of women in the general
population and even more women with PCOD will have anxiety – 57% compared
to 18% of women in the general population.

There may be some link to hormones and PCOD but more research is needed in
this area before we can understand why and how the hormones impact on
mental wellbeing in PCOD.
Coping with hirsutism, severe acne, weight changes and fertility problems may
affect your body image, self-esteem, sexuality and femininity. This may add to
depression and anxiety levels. Problems with fertility can have an impact on
your mood, particularly if fertility has been a concern for a long time.
Figure 6.1 Ultrasound View of Polycystic Ovary
5.Diagnosing PCOD:
A diagnosis of polycystic ovary syndrome can be made when at least two out of
three of the following criteria are met:

The ovaries are 'polycystic' because:

 12 or more follicles are visible on one ovary, or
 the size of one or both ovaries is increased

There are high levels of 'male' hormones (androgens) in the blood

(hyperandrogenism:
Symptoms suggesting an excess of androgens such as:
 excess facial or body hair growth
 scalp hair loss
 acne

There is menstrual dysfunction such as:

 lack of periods or menses (menstrual flow)
 menstrual irregularity
 lack of ovulation (where an egg is released)

A woman can be diagnosed with PCOD even if she has regular periods or normal
androgen levels.

6.Tests To Detect PCOD:

Not all tests are necessary for every woman.

6.1 Medical history & examination

As part of the diagnosis, your doctor will review your medical history and assess
your physical symptoms, weight and BMI (body mass index).

6.2 Ultrasound
An ultrasound of the uterus, ovaries and the pelvis can be carried out to identify
whether there are any cysts on your ovaries and whether an ovary is enlarged.

A transvaginal ultrasound is a painless test with no radiation. It uses a pen–

shaped probe with an ultrasound sensor on the tip, which is inserted into the
vagina. This produces a much clearer picture than an abdominal ultrasound.

Transvaginal ultrasounds are only performed on women who have been sexually
active, otherwise an abdominal scan is done where the ovaries are viewed from
the outside through the stomach wall.
Table 6.2 Comparison Chart between Blood Test Results of PCOD and non-PCOD Individuals
6.3 Blood tests
Blood tests are used to assess the levels of androgens in your body. Blood tests
for androgens (such as testosterone) and free androgen index (FAI) are the best
tests for diagnosing whether you have hyperandrogenism (high androgen
levels).

Other blood tests that can be useful in identifying high androgen levels include:
 sex hormone binding–globulin (SHBG)
 dehydroepiandrosterone sulphate (DHEAS)
 androstenedione

Blood tests may also be done to assess the levels of other reproductive hormones
in your body as these may affect your menstruation. These may include testing
your levels of:
 oestradiol (oestrogen)
 follicle stimulating hormone (FSH)
 luteinising hormone (LH)

Blood tests to exclude other conditions that have similar symptoms to PCOS may
measure the levels of:
 thyroid stimulating hormone (TSH)
 prolactin
 hormones related to adrenal function (glands found above the kidney),
e.g. 17-hydroxyprogesterone
7. Complications of PCOD:
Besides insulin resistance and the high levels of androgens ('male' hormones)
associated with PCOS, other health issues women with PCOS may encounter
include:
 Weight gain or obesity
 Prediabetes
 Type 2 diabetes
 Cardiovascular disease
 Metabolic syndrome (generally having at least two of high blood pressure,
high cholesterol, obesity, high fasting blood glucose)
 Endometrial cancer
 Sleep apnoea

7.1 Weight gain & obesity

PCOD can occur in women of any weight, however, up to 75% of women with
PCOD are overweight or obese. This excess weight is more likely to be
concentrated around the abdominal (stomach) region and around the hips,
buttocks and thighs.

Being overweight, and especially having a high amount of abdominal obesity, is

associated with:
 A higher risk of insulin resistance (a state where the body doesn't use the
available insulin effectively to help keep the glucose levels stable, ie the
insulin produced is not working properly)
 Problems with infertility
 A higher risk of type 2 diabetes
 A higher risk of cardiovascular disease, including high blood pressure and
heart disease

7.2 Metabolic syndrome

Women with PCOD have a higher prevalence of metabolic syndrome. Metabolic
syndrome is a collection of conditions (listed below) that often occur together
and increase the risk of type 2 diabetes and cardiovascular disease:
 Impaired glucose tolerance (indicating the beginnings of insulin
resistance)
 High blood pressure
 Abdominal obesity
 High blood cholesterol

7.3 Prediabetes & type 2 diabetes

Women with PCOS have between four and seven times increased risk of
developing prediabetes and type 2 diabetes than women without PCOS.
Prediabetes is the stage before type 2 diabetes. Women with PCOS are also more
likely to develop diabetes earlier, eg in their 30s and 40s. This risk is further
increased by:
 being overweight or obese
 having insulin resistance
 having an immediate family member with type 2 diabetes

Women with PCOS have a higher risk of developing diabetes in pregnancy

(gestational diabetes). This risk increases if you are overweight when pregnant.

7.4 Cardiovascular disease

Women with PCOD are thought to be at higher risk of having future heart disease
or stroke. There are a number of factors that increase the risk of cardiovascular
disease such as:
 high blood fats or cholesterol
 high levels of 'bad' cholesterol or low density lipoprotein cholesterol
which increases the risk of developing heart disease
 high levels of inflammatory proteins, which can alter the function of blood
vessels and increase insulin resistance
 high blood pressure
While being overweight can increase these risks, these risks appear to be
increased in PCOD independent of the effect of obesity.

7.5 Endometrial cancer

Having the condition PCOS does not cause endometrial cancer, rather it is having
very infrequent periods which may increase the risk of endometrial cancer.

Chronic anovulation (lack of eggs being released regularly) leads to a lack of

menstruation or shedding of the lining of the uterus (endometrium). If this
happens, the endometrium can thicken which can increase the risk of abnormal
cells that, as a woman ages, can develop into cancerous cells.

This risk can be greatly reduced with treatments such as the oral contraceptive
pill. By improving the regularity of the menstrual cycle, the uterine lining is shed
more often during menstruation.

Adequate physical activity and having a healthy body weight can also assist in
normalising periods and reducing the risk of endometrial cancer.

7.6 Sleep apnoea

Women with PCOS, particularly when they are overweight or insulin resistant,
can be at an increased risk of developing sleep disordered breathing or sleep
apnoea. Sleep apnoea occurs when the upper airway is obstructed during
sleep. Excessive fatty tissue in the neck can partially block the airway leading to
sleep loss, fatigue, tiredness and reduced quality of life.
8. Treatment for PCOD:
PCOD can be successfully treated with the following methods:
8.1 physical activity and weight loss
8.2 healthy diet plan
8.3 the oral contraceptive pill
8.4 insulin sensitising drugs such as Metformin
8.5 hormones that are called gonadotrophins
8.6 testosterone lowering drugs
8.7 weight loss drugs
8.8 antidepressants
8.9 anti-anxiety drugs.
9. Bibliography:

9.1 https://jeanhailes.org.au/health-a-z/pcos/management-treatment

9.2 https://www.columbiaasia.com/india/health-articles/what-polycystic-ovarian-
disease-pcod-causes-treatment-pcod

9.3 https://www.webmd.com/women/what-is-pcos

9.4 https://www.acfs2000.com/polycystic-ovarian-disease-pcod.html
 Case Study

Subject: Meher Shivie Choudhry

Year of Diagnosis: 2015
Diagnosed by: Dr. Anju Virmani (Endocrinologist)