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Polycystic ovarian disease in adult and perimenopausal women

Shakuntala Chhabra

Polycystic ovarian disease (PCOD) is most common endocrine disorder in women. Symptoms are variable and often involve more than one body function. The major clinical features are hirsutism, menstrual irregularities, obesity, insulin resistance, hyperinsulinemia, polycystic ovaries (PCO). Other characteristics include malepattern balding, acanthosis negricans, sleep apnea with increased risk for hypertension, cardiovascular disease, diabetes mellitus, endometrial carcinoma, and overproduction of ovarian androgens and luteinizing hormone. While some believe that PCOD disappears after menopause, symptoms can persist after menopause. The cause of PCOD is still unknown. Genetic studies suggest that transmission is autosomal dominant with decreased penetrance because of hypersensitive intra-ovarian-insulin-androgen signaling with disturbances in gonadotropin levels, hyperandrogenism, and reduced insulin sensitivity. Hyperinsulinaemia frequently stimulates lipid storage with alterations in lipoproteins, cholesterol, hyperlipidaemia obesity. Anti-Mullerian hormone might be responsible for these abnormalities.

Information on PCOD in adult perimenopausal women is scarce as it may be difficult to diagnose, since one marker is irregular menstruation. PCO, a common feature of PCOD, may occur with or without other disorders and the associated obesity is of android (central) type with a waist-hip ratio (WHR) of > 0.8. Fasting glucose insulin ratio (FGI) has become a popular diagnostic criteria. Triglycerides, low-density lipoprotein (LDL), and cholesterol are elevated with decreased levels of sex hormone binding globulin (SHBG) due to hyperinsulinemia. The elevated levels of serum leptin and insulin and their linkage to obesity suggest the potentially complicated implications for obese patients.

Preventative measures for PCOD are limited. Clinical management is primarily focused on treating symptoms and manifestations and preventing long-term complications. Oral contraceptive pills (OCP) have several benefits, including treatment of irregular menstruation. Insulin-sensitizing agents can ameliorate insulin resistance, endocrine, and metabolic reproductive abnormalities. Metformin has been extensively used and is not associated with an increase in insulin secretion or risk of hypoglycaemia. The weight loss that accompanies protracted therapy may account for some of the beneficial effects. Long-term follow-up is needed to determine the effectiveness in changing the metabolic outcomes without causing other complications, such as reducing hair growth. Management should include patient education, with particular attention to diabetes, cardiovascular risk, obesity and endometrial cancer.