This is a hormonal disorder causing enlarged ovaries with small benign cysts on the outer edges. This is associated with insulin resistance and infertility. The Rotterdam criteria for diagnosis includes: hyperandrogenism; ovulatory dysfunction and polycystic ovaries. Obesity is a significant contributory factor.
Medications:
If fertility is desired:
- Tab. Fertomid 50 (Clomiphene 50 mg) – one tablet a day from day 3 to 7 of cycle. Repeat the dose in next cycle if there is no evidence of ovulation.
- Tab. Glycomet 500 SR (Metformin 500 mg) – one tablet twice a day. Gradually increase this by 500 mg every week up to a maximum 1000 mg twice a day if tolerable. Adjust individual doses for patients with renal insufficiency, liver disease.
- Cap. Becosule Z (Vitamin B12 and Folic acid) – one tablet a day along with Metformin.
- If patient conceives on tab. Glycomet 500 SR, continue for first 20 weeks. Adjust dose as per eGFR and watch for side-effects.
- Tab. Normoz (Myoinositol 550 mg, D-Chiro-inositol 13.8 mg) – one tablet twice a day till clinical improvement
If fertility not desired:
- Tab. Deviry 10 (Medroxyprogesterone 10 mg) – one tablet once a day from 16th day of the cycle for 10 days. Continue with this regime till clinical improvement.
- Tab. Glycomet SR (Metformin 500 mg) – one tablet twice a day. Gradually increase this by 500 mg every week up to a maximum 1000 mg twice a day if tolerable. Adjust individual doses for patients with renal insufficiency, liver disease.
- Cap. Becosule Z (Vitamin B12 and Folic acid) one tablet a day along with Metformin.
Supportive treatment:
- Tab. Evecare Forte (herbal remedy) – one tablet twice a day for 3 to 6 months.
General advice:
- Weight loss is vitally important and specifically aim for fat loss.
- Advice regular exercise to facilitate fat loss.
- Avoid fatty foods and advice balanced diet.
Investigations:
- Serum DHEA (di-hyro-epi-androsterone) – Raised in PCOD
- Serum total testosterone – Can be raised in PCOD
- USG abdomen and pelvis – To identify polycystic ovaries
- Urine pregnancy test
- Thyroid stimulating hormone (TSH) – To rule out associated hypothyroidism
- Serum prolactin – Can be raised in prolactinoma or other differential diagnosis
- Blood pressure – likely to be high in metabolic syndrome
- Fasting blood sugasr and post lunch sugars – Aim for good blood sugar management
- Lipid profile – To rule out dyslipidemia
- Serum LH (leutinising hormone): Serum FSH (follicle stimulating hormone) – This ratio is reversed in PCOD. It will help in other differential diagnosis
- Serum estradiol – High estradiol levels are suggestive of PCOD
Referral:
Consider referral to gynaecologist for structural pathologies. Consider referral to endocrinologist for metabolic disorders.