PCOS and PCOD: Learn the Symptoms, Differences, and Treatment Options

21 November,2024

Polycystic Ovary Syndrome (PCOS) and Polycystic Ovary Disease (PCOD) are common hormonal disorders in women. These disorders can significantly impact overall health, fertility, and quality of life. It would be difficult to be unaware of the terms PCOD and PCOS if you are a girl who has come to the age of reproductivity. However, most people don't understand the difference between these terms and often use them interchangeably.

With over 116 million women affected by PCOS, it is our responsibility to educate our readers about the disease and help them make informed decisions. Let's break down what PCOS and PCOD problems are, how they differ, and explore effective ways to manage them.

What is PCOS?

The full form of PCOS is polycystic ovary syndrome. It is a common hormonal disorder that impacts a woman's reproductive system, particularly affecting the ovaries' ability to function as they normally would.  Here's a closer breakdown of how PCOS impacts the body:

Ovarian Hormones:

• The ovaries produce progesterone and estrogen, hormones essential for regulating the menstrual cycle, and a small amount of androgens (male hormones).
• PCOS leads to an excess of androgens, which disrupts this balance, contributing to menstrual irregularities and other symptoms.

Ovulation and Hormonal Control:

• Ovulation is normally controlled by two key hormones from the pituitary gland: follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
• FSH stimulates the development of ovarian follicles, each containing an egg. LH then triggers the release of a mature egg from the ovary in a process called ovulation.
• In women with PCOS, hormonal imbalances hinder this process, leading to the release of immature eggs. It also causes ovulation to become infrequent or absent.

Follicles and Cysts:

• With PCOS, numerous small, fluid-filled sacs, known as follicles, accumulate in the ovaries. Each follicle holds an immature egg that doesn't fully develop.
• Since these follicles don't mature enough to release eggs, ovulation does not occur as it should. The term "polycystic" indicates the presence of many such cyst-like follicles.

Impact on Hormone Levels:

• The lack of regular ovulation affects the levels of several hormones:
  • Progesterone levels drop, leading to irregular or missed menstrual cycles.
  • Androgen levels increase, causing symptoms like acne, excess body hair, and scalp hair thinning.

What are the Different Types of PCOS?

PCOS is a metabolic disorder affecting women of reproductive age (12 to 51). It may also lead to other health concerns, like insulin resistance, obesity, and skin conditions. PCOS can present differently in individuals, and understanding its specific type is crucial for effective management. Here's a concise overview of the seven primary types of PCOS and their treatment approaches:

1. Insulin-Resistant PCOS: In insulin-resistant PCOS, the body cells become resistant to insulin, leading to abnormally high amounts of glucose in the blood. It further leads to increased androgen production and disrupts hormonal balance. Insulin-resistant PCOS is the most common type of PCOS, responsible for over 70% of cases. 

• Symptoms of insulin-resistant PCOS include weight gain, acne, excess hair growth, and irregular cycles.
• Treatment includes lifestyle modifications such as a balanced diet (low glycemic index), regular exercise, stress management, and adequate sleep. Medical management includes Insulin-sensitizing medications (e.g., Metformin) and supplements like inositol.

2. Lean PCOS: Lean polycystic ovarian syndrome affects women who are of normal weight or are underweight. It leads to hormonal imbalances and irregular periods.

• Symptoms of lean PCOS are irregular periods, acne, and fertility challenges.
• Treatment focuses on enhancing insulin sensitivity and balancing hormones. The approach is similar to insulin-resistant PCOS, emphasizing individualized diet and exercise.

3. Inflammatory PCOS: In women with PCOS, chronic low-grade inflammation can worsen insulin resistance and disrupt hormonal balance. An increased thyroid level, decreased vitamin D levels, and abnormal blood count levels can indicate this type of PCOS.

• Symptoms of inflammatory PCOS can be different and can manifest as fatigue, joint pain, digestive issues, and skin flare-ups.
• Treatment includes dietary and lifestyle changes, such as anti-inflammatory foods (rich in omega-3s, antioxidants, and whole foods) and stress reduction techniques (e.g., yoga and meditation). Anti-inflammatory medications can also be prescribed if needed.

4. Hidden-Cause PCOS: When the exact reason for PCOS is not readily apparent, it is known as hidden-cause PCOS. It can be multifactorial, potentially genetic, or environmental.

• Symptoms of hidden cause PCOS can vary widely, making it hard to identify the primary cause.
• Treatment includes hormone regulation and lifestyle adjustments.

5. Pill-Induced PCOS or Post-Pill PCOS: Women taking birth control pills often fear developing PCOS. While hormonal pills do not cause PCOS, suddenly stopping them could temporarily lead to irregular periods and other PCOS-related symptoms. It is reversible and gets resolved within months after the pills are withdrawn. 

• Symptoms of pill-induced PCOS appear as increased hair growth, acne, a high LH to FSH ratio, and irregular periods.
• Treatment includes discontinuing the contraceptive and allowing the body to recalibrate. Supportive Measures include a healthy diet, exercise, and supplements to promote hormonal recovery.

6. Adrenal PCOS: Around 10% of PCOS cases are caused by abnormal stress response and excessive androgen production by the adrenal glands. In adrenal PCOS, the levels of androgen DHEA-S are elevated, while testosterone remains normal. 

• Symptoms include excessive hair growth, acne, and irregular periods.
• Treatment options for adrenal PCOS are medications and supplements to manage adrenal hormone levels, stress management, and a nutrient-rich diet.

7. Post-Pregnancy PCOS: Mothers can develop postpartum PCOS after giving birth. This is due to hormonal imbalances during and after pregnancy. 

• Symptoms of post-pregnancy PCOS include irregular periods, difficulty losing pregnancy weight, and postpartum depression.
• Treatment includes postpartum-specific exercise, diet adjustments, hormonal therapy, or supplements as needed.

Other Types of PCOS Phenotypes

Some researchers suggest categorizing PCOS based on symptom patterns and hormone profiles, which can provide a more specific framework for understanding and managing the condition. Here's a breakdown of the four proposed types of PCOS based on these criteria:

1. Full-Blown PCOS (Type A): The Type A phenotype, or full-blown PCOS, is characterized by high levels of androgens, ovulatory dysfunction (irregular or absent ovulation, often causing irregular periods), and multiple cysts on the ovaries. It is the most severe form, typically associated with symptoms like acne, hirsutism (excessive hair growth), weight gain, and fertility issues.
2. Non-PCO PCOS (Type B): Type B PCOS is a non-polycystic ovary type of PCOS marked by the absence of visible cysts on the ovaries upon ultrasound examination. Symptoms are often similar to full-blown PCOS, with excess androgens causing acne, hirsutism, and irregular periods.
3. Ovulatory PCOS (Type C): Type C phenotype is the ovulatory form of PCOS characterized by regular ovulation and menstrual cycles (distinct from other types of PCOS). Since ovulation occurs, the chances of infertility are less compared to other forms of PCOS. Symptoms may include acne, hirsutism, and sometimes weight gain due to androgen excess, but periods are generally regular.
4. Non-Hyperandrogenic PCOS (Type D): Non-hyperandrogenic PCOS is the mildest form with no elevated androgen levels. It is characterized by lesser endocrine and metabolic dysfunction and a much lower chance of hyperandrogenism, obesity, and insulin resistance. Women with type D PCOS are less likely to experience androgenic symptoms like acne or hirsutism. Primary issues are irregular cycles and possible infertility.

What is PCOD?

PCOD (Polycystic Ovary Disease) is similar to PCOS in that it involves multiple small cysts on the ovaries. However, PCOD is often viewed as less severe and more manageable with lifestyle changes. 

• In PCOD, the ovaries release immature eggs in large quantities. Over time, these eggs turn into cysts and increase the size of the ovaries. 
• The ovaries then release large amounts of male hormones, which can lead to hormonal imbalance and irregular periods. 
• Other symptoms, such as abnormal weight gain and excess hair growth, are also there but are usually less pronounced than in PCOS.

Some Key Facts Regarding PCOD and PCOS

• PCOS and PCOD are one of the most common disorders in women. PCOS is the major reason for anovulation and a leading cause of infertility.
• According to WHO, the condition affects 8 to 13% of women of reproductive age. 
• It is surprising to know up to 70% of females suffering from PCOS remain undiagnosed worldwide.
• PCOS often runs in families, but it can show different symptoms and affect people in various ways depending on their ethnicity.
• Around 20 to 30% of women suffering from PCOS are expected to develop diabetes and hyperlipidemia at some point in life.
• Approximately 30 out of 100 women having normal BMI (body mass index) suffer from lean PCOS.
• PCOS is associated with infertility, and over 70% have difficulty getting pregnant.
• PCOS increases the risk of heart attack by 4 to 7 times.
• Chances of endometrial cancer also increase by 3 times in women having PCOS.

What is the Difference Between PCOS and PCOD?

While PCOS and PCOD are related conditions that significantly affect women’s health, they still have some distinct features. Learning about the differences between the two can help navigate the treatment journey better.

• Definition and Prevalence: PCOD is a condition in which a woman’s ovaries produce multiple immature or partially mature eggs that develop into cysts. PCOS is a more severe metabolic syndrome characterized by the excessive production of androgens (male hormones), causing numerous cysts in the ovaries. PCOD is quite prevalent, affecting approximately one in three women globally. PCOS is less common than PCOD, with an estimated prevalence of 8 to 13% of women worldwide.
• Hormonal Differences: PCOD does not involve significant increases in male hormones (androgens). Symptoms are often less frequent and milder, with hormonal levels that are closer to normal. In PCOS, androgen levels are significantly elevated, leading to more pronounced symptoms such as acne, hirsutism (excess hair growth), and scalp hair thinning. Hormonal imbalances are more severe and disrupt ovulation and metabolic functions.
• Menstrual Irregularities: PCOD is often associated with infrequent or absent periods due to irregular ovulation. Menstrual irregularities are generally less severe. PCOS frequently causes irregular or heavy menstrual bleeding as a result of severe hormonal imbalance and disrupted ovulation. PCOS often requires medication or hormone therapy to regulate cycles, while PCOD can be managed with diet and lifestyle changes.
• Impact on Fertility: PCOD usually does not significantly impact fertility, and most women can conceive with minimal medical assistance. Approximately 80% of women with PCOD can become pregnant with lifestyle modifications and occasional medication. Whereas PCOS adversely affects fertility due to irregular ovulation or anovulation (absence of ovulation). Women with PCOS may face challenges in conceiving, and even if pregnancy occurs, there’s a higher risk of miscarriage, premature birth, or pregnancy complications.
• Health Complications: PCOD is rarely linked to serious health complications and is generally manageable with a healthy lifestyle. It is considered less severe and often does not lead to metabolic issues. PCOS poses significant health risks, including type 2 diabetes, high blood pressure, cardiovascular diseases, and a heightened risk of endometrial and breast cancers. It has metabolic implications, with risks of obesity and insulin resistance.

Differences Between Causes, Symptoms, and Treatment Options for PCOD and PCOS

As mentioned earlier, PCOD and PCOS are related conditions impacting the ovaries in women, but they have notable distinctions in symptoms, severity, causes, and treatment. Here’s a comprehensive look at the differences:

• Causes: PCOD is typically associated with lifestyle factors, such as poor diet, obesity, stress, and mild hormonal imbalance. It is not necessarily linked to metabolic syndrome or chronic inflammation. PCOS is a complex metabolic disorder, often involving genetic, hormonal, and environmental factors. Insulin resistance, inflammation, and significant hormonal imbalance are common contributing factors for PCOS.
• Symptoms and Severity: Symptoms of PCOD are mild to moderate and may include irregular periods, mild weight gain, and minimal androgen-related symptoms. These are often managed with diet, exercise, and occasional medication, with symptoms typically emerging later in life. PCOS symptoms are more pronounced and usually begin at a younger age. Women with PCOS frequently struggle with issues like hirsutism, acne, scalp hair loss, obesity, and severe menstrual irregularities, which require active management and sometimes hormone therapy.
• Treatment and Management: PCOD is mostly managed effectively through lifestyle modifications, such as regular exercise, weight management, and a balanced diet. Symptoms typically improve with minimal medical intervention, and fertility remains largely unaffected. PCOS, on the other hand, requires a comprehensive treatment approach, including lifestyle adjustments, medications to manage insulin resistance and androgen levels, and often fertility treatments for those trying to conceive. PCOS management is ongoing and may include monitoring for metabolic and cardiovascular risks.

Summary of Key Differences

What are the Signs and Symptoms of PCOS and PCOD?

PCOS is not a singular disease but a syndrome—a collection of symptoms that varies widely from person to person. Its effects can change throughout a woman's life, making individualized diagnosis and treatment critical for effective management. Here's a detailed overview of how it manifests and progresses across different stages of life: 

When Symptoms Start

Some women begin experiencing symptoms as early as their first menstrual cycle (menarche). Others may only notice signs after significant weight gain or struggles with fertility.

• Younger Women (Reproductive Years): Symptoms often focus on reproductive health, such as irregular periods, difficulty conceiving, and symptoms of elevated androgens (e.g., acne, hirsutism).
• Older Women (Post-Menopause): Metabolic complications become more pronounced, such as weight gain, insulin resistance, and increased risk of heart disease.

Common Symptoms of PCOS/PCOD

Common symptoms shared by both PCOS and PCOD include:

• Menstrual Irregularities: Many women with PCOS/PCOD have fewer than eight periods per year or none at all. It is due to a lack of regular ovulation. When periods occur, they may be heavier than normal because the uterine lining builds up over time without regular shedding.
• Signs of Androgen Excess: Over 70% of women with PCOS experience excess hair growth on the face, chest, back, or abdomen. Increased oil production from male hormones can lead to breakouts on the face, chest, and upper back. Hair thinning or loss, particularly at the crown of the scalp.
• Weight and Metabolic Issues: Up to 80% of women with PCOS and PCOD are overweight or obese. Many women develop insulin resistance, which worsens weight gain and leads to type 2 diabetes.
• Skin Changes: Dark, velvety patches of skin may appear in body folds, such as the neck, groin, and under the breasts.
• Other Symptoms: Hormonal fluctuations can trigger headaches in some women. PCOD is one of the leading causes of infertility due to irregular or absent ovulation.

Severity of Symptoms

• Mild PCOS: Some women might have minimal or no noticeable symptoms and may only discover the condition during investigations for infertility or menstrual irregularities.
• Moderate to Severe PCOS: Others experience more pronounced symptoms, including significant androgen excess, metabolic issues, and challenges with fertility.

What is the Cause of PCOS and PCOD?

The exact causes of PCOD and PCOS are unknown. However, researchers have attributed several factors that can lead to these conditions. 

• Insulin Resistance: Women with PCOS and PCOD problems suffer from insulin resistance. The body produces more insulin to cope with high blood sugar. This, in turn, stimulates ovaries to produce androgens in higher quantities, leading to PCOD/PCOS.
• Hormonal Imbalances: Abnormally high amounts of male reproductive hormones such as testosterone can prevent the release of eggs from the ovaries. It leads to irregular menstruation. Abnormal ovulation causes the formation of small fluid-filled sacs, ultimately leading to PCOD/PCOS. High levels of androgen are also responsible for excess hair growth and acne.
• Genetics: PCOD and PCOS frequently occur in familial patterns. This means that individuals with a family history of these gynecological disorders are at a higher risk of developing them themselves. Genetic predisposition may influence factors such as hormone levels, metabolism, and insulin sensitivity, which contribute to the onset of these conditions.
• Lifestyle Factors: Unhealthy eating habits, characterized by a diet high in sugars, processed foods, and unhealthy fats, alongside elevated stress levels, can lead to the development of PCOS and PCOD. Furthermore, a lack of regular physical activity due to a poor exercise regimen exacerbates these issues.
• Environmental Factors: Research suggests that exposure to certain environmental toxins, particularly chemicals like bisphenol A (BPA) and phthalates, may significantly influence the onset and development of PCOD or PCOS. These substances are commonly found in various everyday items, such as plastics and personal care products, and their potential effects on hormonal balance could be a contributing factor to these reproductive health issues.
• Inflammation: Individuals with PCOS often experience persistent low-grade inflammation. This ongoing state of inflammation plays a significant role in the onset and progression of PCOS, contributing to the various symptoms and complications associated with the condition. 

How is PCOD and PCOS Diagnosed?

There is no single way of diagnosing PCOS or PCOD. Doctors run multiple tests to determine whether you have these disorders and rule out other causes of symptoms. Common tests to diagnose PCOD/PCOS are:

• Physical Exam: The doctor measures the body mass index and waist size during a physical exam. They look for excess hair on the face, chest, and back, skin tags, and skin discoloration.
• Pelvic Exam: During a pelvic exam, the gynecologist will insert gloved fingers inside your vagina and look for symptoms of excess male hormones. These include swollen ovaries, enlarged clitoris, and the presence of cysts.
• Pelvic Ultrasound: A sonogram or pelvic ultrasound uses sound waves to detect the presence of ovarian cysts and examines the lining of the uterus (endometrium).
• Blood Test: PCOS is marked by an excess of male hormones. Blood tests help identify the levels of androgen in the body. Other tests, such as blood glucose and thyroid function tests, are also done. 

To confirm the diagnosis of PCOD or PCOS, patients must have at least two of the following symptoms:

1. Irregular menstrual cycle
2. High levels of male hormones (androgens)
3. Cysts on one or both ovaries

What are the Treatment Options for PCOS and PCOD?

PCOS does not have any curative treatment. Instead, doctors use various approaches to manage symptoms effectively. The treatment plan is also determined based on whether you want to get pregnant or not. Medications used for treating PCOS are:

• Hormonal Birth Control: Doctors prescribe hormonal birth control, such as pills, patches, vaginal rings, shots, or intrauterine devices, to help regulate periods. Hormonal contraceptives also help manage other PCOS symptoms, such as excess facial hair and acne. It also lowers the chances of endometrial cancer.
• Insulin-sensitizing Medications: PCOS is often accompanied by insulin resistance and leads to increased blood glucose levels. Doctors prescribe metformin off-label, a drug used to lower the level of sugar in the blood. It is not FDA-approved for the sole treatment of PCOS, but doctors believe it helps regulate the menstrual cycle. 
• Androgen Blockers: Anti-androgen medicines block the release of male hormones and reduce signs such as excessive hair growth and acne. These medications can cause congenital disabilities and are not prescribed for women who wish to get pregnant.

Can PCOD be Permanently Cured?

There is no permanent cure for PCOD or PCOS as of now. While the disorders can be managed with medications, weight management, dietary changes, and exercise, curing them permanently is not possible due to genetic links. 

Can Women With PCOD or PCOS Get Pregnant?

PCOS is more severe than PCOD, causing fertility problems in 70 - 80% of the women. However, with proper treatment, pregnancy is possible for women suffering from PCOS. The treatment plan includes:

• Medications: Medicines like letrozole, clomiphene, and gonadotropins are known to increase ovulation. Metformin is also considered to trigger ovulation and is the first line of drugs for women with PCOS trying to conceive.
• IVF: Doctors consider in vitro fertilization when medications alone can't help achieve pregnancy. In IVF, the eggs are extracted from females and fertilized with their partner's or donor's sperm in a laboratory. Once the embryo is formed, it is implanted back into the uterus. IVF has better chances of pregnancy than medication and reduces the risk of twins and triplets.
• Surgery: Doctors use laparoscopic ovarian drilling to remove the part of the ovaries that produces the most androgen. However, with advancements in science, medications are now available that serve the same purpose, so ovarian drilling is less frequently used as an option.

The best age to get pregnant with PCOS is before 30. By monitoring ovulation and using assisted reproductive techniques, women can conceive up to 37 to 40 years of age. Chances of successful pregnancy decrease steeply after the age of 40. Hence, it is necessary to start early if you suffer from PCOS and wish to get pregnant.

What is the PCOS Treatment for Unmarried?

PCOS can affect women of any age. The treatment options depend on the individual's choice of getting pregnant in the future or not. For unmarried women with PCOS, treatment focuses on symptom management, hormonal regulation, and preventive measures. 

PCOS treatment for unmarried women includes hormonal birth control, progestin therapy, lifestyle adjustments, and medications like antiandrogen and metformin. Lifestyle changes such as eating a balanced diet, losing weight, and exercising can help treat PCOS symptoms in young unmarried girls.

Does PCOS and PCOD Increase the Risk of Cancer?

Hormones play an important role in the development of cancer. Women with PCOS have high estrogen levels and have 3 times higher chances of developing endometrial cancer. PCOS also increases the risk of ovarian cancer by 2 to 3 times. Other cancers associated with polycystic ovarian syndrome are uterine, breast, endocrine, kidney, and bone cancer.

What is the Recommended Diet for PCOD and PCOS?

Diet plays an important role in the nonpharmacological treatment of PCOS and PCOD problems. Having a proper PCOS diet will help in

• Reducing blood glucose levels
• Lowering insulin resistance and diabetes risk
• Improving cholesterol
• Reducing basal metabolic rate
• Lowering the risk of hypertension
• Improving the chances of pregnancy

Women suffering from PCOD/PCOS should consume a diet rich in -

• Proteins: Fish, plant-based proteins (peas, tofu, beans), and chicken.
• Complex Carbohydrates: Whole grains, legumes, brown rice, barley, and quinoa.
• Antioxidants: Bright-colored fruits and vegetables such as apples, cherries, strawberries, beets, tomatoes, bell peppers, and leafy vegetables.
• Non-starchy Vegetables: Broccoli, eggplant, and green beans. 
• Healthy Fats: Olive oil, avocado, cashews, sunflower seeds, Brazil nuts, and almonds.
• Omega-3 Fats: Fatty/oily fish (salmon, shrimp, tuna, and cod), seaweed, algae, chia seeds, flaxseeds, and walnuts.

A few items that PCOD/PCOS patients should limit or avoid are - 

• Refined Carbohydrates: White bread, muffins, breakfast pastries, and sugary desserts.
• Fried Foods like fast food.
• Beverages with Added Sugar: Soda and energy drinks.
• Processed Meats: Luncheon meats, hot dogs, and sausages.
• Red Meat (in excess): Steak, hamburgers, and pork.

What are the Lifestyle Modifications and Home Remedies for PCOS?

Lifestyle changes significantly help in managing polycystic ovary syndrome. These include:

• Exercise: Burning a few calories can help patients battle obesity and lower insulin resistance. Building muscles also helps properly absorb insulin from the blood. Exercise also helps reduce cholesterol and androgen levels in the body.
• Manage Weight: Obesity and PCOS are interconnected. Reducing just 5% of weight can help manage PCOD problem effectively. Weight management also helps in combating complications associated with PCOD/PCOS, such as stroke, hypertension, diabetes, etc.
• Reduce Sugar and Carbs: Insulin resistance is a common problem linked with PCOS. Consuming sugar and carbohydrates increases blood sugar. Doctors advise focusing on complex carbs, such as whole grains, instead of simpler carbs.
• Stress Management: Chronic stress often leads to hormonal imbalances and worsens the symptoms of PCOD. Applying stress management techniques such as meditation and deep breathing exercises can help reduce PCOD/PCOS symptoms.
• Proper Sleep: Adequate quality sleep is essential for reducing stress and improving hormonal balance in the body. 

How Do PCOS and PCOD Affect Mental Health?

PCOD and PCOS have psychological effects on affected women. Both disorders negatively impact mental health. Common aspects associated with PCOS and PCOD are:

• Anxiety and Depression: Managing a chronic condition like PCOS can be emotionally difficult. This, along with social pressures and worries about fertility, can lead to higher rates of depression and anxiety in those with PCOS. Chances of bipolar syndrome and obsessive-compulsive disorder are also heightened with PCOS. 28% to 39% of women with polycystic ovarian syndrome suffer from anxiety, and 11% to 25% from depression.
• Body Image Issues: Physical symptoms such as facial and body hair, acne, and weight gain create major self-esteem issues, particularly in young women. Beauty standards set by society also play an important role in creating body image issues.
• Relationships and Fertility Issues: PCOS affects a woman's ability to get pregnant. Although manageable with treatments like IVF, infertility is a major concern. It also leads to relationship issues among couples. Open communication and holistic care, including therapy, can help cope with these issues.
• Mood and Hormonal Function: Hormonal imbalances lead to hirsutism and irregular periods. These conditions can further lead to mental issues such as anxiety and hostility. Understanding these effects is important for comprehensive care and improved quality of life.

The Bottomline

PCOS and PCOD require proactive management, as they affect more than just reproductive health. With the right approach, many women manage to control symptoms and lead healthy lives. A combination of medical guidance, dietary changes, exercise, and mental health support can make a substantial difference. If you or someone you know is struggling with symptoms, consult a healthcare provider for an individualized approach to management.