Gynaecology
What is PCOD?
Polycystic Ovarian Disease (PCOD), also known as Polycystic Ovary Syndrome (PCOS), is a common condition affecting women of reproductive age. It impacts about 5% to 10% of women between the ages of 12 and 45. PCOD causes a hormonal imbalance, leading to irregular menstrual periods and making it difficult for women to conceive. Key symptoms include lack of ovulation, irregular periods, acne, and excessive hair growth. If left untreated, PCOD can lead to more serious health issues such as insulin-resistant diabetes, high cholesterol, and heart disease.
Difference between PCOS and PCOD
PCOS is an endocrine disorder, while PCOD is caused by hormonal imbalances.
In PCOS, the ovaries produce higher-than-normal levels of androgens (male hormones), which disrupts egg development and release. Some eggs turn into cysts, which grow and enlarge the ovaries.
In PCOD, hormonal imbalance leads to the accumulation of mature eggs in the ovaries, which turn into cysts. These cysts can multiply, leading to more cysts and perpetuating the cycle.
Both conditions involve irregular periods and hormonal imbalances that cause infertility. However, PCOS is generally considered more severe than PCOD.
Causes of PCOD
Normally, the ovaries produce female sex hormones (estrogen) and small amounts of male hormones (androgens) to regulate the development of eggs during the menstrual cycle.
In PCOS, the ovaries produce more androgens than usual, leading to a halt in ovulation, acne, and extra hair growth on the face and body.
In PCOS, the eggs in the follicles do not mature properly and are not released from the ovaries, forming small cysts known as polycystic ovaries.
PCOS often runs in families, so if other women in the family have had PCOS, irregular periods, or diabetes, the likelihood of developing PCOS increases.
Common Symptoms of PCOD
• Acne
• Weight gain and difficulty losing weight
• Excess facial and body hair (hirsutism)
• Hair thinning or hair loss
• Irregular periods (less than nine periods a year, no periods, or heavy bleeding)
• Difficulty getting pregnant (infertility)
Complications of PCOD
• Increased risk of endometrial cancer
• Infertility (early treatment can improve chances of pregnancy)
• Obesity-related issues, such as high blood pressure, heart disease, and diabetes
• Potential risk of breast cancer
Treatments for PCOD
Medications to Regulate Menstrual Cycle
Combined Birth Control Pills:
These pills contain two hormones, estrogen and progestin, which work together to reduce the production of androgens (male hormones) in your body. By balancing these hormones, birth control pills can help regulate your menstrual cycle, reduce excessive hair growth (hirsutism), control acne, and lower the risk of developing endometrial cancer. If you prefer not to take pills, other options include a skin patch or a vaginal ring that also provides a continuous dose of these hormones.
Progestin Therapy:
This treatment option involves taking progestin, a hormone that can help regulate your menstrual cycle if you don’t wish to conceive. Progestin therapy reduces the likelihood of conception and giving birth. A progestin shot is effective for three months, so you would need four shots each year. Alternatively, you can opt for a progestin-only mini pill or a progestin-containing intrauterine device (IUD), which is a better choice if you want to avoid pregnancy.
Medications to Help with Ovulation
Letrozole (Femara):
Letrozole is commonly used to treat breast cancer, but it can also be used to stimulate your ovaries to help with ovulation, which is essential if you’re trying to get pregnant.
Metformin:
Metformin is a medication typically used to manage diabetes by controlling blood sugar levels. However, in women with PCOD, it can also help with weight loss and may assist in restoring normal ovulation if you have prediabetes.
Gonadotropins:
These are hormone medications that stimulate your ovaries to produce estrogen and progesterone, which are crucial for ovulation and maintaining a healthy menstrual cycle.
Medications to Reduce Excessive Hair Growth
Birth Control Pills:
By reducing androgen production, these pills can also help manage hirsutism, which is the excessive growth of hair on the face and body.
Spironolactone (Aldactone):
Spironolactone is a medication that blocks the effects of androgens on your skin, which can help reduce unwanted hair growth. However, it’s important to note that Spironolactone can cause birth defects, so it should not be taken if you’re pregnant or planning to become pregnant.
Eflornithine (Vaniqa):
This topical cream can slow down the growth of facial hair in women, providing another option for managing hirsutism.
Electrolysis:
In this procedure, a tiny needle is inserted into each hair follicle, where it emits a small electric current to destroy the follicle, preventing future hair growth. Multiple treatments may be necessary to achieve the desired results.
Common Medical Treatments for PCOD-Related Problems
Weight-Loss Medications:
Medications like Xenical (orlistat) can help with weight management by reducing the amount of dietary fat absorbed by your intestines, which can be beneficial if you’re struggling with obesity related to PCOD.
Cholesterol-Reducing Medications (Statins):
Statins are used to lower cholesterol levels in your blood by blocking the substance your body needs to make cholesterol. This can help reduce the risk of heart disease, which is a concern for women with PCOD.
Acne Treatments:
Various medications and treatments are available to help manage acne, a common symptom of PCOD caused by hormonal imbalances.
Surgical Treatments
Wedge Resection:
In some cases, surgery may be recommended to treat PCOD. Wedge resection is a surgical procedure in which a portion of the ovary is removed. This can help restore normal ovulation, increasing the chances of pregnancy for women with PCOD.
Ovarian Drilling:
This is another surgical option where small holes are made in the membrane surrounding the ovary using a laser or surgical needle. The goal of ovarian drilling is to restore a regular ovulation cycle, which can improve fertility.
PCOD and Pregnancy Tests
False Positives on Pregnancy Tests
It’s possible to get a false positive on a pregnancy test, but PCOD itself doesn’t directly cause this. Pregnancy tests work by detecting the hormone human chorionic gonadotropin (HCG) in your urine, which is produced during pregnancy. If you’re undergoing fertility treatments that involve taking medications containing HCG, this can lead to a false positive result on a pregnancy test. Other factors that can cause a false positive include using an expired pregnancy test kit or not following the test instructions properly.
False Negatives on Pregnancy Tests
If you have PCOD, your hormone levels can be uneven, which might lead to a false negative result on a pregnancy test. This means the test might show that you’re not pregnant when you actually are. Some women with PCOD may not realize they are pregnant until several weeks after conception.
Pregnancy Success Rate with PCOD
Women with PCOD can face challenges when trying to conceive. However, with treatments like in vitro fertilization (IVF), the chances of getting pregnant range from 20% to 40%. Factors such as age (especially women over 35) and being overweight can lower the likelihood of pregnancy.
How is PCOD Diagnosed?
Ultrasound: An ultrasound is used to view the uterus, ovaries, and pelvis. It can detect cysts and enlarged ovaries, and assess the thickness of the womb lining, which may increase due to irregular periods, raising the risk of womb cancer.
Diet and Lifestyle Tips for Managing PCOD
1. Exercise: Regular exercise can help with weight loss and improve menstrual cycles. Losing 5-10% of body weight can reduce PCOS symptoms and lower the risk of diabetes and heart disease. Aim for at least 30 minutes of moderate exercise three days a week.
2. Healthy Diet: Focus on whole grains, fruits, vegetables, and plant-based proteins. Limit sugar, processed foods, and trans fats. Nutritional supplements may also be beneficial, depending on your health.
3. Physical Activity:Opt for stairs over elevators and incorporate more movement into your daily routine to combat a sedentary lifestyle.
4. Proper Sleep: Aim for eight hours of sleep each night, as lack of sleep can worsen PCOS symptoms. Manage stress through engaging in enjoyable activities.
5. Herbal Teas: Drinking green tea or spearmint tea twice a day may help alleviate PCOS symptoms. Avoid alcohol, as it can increase insulin levels and disrupt hormone balance.
What Are Menstrual Problems?
Phases of the Menstrual Cycle
Common Menstrual Problems
When to See a Doctor
Menstrual Symptoms
Signs of Menstruation
Types of Menstrual Problems (Disorders)
Causes of Menstrual Disorders
Menstrual Problems Complications
Diagnosing Menstrual Problems
If you experience long-term menstrual problems, it’s essential to see a doctor for a proper diagnosis. Sometimes, the cause of abnormal periods can be challenging to pinpoint, requiring a thorough medical evaluation.
Treatment for Menstrual Problems
Medications for Menstrual Disorders
What is the fallopian tube & its part?
The fallopian tube is a vital part of the female reproductive system, acting as a pipeline that connects the ovary and the abdominal cavity (peritoneum) to the uterus.
Measuring typically 10-12 cm in length, the fallopian tube consists of several distinct sections: the fimbrial end, which is closest to the ovary; the ampulla, a broader portion of the tube; the mid-tubal region; and finally, the cornua, where the tube connects to the uterus.
Each of these parts plays a unique and essential role in the function of the fallopian tube.
Role of the Fallopian Tubes
The fimbrial end of the fallopian tubes plays a crucial role in capturing the ruptured egg during ovulation and guiding it into the tube. This section is lined with cilia, small hair-like structures that help propel the egg towards the inside of the tube. During fertility assessments, the microstructure of this part is examined in detail through a procedure called Salpingoscopy, which requires specialized instruments to evaluate the internal structure of the fallopian tubes.
The next part, the ampulla, is where fertilization typically occurs. It’s important to note that the egg remains viable for fertilization for about 12 hours after ovulation. If natural intercourse or IUI occurs during this time, a sufficient concentration of sperm will be present in the fallopian tubes, facilitating fertilization. Sperm can remain viable in the female reproductive system for approximately 48-72 hours.
After fertilization, the embryo begins a slow journey toward the uterus, taking about five days to travel the 7-8 cm length of the fallopian tube. During this time, the embryo is nourished by fluid secreted by the fallopian tubes, known as Human Tubal Fluid (HTF), which provides essential nutrients and energy for cell division. The embryo develops from a fertilized egg into a 120-cell Day 5 Blastocyst within the fallopian tube, and IVF media often mimic the composition of HTF.
Finally, the embryo reaches the narrowest part of the fallopian tube, the cornua, from where it enters the uterus and prepares for implantation.
What Tests Check for Blocked Fallopian Tubes?
Assessing fallopian tubes is essential for any patient planning to conceive. Traditionally, this was done using Hysterosalpingography (HSG), a procedure that involves injecting a medical dye into the uterus and tracking its flow through the fallopian tubes via X-ray. The X-ray image is then analyzed by a doctor to check for blockages. However, HSG can be quite painful, and the discomfort associated with it often makes women hesitant to undergo the test. Fertility support groups sometimes share varied opinions about HSG, further adding to the apprehension.
Fortunately, HSG is now considered outdated and has been replaced by Saline Sonosalpingography (SSG). A common concern is whether SSG is also painful, but here’s the reassuring part: in SSG, the dye used contains a local anesthetic, making the procedure virtually painless. Women who undergo SSG typically find it much more comfortable than HSG.
Another advantage of SSG is its ability to provide a 3D view of the fallopian tubes and simultaneously examine the internal structure of the uterus, offering comprehensive information for assessing the female reproductive system.
The fallopian tubes play a crucial role in fertility, as they connect both the peritoneum and the uterus. Due to this connection, they are susceptible to blockages, often caused by silent infections like Chlamydia and Gonorrhea. In India, tubal blockages are particularly common, largely due to the prevalence of endemic pelvic infections.
Types and Treatments for Blocked Fallopian Tubes
Blocked fallopian tubes are generally categorized into Cornual Blocks, Mid-tubal Blocks, and Fimbrial Blocks. Among these, Cornual Blocks are the easiest to treat and offer the best outcomes. Treatment typically involves fallopian tube cannulation, a procedure requiring precision to avoid perforation. When performed by skilled hands, this procedure often leads to natural pregnancies post-surgery.
For Mid-tubal or Fimbrial Blocks, laparoscopic surgery is usually required, though the success rates are around 45%, and outcomes are best when an experienced surgeon performs the procedure. Fimbrial Blocks, in particular, require advanced surgical techniques for Fimbrial repositioning, a procedure carried out by only a few specialists in India, who achieve high success rates due to their expertise.
Mid-tubal blocks, especially those caused by adhesions or endometriosis, often have poor outcomes even with laparoscopy, primarily due to intraluminal compromise. Expert surgical intervention is necessary to delicately reopen these blockages.
Post-surgery, antibiotics are commonly prescribed. Some patients explore alternative therapies like Ayurvedic treatments, such as Uttar Basti, for fallopian tube blockages. However, these treatments require careful preparation and multiple sessions, with success rates generally being lower.
Cervical Incompetence and Laparoscopic Transabdominal Cerclage (TAC)
Cervical incompetence, or cervical insufficiency, is a medical condition where the cervix, the lower part of the uterus, starts to thin and dilate prematurely during pregnancy without contractions or labor pains. This can lead to miscarriage or preterm birth, usually in the second trimester. Women with cervical incompetence often have a history of recurrent pregnancy loss or early deliveries. Early diagnosis and appropriate treatment are essential to improving pregnancy outcomes.
Causes of Cervical Incompetence:
Congenital Cervical Abnormalities: Some women may be born with a naturally weak or abnormally shaped cervix.
Previous Cervical Surgery: Procedures such as a cone biopsy or dilation and curettage (D&C) can weaken the cervical tissue.
Uterine Anomalies: Structural issues with the uterus can contribute to early cervical dilation.
Trauma: Damage from previous deliveries, abortions, or surgeries can cause cervical insufficiency.
Treatment: Laparoscopic Transabdominal Cerclage (TAC)
For women at high risk of pregnancy loss due to cervical incompetence, laparoscopic transabdominal cerclage (TAC) offers a minimally invasive surgical option. Unlike traditional vaginal cerclage methods, TAC involves placing a permanent stitch around the cervix through a laparoscopic approach. This procedure is particularly beneficial for women with a severely weakened cervix or those for whom vaginal cerclage has been unsuccessful in previous pregnancies.
How Laparoscopic TAC is Performed:
Timing: Laparoscopic TAC is generally performed before pregnancy or during early pregnancy (up to around 12-14 weeks), once cervical insufficiency has been identified.
Procedure: Using laparoscopy, a small incision is made in the abdomen, and a camera (laparoscope) is inserted. The surgeon uses specialized instruments to place a permanent stitch around the cervix to prevent premature dilation.
Advantages of Laparoscopy: Laparoscopic TAC offers a faster recovery time, smaller incisions, less pain, and minimal scarring compared to open surgery.
Long-Term Solution: The cerclage remains in place throughout the pregnancy and can be left in for future pregnancies, eliminating the need for repeated surgeries.
Post-Surgical Care and Precautions
After undergoing laparoscopic TAC, certain precautions are necessary to ensure a healthy pregnancy:
Activity Restriction: Patients are advised to limit strenuous physical activity and avoid heavy lifting. Bed rest may be recommended in some cases.
Monitoring: Regular prenatal appointments and ultrasounds are crucial to monitor the health of the cervix and detect any signs of premature labor.
Avoiding Strain: Activities that put pressure on the lower abdomen, such as excessive bending or lifting, should be avoided.
Sexual Abstinence: Sexual activity may be restricted during critical stages of pregnancy to avoid placing strain on the cervix.
Potential Risks: Though rare, laparoscopic TAC carries risks such as infection, injury to nearby organs, or premature labor. Close monitoring and adherence to medical advice are essential for a successful pregnancy.
Alternatives: McDonald’s Cerclage and Modified Shirodkar’s Cerclage
In addition to TAC, there are other cerclage techniques used to treat cervical incompetence:
McDonald’s Cerclage: This is a vaginal cerclage technique in which a stitch is placed around the cervix through the vagina. It is commonly performed between 12-14 weeks of pregnancy. McDonald’s cerclage is typically used for women with less severe cervical incompetence and is removed around 37 weeks of pregnancy.
Shirodkar’s Cerclage: Similar to McDonald’s, this technique also involves placing a stitch through the vagina but in a slightly higher position. The modified Shirodkar method provides more support to the cervix and is suitable for women with a higher risk of pregnancy loss. The stitch is usually left in place until delivery.
Why Choose Laparoscopic TAC at Amayra Healthcare?
At Amayra Healthcare, we are dedicated to providing expert care for high-risk pregnancies, including the treatment of cervical incompetence. Our experienced obstetricians and state-of-the-art laparoscopic facilities ensure that you receive the most advanced, minimally invasive treatments available. We offer personalized care plans to support each patient from diagnosis to delivery, helping you achieve a safe and healthy pregnancy, even in complex cases.