The ovary is enlarged and produces excessive amounts of androgen and estrogenic hormones. This excess, along with the absence of ovulation, may cause infertility.

Patients with PCOD typically have persistently elevated levels of androgens and estrogens.  Obesity can aggravate PCOD because fatty tissues are hormonally active and they produce estrogen which disrupts ovulation. Overactive adrenal glands can also produce excess androgens, and these may also contribute to PCOD. Some women who are obese also tend to have insulin resistance, that is the cells in their boded not respond to insulin

Symptoms and signs

irregular menstrual cycles, which are unpredictable and can be very heavy

Sometimes there may be no periods for an extended period and the woman may need to take hormonal tablets to induce a period.

They are usually obese and may have hirsutism, (excessive facial and body hair) as a result of the high androgen levels.

Diagnosis

Vaginal ultrasound shows both the ovaries are enlarged and there are multiple small cysts in the ovaries.

Blood tests are also very useful for making the diagnosis. blood levels of hormones reveal a high LH (luteinizing hormone) level and a normal FSH level (follicle stimulating hormone) and elevated levels of androgens ( a high dehydroepiandrosterone sulfate ( DHEA-S) level)

Treatment

As Anovulation is the main cause for the signs and symptoms of PCOD. Treatment lies in regularizing the periods and convert it back to ovulatory cycles.

Patients who are obese could benefit from weight loss as we had seen earlier that fatty tissues are hormonally active and they produce estrogen which disrupts ovulation.

Increasing physical activity is an important step in losing weight. Aerobic activities such as walking, jogging or swimming are advised. Long-term permanent weight loss is important than crash diets.

Another form of treatment is inducing ovulation. This is done with medication. The first choice of drug in obese women is Metformin. This is also used in diabetic patients in order to decrease their insulin resistance. The same principle is used here as many women with PCOD are also thought to have insulin resistance. So Metformin could improve their condition.

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