Monday, November 28, 2016

PCOD - Polycystic ovarian disease

Let me go through some details about PCOS or PCOD, because 'everyone seems to have it these days'. The interesting thing is, it doesn't need any medical knowledge, rather it's something that can be understood and derived as in maths.

Little bit about physiology - HPO (hypothalamus, pitutary, overy) is the collection of organs that produce the hormones that control menstruation (as well as ovum production, which is related to pregnancy). interestingly, unlike any other process in the body, uterus doesn't have a feed back to the HPO, if it has bleeding problems, HPO doesn't respond to it and correct. that's because, during evolution, our females rarely bled, they were shortlived and conceived and fed more children during which they dont bleed. As a result, evolution never got to attempt at correcting bleeding disorders.

Though HPO doesn't respond to the problems with uterus (it's target organ) and it's bleeding, HPO receives lot of feedback from the process of ovum production, it's other function. Though we like it or not, childbearing was the primary function of a living being, and the nature needed to control it finely. It makes sure the individual doesn't conceive during unfavorable circumstances, which were plenty in our wild origins. Thus it made sure HPO received feed back from every organ and process in the body, apart from the Ovum production, so that any internal or external threat or malfunction could be noted and individual's 'conceivability' averted. Thus we find the interesting thing that, the HPO is unique in the way that, it's one target organ doesnt give any feed back, where as it's other target organ as well as every other organ in the body gives feed back and controls it.

Thus HPO is an organ that's waiting to be 'tuned' to abort an attempt at pregnancy, by controlling the ovum production. Any stresses, internal or external jeopardises the HPO. The external manifestation of this HPO tuning is changes in the menstruation, because we don't see the process of ovulation, which happens inside the body. The ultrasound picks up the abnormal growth of ovulation, and due to various physiological reasons, the ovary in ultrasound appears as PCO (poly cystic ovary, which is actually a misnomer, the correct term should be 'multi follicular ovary'). Thus every female is carrying the 'tendency' to throw the process of menstruation into disarray, which is actually a normal physiological adaptation to control the timing of pregnancy.

Every female will have abnormal bleeding times, during diseases, stresses, external factors like any drug intake etc. It's common to see young girls missing their periods during exams, when they get married, when they take part in physically stressful sports activities etc. In olden times it would have been during famine, wild fires, wars etc. It's quite normal to have 'abnormal bleeding' thus, during periods of stress and diseases. During very recent times, it's actually 'obesity', which is becoming an epidemic, and the body interprets it as a 'stress to pregnancy'. (and hence the advise to lose the weight).

The 'tendency' of every female to 'tune' the HPO differs as does everything in biology. In some, their HPO becomes abnormal too easily, at slight stimulus. These females rarely get normal periods, as there's always this or that stress they face. These are the actual women who are so called afflicted with PCOD, and their numbers are not really that high. If bleeding becomes abnormal during some months and at other times it's normal, or they were normal a few years back, the woman is unlikely to be having PCOD. It's some stress, weight gain or such changes in the body that's producing the abrnomal bleeding. The ultrasound will show PCO pattern in any woman whose bleeding is abrnomal, so no need to get alarmed at ultrasound report.

Even the hardest PCOD, those who always have abnormal bleeding, whose HPO derails at slightest provocations, are amenable to treatment. This is where another interesting aspect of this disease surfaces. Because the processes inside the HPO are highly interconnected web, it's not easy to treat by exactly targetting the malfunction process. Just like in OOP (Objected Oriented Programming) in computer programming, we need not open up the HPO, rather treat it as a unit. We have drugs that completely suppress the PCO, give for a couple of months, during which the HPO remains dormant, all the processes die down inside the system, and gives the woman time to address the internal or external factors or stress that caused the malfunction. She has to try to reduce weight during the time (it she's overweight), get any disorder like thyroid problem treated, avoid stressful environment etc, and when the suppression is withdrawn and HPO bounces back to function, it'll mostly be normally functioning. These drugs are nothing special, they are just OC pills or oral contraceptive pills, which are used in contraception, because of their action of suppressing HPO and preventing ovulation. If the woman doesn't want to get pregnant, but just need normal bleeding, it's even easier to treat. The HPO in PCO will be anovulatory, producing only estrogen continuously without the progesterones, which are produced only after ovulation. Thus woman should take progesterone cyclically, to replace the progesterone, which together with the estrogen that comes from HPO will produce normal bleeding. 

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