Monday, December 14, 2015

Not all patients with irregular cycles have PCOD

We often see that every patient who has irregular cycles is labeled as having polycystic ovarian disease or PCOD. Some patients diagnose it for themselves; in some cases, it's a skin doctor or a family physician who makes the diagnosis; and sometimes it's the gynecologist who make this misdiagnosis.

Often it's a result of mental laziness and excessive media coverage . PCO seems to have become the disease of the decade, and every girl who's a little overweight or who's got a little extra facial hair or whose periods are irregular is thought to have PCO. The trouble is that lots of doctors don't apply their mind, and it's easy to put a label on the patient, and then start treating here.

The reality is that there are lots of other reasons for irregular cycles, and not all patients with irregular cycles have PCOD. The reason for irregular cycles is anovulation, which means the woman doesn't produce eggs. Often, for the older women , the correct diagnosis is poor ovarian reserve, and their periods are irregular because they're perimenopausal. However, even young women can have poor ovarian reserve, and that's why doctors need to be think critically before labeling every patient with irregular cycles as having PCO.

It's important to confirm the diagnosis , rather than just go by symptoms or by gut feel, and an easy way to do this by checking the AMH level. Now patients with PCO will have high AMH levels, so that if you have irregular cycle and a low AMH level, you can pretty much rule out polycystic ovarian disease and start thinking about poor ovarian reserve as the correct diagnosis for your irregular periods.

Checking the antral follicle count by getting a scan done from a good sonographer is an other easy way of establishing this diagnosis, but the trouble is that lots of sonographers don't know how to do an antral follice count properly. They don't measure the antral follicles properly , and don't bother to measure the ovarian volume or the ovarian stroma. Many will just describe the ovaries as having MSF ( multiple small follicles), without bothering to take images or measurements.

Making the right diagnosis if you have irregular cycles can make a world of a difference if you want to maximise your chances of getting a baby.

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