PCOD To Fibroids: Increased Prevalence Of Reproductive Disorders In Women

Reproductive disorders like PCOD/PCOS and uterine fibroids are now becoming increasingly common in women of reproductive age. Globally, the incidence of PCOS is estimated to be around 8-13% among women, but this number often remains unknown. For instance, in India, there are estimates of its incidence ranging between 3% to 20% and more, depending upon diagnostic criteria and population studied. Uterine fibroids are benign smooth muscle tumours that occur in the uterus and are found in an estimated 20-40% women in their reproductive life, especially those aged between 30 and 50.

PCOD: A Metabolic-Endocrine Disorder

PCOD is marked by hyperandrogenism, ovulatory dysfunction, and polycystic ovaries. One important component of this condition is insulin resistance, which is found in many women suffering from PCOD, irrespective of their body size. The presence of a metabolic disorder results in hormonal imbalances, causing irregular menstruation, acne, and hirsutism. PCOD may lead to more serious health problems, including diabetes mellitus type 2, metabolic syndrome, and heart disease. There is evidence that the development of symptoms is promoted by poor lifestyle habits like consuming high-calorie meals, lack of exercise, and circadian rhythm disturbance.

Uterine Fibroids: Growth Dependent on Hormones

Uterine fibroids (also known as leiomyomas) are tumours of the uterus that develop under the influence of estrogen and progesterone. The presence of fibroids is not necessarily linked with any symptoms; however, the symptoms may occur and manifest themselves through heavy menstrual periods, painful cramps, and fertility-related issues.

Urbanisation and Lifestyle Changes as Major Influencers

Fast urbanisation has resulted in a shift in lifestyles and affected the reproductive health of women. Sedentary living, excessive intake of ultra-processed food products, high stress levels, and chemical exposure (endocrine-disrupting compounds) contribute to PCOD and fibroid formation. Investigations have revealed higher rates of menstrual disorders and metabolic disturbances among urban women when compared with their rural peers. Moreover, late motherhood prevalent in an urban setting increases the exposure to female hormones and possibly causes fibroids.

Insulin Resistance, Androgens, and Estrogens: What's the link?

Though being separate gynaecological conditions, PCOD and fibroids feature similar mechanisms of interaction and metabolism of estrogens. PCOD is often accompanied by insulin resistance, which causes increased synthesis of male hormones. Adipocytes, on the other hand, take part in the transformation of peripheral estrogens, which are involved in the development of uterine fibroids.

Psychological and Quality-of-Life Considerations

PCOD and fibroids both have psychological consequences and impair quality of life. Women with PCOD are more likely to experience anxiety, depression, and negative body image due to symptoms like obesity and excessive hair growth. Likewise, fibroids could cause persistent pain, exhaustion due to profuse menstrual flow, and problems with conception, thus causing emotional stress. There is evidence that supports the need for mental evaluation during gynaecological examinations.

Evidence-Based Treatment Strategies

Treatment regimens for PCOD and fibroids are based on the intensity of symptoms, fertility desires, and predisposing factors. First-line management of PCOD involves behavioural modification, such as regular exercise, improved diet to enhance insulin sensitivity, and weight reduction. Drug therapy may involve administering medications that increase sensitivity to insulin, along with hormone therapy. On the other hand, fibroids may be managed medically, such as regulating hormones, or surgically, using methods like myomectomy or hysterectomy.

Importance of Early Diagnosis and Preventive Medicine

It is essential to detect the symptoms early on, such as problems with menstruation, heavy bleeding, or pain in the pelvic area. Preventive medicine involves regular visits to the gynaecologist, metabolic tests, and the consideration of all possible risk factors. Public health policy focuses on educational work aimed at preventing serious complications related to the condition.

Conclusion: Considering Current Factors Related to the Health of Women

The rising rate of PCOD and fibroids is due to several factors that affect society as a whole, including changes in lifestyle and the environment, as well as the number of pregnancies in women. They cannot be considered purely gynaecological disorders since they also touch upon the general state of hormonal balance and metabolism in women.

(Dr Aruna Kalra, Director - Obstetrics & Gynaecology, Director Academics - Robotic Gynaecology, CK Birla Hospital, Gurugram)

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