PCOD vs PCOS Understanding the Key Differences

Both terms PCOD and PCOS are heard at any gynaecology clinic in Jaipur. Many women are given a prescription and a medical diagnosis of "PCOD or PCOS" on their report without knowing what it is or why knowing PCOD vs PCOS difference is important. In some clinics, these two conditions are often treated as if they are the same, and are treated as such by some clinicians. They shouldn't be because the mechanisms are different, the severity, the health risks and the treatment is different.

The World Health Organization estimates that approximately 8-13% of women of reproductive age (15-44) worldwide are affected by PCOS. According to a research published in IJPS, the prevalence of PCOS is 5 to 10% in India, and PCOD is experienced by even more women, around 22.5% in certain Indian studies. The diagnosis you are making is a critical determinant of the need for medical treatment and the type of treatment that is needed.

What Is PCOD?

PCOD or Polycystic Ovarian Disease is a disorder in which an excess of immature or partially mature eggs are produced from the ovary. These eggs don't escape through an egg release but remain in the ovary in small fluid-filled cysts. The ovaries grow slightly, and the change in the hormones triggers the PCOD symptoms that occur in most women during the process: irregular periods, mild weight gain, oily skin and sometimes mild excess hair growth.

PCOD is basically an ovarian disease. It does not directly impact any other organ system as PCOS does. It does cause a hormonal imbalance, but it is less severe. Despite this, the majority of the women with PCOD continue to ovulate, and hence they are able to conceive even without medical help. The most significant clinical aspect of PCOD is that it is reversible  with planned lifestyle modifications including diet, exercise and weight-loss, a significant number of women can restore their regular cycles and decrease the number of cysts.

What Is PCOS?

Polycystic Ovary Syndrome (PCOS) is a condition. Syndrome is an important clinical term. While PCOD is a structural issue of the ovary, PCOS is a complex endocrine-metabolic disorder that involves many systems of the body. It is the most common endocrine disease in women of reproductive age and the most common cause of female infertility in India.

PCOS Causes: PCOS is a condition in which excessive amounts of androgens (male hormones like testosterones) are made in the ovaries. This androgen excess results in a disruption of the normal hormonal sequence that controls ovulation (eggs begin to develop in the follicles, but fail to mature and release properly). These follicles stay as cysts and over time, these high androgens make it harder to ovulate, which leads to more androgens being produced, and insulin resistance (which affects most people with PCOS) increases androgens even more.

The Rotterdam Criteria are used to diagnose PCOS, which consists of two of three criteria: irregular or absent ovulation; clinical or biochemical hyperandrogenism; and polycystic ovaries by ultrasound. This is a formal diagnostic criteria and what separates it from the less definitive category of PCOD.

Here's a comparison of PCOD and PCOS:

The table below summarises the key clinical differences:

Factor	PCOD	PCOS
Full Form	Polycystic Ovarian Disease	Polycystic Ovary Syndrome
Nature	Ovarian condition, first involves the ovaries.	Endocrine-metabolic, involves many systems in the body
Root Cause	Lifestyle and hormonal imbalance, immature egg that does not ovulate, becomes a cyst;	Excessive production of androgen and insulin resistance; more complex hormonal cascade
Ovulation	Ovulation takes place, but can be irregular.	Many cycles have a marked decrease or lack of ovulation.
Severity	Milder, may be reversible with lifestyle changes	More severe – Long-term medical management
Androgen Levels	Slightly elevated/normal	Highly elevated, principle cause of majority of symptoms
Fertility Impact	Less severe – many women can conceive with lifestyle changes	The leading cause of infertility in Indian women and often the need to assist reproduction is required.
Long-Term Risks	Decreased risk of systemic complications; may develop into PCOS if not treated	Type 2 diabetes, cardiovascular disease, endometrial cancer.
Medical Term	Usually employed in India, less exact clinically	Medical diagnosis, formal, of endocrine syndrome; Rotterdam Criteria.
Primary Treatment	Lifestyle modification: diet, exercise, weight management	Medication, structured lifestyle changes, and monitoring.

Clinical importance of the use of the term: PCOD is mainly an Indian usage term and is not linked with any formal diagnostic international category. The Rotterdam Criteria are the official criteria for the diagnosis of PCOS as an endocrine syndrome and are included in all international clinical guidelines. If a doctor has stated "PCOD" or "PCOS" on a report without specifying which, it usually means that a doctor has observed PCOD/PCOS on ultrasound but hasn't performed a full hormonal assessment. Blood testing is more important than just an ultrasound finding.

A Comparison Of The Symptoms Of PCOD And PCOS Symptoms

Some of the symptoms are similar, which is the reason for the confusion between the two. The only difference is in the degree of severity and systemic involvement.

Shared Symptoms

Irregular or missed periods:Periods that do not occur at regular intervals of less than 8 periods a year, or at intervals greater than 35 days, or that are regular but are not predictable.

Weight gain:Especially around the belly button; struggle to lose weight no matter what they eat or do.

Acne:Hormonal acne, usually on chin, jaw and lower face, which is unresponsive to an effective topical treatment alone.

Hair changes:Excessive facial and body hair (hirsutism) due to androgen excess, and thinning or loss of hair from the scalp.

Multiple small follicular cysts: Ultrasound findings in both conditions.

In addition to the above symptoms, these are more specifically associated with PCOS:

When the androgen activity is high: Severe acne, significant hair loss on the scalp and excessive hair growth is more typical of PCOS than PCOD.

Absent ovulation (anovulation): For PCOS, not only do the cycles become irregular but many of them actually do not produce an egg. This is the most important cause of infertility

Insulin resistance: The metabolic aspect of PCOS is characterized by insulin resistance, which includes the presence of darkening skin folds (acanthosis nigricans) in the body folds, high craving for carbohydrates and energy slowdowns after eating.

Mood disturbances: Hormonal disturbances associated with depression and anxiety are more common in women with PCOS than in the general population and may be related to hormonal imbalance and the psychological stress of PCOS

PCOD and PCOS Causes

The causes of either condition are not known. Both are due to a combination of genetic susceptibility and environmental triggers, but the mechanisms are different:

PCOD Causes

There is a strong association between PCOD and lifestyle. Sedentary lifestyle, excess consumption of refined carbohydrates and processed food, high levels of stress, lack of sleep and obesity are all contributing factors for PCOD. These factors lead to a decrease in FSH (follicle-stimulating hormone) which can prevent follicles from maturing and leads to a buildup of immature eggs. Lifestyle modification is the best treatment for PCOD, as lifestyle is one of the main PCOD causes.

PCOS Causes

The form of PCOS is a more complicated and multifactorial hormonal cascade. It is driven by four interrelated mechanisms:

Androgen excess:excess of testosterone directly inhibits ovulation due to high levels of the hormone produced by the adrenal glands or the ovaries

Insulin resistance:Most women with PCOS suffer from insulin resistance. The body's cells don't use insulin effectively, creating higher blood insulin levels which stimulate extra production of androgen. This is the metabolic connection that is what makes PCOS, a systemic disease, rather than just an ovarian one.

Imbalance of LH/FSH ratio: In women with PCOS, there is usually an increased ratio of LH (luteinising hormone) to FSH (follicle stimulating hormone) which causes a disorganized sequence in the maturation of follicles.

Familiarity: PCOS tends to run in families. There appears to be a polygenetic genetic cause, as if a mother or sister has PCOS, the risk is significantly increased.

How Are PCOD & PCOS Diagnosed?

Investigation is required in addition to clinical assessment for diagnosis and an ultrasound alone is not enough to differentiate PCOS from PCOD; About 20-30% of normal women have polycystic-appearing ovaries on ultrasound without fulfilling the PCOS criteria.

A complete hormonal workup by a gynecologist in Jaipur should include:

Pelvic ultrasound: Evaluates the shape, size and number of follicles, thickness of endometrium and the shape of the ovary

LH, FSH and their ratio: LH/FSH ratio > 2:1 or 3:1 is indicative of PCOS

Total and free testosterone – Evaluates androgen excess; is crucial for diagnosing PCOS and differentiating it from other causes of excess hair.

Fasting insulin and blood glucose (HOMA-IR): indicates insulin resistance, HOMA-IR > 2.5 is indicative of metabolic involvement

Thyroid function (TSH): Thyroid disorders have the same symptoms and should be ruled out before a diagnosis of PCOS is made.

Prolactin: If you see an increased level of prolactin, then irregular cycles are ruled out and this is excluded as a differential diagnosis.

An ultrasound with polycystic ovaries is not a diagnosis. According to the Rotterdam Criteria, a woman is diagnosed with PCOS if she fulfills 2 of 3 criteria: Irregular periods, Clinical or biochemical androgen excess, and Polycystic Ovarian Morphology. A doctor can't tell if a woman has PCOD or normal polycystic ovarian morphology or PCOS without blood testing.

The difference between PCOD and PCOS Treatment

PCOD Treatment: Lifestyle is First Medicine.

Structured lifestyle intervention is the best first line option for most women with PCOD treatment that can result in significant improvements in symptoms often before medication:

Diet: Decrease of refined carbohydrates (white rice, maida, sugar) and increase of protein, fibre and complex carbohydrates (ragi, bajra, dal, vegetables). A low-glycaemic diet helps to keep insulin levels down, which helps to suppress androgen production.

Exercise:At least 150 minutes of moderate aerobic activity each week and resistance training 2-3 times a week. Exercise increases insulin sensitivity and decreases levels of androgens.

Weight management: A reduction in weight of 5-10% among overweight women with PCOD can normalize their ovulation and alleviate symptoms.

Stress management and sleep: Disturbed sleep quality from chronic stress is a legitimate clinical intervention, not a "lifestyle" suggestion; chronic stress alters the functioning of the hypothalamic-pituitary-ovarian axis.

Specific PCOD presentations will require the use of medication, such as combined oral contraceptive pills to regulate the cycles, anti-androgens for extensive hirsutism or acne and the use of ovulation induction agents (clomiphene citrate) if the main concern is fertility.

PCOS Treatment: Structured Management.

Lifestyle is also key to PCOS treatment but usually not enough to treat it on its own. In most cases, PCOS is a metabolic disorder that means it needs:

Metformin: This drug is the most commonly used treatment for PCOS and works to increase insulin sensitivity, decrease androgen production, and in many women, brings back more regular ovulation. Often used as a long-term treatment.

Combined oral contraceptive pills: Reduce the production of androgens and regulate the cycles, most effective for acne and hirsutism.

Anti-androgens (spironolactone): Block the action of androgen directly, which are used in severe hirsutism, and androgenic alopecia that doesn't respond to the pill only.

Ovulation induction: Clomiphene or letrozole or gonadotropin injections for women who want to get pregnant, or in resistant cases, ovarian drilling or IVF may be considered.

Annual review of long-term cardiovascular and metabolic monitoring: Blood glucose, HbA1c, lipid profile and blood pressure should be performed every year in all women with confirmed PCOS, there is an increased lifetime risk of Type 2 diabetes and cardiovascular disease.

Do not discontinue PCOS medication due to improvement: PCOS is a chronic condition so don't stop medication because symptoms are better. Frequently the symptoms can be treated with medication but the metabolic disease remains. Withdrawal of medications will ordinarily cause symptoms to return unless they are taken under medical supervision. The PCOS treatment should always be done in consultation with a best gynecologist in Jaipur and should never be done on one's own.

Fertility and PCOD / PCOS: What Women should know

The overall effect of PCOD on fertility is less. As most cycles with PCOD will ovulate (although they are irregular), it is possible for women to conceive naturally after they have been able to regulate their cycle. The initial treatment for ovulation induction, which is typically the first line of treatment for those at risk, is generally successful.

The most common cause of anovulatory (infertility due to failure to ovulate) in Indian women is PCOS. The combination of insulin resistance, androgen excess and disturbed LH:FSH signalling will make many women with PCOS unlikely to ovulate regularly and reliably without medical help to conceive naturally. But, fertility treatment options are effective: most women with PCOS who wish to conceive will be able to do so with proper treatment whether through ovulation induction, IUI or IVF.

However, pregnancy in women with PCOS is associated with an increased risk of gestational diabetes, pregnancy-induced hypertension and premature labor, so it is crucial to monitor women with PCOS throughout their pregnancy by a best gynecologist in Jaipur.

PCOD and PCOS Management: Jaipur Vatika Hospital

Dr. Rinku Barwar (MBBS, DGO  FOGSI Manyata Certified) from the Obstetrics and Gynaecology Department at Jaipur Vatika Hospital will give you a comprehensive PCOD and PCOS assessment and management on the Jaipur-Ajmer Expressway at Thikariya.

The elements of a complete evaluation at JVH:  

Clinical evaluation: Thorough menstrual history, symptom review, physical examination (BMI and waist measurement), disease activity assessment (AN and hirsutism assessment)

Pelvic ultrasound: Assessments of ovarian morphology, follicle count, ovarian volume, and evaluation of the endometrium (coordinated on-site)

Same visit hormonal blood panel (NABL accredited in-house lab) including; LH, FSH, total testosterone, free testosterone, DHEAS, fasting insulin, HOMA-IR, HbA1c, thyroid function and prolactin that are provided the same day.

Diagnosis: The use of the Rotterdam criteria to differentiate PCOS from PCOD and other causes of irregular cycles and androgen excess is formal diagnosis/differential diagnosis.

Personalised treatment plan: Medication, structured dietary instructions for the Rajasthani diet, supervised ovulation induction for women desiring pregnancy, long-term follow-up monitoring

Accessibility: The hospital is located directly on the Ajmer Expressway, which is easily accessible from Bagru and Dudu and only a 15-minute drive without having to navigate through the city centre to get there in time for evaluation.

Conclusion

While PCOD and PCOS look alike in terms of symptoms, they are fundamentally different with respect to the underlying cause, severity and health consequences. PCOD is a condition of the ovary which may be responsive to lifestyle changes. PCOS is a systemic condition that needs a structured medical management and lifestyle intervention and involves monitoring for metabolic and cardiovascular risk over years.

If it is known to you that you have either been diagnosed with PCOD or PCOS, but you are not sure whether it is which, the next step is to go for a full-blown hormonal panel, not just an ultrasound. The Obstetrics and Gynaecology department at Jaipur Vatika Hospital provides a hormonal evaluation, a formal diagnosis and an individualised treatment plan all within the same appointment at Thikariya on the Ajmer Expressway. You can book via the JVH E-Consultation App or call +91-8209809753.