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How to best manage PCOD?

Q: I am a 24 year old unmarried female having problem of oligomenorrhoea since my menarche. I am having slight degree of hirsutism but no obesity. I consulted an endocrinologist in Delhi 3 years back. I got USG pelvis done which shows bilateral cyst in ovaries, my testosterone & DHEAs levels were markedly raised and FSH:LH ratio was low. I was diagnosed PCODs with late onset congenital adrenal hyperplasia. I was started on DIANE 35 (D2 of cycle for 21 days & ALDACTONE 100 mg OD). After 2 years aldactone was stopped & I was on Diane 35 and Fincar 5 mg OD and hirsutism subsided a bit. 4 months back I developed fibroadenosis of breast for which the doctor stopped diane and gave primrose oil. Now again my periods have become irregular on stoppage of Diane-35 and now I'm only on Fincar. I got my hormone profile done recently which shows normal testosterone, DHEA, FSH & LH (might be because I'm on Fincar currently) but USG shows bilateral PCODs. The doctor says that I have to be on medicine for 2 more years and PCOD doesn't get cured. Should I have to be on medicine throughout my life or does this disease get cured with treatment ? What should be the proper treatment? What are my chances of conceiving and abortion rates? And if I conceive will my baby be normal? Please help me.

A:1. These medicines are not to be taken throughout ones life, but only to the extent of improving the symptomatology and achieving the end-objective which often is pregnancy. 2. Once the FSH and LH levels come to acceptable levels on day 2 of the menstrual cycle, in addition to other hormonal levels being normal (prolactin, estradiol, testosterone, DHEAs etc), pregnancy can then be planned and monitored carefully thereafter. The chance of early pregnancy loss (abortion) is higher in women with PCOS when compared to normal healthy women, but with the advent of newer medicines for pregnancy support, the chance of abortions are coming down. 3. Should there be insulin resistance (fasting sugar: insulin ratio < 4.5), addition of medication like metformin / troglitazone and chiro-inositol is helpful not only regularise the menstrual cycle but also improve ovulation and thereby, increase pregnancy rates. 4. If both the ovaries are really enlarged, laparoscopic ovarian drilling (LOD: a maximum of 3-4 drills per ovary) is considered helpful to reduce the hyperandrogenaemia.

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