PCOS and Endometriosis
Diagnosis and Management
PCOS — A Whole-Body Condition
Polycystic Ovarian Syndrome is one of the most common hormonal conditions affecting women worldwide, and it is both significantly underdiagnosed and significantly misunderstood. Many women are told they have PCOS and given a prescription for the contraceptive pill — without any discussion of what PCOS actually is.
Dr. Krishnakumar’s approach treats PCOS as the complex disorder it is. Associated with insulin resistance, cardiovascular risk, and androgen imbalances, PCOS disrupts ovulation and creates a hormonal environment that increases risks for miscarriage and gestational diabetes.
The Diagnosis of PCOS
PCOS is diagnosed according to the Rotterdam criteria, requiring two of three features: irregular ovulation, elevated androgens (acne, hirsutism, or elevated testosterone), and polycystic ovarian morphology on ultrasound (20+ follicles or volume > 10mL). The diagnosis is made after exclusion of conditions like thyroid disease or hyperprolactinaemia through appropriate blood testing.
Clinical Management
Lifestyle & Metformin
Regular aerobic exercise combined with a low-glycaemic-index diet is the most evidence-based intervention. Even a 5 to 10 percent reduction in body weight can restore ovulation. Metformin is used to improve insulin sensitivity and promote regular ovulation.
Ovulation Induction
For those trying to conceive, Letrozole is now the first-line medication, producing higher live birth rates than clomiphene with lower risks of multiple pregnancy. Injectable gonadotropins are used when oral options fail, requiring expert care to minimize OHSS risk.
IVF for PCOS
Women who do not conceive with IUI are candidates for IVF. This requires a carefully personalised protocol to maximise egg number while minimising OHSS risk. Dr. Krishnakumar utilizes antagonist protocols, GnRH agonist triggers, and “freeze-all” strategies to ensure the safest and most effective outcomes.
Endometriosis — Taking the Pain Seriously
For far too long, the severe pelvic pain associated with endometriosis has been dismissed or normalized. It is a serious, inflammatory condition with real anatomical consequences. The average time from first symptoms to diagnosis in India is seven years—seven years of pain treated inadequately.
Dr. Krishnakumar investigates endometriosis thoroughly and treats it effectively using advanced surgical skills (ECRES certification). Complete laparoscopic excision of all visible disease is the only treatment that addresses the disease at its root. Symptom recurrence is substantially lower after excision, and fertility outcomes are significantly improved.
For women trying to conceive, surgical excision before IVF improves the intrauterine environment and reduces inflammatory burden. However, for some, a direct approach to IVF is the better strategy—a decision made on an individual basis at consultation.
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