Monthly Archives: February 2017
Monthly Archives: February 2017
Women’s health issues are commanding much more attention when compared with a decade ago. This is because health and wellness need to be gender specific as they are clear distinctions between the chronic diseases with respect to the influence of hormones and lifestyle to name a few. Among the most discussed women’s issues are:
Of those issues related to infertility the more prevalent ones include:
What is polycystic ovarian syndrome (PCOS)?
PCOS is a disorder which occurs as a result of a complex hormonal dysfunctional. It is characterized by multiple small cysts in the ovaries but the effect of this dysfunction is manifested in several body systems (reproductive, cardiovascular and metabolic). About 1 in 15 women are living with this disorder. There are two ovaries which form part of the female organs and their main function is the production of eggs, female hormones. The female hormones are estrogen, progesterone. In addition to the female hormones, women do have low levels of the male hormone androgen. However, in the case of PCOS there is an overproduction of ovarian androgens leading to a
heterogeneous range of symptoms including hirsutism, acne, anovulation and infertility.
What causes PCOS?
It is unclear what causes PCOS. and some researches have classified the disorder as a genetic disease. It is not unusual that sisters and mothers and their daughters have the disorder.
Symptoms of PCOS
Based on the predominant symptoms three (3) principal features have been described:
Some researchers agree that 5-10% of the female population of reproductive age develop symptoms.
It is important for women to be screened for the disease if they have been experiencing one or more of the symptoms previously described.
How is PCOS diagnosed?
There is no one test that can confirm the diagnosis of PCOS. The doctor may determine the diagnosis based on the medical history and the physical examination.
The patient will be asked about any changes that have been observed with the menstrual cycle, weight and skin. If there has been a problem getting pregnant, this is an important clue. The family history of similar issues and diabetes should be established.
On examination, the doctor will pay special attention to the skin, hair, distribution of body fat, cardiovascular system and pelvic examination. Acne, facial hair are important clinical findings.
Diagnostic tests may be requested i.e.
How is PCOS treated?
Medical treatment typically involves treatment of the complications. In other words, for women who develop diabetes their doctor should prescribe treatment for this condition. Similarly, other conditions such as infertility, acne and hirsutism should be treated with anti-androgen drugs.
The surgical intervention offered is the laparoscopic (keyhole surgery) ovarian drilling
What are the potential complications of PCOS?
It follows that from the principal features mentioned previously, the following complications have been noted:
It is recommended to have screening done for diabetes especially if the other risk factors are present (family history of PCOS, obesity, sedentarism, or a past history of gestational diabetes).
Th risk for cardiovascular disease should be established using screening tools for cholesterol, triglycerides, BMI and blood pressure.
Therapy for selected complications
Diabetes, Cardiovascular Diseases
For diabetes, the doctor will determine whether insulin therapy and or a combination with diabetic drugs namely metformin will be prescribed.
Fertility Risks include:
The cause is still unclear and some researches have classified the disorder as a genetic disease as it is not unusual that sisters and mothers and their daughters have the disorder.
Medical treatment typically involves treatment of the complications. Hormone therapy (oral contraceptive) is used to regulate the menstrual cycle. It keeps the endometrial lining from becoming too thick as this could in the long-term lead to uterine cancer. The hormone therapy can also be used to treat hirsutism, hair loss and acne.
Drugs are used to treat infertility and a well- known drug is clomid. Clomid hyper-stimulates the ovary to produce eggs.
The surgical intervention offered is the laparoscopic (keyhole surgery) ovarian drilling. This is a way of stimulating ovulation (the production of eggs).
Diet, exercise and weight management are important components of the lifestyle program.
The Fertility Diet
The organic diet recommended for fertility promotes the health of the womb (uterus), increases ovulation and decreases the incidence of miscarriages.
Herbs which promote hormonal balance include the following:
Diet and Exercise in the Management of Obesity
Consult with a registered dietician if this is an option for you. A personalized plan is ideal. Aim to reduce your daily caloric intake by 500 calories daily.
Personalized exercise prescriptions are highly recommended and a health & fitness coach can be consulted on this.
For persons who are already active and engaged in physical exercise:
The goal is < 35 inches for women and,
< 40 inches for men
Endometrial and Breast cancers
If there is a family history of breast or endometrial cancer, regular screening should be done for early detection. Basic screening tools are pap smear, ultrasonography and mammogram.
The exercise prescription should take into account the following:
For each client, the degree of sedentarism and conversely physical activity should be assessed. If the client is sedentary, then walking 15-20 minutes daily is a good start. Also of importance is the BMI of the client. BMI >40 is an obese individual and may do better with water aerobics and/or low impact aerobics (pilate, yoga) so as not to damage or compromise the ankles and knees.
It is important to have a medical check before starting any exercise programme.
Smoking cessation help should be offered to persons who smokeThe patch and gums are often useful to quit the habit.
Therapy for depression and Stress Management
Depression can be treated and must be treated as if left untreated could lead to more severe mental health issues. Concerns about body image, infertility can be addressed in a support group. A health coach can assist with identifying stressors and lifestyle changes to reduce stress levels
When to call your doctor
Call your doctor if you have:
How is PCOS diagnosed?
To diagnose PCOS, the doctor will:
You may also have a pelvic ultrasound to look for cysts on your ovaries. Your doctor may be able to tell you that you have PCOS without an ultrasound, but this test will help him or her rule out other problems.
How is it treated?
Research on Polycystic Ovarian Syndrome
In the last 10 years, there has been a body of research done on the etiology
and pathophysiology of polycystic ovary syndrome. Here are a few research papers that have been cited:
This paper establishes that Polycystic ovary syndrome in its most typical form, the association of hyperandrogenism and chronic anovulation is one of the most common endocrine disorders. The clinical and biochemical features are heterogeneous in all cases.
Ehrmann describes the multiple components of PCOS i.e. the reproductive, metabolic, and cardiovascular involvement with health implications for the patient’s entire life span.
In this study the prevalence of Polycystic ovary syndrome is determined to be about one in 15 women worldwide. The researchers reported that the major endocrine disruption is excessive androgen secretion or activity, and a large proportion of women also have abnormal insulin activity.
In summary, the researcher determined that women with polycystic ovarian syndrome have chronic anovulation and androgen excess not attributable to another cause. This condition occurs in approximately 4% of women. The fundamental pathophysiologic defect is unknown, but important characteristics have been noted.
Polycystic ovary syndrome (PCOS) refers to a heterogeneous group of gynecologic disorders with variable degrees of ovarian and adrenal hyperandrogenism. Although its precise definition remains elusive, the classic description in 1935 by Stein and Leventhal are still very useful.
Polycystic ovary syndrome (PCOS) is the most common female endocrinopathy, affecting 5–10% of the female population. It involves overproduction of ovarian androgens leading to a heterogeneous range of symptoms including hirsutism, acne, anovulation and infertility.
Most physicians would agree that polycystic ovary syndrome (PCOS) can be diagnosed clinically in the woman presenting with hirsutism, irregular menstrual cycles, obesity, and a classic ovarian morphology.
ABSTRACT Polycystic ovary syndrome (PCOS) is a common endocrine disorder, affecting between 4% and 8% of reproductive aged women. This syndrome is a complex disorder with multiple components, including reproductive, metabolic, and cardiovascular manifestations.
Polycystic ovary syndrome (PCOS) is the commonest endocrine disorder in women of reproductive age. The classical symptoms are those of hyperandrogenism (hirsutism, persistent acne, androgen dependent alopecia) together with symptoms of anovulation.
Enormous progress has been made in the past 10 years in the understanding of the etiology and pathophysiology of the polycystic ovary syndrome. The author describes the causes and manifestation of the syndrome.
Historically, it is unclear when polycystic ovary syndrome (PCOS) was first described, but there are some clues in the Egyptian papyri to suggest the presence of PCOS-like syndrome. Hippocrates in his writing alluded to menstrual periods which lasted less than 3 days.
Sporadic accounts of sclerocystîc changes in human ovaries have been noted for more than 100 years. Formal recognition of this anatomic alteration in association with amenorrhea and infertility was first described by Stein and Leventhal in 1935.
Abstract Polycystic ovary syndrome (PCOS) is a common gynecologic endocrinopathy. The pathogenesis of PCOS is associated with both heredity and environment. PCOS has adverse impacts on female endocrine, reproduction, and metabolism.
Polycystic ovary syndrome (PCOS) is a condition of ovarian dysfunction that affects 6% to 10% of women of reproductive age. The hallmarks of PCOS are menstrual cycle irregularities, androgen excess, and polycystic ovaries, as defined by the Rotterdam guidelines.
Since the 1990 National Institutes of Health–sponsored conference on polycystic ovary syndrome (PCOS), it has become appreciated that the syndrome encompasses a broader spectrum of signs and symptoms of ovarian dysfunction than those defined by the original researchers.
In 1935 Stein and Leventhal described seven hirsute and infertile women with amenorrhoea or oligomenorrhoea in whom bilateral cystic ovarian enlargement was found at laparotomy, and ascribed the diagnosis to polycystic ovarian disorder.
The term polycystic ovary syndrome (peOS) is meant to describe a clinical endocrinopathy characterized by menstrual irregularity and evidence of hyperandrogenism. While recognized since the 1800s, a clinical composite was not constructed until 1935.
Abstract Hyperinsulinemia secondary to a poorly characterized disorder of insulin action is a feature of the polycystic ovary syndrome (PCO). However, controversy exists as to whether insulin resistance results from PCO or the obesity that is frequently associated with it.
Notwithstanding the potential public health impact of the polycystic ovary syndrome (PCOS), estimates regarding its prevalence are limited and unclear. Between July 1998 and October 1999, 400 unselected consecutive premenopausal women (18–45 yr of age) were reviewed. Fewer
Polycystic ovary syndrome (PCOS) is the most frequent disorder affecting women of reproductive age. Recent years have shown substantial advances in our understanding of the complex genetic, biochemical, metabolic, cardiovascular, and reproductive issues.
The polycystic ovary syndrome (PCOS) is the most frequent endocrine disease in women of reproductive age. Hyperandrogenism, anovulation and metabolic syndrome are the cardinal features of PCOS.
Abstract Using polycystic ovary syndrome (PCOS) as a model of insulin resistance and hyperandrogenism, our specific aim was to assess the effect of Metformin on lipoproteins, sex hormones, gonadotropins, and blood pressure in 26 women with PCOS.
I. Introduction A. Background and historical perspective B. Definition of PCOS II. Insulin Action in PCOS
A. Glucose tolerance
B. Insulin action in vivo in PCOS
C. Insulin secretion in PCOS
D. Insulin clearance in PCOS
E. Cellular and molecular mechanisms of insulin.
Women with polycystic ovary syndrome (PCOS) are insulin resistant, have insulin secretory defects, and are at high risk for glucose intolerance. They27. performed this study to determine the prevalence of glucose intolerance and parameters associated with risk for this in PCOS
In this study, obese women with polycystic ovary syndrome have a greater frequency of menstrual disturbance and of hirsutism than lean women with the syndrome. Initial studies have demonstrated a marked improvement in endocrine function following treatment.Fewer
Abstract Polycystic ovary syndrome is a disorder of unknown cause characterized by anovulation, hyperandrogenism, and gonadotropin secretory abnormalities producing oligo-menorrhea, ovulation or anovulation. Hyperinsulinemia and insulin resistance are important features of this syndrome.
The researchers prospectively estimated the prevalence of the polycystic ovary syndrome (PCOS), as defined by the NIH/NICHHD 1990 endocrine criteria, in a population of 154 Caucasian women of reproductive age reporting spontaneously for blood donation.
Among the women’s health issues that are being discussed widely are menstrual issues, infertility, uterine fibroids, cervical cancer, uterine cancer, sexually transmitted infections, sexual dysfunction and endometriosis. It is important for general practitioners to be competent in recognizing these health issues in females and refer appropriately to the gynaecologists for specialized interventions.
What is Endometriosis?
Endometriosis is a condition which occurs when uterine tissue migrates to areas outside of the uterus. Some of these sites which can have uterine tissue are the:
The mere presence of uterine tissue on these organs is not the only problem. This tissue swells up and bleeds at the time the female is having her monthly menses. The same hormones which regulate the menstrual cycle also act on the endometrial tissues to cause same bleeding effect. It is still not clearly understood why endometrial tissue grows outside of the uterus. What is known is that high estrogen levels worsen the symptoms and this explains why this gynecological problem is seen in the adolescent years up to women in their forties.
When an adolescent or woman has been diagnosed with endometriosis, she need to know as much as she can about this gynecology condition and how to monitor and self-manage the symptoms. It is still not clearly understood why endometrial tissue grows outside of the uterus. What is known is that high estrogen levels worsen the symptoms and this explains why this gynecological problem is seen in the adolescent years up to women in their 40s. Symptoms improve and may even abate in the menopausal period of a woman’s life. Endometriosis is a chronic, painful condition that has no cure. Alleviation of symptoms is offered by GPs and gynaecologists. Women who have been diagnosed with this disease are being instructed how to monitor and self-manage the symptoms.
Endometriosis Signs and Symptoms
The symptoms of endometriosis vary from one patient to the next. This is as a result of the important link between where the abnormal endometrial tissue is growing and the symptoms that are experienced by the patient. Take for example the patient who coughs up blood during her menses, this raises the index of suspicion that her lungs may have endometrial tissue. Another example is passing blood in the stool during the menstrual bleeding, this implicates endometriosis involving the bowels.
Frequently experienced symptoms include:
It is useful to make notes on where and when the symptoms occur. Also, note improvement, worsening or no real change when given medication or when a procedure has been performed. There are also women who have no symptoms at all and the endometriosis is an incidental finding during infertility procedures.
Adolescents with a strong family history of endometriosis are at risk of developing this condition. Another risk factor for developing endometriosis is taking high doses of estrogen and other menstrual cycle hormones.
History taking: The doctor takes a detailed history to ascertain how long you have been having the symptoms. It is also important to establish whether there is any association with the menstrual cycle. Pain and bleeding are most noted during the menses.