February 15, 2017

Polycystic Ovarian Syndrome

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:

  • Gynecological health and disorders
  • Reproductive health and pregnancy issues
  • Menopause
  • Cancer (cervical and breast are the most common)

Of those issues related to infertility the more prevalent ones include:

  • Uterine fibroids
  • Ovarian insufficiency
  • Endometriosis
  • Polycystic Ovarian Syndrome(PCOS)


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.

Young beautiful Caucasian woman on bed having stomach pain / period menstruation / food poisoning / cramps sickness
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

Gynecology

  • Infertility
  • Infrequent or no periods
  • Pelvic pain

Dermatology

  • Facial Hair
  • Acne, oily skin, dandruff
  • Male pattern alopecia (baldness)
  • Patches of brown or black discolouration of the skin
  • Skin tags

Mental disorders

  • Anxiety or depression
  • Sleep apnoea

Others

  • Weight gain

Based on the predominant symptoms three (3) principal features have been described:

  1. Anovulation which is no ovulation, amenorrhoea when there is no menstruation and irregular menstruation.
  2. Androgenic syndrome with high levels of masculinizing hormones causes acne, hirsutism including facial hair and infertility.
  3. Insulin resistance which results in obesity, Type 2 Diabetes, and an increase in cholesterol.

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.


Medical Concept: Ovarian Cyst - Medical Concept on Black Chalkboard. Medical Concept: Ovarian Cyst Handwritten on Black Chalkboard. Top View of Blue Stethoscope on Chalkboard. 3D Rendering.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.

Medical history

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.

Physical exam

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.

  1. Pelvic ultrasound which might show enlarged ovaries with small cysts. These are signs of PCOS. But many women with PCOS don’t have these signs.
  2. Lab tests
  • A pregnancy test Human chorionic gonadotropin (HCG)
  • Testosterone level, which would explain the presence of acne, facial hair, excessive body hair, and alopecia (hair loss from the scalp).
  • Prolactin level, which can cause amenorrhea (lack of menstrual cycles) or infertility.
  • Cholestrol and triglycerides which tend to be elevated with PCOS.
  • Thyroid stimulating hormone (TSH) to check for an overactive or underactive thyroid.
  • Adrenal gland hormones, such as DHEA-S or 17-hydroxyprogesterone.  An adrenal problem can cause symptoms much like PCOS.
  • Glucose tolerance and insulin levels, which can show insulin resistance and diabetes mellitus.

How is PCOS treated?

OvaryMedical Treatment

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.

Surgical Treatment

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:

  • Pre-diabetes
  • Higher risk of heart attack
  • Higher risk of high blood pressure
  • High levels of LDL (bad fat)
  • Sleep apnoea
  • Infertility
  • Increase risk for endometrial and breast cancers

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

femme couche qui souffreDiabetes, 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:

  • Infrequent or no periods
  • Infertility, inability to conceive
  • Miscarriage

Related symptoms

  • Weight gain
  • Pelvic pain

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.

Treatment-Medical

Beautiful young woman lying on bed and holding hands on her stomach.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.

Treatment-Surgical

The surgical intervention offered is the laparoscopic (keyhole surgery) ovarian drilling. This is a way of stimulating ovulation (the production of eggs).

Lifestyle interventions

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.

  • Whole food includes (whole grain and sprouted grain)
  • Vegetables such as kelp, mustard green, collard and kale
  • Chinese herbs. Wakame seaweed is one used for fertility
  • Lean organic protein
  • Omega fatty acid from animal (fatty fish) and plant sources
  • Whole grain
  • Multi-vitamins especially vitamin D, minerals which should include calcium and the micronutrient chromium which normalizes blood sugar
  • Limit processed foods and foods with added sugar

Herbs which promote hormonal balance include the following:

  • Licorice
  • Maca
  • Vitex
  • Tribulus
  • White peony

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.

  • A healthy diet must be balanced and should contain foods from the following food group (carbohydrates, proteins, fats).
  • Decrease fats, salt and sugar in your meals
  • 3-5 serving of fruits and vegetable.
  • Eat lean meat
  • Vegans will need to have a variety of legumes, green leafy vegetables, tubers and a good supplement of liquid amino acids.
  • Increase daily water intake to 8-10 glasses for hydration and detox.

Exercise Plan

Personalized exercise prescriptions are highly recommended and a health & fitness coach can be consulted on this.

  • Make a conscious effort to walk (or be more active) around the house and at work.
  • Opt to use the staircase when there is an option but it you are having issues with your knees then just simply walk on the level
  • Park and walk in the shopping areas
  • Investing in comfortable footwear will encourage you to walk and exercise more.

For persons who are already active and engaged in physical exercise:

  • Ensure you have a combination of cardio and resistance training and increase gradually the routine.
  • Target the problem areas (waist, hips, thighs, buttocks etc.)

Waist circumference

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.

Exercising

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.

No Smoking

This pain is so exhaustiveSmoking 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:

  • Changes in the monthly menses i.e. heavy, scanty or irregular bleeding.
  • No success in getting pregnant if you have been trying for more than 12 months.
  • Symptoms suggestive of diabetes i.e. excessive thirst and frequent urination at night, unexplained weight loss despite having a good appetite, fatigue, vision disturbance, tingling or numbness sensations in your feet.
  • Depression and/or anxiety that can be linked to PCOS. Continued

How is PCOS diagnosed?

To diagnose PCOS, the doctor will:

  • Ask questions about your past health, symptoms, and menstrual cycles.
  • Do a physical exam to look for signs of PCOS, such as extra body hair and high blood pressure. The doctor will also check your height and weight to see if you have a healthy body mass index (BMI).
  • Do a number of lab tests to check your blood sugar, insulin, and other hormone levels. Hormone tests can help rule out thyroid or other gland problems that could cause similar symptoms.

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?

Regular exercise, healthy foods, and weight control are the key treatments for PCOS. Treatment can reduce unpleasant symptoms and help prevent long-term health problems.


Research on Polycystic Ovarian Syndrome

Asian woman touching her own belly with stomachache, appendicitis pain

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:

  1. Poycystiv ovary syndrome, S Franks – New England Journal of Medicine, 1995 – Mass Medical Soc.

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.

  1. Polycystic ovary syndrome, DA Ehrmann – New England Journal of Medicine, 2005 – Mass Medical Soc

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.

  1. Polycystic ovary syndrome, RJ Norman, D Dewailly, RS Legro, TE Hickey – The Lancet, 2007 – Elsevier

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.

  1. Polycystic ovary syndrome, DS Guzick – Obstetrics & Gynecology, 2004 – journals.lww.com

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.

  1. Polycystic ovary syndrome, VT Goudas, DA Dumesic – Endocrinology and metabolism clinics of North, 1997 – Elsevier

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.

  1. Polycystic ovary syndrome, R Homburg – Best Practice & Research Clinical Obstetrics &, 2008 – Elsevier

Have a Stomachache

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.

  1. Polycystic ovary syndrome, AE Taylor – Endocrinology and Metabolism Clinics, 1998 – endo.theclinics.com

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.

  1. Polycystic ovary syndrome, J King – Journal of Midwifery & Women’s Health, 2006 – Wiley Online Library

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.

  1. Polycystic ovary syndrome, S Franks – Archives of disease in childhood, 1997 – adc.bmj.com

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.

  1. Polycystic ovary syndrome, SJ Robboy – 2002 – journals.lww.com

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.

  1. Polycystic ovary syndrome,  A Nandi, Z Chen, R Patel, L Poretsky – Endocrinology and metabolism …, 2014 – Elsevier

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.

  1. , AP Cheung, RJ Chang – Clinical obstetrics and gynecology, 1990 – journals.lww.com

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.

  1. Polycystic ovary syndrome, ZJ Chen, Y Shi- Frontiers of medicine in China, 2010 – Springer

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.

  1. Polycystic ovary syndrome, JF Reckelhoff – Hypertension, 2007 – Am Heart Assoc

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.

  1. Revised 2003 consensus on diagnostic criteria and long term health risks related to polycystic ovary syndrome, TR ESHRE… – Fertility and sterility, 2004 – Elsevier

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.

  1. Polycystic ovary syndrome, J Ginsburg, CW Havard – British medical journal, 1976 – ncbi.nlm.nih.gov

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.

  1. [B] Polycystic ovary syndrome,  RJ Chang – 2012 – books.google.com

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.

  1. Profound peripheral insulin resistance, independant of obesity, in polycystic ovary syndrome,  A Dunaif, KR Segal, W Futterweit, A Dobrjansky – Diabetes, 1989 – Am Diabetes Assoc

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.

  1. The prevalence and features of the polycystic ovary syndrome in an unselected population, R Azziz, KS Woods, R Reyna, TJ Key… – The Journal of …, 2004 – press.endocrine.org

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

  1. Polycystic ovary syndrome,  D Macut, M Pfeifer, BO Yildiz, E Diamanti-Kandarakis – 2012 – books.google.com

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.

  1. Polycystic ovary syndrome, , D Dewailly – Journal de gynecologie, obstetrique et biologie de l, 2000 – europepmc.org

, 3D rendering, rough street sign collection

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.

  1. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach, JK Zawadzki, A Dunaif – Polycystic ovary syndrome. Boston: Blackwell, 1992 – joplink.net
  1. Metformin therapy in polycystic ovary syndrome reduces hyperinsulinemia, insulin resistance, hyperandrogenemia, and systolic blood pressure, EM Velazquez, S Mendoza, T Hamer, F Sosa… – Metabolism, 1994 – Elsevier

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.

  1. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis 1, A Dunaif – Endocrine reviews, 1997 – press.endocrine.org

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.

  1. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254, RS Legro, AR Kunselman, WC Dodson- The journal of clinical, 1999 – press.endocrine.org

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

  1. Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome, DS Kiddy, D Hamilton‐Fairley, A Bush Clinical, 1992 – Wiley Online Library

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

  1. Polycystic ovary syndrome, DR Shelley, A Dunaif- Comprehensive therapy, 1990 – europepmc.org

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.

  1. A prospective study of the prevalence of the polycystic ovary syndrome in unselected women from spain 1, M Asunción, RM Calvo, JL San Millán – The Journal of, 2000 – press.endocrine.org

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.

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