IndexEtiology and pathophysiologyClinical signs and symptomsDifferential diagnosisPossibly laparoscopyNatural medicinePrognosisWorks Cited Polycystic ovary syndrome (PCOS) is a complex endocrine metabolic disorder that affects the functioning of a woman's ovaries. It mainly involves ovarian hyperandrogenism and is linked to insulin resistance. (Minerva Pediatrica, 2010) Associated with polycystic ovaries, menstrual dysfunction, anovulation, ovulatory dysfunction and other metabolic disorders. Also known as Stein-Leventhal syndrome. Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an original essay PCOS affects between 8% and 20% of women of reproductive age worldwide. (Sirmans & Pate, 2014) Because there is no universal definition of PCOS, the exact number of women with PCOS is unknown. Most women are diagnosed with the syndrome when they are in their twenties and thirties, but PCOS can affect girls as young as 11 who have not even had their first menstrual period. (National Center for Biotechnology Information, 2016) Menstrual disorders commonly seen in PCOS include oligomenorrhea, amenorrhea, and prolonged irregular menstrual bleeding. (Farquhar C, 2007) However, 30% of women with PCOS will have normal periods. (Balen, 1995) Approximately 85%–90% of women with oligomenorrhea have PCOS while 30%–40% of women with amenorrhea will have PCOS. (Hart, 2007) Prevalence estimates of PCOS, as defined by the NIH/NICHD criteria, indicate that PCOS is a common endocrinopathy affecting 4%-8% of women of reproductive age. (J Clin Endocrinol Metab. 2004) Recently several groups have demonstrated that the prevalence of PCOS varies depending on the diagnostic criteria used (see Table 2). (March et al, 2010-2012) These studies consistently report that prevalence estimates using the Rotterdam criteria are two to three times greater than those obtained using the NIH/NICHD criteria. Prevalence of polycystic ovary syndrome (PCOS) using different diagnostic criteria Source Population NIH/NICHD criteria ESHRE/ASRM criteria (Rotterdam) Androgen excess and PCOS society criteria:March et al 728 Australian women 8.7% 17.8% 12.0%Mehrabian et al 820 Iranian women 7% 15.2% 7.92%Tehrani et al 929 Iranian women 7.1% 14.6% 11.7%Yildiz et al 392 Turkish women 6.1% 19, 9% 15.3% Abbreviations: ESHRE/ASRM, European Society for Human Reproduction and Embryology/American Society for Reproductive Medicine; NIH/NICHD, National Institutes of Health/National Institute of Child Health and Human Disease. A family history of PCOS is a risk factor for PCOS. Based on the clustering of cases in families, PCOS is considered to be a hereditary disease. (Franks et al, 1997) A high prevalence of PCOS or its features among first-degree relatives suggests genetic influences. (Amato et al, 2004) Furthermore, greater concordance has been reported in monozygotic twins compared to dizygotic twins. (Vink et al, 2006) However, the mode of inheritance remains elusive. Problems that hinder progress in this area include the heterogeneity of PCOS phenotypes, difficulty in assigning a phenotype to men, postmenopausal women, and prepubertal girls, and difficulty in obtaining sample sizes large enough to allow a adequate statistical power. (Goodarzi et al, 2011) A genome-wide association study conducted among Han Chinese identified loci on chromosomes 2p16.3, 2p21, and 9q33.3. (Chen et al, 2011) Some of these findings have been replicated in European cohorts, namely the THADA chromosome 2p21 and DENND1A chromosome 9p33.3 susceptibility loci. Sharingof the same susceptibility genes suggests that PCOS is an ancient disorder that originated before humans migrated from Africa. (Diamanti-Kandarakis et all, 2012) A higher prevalence of PCOS is associated with a number of conditions. A history of weight gain often precedes the development of the clinical features of PCOS (Isikoglu et al, 2007) and following a healthy lifestyle has been shown to reduce body weight, abdominal fat, reduce testosterone, improve resistance to insulin and decreases hirsutism in women with PCOS. (Moran et al, 2011) Obese women referred for weight loss assistance had a PCOS prevalence of 28.3%. (Alvarez-Blasco et al, 2006) However, in an unselected population, the prevalence of PCOS did not vary significantly by obesity class. (Yuldiz et al, 2008) The prevalence rates of PCOS for underweight, normal weight, overweight, mildly obese, moderately obese, and severely obese women were 8.2%, 9.8%, 9.9%, 5.2, respectively %, 12.4% and 11.5%. . The authors concluded that obesity may increase the risk of PCOS but that the effect is modest. Etiology and pathophysiology Main causes and risk factors: Obesity and/or insulin resistance. Family history of polycystic ovaries or metabolic disorders. Early menarche. Early adrenarche. Hyperandrogenism Type 1, 2, gestational DM. The DENND1A gene from antiepileptic drugs (e.g. valproate) is linked to PCOS in many populations. The clinical, biochemical and diagnostic characteristics of PCOS are known, but the etiology remains unknown (Elghblawi, 2007). Three-quarters of women with secondary amenorrhea meet the diagnostic criteria for PCOS (Hill, 2003). Women with PCOS are at risk of developing type 2 diabetes mellitus, hyperlipidemia, reproductive system tumors, sleep apnea, and infertility problems (Ehrmann, 2005; Guzick, 2004; Sherif, 2006; Taylor, 1998). Typically, PCOS symptoms first appear in adolescence. , normally around the state of menstruation. Occasionally, some women do not develop symptoms of PCOS until their mid-20s. One of the most common symptoms of PCOS is irregular periods. Polycystic ovary syndrome (PCOS) becomes symptomatic during adolescence and affects at least 5% of women of reproductive age. PCOS is a heterogeneous syndrome of chronic unexplained hyperandrogenism and oligoanovulation, in which polycystic ovaries constitute an alternative diagnostic criterion. Clinical Signs and Symptoms In addition to the three features used to diagnose polycystic ovary syndrome (PCOS) (absence of ovulation, high androgen levels, and ovarian cysts), PCOS has numerous signs and symptoms, some of which may seem unrelated ( American College of Obstetricians and Gynaecologists, 2015). Menstrual irregularities: Absence of menstruation – amenorrhea Frequently missed periods – oligomenorrhea Very heavy periods – menorrhagia Bleeding but no ovulation – anovulatory periods Infertility Hirsutism – excessive hair growth on the face, chest, belly or upper thighs Severe, late-onset acne or persistent that does not respond well to usual treatments Obesity, weight gain or difficulty losing weight, especially around the waist Pelvic painCysts on one or both ovaries (not necessarily, only present in some patients)Oily skinMale pattern baldnessAcanthosis nigricans – patches of skin thickened, dark and velvetyAnxiety and depressionBecause many women do not consider problems such as oily skin, excessive hair growth or acne to be symptoms of a serious health condition, they may not mention these things to their healthcare providers. As a result, many women are not diagnosed with PCOS until they have difficulty stayingpregnant or if they have abnormal periods or missed periods. Differential Diagnosis Conditions that resemble or may present similarly to PCOS are: Adrenal hyperplasia (excessive production of hormones by the adrenal glands) Problems with the function of the thyroid gland Hyperprolactinemia (excessive production of the hormone prolactin by the pituitary gland). Practitioners Health care providers look for three characteristics of polycystic ovary syndrome (PCOS): absence of ovulation, high levels of androgens, and cysts on the ovaries. Having one or more of these characteristics could lead to the diagnosis of PCOS. After ruling out other conditions and before making a diagnosis of PCOS, your healthcare provider will do the following: Take your complete family medical history. The patient's menstrual cycle and any history of infertility, as well as whether there is a history of PCOS symptoms in a family. Blood tests: increased androgens (testosterone, androstenedione, and DHEA-S), low sex hormone binding globulin (SHBG), high LH: normal or low FSH, high estrogen (estradiol), hyperinsulinemia, and blood glucose levels . Ultrasound to investigate the presence of 12 or more follicles in each ovary measuring 2 to 9 mm in diameter and/or increased ovarian volume. Possibly laparoscopy Orthodox medical treatment - objectives: Treat hyperandrogenic symptoms such as acne and hirsutism. Treat underlying metabolic disorders. Prevent complications such as hyperplasia or carcinoma. Contraception for those who are not carrying a pregnancy. Ovulation induction for those who are carrying carrying out a pregnancy. Lifestyle modifications: diet, exercise for weight reduction. Women who do not carry on a pregnancy: The first line treatment is combined estrogen-progesterone oral contraceptive pill 20 mcg. Benefits include endometrial protection, contraception, and control of hyperandrogenic symptoms. If hyperandrogenic symptoms do not resolve after 6 months, antiandrogens may be added. For example, spironolactone 50 to 100 mg twice daily. Metformin to reduce insulin levels. Statin to reduce cholesterol. Ovulation induction: clomiphene citrate as first-line therapy for nonobese women, if obese, letrozole is a choice. In vitro fertilization .Natural medicineNutrition can play an important role in a strategy to reverse PCOS, but there is no best diet for this because there is no PCOS. (Goodwin, 2017) PCOS is a syndrome, meaning it is a constellation of symptoms grouped together to make more sense of what is going on (just like in irritable bowel syndrome or chronic fatigue syndrome). Most women with PCOS suffer from insulin resistance, which means their body struggles to use carbohydrates for energy, and so stores them as fat, especially around the belly. In this case, options such as a low-carb/moderate-protein/high-fat diet (variations of the keto and paleo diets tailored to an individual's needs) might be considered in order to reverse insulin resistance. Another option to consider for reversing insulin resistance would be intermittent fasting. Natural remedies to support this process: Chromium, Vitamin D, Cinnamon, Gymnema. Other women with PCOS may not have insulin resistance and may instead have elevated levels of DHEA-S, which shows that stress hormones are the problem. So if we reduce carbohydrates too much for her, the situation will get worse. In this case, we would prefer to focus on improving the function of the adrenal glands. Natural Remedies: Nutrients That Support Adrenal Fatigue.00418-012-0913-6