Polycystic Ovarian Syndrome

Polycystic Ovarian Syndrome is recognized as the most common endocrinopathy in reproductive aged women. It is characterized by menstrual irregularities, infertility, obesity, hirsutism and numerous follicular cysts in enlarged ovaries. Oral contraceptive pills, Insulin sen- sitizers and surgical methods are mainly used in allopathic treatments. It is not affordable and said to be having many side effects. In Ayurveda, Pushpagni jataharini mentioned in kasyapa samhitha presents a clinical picture somewhat similar to that of PCOS. Analysing the signs and symptoms of disease, it can be inferred that vitiated kapha causes srotorodha resulting in vatavaigunya. Agneya property of pitha is also depleted. So adopting vata kaphahara and pitha vridhikara treatment, we can manage the disease through Ayurveda, which is affordable and de- void of major side effects

What is PCOS? Polycystic ovarian syndrome (PCOS) is a disorder that affects up to 1 in 10 women of reproductive age (the years between the first menstrual period and menopause). PCOS changes how a woman’s hormones work, which can interfere with monthly ovulation. That can lead to infertility. When a woman has trouble getting pregnant because she’s not ovulating regularly, PCOS is the most common reason.

Introduction Polycystic ovarian syndrome (PCOS) is sometimes called Stein-Leventhal Syndrome after the two doctors who first described it in 1935.1 It is the most common ovarian disorder with typical features of obesity, anovulation, hyperandrogenism, hirsutism and infertility. The accepted nomenclature for the syndrome is PCOS, despite the fact that polycystic ovaries are non-specific findings and can occur in women with regular cycles and no hormonal derangements.2 Other names such as hyperandrogenic chronic

Received 21 April 2011; revised 25 May 2011; accepted 3 June 2011. ABSTRACT Objective: The article will review the associations between Prediabetes (PD) and Polycystic Ovarian Syndrome (PCOS) and present factors that decrease the progression of PD into type 2 diabetes mellitus (T2DM).Metformin will also be examined for its role in ovulation induction, pregnancy and ameliorating the metabolic syndrome. Study Design: Medline search. Methods of study: Keyword search: Predia- betes (PD), Polycystic Ovarian Syndrome (PCOS), Metformin, Glucose Tolerance Test (GTT), Type 2 Diabetes Mellitus. Results: As the most common en- docrinopathy during the reproductive years, PCOS has a genetic multifactorial inheritance and is associ- ated with a high risk of insulin resistance. The use of metformin has shown mixed results in this patient population as a therapy to improve ovulation func- tion and the metabolic syndrome and showed no de- finitive reduction in the rate of miscarriage. PCOS patients are significantly predisposed to PD and T2DM. Conclusion: Lifestyle changes such as weight loss and physical activity reduce the progression of PD into T2DM in PCOS patients. The new AACE and ADA guidelines establish simplified methods of screening and treating PD. The role of metformin remains undefined in the infertile PCOS patient.

Abstract Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, associated with chronic anovulation and hyperan- drogenism. The cause of PCOS is multi-factorial and the mechanism is still un- clear. A number of complications are closely related with PCOS such as infertil- ity, hairy and obesity. Approximately up to one-third of females with PCOs have issues with infertility. Obesity is an independent factor which exacerbates infer- tility in PCOS, reduces the efficacy of infertility treatment and provokes a greater risk of miscarriage. Preconception counseling and guidelines play an initial ma- jor role in infertility treatment. The option of the most appropriate treatment depends upon various factors such as age, tubal patency, quality of sperm, expe- rience, and duration of previous treatments and the level of anxiety of the couple. Tubal patency test and semen analysis are mandatory to decide the suit- able treatment. Treatment modalities have two measures—non-pharmacological and the pharmacological. Oral clomiphene citrate remains the first line treat- ment to trigger ovulation. Gonadotrophin and laparoscopic ovarian drilling (LOD) surgery are the other treatment option. In vitro fertilization (IVF) and embryo transfer are the third line treatment and IVF remains the first option in the patient with diagnosed and established bilateral tubal occlusion and/or con- centration of recovered motile sperm less than or equal to 5 million. Here, etiol- ogy, pathophysiology and molecular mechanisms of PCOS are reviewed, and perspectives are given for further research. The recent development, treatment, and diagnosis of PCOS are also highlighted. The summary will be of guiding significance in the prevention and treatment of PCOS.

Fax +44 1482 675395 Email l.cho@hull.ac.uk AUTHOR COPY. Not for publication Abstract: It is estimated that 6%–7% of women of reproductive age have polycystic ovarian syndrome (PCOS). Women with this condition exhibit an adverse cardiovascular risk profile, characteristic of the cardiometabolic syndrome and given the high prevalence of PCOS in the female population, this condition may contribute towards the acceleration of cardiovascular disease among young women. This article summarizes the recent development and findings in the cardiometabolic abnormalities in patients with PCOS. Patients with PCOS have the clinical features of oligomenorrhoea, hirsutism and infertility; however, they also exhibit hyperinsu- linemia, obesity, hypertension, dyslipidemia, and an increased pro-thrombotic state. They have an increased risk of type 2 diabetes and impaired glucose tolerance, and sleep apnea is also found more commonly in this population. However, despite the presence of cardiovascular risk factors and increased surrogate markers of cardiovascular disease it is unclear if they have accelerated atherosclerosis. End point studies are currently lacking and the available evidence are conflicting.

INTRODUCTION Polycystic ovarian syndrome (PCOS) is one of the most frequently encountered endocrine disorders that occurs in as many as 4 to 10% of women of reproductive age group. 1 The excessive secretion of androgens in PCOS patients results in a series of skin changes including hirsutism, acne, seborrhea, androgenetic alopecia, acanthosis nigricans and acrochordons. 2

Department of Pharmaceutical Sciences, University of Kashmir, Hazratbal Srinagar - 190006, Jammu and Kashmir, India. ABSTRACT: Polycystic ovarian syndrome (PCOS) is one of the most prevalent endocrine disorders in females of reproductive age. Globally, it has been found that PCOS affects 10% of reproductive-age women when using the NIH criteria for diagnosis, and up to 18% of reproductive-age women are diagnosed with PCOS as per the Rotterdam criteria. Mostly symptoms of PCOS include irregular menstrual cycles, signs of hyperandrogenism and insulin resistance. Women with PCOS are at increased risk for developing reproductive, metabolic and cardiovascular disorders. The measures for management of PCOS targets the symptoms which are present in a patient such as lowering body weight and insulin levels, restoring fertility, treating hirsutism or acne, restoring regular menstruation and preventing complications. Early detection of long-term morbidities through appropriate screening tests constitutes an essential part of the management of this condition. Future research has to focus on the missing blocks in our growing knowledge about this condition, following that physicians will be able to provide the finest care for patients.

Polycystic Ovarian Syndrome is one of the most common female endocrine disorders af- fecting approximately 5% to 10% of women of reproductive age and is thought to be one of the leading [r]

The association between hyperandrogenism and glucose intolerance was first described in 1921 by Theirs and Archard 8 . They reported a diabetic women with beard . Insulin resistance is a feature of variety of conditions like type 2 diabetes, obesity, pregnancy, stress, and PCOS. The role of insulin in the pathogenesis of polycystic ovarian syndrome was first suggested in 1980 . In that study significant correlation was demonstrated between testosterone and basal levels of insulin. They also demonstrated correlation after an oral glucose load between testosterone and insulin levels

Results: Mean age was 19.4±3.5 years. Oligomenorrhea found in 42 out of 50 cases. Hirsutism found in 54% of cases. There is a statistically significant difference in weight, BMI and waist circumference among PCOS cases and controls. Hypertriglyceridemia was found to be significantly higher among PCOS cases. Fasting glucose and 2-hour OGTT were found to be statistically significantly different. No association was found between metabolic syndrome and clinical hyperandrogenism, but metabolic syndrome was significantly associated with higher BMI. BMI, Hip circumference and oral glucose tolerance test were independent predictors of polycystic ovarian syndrome. Metabolic syndrome was present in 34% of cases. The odds ratio of having metabolic syndrome in a case of PCOS is 5.92.

Background: This study was conducted to examine influence of hypothyroidism on pathophysiology and features of PCOS with respect to clinical characteristics of polycystic ovarian syndrome (PCOS), hormonal and metabolic profile. Methods: 102 euthyroid PCOS and 18 hypothyroid PCOS women were included in this cross-sectional study after considering inclusion and exclusion criteria. The study subjects were assessed for various signs and symptoms like recent weight gain, obesity, abnormal hair growth, hirsutism, hair loss, acne, acanthosis nigricans and infertility.

risk of developing anxiety and depressive disorders, bipolar disorders, social and sexual impairment and mood or eating disorders when compared to general population. 5 Exact etiology of these non- reproductive health related complications is not well known. 6 Evidence has empirically suggested that high insulin and androgen are associated with change in monoamine levels and results in mood disturbances. 7 Some researchers have linked symptoms of infertility, loss of femininity, body image concerns and lower self-worth as the likely cause of poor psychological wellbeing in affected females. 8 Although several cross-sectional and epidemiological studies have evaluated the association of emotional impairment with polycystic ovarian syndrome but results are highly conflicting. Earlier research demonstrates that prevalence of depression varies from 28 to 64%. Anxiety is another common psychological disturbance associated with this syndrome, varying from 34% to 57%. 9

Association between glucose intolerance and ABSTRACT Background: Polycystic ovarian syndrome (PCOS) is one of the most common endocrinal disorders of the reproductive age group causing anovulation, infertility incidence being 8.7-17.8%. It is associated with obesity, insulin resistance, dyslipidaemia and metabolic syndrome. This study was aimed to study the different clinical characteristics of women diagnosed with PCOS, attending a tertiary care hospital outpatient department.

Roby et al. World Journal of Pharmaceutical and Medical Research AOVERVIEW AND MANAGEMENT OF POLYCYSTIC OVARIAN SYNDROME WITH TREATMENT MODULATION Dr. Kanamala Arun Chand Roby*, Bonigala Sunny Dev, Ch. Pavan Kumar, M. Sri Divya and SK. Kishan Babu Associate Professor and Pharm D students, Department of Pharmacy Practice, Priyadarshini Institute of Pharmaceutical

The polycystic ovary syndrome is originally called as the Stein–Leventhal syndrome. Polycystic Ovarian Syndrome (PCOS) is a serious disorder in women in which the ovaries become enlarged with many ‘cysts’ which are in fact small undeveloped follicles. Over time there is thickening and fibrosis of the ovarian casing which prevents any follicles which do ripen from being released. PCOS is associated with anovulation and menstrual irregularities, infertility and insulin resistance. There may be acne, hirsutism and weight gain. As the condition progresses it may become associated with dysfunctional uterine bleeding, obesity, Type 2 diabetes, endometrial cancer, high cholesterol and cardiovascular disease 6-7 .

A large number of women experience significant symptomatology from chronic androgen excess and / or polycystic ovarian syndrome. Symptoms often commence in the late teens and early twenties with menstrual disturbances and masculinizing features. Infertility is common. Drug and surgical interventions may lead to distressing side effects.

Infertility Infertility is a common presenting problem in patients with polycystic ovarian syndrome. PCOS is associated with approximately 80–90% of women who suffer from infertility due to anovulation. Therapy of most anovulatory patients can be planned at the first visit. If the patient desires pregnancy, she is a candidate for the medical induction of ovulation. When pregnancy is achieved, patients with polycystic ovaries appear to have an increased risk of spontaneous miscarriage (9) . This increased risk has been attributed to elevated levels of LH that may produce an adverse environment for the oocyte, perhaps even inducing premature maturation and completion of the first meiotic division. For this reason, consideration should be given to pretreatment suppression prior to the induction of ovulation.

reproductive age or potential. (Polycystic Ovarian Syndrome Association, Inc, 2009). This topic has had extensive research done over the past five years because of the growing incidence of occurrence among adolescent females, as well as the systemic repercussions that are being discovered with older women who were not managed optimally due to lack of research available to guide treatment. Although there is still much to learn about the topic, treatment guidelines and diagnostic criteria have been developed that allow healthcare providers to confidently manage and treat women with symptoms suggesting PCOS.

Background: It has been estimated that prevalence of PCOS ranges from 5-10% in reproductive females. Thus, it becomes most common endocrinopathy in this age group. Lack of ovulation and androgen over activity are key features of PCOS. The objective of this study was to patients with polycystic ovarian syndrome at a tertiary care center.