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Polycystic Ovarian Syndrome
Unfortunately, according to studies, women with PCOs after the reproductive age, are associated to continuously increase risk of type II diabetes, with no increasingaltered glucose tolerance(20), CVD and hypertension(21).
The prevention and management
Polycystic ovary syndrome (PCOS) is unpreventable in Western medicine. Early diagnosis and treatment may reduce risk of its complications, including infertility, metabolic syndrome, obesity, diabetes, cardiovascular diseases, stroke, etc.
Although PCOS cannot be completely avoided, strengthening immunity has shown a significant reduction of chronic inflammatory diseases(266)(267)(268).
Types of Conventional treatments
There is no medical treatment for PCOs (induced weight loss for obese PCOs is primary objective). If pregnancy is not the concern, oral contraceptive medicine are prescribed. If pregnancy is a concern, the below have found to be most frequent treatment used conjunction with artificial insemination.
A. Fertility Drugs
a) The effectiveness of metformin
Metformin, an oral anti-diabetic drug used to treat type II diabetes(652)(653) used widely in treating PCOs to induce weight loss in subjects with obesity,and infertility, improved insulin resistance(654)(655) by suppressing the production of endogenous glucose(656)(658) by the livcer(659)(661) and induced weight loss in obese patients(657)(658) through a reduction in calorie intake(657), as it makes insulin working more effective without changing the level of insulin in the body(659) by enhancing insulin-stimulated glucose disposal in skeletal muscle(659), which can lead to a lowering thyroid-stimulating hormone(660) and improved ovarian angiogenesis and follicular development(664) inhvolved PCOs pregancy(662)(663).
b) Side effects
i) Gastrointestinal upset(666)(667), especially for patient with disequilibrium of 2 genetic variations in OCT1(665), are mostly diarrhea(666)(667). Some patient may also experience nausea, vomiting, and decreased appetite(669).
ii) Reduce intestinal absorption of group B vitamins and folate in chronic therapy(668), may lead to accelerate the progression of vascular disease(668).
iii) Abdominal pain or cramps(669).
(iv) Metformin may have a growth-static effect on several cancers, including endometrial cancer, according to pre-clinical experiments(671)
2. Chomiphene (Clomid)
a) The effectiveness of chomiphene
It is considered as a fertility medication(670). The effectiveness of clomiphere is to induce ovulation(672) for natural conception for women with or without PCOs with luteal phase defect by stimulating the function of pituitary gland in series of hormone production(673), including LH, FSH. However, combination of metformin and clomiphene citrate may have some effects in improved pregnancy rates but not significantly improve the live birth rate over that of clomiphene citrate alone in women with polycystic ovary syndrome(674). Acupuncture, herbal medicine andclomiphene combination used for treatment of infertility on women with PCOs have shown to improve the pregnancy rate and reduce early abortion rate (675), according to Zhongguo Zhen Jiu. 2015 Feb;35(2):114-8.
b) Side effects
i) Abdominal pain and cramps(676).
ii) Breast tenderness(676)
iii) Ovaries edema(677)(678)
iv) Central nervous symptoms such as nervousness, sleeplessness, headaches, visual disturbances, vertigo(682), irritability, mood swings, feeling down(680)
v) Bloating(682) and hot flushes(681).
vi) Nausea, vomiting and dermatitis(683)
(vi) Women with BRCA mutation carriers may be at increased risk of invasive epithelial ovarian cancer (IEOC)(669).
(v) Risk of ovarian cysts(676)
(vi) Risk of ovarian cancer(684)(685)
(vii) Risks of melanoma and thyroid cancer(679).
3. Human Chorionic Gonadotropin (HcG)
a) The effectiveness of HCG
Human Chorionic Gonadotropin (HcG) is a hormone secreted by specialized cells called trophoblasts and later by the placenta following implantation(686)(687). The drug has been used conjunction of IVF for treatment of infertility to induce ovulation by stimulating the release of mature egg(688)(689), approximate 36 hour after taking it. HCG not only pinpoint the best time for sexual intercourse with success conception or assisting intrauterine insemination in egg retrieval(690)(691). The medicine also used for treatment to obese women with PCOs for weight loss(692)(693)(694) with controversy.
b) Side effects
Although side effects of HCG is not common, but some women may experience(697)
iii) Restlessness, slight
iv) Water retention
v) Breast tenderness
Other risks may include
(vii) Obstetrical complications, adverse perinatal outcomes, structural congenital abnormalities, chromosomal abnormalities, imprinting disorders, and childhoodcancer(697)
(Vii) Ectopic pregnancy(689)
(viii) Blurred vision and scotomas(695).
(ix) Multiple pregnancy, miscarriage, ovarian hyperstimulation syndrome (OHSS)(696)
4. Human menopause gonadotropin(HMG)(Menotropin)
a) The effectiveness of HMG
HMG contains natural FSH and LH, is a purified form of urine of post menopausal women(699). By stimulating production of LH and FSH to right levels, the drug induces ovulation and develop mature follicles(700). The medication may be also used if chomiphere therapy and other medication have been failed to induce ovulation(701).
b) Side effects
i) Risk of multiple pregnancy, and spontaneous abortion(702)
ii) Ovarian enlargement (Caused by over stimulation)(705)
iii) Ovarian hyper stimulation syndrome (OHSS)(703)(704)
iv) Risk of miscarriage(704)
v) Risk of ovarian cancer(706)(707)
vi) Shortness of breath, dizziness, pelvic pain, nausea, and vomiting(708).
a) The effectiveness of dexamethasone
Dexamethasone is a synthetic member of the glucocorticoid class of steroid hormones and a prescribed medication for fertility to induce ovulation(709) for artificial insemination(710)by suppressing the androgen levels(711), resulting in increasing the chance of fertility(710).
b) Side effects
i) Risk of miscarriage(710)
i) Risk of bone growth at different developmental stages(713)
Other side effects, according to Rxlist(712) include
sleep problems (insomnia), mood changes;
acne, dry skin, thinning skin, bruising or discoloration;
slow wound healing;
headache, dizziness, spinning sensation;
nausea, stomach pain, bloating;
muscle weakness; or
changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts, and waist).
Surgery is not commonly performed. If necessary, PCOs infertility can be treated by either a laparoscopic surgery also is known as ovarian drilling(714)(715), the surgical procedure is not proven to be effective for women with PCOs infertility if used alone with potential surgical risks(714) or wedge resection(716), only to PCOs patients did not conceive with standard ovulation induction protocols(717). It is to your benefit to forgo this type of expensive treatment in favour of other such as IVF.
B. Oral Contraceptive
Only if pregnancy is not the concerns
1. The benefits of oral contrecptive
a. Reduce total testosterone levels and acne(718)
b. Improve lipid profiles, hsCRP levels, insulin resistance and hyperandrogenism(719)(720)
b. Regular menstrual cycle(720)
c. Lower androgen hormone levels(720) and lessen the amount of excess hair growth (also called “hirsutism”)(720)(721).
d. Decreased mentrual Cramps, or No Cramps(722)
e. Reduce risk of colorectal and endometrial cancers(723), ovarian cancer(724), and ovarian cysts(725).
2. Risks and side effects
i) Risks of blood clots(728), stroke(728), heart disease(726), cervical cancer(724) and breast cancer(727)(723)
ii) Hypertension(726) and increase heart rate(726) caused by thickening of blood in arteries.
b) Side effects
i) Bleeding and spotting(729)
ii) Weigh gain(730)(731)(732)(inconclusive result)
Remember the most effective long term treatment for PCOs can be done naturally at comfort at your own home.
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(1) Adiposity and metabolic dysfunction in polycystic ovary syndrome by Sam S.(PubMed)
(2) A "kiss" before conception: triggering ovulation with kisspeptin-54 may improve IVF by Young SL.(PubMed)
(3.) Androgen hyperfunction and excessive heterosexual hair growth in women, with special attention to the polycystic ovarian syndrome by Lunde O1.(PubMed)
(4) Expression of anti-Müllerian hormone in letrozole rat model of polycystic ovary syndrome by Du DF1, Li XL, Fang F, Du MR.(PubMed)
(5) [Serum levels of anti-muller hormone in women with polycystic ovary syndromeand healthy women of reproductive age].[Article in Bulgarian] by Parahuleva N, Pehlivanov B, Orbecova M, Deneva T, Uchikova E.(PubMed)
(6) [Current opinions on the etiology and pathophysiology of hirsutism].[Article in Polish] by Krysiak R1, Kedzia A, Okopień B.(PubMed)
(7) The clinical evaluation of hirsutism by Somani N1, Harrison S, Bergfeld WF.(PubMed)
(8) Polycystic ovary syndrome and insulin: our understanding in the past, present and future by Mayer SB1, Evans WS, Nestler JE.(PubMed)
(9) Association of mean platelet volume with androgens and insulin resistance in nonobese patients with polycystic ovary syndrome by Dogan BA1, Arduc A2, Tuna MM1, Karakılıc E1, Dagdelen I1, Tutuncu Y1, Berker D1, Guler S1.(PubMed)
(10) Approach to the patient: contraception in women with polycystic ovary syndrome by Yildiz BO1.(PubMed)
(11) Polycystic ovarian syndrome (PCOS): a significant contributor to the overall burden of type 2 diabetes in women by Talbott EO1, Zborowski JV, Rager JR, Kip KE, Xu X, Orchard TJ.(PubMed)
(12) Prevalence of vitamin D deficiency in Slovak women with polycystic ovary syndrome and its relation to metabolic and reproductive abnormalities by Figurová J1, Dravecká I, Javorský M, Petríková J, Lazúrová I.(PubMed)
(13) Role of Insulin Sensitizers on Cardiovascular Risk Factors in Polycystic Ovarian Syndrome: A Meta-Analysis by Thethi TK1, Katalenich B2, Nagireddy P3, Chabbra P4, Kuhadiya N5, Fonseca V1.(PubMed)
(14) Acne in hirsute women by Lumezi BG1, Pupovci HL1, Berisha VL1, Goçi AU2, Gerqari A3.(PubMed)
(15) Obesity and polycystic ovary syndrome by Naderpoor N1, Shorakae S, Joham A, Boyle J, De Courten B, Teede HJ.(PubMed)
(16) Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan by Teede H1, Deeks A, Moran L.(PubMed)
(17) Metabolic Evidence of Diminished Lipid Oxidation in Women With Polycystic Ovary Syndrome. by Whigham LD1, Butz DE2, Dashti H3, Tonelli M3, Johnson LK1, Cook ME2, Porter WP4, Eghbalnia HR5, Markley JL6, Lindheim SR7, Schoeller DA8, Abbott DH9, Assadi-Porter FM10.(PubMed)
(18) Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis by Barry JA1, Azizia MM1, Hardiman PJ2.(PubMed)
(19) Risk of cancer among women with polycystic ovary syndrome: a Danish cohort study by Gottschau M1, Kjaer SK2, Jensen A1, Munk C1, Mellemkjaer L3.(PubMed)
(20) Polycystic ovary syndrome: metabolic consequences and long-term management by Carmina E1.(PubMed)
(21) Arterial stiffness is increased in asymptomatic nondiabetic postmenopausal women with a polycystic ovary syndrome phenotype by Armeni E1, Stamatelopoulos K, Rizos D, Georgiopoulos G, Kazani M, Kazani A, Kolyviras A, Stellos K, Panoulis K, Alexandrou A, Creatsa M, Papamichael C, Lambrinoudaki I.(PubMed)
(652) A 24-week, prospective, randomized, open-label, treat-to-target pilot study of obese type 2 diabetes patients with severe insulin resistance to assess the addition of exenatide on the efficacy of u-500 regular insulin plus metformin by Distiller LA1, Nortje H2, Wellmann H3, Amod A4, Lombard L5.(PubMed)
(653) One-year sustained glycemic control and weight reduction in type 2 diabetesafter addition of liraglutide to metformin followed by insulin detemir according to HbA1c target by Rosenstock J1, Rodbard HW, Bain SC, D'Alessio D, Seufert J, Thomsen AB, Svendsen CB, DeVries JH; Liraglutide-Detemir Study Group.(PubMed)
(654) An investigation into the therapeutic effects of statins with metformin onpolycystic ovary syndrome: a meta-analysis of randomised controlled trials by Sun J1, Yuan Y1, Cai R1, Sun H1, Zhou Y1, Wang P1, Huang R1, Xia W1, Wang S1.(PubMed)
(655) Polycystic ovary syndrome (PCOS): metformin by Cahill DJ1, O'Brien K.(PubMed)
(656) Effects of metformin therapy on hyperandrogenism in women with polycystic ovarian syndrome by Kazerooni T1, Dehghan-Kooshkghazi M.(PubMed)
(657) Metformin decreases food consumption and induces weight loss in subjects with obesity with type II non-insulin-dependent diabetes by Lee A1, Morley JE.(PubMed)
(658) The effects of metformin on body mass index and glucose tolerance in obese adolescents with fasting hyperinsulinemia and a family history of type 2 diabetes by Freemark M1, Bursey D.(PubMed)
(659) Reducing insulin resistance with metformin: the evidence today by Giannarelli R1, Aragona M, Coppelli A, Del Prato S.(PubMed)
(660) Metformin and low levels of thyroid-stimulating hormone in patients with type 2 diabetes mellitus by Fournier JP1, Yin H1, Yu OH1, Azoulay L2.(PubMed)
(661) Metformin activates a duodenal Ampk-dependent pathway to lower hepatic glucose production in rats by Duca FA1, Côté CD2, Rasmussen BA2, Zadeh-Tahmasebi M2, Rutter GA3, Filippi BM1, Lam TK4.(PubMed)
(662) Correlation of endometrial glycodelin expression and pregnancy outcome in cases with polycystic ovary syndrome treated with clomiphene citrate plusmetformin: a controlled study by Uysal S1, Zeki Isik A2, Eris S3, Yigit S4, Yalcin Y5, Ozun Ozbay P6.(PubMed)
(663) Metformin improves pregnancy and live-birth rates in women with polycystic ovary syndrome (PCOS): a multicenter, double-blind, placebo-controlled randomized trial by Morin-Papunen L1, Rantala AS, Unkila-Kallio L, Tiitinen A, Hippeläinen M, Perheentupa A, Tinkanen H, Bloigu R, Puukka K, Ruokonen A, Tapanainen JS.(PubMed)
(664) Metformin regulates ovarian angiogenesis and follicular development in a female polycystic ovary syndrome rat model by Di Pietro M1, Parborell F, Irusta G, Pascuali N, Bas D, Bianchi MS, Tesone M, Abramovich D.(PubMed)
(665) Association of genetic variation in the organic cation transporters OCT1, OCT2 and multidrug and toxin extrusion 1 transporter protein genes with the gastrointestinal side effects and lower BMI in metformin-treated type 2 diabetes patients by Tarasova L1, Kalnina I, Geldnere K, Bumbure A, Ritenberga R, Nikitina-Zake L, Fridmanis D, Vaivade I, Pirags V, Klovins J.(PubMed)
(666) Ondansetron and metformin-induced gastrointestinal side effects by Hoffmann IS1, Roa M, Torrico F, Cubeddu LX.(PubMed)
(667) Metformin treatment before and during IVF or ICSI in women with polycystic ovary syndrome by Tso LO1, Costello MF, Albuquerque LE, Andriolo RB, Macedo CR.(PubMed)
(668) Non-insulin antidiabetic therapy in cardiac patients: current problems and future prospects by Fisman EZ1, Motro M, Tenenbaum A.(PubMed)
(669) Efficacy and safety of linagliptin co-administered with low-dose metforminonce daily versus high-dose metformin twice daily in treatment-naïve patients with type 2 diabetes: a double-blind randomized trial by Ji L1, Zinman B, Patel S, Ji J, Bailes Z, Thiemann S, Seck T.(PubMed)
(670) Fertility treatments and invasive epithelial ovarian cancer risk in Jewish Israeli BRCA1 or BRCA2 mutation carriers by Perri T1, Lifshitz D2, Sadetzki S3, Oberman B4, Meirow D5, Ben-Baruch G2, Friedman E6, Korach J2.(PubMed)
(671) Metformin in reproductive health, pregnancy and gynaecological cancer: established and emerging indications by Sivalingam VN1, Myers J2, Nicholas S3, Balen AH3, Crosbie EJ4.(PubMed)
(672) The association between follicular size at the time of spontaneous rupture and pregnancy rates in clomiphene citrate treated PCOS patients in coit cycles by Portocarrero-Sanchez C1, Gomes-Sobrinho DB, Nakagawa HM, Silva AA, Carvalho BR, Sarkis NT, Peraçoli JC, Cardoso MT.(PubMed)
(673) Clomid- Clomiphene Citrat(The reproductive medincine and surgery center of |Virginia. PLC)
(674) Metformin combined with clomiphene citrate may increase ovulation rates and pregnancy rates but does not significantly improve the live birth rate over that of clomiphene citrate alone.(I-A) Ovulation induction in polycystic ovary syndrome by Vause TD, Cheung AP, Sierra S, Claman P, Graham J, Guillemin JA, Lapensée L, Stewart S, Wong BC; Society of Obstetricians and Gynecologists of Canada.(PubMed)
(675) [Infertility in polycystic ovary syndrome treated with acupuncture andclomiphene: a randomized controlled trial].[Article in Chinese]by Jiang D, Zhang Y, Wu X, Wu S.(PubMed)
(676) Clomiphene therapy in epileptic women with menstrual disorders by Herzog AG1(PubMed)
(677) Massive ovarian edema in pregnancy after ovulation induction usingclomiphene citrate by Kawaguchi R1, Ueda S, Tsuji Y, Haruta S, Kanayama S, Yamada Y, Ooi H, Kobayashi H.(PubMed)
(678) Massive ovarian edema in a woman receiving clomiphene citrate. A case report by Patty JR1, Galle PC, McRae MA.(PubMed)
(679) Melanoma, thyroid, cervical, and colon cancer risk after use of fertility drugs by Althuis MD1, Scoccia B, Lamb EJ, Moghissi KS, Westhoff CL, Mabie JE, Brinton LA.(PubMed)
(680) Psychological side-effects of clomiphene citrate and human menopausal gonadotrophin by Choi SH1, Shapiro H, Robinson GE, Irvine J, Neuman J, Rosen B, Murphy J, Stewart D.(PubMed)
(681) Letrozole versus clomiphene for infertility in the polycystic ovary syndrome by Legro RS1, Brzyski RG, Diamond MP, Coutifaris C, Schlaff WD, Casson P, Christman GM, Huang H, Yan Q, Alvero R, Haisenleder DJ, Barnhart KT, Bates GW, Usadi R, Lucidi S, Baker V, Trussell JC, Krawetz SA, Snyder P, Ohl D, Santoro N, Eisenberg E, Zhang H; NICHD Reproductive Medicine Network.(PubMed)
(682) Clomiphene citrate as a possible cause of a psychotic reaction during infertility treatment by Siedentopf F1, Horstkamp B, Stief G, Kentenich H.(PubMed)
(683) [Efficacy and safety evaluation of acupuncture combined with auricular point sticking therapy in the treatment of polycystic ovary syndrome].[Article in Chinese]by Li N1.(PubMed)
(684) Fertility drugs, reproductive strategies and ovarian cancer risk by Tomao F1, Lo Russo G2, Spinelli GP2, Stati V2, Prete AA2, Prinzi N3, Sinjari M2, Vici P4, Papa A2, Chiotti MS2, Benedetti Panici P1, Tomao S2.(PubMed)
(685) Ovarian cancer risk after the use of ovulation-stimulating drugs by Brinton LA1, Lamb EJ, Moghissi KS, Scoccia B, Althuis MD, Mabie JE, Westhoff CL.(PubMed)
(686) New discoveries on the biology and detection of human chorionic gonadotropin by Laurence A Cole(PubMed)
(687) α-Fetoprotein and β-Human Chorionic Gonadotropin by John J. Gregory Jr, and Dr Jonathan L. Finlay(Spingerlink)
(688) human chorionic gonadotropin (HCG)(Drug.com)
(689) Ectopic pregnancy after in-vitro fertilization is characterized by delayed implantation but a normal increase of serum human chorionic gonadotrophin and its subunits by Korhonen J1, Tiitinen A, Alfthan H, Ylöstalo P, Stenman UH.(PubMed)
(690) Human chorionic gonadotropin administration is associated with high pregnancy rates during ovarian stimulation and timed intercourse or intrauterine insemination by Mitwally MF1, Abdel-Razeq S, Casper RF.(PubMed)
(691) A randomized trial of ovulation induction with two different doses of Letrozole in women with PCOS by Ramezanzadeh F1, Nasiri R, Sarafraz Yazdi M, Baghrei M.(PubMed)
(692) Changes in chronic low back pain and cardiovascular risk factors using a homeopathic human chorionic gonadotropin-based weight loss program: a case report by Morningstar MW1, Strauchman MN.(PubMed)
(693) An unfortunate resurgence of human chorionic gonadotropin use for weight loss by Lovejoy JC1, Sasagawa M.(PubMed)
(694) Human chorionic gonadotropin is of no value in the management of obesity by C. L. Birmingham and K. C. Smith(PubMed)
(695) Ocular adverse effects of human chorionic gonadotropin by Lee M, Fried WI, Sharifi R.(PubMed)
(696) Synchronised approach for intrauterine insemination in subfertile couples by Cantineau AE1, Janssen MJ, Cohlen BJ, Allersma T.(PubMed)
(698) Pregnancy outcomes after assisted reproductive technology.[Article in English, French] by Allen VM1, Wilson RD, Cheung A; Genetics Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC); Reproductive Endocrinology Infertility Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC).(PubMed)
(699) Compositional analyses of a human menopausal gonadotrophin preparation extracted from urine (menotropin). Identification of some of its major impurities by van de Weijer BH1, Mulders JW, Bos ES, Verhaert PD, van den Hooven HW.(PubMed)
(700) Unexplained infertility and ovulatory induction with menopausal gonadotropins by Leanza V1, Coco L, Grasso F, Leanza G, Zarbo G, Palumbo M.(PubMed)
(701) Ovulation induction with clomiphene citrate for infertile couple by Leanza V1, Coco L, Grasso F, Leanza G, Zarbo G, Palumbo M.(PubMed)
(702) Patient-specific predictions of outcome after gonadotropin ovulation induction/intrauterine insemination by Goldman RH1, Batsis M2, Petrozza JC3, Souter I3.(PubMed)
(703) A case of severe ovarian hyperstimulation syndrome after gonadotropin therapy by Moneta E, Garcea N, Scirpa P, Mango D.(PubMed)
(704) [Effect of domestic highly purified urinary follicle stimulating hormone on outcomes of in vitro fertilization-embryo transfer in controlled ovarian stimulation].[Article in Chinese] by Ye H1, Huang GN, Cao YX, Zhong Y, Huang YH, Zhu GJ, Zhou LM, Chen ZJ, Shi JZ, Zeng Y, Weng N, Huang XF, Yang J, Zhu YM, Li YP, Yi D, Zhuang GL.(PubMed)
(705) Hemodynamic state and the role of angiotensin II in ovarian hyperstimulation syndrome in the rabbit by Teruel MJ1, Carbonell LF, Llanos MC, Parrilla JJ, Abad L, Hernandez I.(PubMed)
(706) Two cases of ovarian tumours in women who had undergone multiple ovarianstimulation attempts by Grimbizis G1, Tarlatzis BC, Bontis J, Miliaras D, Lagos S, Pournaropoulos F, Mantalenakis S.(PubMed)
(707) Ovarian cancer after successful ovulation induction: a case report by Hull ME1, Kriner M, Schneider E, Maiman M.(PubMed)
(708) Fertility drug: Gonadotropins(Baby center)
(709) Dexamethasone in unexplained infertility by Moradan S1, Ghorbani R.(PubMed)
(710) [Steroid 21-hydroxylase deficiencies and female infertility: pathophysiology and management].
[Article in French] by Robin G1, Decanter C2, Baffet H3, Catteau-Jonard S2, Dewailly D2.(PubMed)
(711) The effect of dexamethasone on disruption of ovarian steroid levels and receptors in female rats by Illera JC1, Silván G, Martínez MM, Blass A, Peña L.(PubMed)
(712) Dexamethasone(Rxlist, the internet drug index)
(713) Dexamethasone use during pregnancy: potential adverse effects on embryonic skeletogenesis by Cheng X, Wang G, Lee KK, Yang X1.(PubMed)
(714) Pregnancy outcomes after laparoscopic ovarian drilling in women withpolycystic ovarian syndrome by Al-Ojaimi EH1.(PubMed)
(715) Laparoscopic ovarian drilling: An alternative but not the ultimate in the management of polycystic ovary syndrome by Mitra S1, Nayak PK1, Agrawal S1.(PubMed)
(716) Long-term clinical effects of ovarian wedge resection in polycystic ovarian syndrome by Hjortrup A, Kehlet H, Lockwood K, Hasner E.(PubMed)
(717) Ovarian wedge resection by minilaparatomy in infertile patients withpolycystic ovarian syndrome: a new technique by Yildirim M1, Noyan V, Bulent Tiras M, Yildiz A, Guner H.(PubMed)
(718) Effects of an oral contraceptive containing estradiol valerate and dienogest on circulating androgen levels and acne in young patients with PCOS: an observational preliminary study by Di Carlo C1, Gargano V, Sparice S, Tommaselli GA, Bifulco G, Nappi C.(PubMed)
(719) Comparison of the effects of chlormadinone acetate versus drospirenone containing oral contraceptives on metabolic and hormonal parameters in women with PCOS for a period of two-year follow-up by Yildizhan R1, Gokce AI, Yildizhan B, Cim N.(PubMed)
(720) Effect of oral contraceptive containing ethinyl estradiol combined with drospirenone vs. desogestrel on clinical and biochemical parameters in patients with polycystic ovary syndrome by Kriplani A1, Periyasamy AJ, Agarwal N, Kulshrestha V, Kumar A, Ammini AC.(PubMed)
(721) Ethinylestradiol/Chlormadinone acetate for use in dermatological disorders by Gómez Vázquez M1, Navarra Amayuelas R, Lamarca M, Baquedano L, Romero Ruiz S, Vilar-Checa E, Iniesta MD.(PubMed)
(722) Comparative analysis of the effects of nomegestrol acetate/17 β-estradiol and drospirenone/ethinylestradiol on premenstrual and menstrual symptoms anddysmenorrhea by Witjes H1, Creinin MD, Sundström-Poromaa I, Martin Nguyen A, Korver T.(PubMed)
(723) Oral contraceptive use and risk of breast, cervical, colorectal, and endometrial cancers: a systematic review by Gierisch JM1, Coeytaux RR, Urrutia RP, Havrilesky LJ, Moorman PG, Lowery WJ, Dinan M, McBroom AJ, Hasselblad V, Sanders GD, Myers ER.(PubMed)
(724) [The risk of breast cervical, endometrial and ovarian cancer in oral contraceptive users].[Article in Serbian] by Veljković M1, Veljković S.(PubMed)
(725) Oral contraceptive type and functional ovarian cysts by Lanes SF1, Birmann B, Walker AM, Singer S.(PubMed)
(726) Prospective measurement of blood pressure and heart rate over 24 h in women using combined oral contraceptives with estradiol by Grandi G1, Xholli A1, Napolitano A1, Piacenti I1, Bellafronte M1, Cagnacci A2.(PubMed)
(727) Correlation of age at oral contraceptive pill start with age at breast cancerdiagnosis by Imkampe AK1, Bates T.(PubMed)
(728) Cerebral vein thrombosis in women using short course oral contraceptiveconsumption by Sasannejad P1, Mellat Ardekani A2, Velayati A1, Shoeibi A1, Saeidi M1, Foroughipour M1,Azarpazhooh MR1.(PubMed)
(729) Phase 3 study of desogestrel and ethinyl estradiol combined oralcontraceptive for pregnancy prevention by Kroll R1, Howard B, Hsieh J, Ricciotti N.(PubMed)
(730)Oral contraceptives use and weight gain in women with a Central European life-style by Lech MM1, Ostrowska L.(PubMed)
(731) Weight and body composition changes during oral contraceptive use in obese and normal weight women by Mayeda ER1, Torgal AH, Westhoff CL.(PubMed)
(732) An exploratory analysis of associations between eating disordered symptoms, perceived weight changes, and oral contraceptive discontinuation among young minority women by Hall KS1, White KO, Rickert VI, Reame NK, Westhoff CL.(PubMed)