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Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome is defined as endocrinologic diseases among reproductive-age women caused by undeveloped follicles clumping on the ovaries that interferes with the function of the normal ovaries associated with a high risk for metabolic disorder(1) as resulting of enlarged ovaries(2), leading to hormone imbalance(excessive androgen and anti-müllerian hormone (AMH) )(1)(3)(4)(5), induced Hirsutism(6)(7), reproductive disorder(10(12)), risks of type 2 diabetes(9)(10)(11), metabolic syndrome(10)(12) and early cardiovascular disease(8)(13), acne(10)(14), endometrial cancer(18)(19),weight gain and obesity(15)(16)(17). The syndrome effects over 5% of women population or 1 in 20 women.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 Diagnosis
If you have experienced some of above symptoms, it is for your benefit to visit your doctor or gynecologist immediately. PCOs is easy to identify through your
1. Medical history, including question of your symptoms, such as menstrual irregularity, weight change, skin and sleep patterns, as well as all symptoms may contribute to the susceptible PCOs.
a. History of pregnancy including difficulty to conceive, miscarriage, poor neonatal and maternal pregnancy outcomes(46)(47) ...
b. Medication may influence the development of PCOs
2. Physical exam
The aim of the physicam exam is to check for PCOs symptoms, such as pelvic exam for enlarge and abnormal ovaries, male pattern hair growth, acne, weight gain, body mass index (BMI)(48)(49) etc., and risk of diseases caused by PCOs, such as hypertension, thyroid abnormality(50)(51).
(Please check citations in the topics of symptoms and risk factors)
3. Pelvic ultrasound
The aim of the test is to check for enlarge ovaries(2) and cysts(52). Unfortunately, many women with PCOs do not show these abnormalities.
4. Blood test
The blood test includes testing of
a. Dehydroepiandrosterone(DHEA), is a test for excess adrenal precursor androgen (APA) production(53)(54) found in approximately 20-30% of women withPCOS(53).
b Abnormal testosterone(55) levels may interference with the follicle incubation medium(55)(56).
c. Sex hormone-binding globulin (SHBG)(57) is a surrogate marker of insulin resistance
Lower levels of SHBG are found in women with PCOs(58)
d. Follicle-stimulating hormone (FSH)/LH ratio(LH(58) and FSH ratio(58)(59)). Dr. Li Y and the research team at Second Affiliated Hospital of Sun Yat-sen University, said "PCOS patients with higher LH/FSH ratio are primarily caused by hypothalamic-pituitary dysfunction, while the PCOS patients with normal LH/FSHratio are mainly caused by metabolic disorders"(60).
e. Thyroid-stimulating hormone (TSH)
The aim of the test is to check for levels of TSH (> or =2.5 mIU/l) as the hormone has shown to significantly alter endocrine and metabolic changes(64)
Thyroid dysfunctionis found to be associated to independent risks of ovarian failure and pregnancy related complications in women with Polycystic ovarian syndrome (PCOS)(61). It is said that both PCOS patients combined with SCH have higher risk of cardiovascular risk factors(62)and subclinical hypothyroidism (SCH) is more common in women with PCOs(63).
f. IGTT level (fasting insulin)(65)(66) and several other androgens(67)(68) are used to evaluate adrenal function. If there are abnormal secretion of certain hormones, you may be at a high risk of having PCOs.
Low birth weight may contribute the causation of hyperandrogenism and insulinresistance in adolescents with PCOS, according to the joint study in Italy(64).
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References
(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)
(46) Female Obesity and Infertility by Talmor A1, Dunphy B2.(PubMed)
(47) [Reproductive problems in women with PCOS, the impact of PAL-1 CARRIERS OF 4G PAI -1 polymorphism and BMI].[Article in Bulgarian] by Komsa-Penkova R, Golemanov G, Georgieva G, Slavov N, Popovski K, Ivanov P, Kovacheva K, Atanasova M, Blajev A.(PubMed)
(48) Endothelial function in young women with polycystic ovary syndrome (PCOS): Implications of body mass index (BMI) and insulin resistance by El-Kannishy G1, Kamal S2, Mousa A2, Saleh O2, Badrawy AE2, Farahaty RE2, Shokeir T2.(PubMed)
(49) Body Mass Index and Gonadotropin Hormones (LH & FSH) Associate With Clinical Symptoms Among Women With Polycystic Ovary Syndrome by Esmaeilzadeh S, Andarieh MG1, Ghadimi R, Delavar MA.(PubMed)
(50) Thyroid disorders in polycystic ovarian syndrome subjects: A tertiary hospital based cross-sectional study from Eastern India by Sinha U1, Sinharay K, Saha S, Longkumer TA, Baul SN, Pal SK.(PubMed)
(51) The evaluation and management of hirsutism by Azziz R1.(PubMed)
(52) Pcos.[No authors listed](PubMed)
(53) DHEA, DHEAS and PCOS by Goodarzi MO1, Carmina E2, Azziz R3.(PubMed)
(54) Adrenal androgen excess and body mass index in polycystic ovary syndrome by Moran C1, Arriaga M, Arechavaleta-Velasco F, Moran S.(PubMed)
(55) Superactive human leptin antagonist reverses leptin-induced excessive progesterone and testosterone secretion in porcine ovarian follicles by blocking leptin receptors by Gregoraszczuk EL1, Rak A.(PubMed)
(56) Reproduction in hens: is testosterone necessary for the ovulatory process? by Rangel PL1, Gutierrez CG2.(PubMed)
(57) The value of sex hormone binding globulin (SHBG) in predicting treatment response in polycystic ovary syndrome (PCOS) by Wassell J1, Michail M, Soliman N, Wardle PG.(PubMed)
(58) Effects of metformin treatment in women with polycystic ovary syndrome depends on insulin resistance by Nawrocka J1, Starczewski A.(PubMed)
(59) Serum luteinizing hormone level and luteinizing hormone/follicle-stimulating hormone ratio but not serum anti-Müllerian hormone level is related to ovarian volume in Korean women with polycystic ovary syndrome by Chun S1.(PubMed)
(60) [Effect of luteinizing hormone vs follicular stimulating hormone ratio on anti-Müllerian hormone secretion and folliculogenesis in patients with polycystic ovarian syndrome].[Article in Chinese] by Li Y1, Wei LN, Xiong YL, Liang XY.(PubMed)
(61) Thyroid disorders in polycystic ovarian syndrome subjects: A tertiary hospital based cross-sectional study from Eastern India by Sinha U1, Sinharay K, Saha S, Longkumer TA, Baul SN, Pal SK.(PubMed)
(62) Studies of cardiovascular risk factors in polycystic ovary syndrome patients combined with subclinical hypothyroidism by Pei YJ1, Wang AM, Zhao Y, Yan L, Li M, White RE, Han GC.(PubMed)
(63) Polycystic ovary syndrome and chronic autoimmune thyroiditis by Novais Jde S1, Benetti-Pinto CL, Garmes HM, Jales RM, Juliato CR.(PubMed)
(64) Association of thyroid-stimulating hormone with insulin resistance and androgen parameters in women with PCOS by Dittrich R1, Kajaia N, Cupisti S, Hoffmann I, Beckmann MW, Mueller A.(PubMed)
(65) [Association between levels of serum leptin and insulin resistance in patients with polycystic ovary syndrome].[Article in Chinese]by Cheng X1, Guo J2, Xie J3.(PubMed)
(66) [Clinical study on treating insulin resistance and promoting ovulation in polycystic ovary syndrome].[Article in Chinese]by Liu ZA1, Xue YM, Chen LX, Cai Q, Chen H, Zhang J, Cui QH, Ge J, Yuan T.(PubMed)
(67) Randomized clinical trial evaluating metformin versus oral contraceptive pills in the treatment of adolescents with polycystic ovarian syndrome by Al-Zubeidi H, Klein KO.(PubMed)
(68) Randomized controlled trial evaluating response to metformin versus standard therapy in the treatment of adolescents with polycystic ovary syndrome by Allen HF1, Mazzoni C, Heptulla RA, Murray MA, Miller N, Koenigs L, Reiter EO.(PubMed)
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