PCOD and PCOS may arise from genetic or environmental factors. A PCO ultrasound can help detect the presence of small cysts in the ovaries.

Polycystic Ovary Syndrome (PCOS)

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OMER HOSPITAL LAHORE

Saleha Ijaz

Overview

Polycystic ovary syndrome (PCOS) is a hormonal condition where the ovaries produce an inexplicable amount of androgens (the male sex hormones) that are typically present in women in limited quantities. The name polycystic ovary syndrome refers to the various diminutive growths known as cysts (liquid-filled sacs) that sprout in the ovaries. Although cysts are a characteristic feature, a few women diagnosed with this condition do not develop cysts, while other women, due to several contributing factors, develop cysts even without a hormonal imbalance<a href="#accordion">[8]</a>.

Ovulation is marked from the time the ovary is prepared to release a fully mature egg. This is pivotal as the release of an egg from the female reproductive organ allows the egg to have the opportunity to be fertilized by a sperm. However, most of the time, eggs and sperms do not fertilize or withstand in the environment during the same period, which then prompts the uterus to initiate the menstrual cycle and expel the unfertilized egg from the body<a href="#accordion">[8]</a>.

At times, due to many contributing factors, a person may be unable to develop the necessary and healthy proportion of hormones that are required for ovulation. At the point when anticipated ovulation according to the regular cycle does not occur, the ovaries tend to foster numerous cysts of varying sizes. These cysts promote and boost the levels of certain hormones, called androgens. Individuals diagnosed with PCOS frequently have elevated degrees of androgens. This can create more issues and lead to several complications with an individual&#39;s menstrual cycle<a href="#accordion">[8]</a>. Moreover, it can fester the long and tedious signs and symptoms of PCOS. Treatment for PCOS is in many cases dealt with the proper medication. This should not be used to expect a cure for PCOS, but it does decrease side effects and forestall several medical issues.

<div>&nbsp;</div>

To understand the nature of polycystic ovary syndrome (PCOS) it is important to divulge information regarding the different types of the condition which influence the varying extent of signs and symptoms. The four most common types include the following:

&nbsp;

<ul>
	<li>
	<h5>Insulin Resistant PCOS</h5>
	</li>
</ul>

According to statistics, 70% of all diagnosed patients have insulin-resistant PCOS, making it the most common type of condition<a href="#accordion">[4]</a>. Insulin resistance occurs when there are elevated levels of insulin than the ordinary concentration in the body, otherwise called hyperinsulinemia. This happens when the cells develop a certain immunity and remain unsusceptible to the impacts of insulin, which in turn stimulates the pancreas to siphon out an excessive level of insulin until the cells receive the message. In this sort of PCOS, the individual may face different obstacles such as finding it difficult to maintain a healthy weight, holding unproportioned weight around the stomach/mid-region, and developing frequent urges to consume sugary foods as well as side effects like brain fog, weariness, and fatigue. Elevated degrees of insulin drive up androgen levels which cause issues like overstimulation of hair follicles, which manifest as the growth of unwanted hair, male pattern balding, and hormonal acne. Frequently specialists will simply rely on just testing HbA1c or blood glucose levels, which are helpful as they allow the health care professional to acquire data regarding the glucose levels. However, it does not divulge more details to depict the entire scenario. To preclude insulin resistance, it is imperative to have fasting insulin tested. Typical fasting insulin levels are under 10 mIU/L (60 pmol/L)<a href="#accordion">[4]</a>.

&nbsp;

<ul>
	<li>
	<h5>Adrenal PCOS</h5>
	</li>
</ul>

Most people after undergoing intense trauma and a prolonged period of excessive stress, develop adrenal PCOS, which despite its demanding etiology affects 10% of all those diagnosed. Commonly, DHEA-S (a kind of androgen produced by the adrenal organs) production is stimulated due to excessive stress and/or trauma, while elevated degrees of testosterone and androstenedione are not seen. Unfortunately, this type of androgen is not tested often. Except, if the individual goes through an endocrinologist or other subject matter expert<a href="#accordion">[4]</a>.

&nbsp;

<ul>
	<li>
	<h5>Post Pill PCOS</h5>
	</li>
</ul>

It is not uncommon for some individuals to develop post-pill PCOS after they quit taking the oral contraceptive pill. This type of PCOS shows many side effects like skin break-out, unpredictable periods, and excessive hair development. These signs and symptoms are often absent before beginning the pill and manifest after quitting.&nbsp;

Oral contraceptives, for example, Ginet, Yasmin, and Yaz all cause this sort of PCOS because of the type of manufactured progestins utilized. After falling off the pill, the ovaries are relieved of a strict regimen and routine to follow. Therefore, there is a characteristic flood in androgens that can cause run-of-the-mill PCOS side effects, but in this kind, there is usually no insulin resistance. This is frequently observed by doctors in clients, 3-6 months after halting the pill. It is important to note and remember that like all medical conditions, this also requires a timeline to heal and recuperate. It also needs to be dealt with by a licensed practitioner as they can tend to the situation rapidly by planning a well-balanced diet, recommending suitable lifestyle changes, and prescribing the most effective medication and supplements<a href="#accordion">[4]</a>.

&nbsp;

<ul>
	<li>
	<h5>Inflammatory PCOS</h5>
	</li>
</ul>

Inflammatory PCOS is mostly characterized by persistent inflammation, which obliges the ovaries to create and release an abundance of testosterone, giving rise to the quintessential side effects of PCOS and complications and delays with ovulation. Indications of inflammation in this sort of PCOS could be migraines, joint pain, increased weariness, skin irregularities like dermatitis, and bowel issues like IBS. Usually, inflammatory PCOS when tested for a diagnosis show raised inflammatory markers on a blood test, like a high CRP (C receptive protein). Different tests, for example, fasting glucose and insulin are in the healthy range, yet can in some cases be impacted owing to the ongoing inflammation<a href="#accordion">[4]</a>.

<div>&nbsp;</div>

Causes

Hormonal imbalances are complicated matters, and most are triggered due to inexplicable reasons. Polycystic ovary syndrome (PCOS) albeit common, does not have a definite cause<a href="#accordion">[14]</a>.&nbsp;While research has drawn comparisons and hypotheses after careful and thorough analysis, health care professionals have been able to conjure certain links that could act as contributing factors. These could include the following:

&nbsp;

<ul>
	<li>
	<h5>Hereditary</h5>
	</li>
</ul>

Polycystic ovary syndrome has been demonstrated to be a familial condition, with mothers and daughters being diagnosed with the same condition. Albeit the capacity of hereditary variables in PCOS is unequivocally upheld, qualities engaged with the etiology of the condition have not been completely researched up to this point, along with the environmental contribution in their appearance.

The heterogeneity of the syndrome engages the elusiveness around this condition which concerns many individuals around the world who have experienced difficulties with fertility. Modified and altered expression of a few genes have been accounted for, indicating that the hereditary irregularity in PCOS influences other aspects, which by themselves contribute to PCOS e.g. steroid hormones action, gonadotrophin action and control, signal transduction pathways regulating steroidogenesis, the regulation of insulin, the balance of homeostasis, and chronic inflammation<a href="#accordion">[15]</a>.

&nbsp;

<ul>
	<li>
	<h5>Insulin Resistance</h5>
	</li>
</ul>

An increase in insulin levels triggers the ovaries to respond accordingly, producing and delivering excessive male hormones (androgens). An unaccounted surplus of male hormones, in effect, stifles ovulation and increases the different side effects of PCOS.&nbsp;

Insulin is responsible for regulating and addressing the way the body processes glucose (sugar) and supplies it to various organs and cells for energy. Insulin resistance implies that the body is unable to efficiently distribute and manage insulin. Thus, prompting high glucose levels in the blood.&nbsp;

Not all people with insulin resistance need to witness a glucose augmentation or develop diabetes. However, insulin resistance can increase the likelihood of individuals getting diagnosed with diabetes. Research has suggested a direct relation to a person&#39;s weight as well, with obesity and overweight individuals being high-risk factors, leading to insulin resistance. A raised insulin level, regardless of whether the blood glucose is typical, can&nbsp;demonstrate insulin resistance<a href="#accordion">[1]</a>.

&nbsp;

<ul>
	<li>
	<h5>Low-Grade Inflammation</h5>
	</li>
</ul>

Inflammation is gauged by the white blood cells&#39; resilience to fight against infections. This can be deduced by a healthcare provider performing certain blood tests to measure the levels of the C-reactive protein (CRP) and white blood cells in the blood. A considerable number of examinations have revealed the relationship between polycystic ovary syndrome (PCOS) and low-grade chronic inflammation. Inflammatory markers or their gene markers are higher in PCOS patients. Moreover, it has been identified that the persistent inflammatory state is exacerbated by obesity and hyperinsulinemia. There are studies depicting the shared effect of hyperinsulinemia and <a href="https://www.merisehat.pk/disease/obesity" target="_blank">obesity</a>, hyperandrogenism, and inflammatory state. Endothelial cell dysfunction might be additionally set off by chronic inflammation. Many variables engaged with oxidative stress, inflammation, and thrombosis were proposed as risk factors for cardiovascular conditions, confirming the endothelial cell harm in PCOS. It was additionally suggested that the uterine hyper-inflammatory state in polycystic ovary syndrome might be culpable for the numerous cases of pregnancy-related complications, varying from premature delivery to placental insufficiency<a href="#accordion">[18]</a>.

&nbsp;

<ul>
	<li>
	<h5>Excessive Production Of Male Hormones</h5>
	</li>
</ul>

High androgen levels hinder the ovaries from delivering eggs (ovulation), which causes sporadic and unregulated menstrual cycles. Unpredictable ovulation can likewise lead to the development of liquid-filled sacs (cysts) to foster in the ovaries. High androgen can also cause severe skin to break out (acne) and an abundance of hair development in women, called hirsutism.&nbsp;

Androgen actions are regulated by means of the androgen receptor (AR). Transgenic AR knockout mouse models have revealed that AR-interceded androgen actions play a contributing role in managing female fertility and ovarian capability۔

Recognizing and affirming the areas of AR-interceded actions and the molecular and cellular components associated with the improvement of PCOS is pivotal for public awareness of the expected and successful future advancement of innovative, mechanism-based mediations for the treatment of PCOS. Moreover, by being cognizant of the degree of the condition the healthcare professional will be able to manage treatment options efficiently<a href="#accordion">[17]</a>.

The cause of developing polycystic ovary syndrome (PCOS) may differ from patient to patient, which is why the individual must speak to a doctor to understand their situation in a medically safe environment.&nbsp;

<div>&nbsp;</div>

Diagnosis

As polycystic ovary syndrome (PCOS) is still under investigation for its holistic effects on the body, its diagnosis cannot and has not been reduced to one single test. Considering the lack of a gold standard diagnostic test the doctor is probably going, to begin with, a conversation about the patient&rsquo;s clinical history, including discussions regarding their menstrual cycles, and irregular changes in weight. A physical examination will include checking for indications of hirsutism which is excessive hair development, insulin resistance, and skin inflammation in the form of acne. The wide range of examinations may include:

&nbsp;

<ul>
	<li>
	<h5>Pelvic Examination</h5>
	</li>
</ul>

A pelvic exam comprises the specialist investigating the reproductive organs for visible masses, unusual developments, or different irregularities<a href="#accordion">[11]</a>. The doctor will insert their gloved fingers vaginally to observe and note any bumps, cysts, or formations on the uterus or in the ovaries.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Ultrasound</h5>
	</li>
</ul>

A more common imaging tool to evaluate the internal organs would be an ultrasound. The primary care physician looks at the presence of the ovaries and the thickness of the lining of the uterus (endometrium). Unlike a normal abdominal ultrasound where the transducer is placed on the outside region of the pelvis, a transvaginal ultrasound involves the doctor inserting the transducer 2 to 3 inches into the vaginal canal. A slender wand-like instrument (transducer) is put in the vagina (transvaginal ultrasound). The transducer discharges sound waves that are converted into pictures on a computer screen<a href="#accordion">[11]</a>.

&nbsp;

<ul>
	<li>
	<h5>Blood Tests</h5>
	</li>
</ul>

The patient would be asked to submit a sample of their blood. Blood might be examined to quantify chemical levels (hormonal profile). This testing can avoid potential reasons for menstrual irregularities or androgen overabundance that emulates PCOS. To be safe than sorry, some might also recommend extra blood testing to quantify glucose resilience and fasting cholesterol and triglyceride levels to gauge the risk for complications, such as cardiovascular diseases or diabetes<a href="#accordion">[11]</a>.

<div>&nbsp;</div>

Treatment

Treatment for polycystic ovary syndrome (PCOS) differs from patient to patient depending on their age, marital status, weight, and preference for pregnancy. Therefore, patients should not rely on self-treatment and schedule an appointment with a doctor for better guidance. Treatment options that are commonly suggested include the following:

&nbsp;

<ul>
	<li>
	<h5>Lifestyle Changes</h5>
	</li>
</ul>

&nbsp;

1. Weight:&nbsp;Many, yet not all, individuals diagnosed with PCOS lean towards being overweight. After some time, the situation might lead to <a href="https://www.merisehat.pk/disease/obesity" target="_blank">obesity</a>. That can increase the risk for numerous medical conditions, including infertility for individuals who wish to get pregnant, <a href="https://www.merisehat.pk/disease/diabetes-type-1-and-2" target="_blank">type 2 diabetes</a>, and cardiovascular illnesses. Exercise is considerably more efficient when it is complemented by a healthy eating routine. Diet in addition to exercise and regular physical activity assists in losing more weight than medication alone, and it decreases further medical complications<a href="#accordion">[10]</a>.

There have been several investigations that have discovered that 30 minutes of moderate to intense sessions of exercise for at least three to five days a week can assist individuals with PCOS to lose unwanted weight. Getting fitter with exercise additionally further enhances ovulation and insulin levels<a href="#accordion">[3]</a>.

&nbsp;

2. Diet:&nbsp;Numerous women with PCOS have presented with insulin resistance, in which the body is unable to effectively administer the hormone insulin. Insulin, which is created by the pancreas, empowers the body to utilize glucose, or sugar, for nourishment or energy. It additionally assists by regulating the blood sugar levels under tight restraints to ensure the levels do not exceed the range. To manage the blood glucose level, the consultant might suggest a routine diet low in sugar and devoid of complex carbohydrates<a href="#accordion">[13]</a>.

To ensure that the symptoms of PCOS are kept in check, the ideal eating regimen comprises various food varieties from different nutrition types &mdash; healthy sources of carbohydrates, like vegetables and natural products; lean meats, like poultry; fish; and high-fiber grains. Specialists encourage prioritizing food varieties that are low in sugar and fat and have a low glycemic index. Low glycemic index food sources stimulate the body to release insulin gradually and consistently, making it simpler for the body to digest food as energy as opposed to storing it as fat. Food varieties high in fiber additionally assist with controlling glucose levels<a href="#accordion">[12]</a>.

Since complex carbohydrates are disintegrated into their simpler form i.e. sugar, it is advisable to restrict the usual sum of carbohydrates one consumed before PCOS. Attempt to keep away from refined carbs, which are tracked down in processed food varieties, particularly white flour, rice, potatoes, and sugar. Likewise keep away from sweet beverages, including fizzy drinks<a href="#accordion">[13]</a>.

&nbsp;

3. Acupuncture:&nbsp;Acupuncture is a form of needle therapy that constitutes the sliding of needles into focused physical points (named acupoints), and has been a frequent practice in eastern Asian nations for millennia. As of late, the emergence and popularity of needle therapy in reproductive endocrinology and infertility have acquired rising prominence around the world.

A few clinical and animal exploratory examinations demonstrate that acupuncture is helpful for ovulatory dysfunction and insufficiency in PCOS<a href="#accordion">[6]</a>. Acupuncture has also been accounted for the possible progress and development of insulin responsiveness and sensitivity. Moreover, there has been research to prove how it plays a part to diminish testosterone in patients with PCOS<a href="#accordion">[7]</a>.

Measurable critical advantages of needle therapy treatment were found for as long as 4 months as an adjuvant to medicated drugs. The results were observed in LH levels, LH/FSH proportions, testosterone levels, fasting insulin, and pregnancy rates. However, the degree of proof is exceptionally low, predominantly because of higher susceptibility to bias and heterogeneity. To date, the necessary proof of acupuncture for PCOS remains generally uncertain as the examinations that were checked tried different needle therapy conventions against different control types and the reported results varied based on the aforementioned parameters<a href="#accordion">[5]</a>.

&nbsp;

<ul>
	<li>
	<h5>Medication</h5>
	</li>
</ul>

&nbsp;

1. For People Wanting To Get Pregnant:&nbsp;These medications are used to regulate ovulation. Certain drugs have shown remarkable improvements in individuals with PCOS for regulating the release of eggs, to managing other symptoms, such as insulin resistance and weight gain.&nbsp;

a. Clomiphene: An oral anti-estrogen drug that is ingested during the initial stages of the menstrual cycle<a href="#accordion">[11]</a>.&nbsp;

b. Letrozole (Femara): This is used to prevent and treat advanced complications such as breast cancer. It can attempt to invigorate the ovaries to produce the required levels of hormones<a href="#accordion">[11]</a>.

c. Metformin (Glucophage): This oral drug for type 2 diabetes deters insulin resistance and brings down insulin levels. If the individual has pre-diabetes, metformin can help prevent type 2 diabetes, and also help with weight reduction<a href="#accordion">[14]</a>.

d. Gonadotropins: These hormone supplements are prescribed in the form of injections. Usually inserted in areas with thick muscles, such as thighs or buttocks. It is important not to miss a dose or to take more than the recommended dosage<a href="#accordion">[1]</a>.

Whether taken orally or through injections, these medications must be carefully administered as they tend to overstimulate the ovaries to produce excessive hormones. Moreover, as these have a specific aim to increase the chances of pregnancy, some of these medications may improve the probability of conceiving twins or having multiple births. Normal side effects include bloating in lower regions, specifically the abdomen, along with pain and discomfort in the pelvic region<a href="#accordion">[8]</a>.

&nbsp;

2. For People Not Wanting To Get Pregnant:&nbsp;For individuals who do not wish to conceive, doctors may prescribe them medications to regulate normal flow and maintain a healthy menstrual cycle along with decreasing other symptoms such as excessive hair growth. These medications could include:

a. Combination Birth Control: Pills with formulations of estrogen and progestin decline the production of androgen and manage estrogen. Managing the hormones can exponentially decrease an individual&#39;s probability of developing any form of endometrial disease, prevent irregularly frequent heavy bleeding, prevent overstimulation of hair follicles that cause facial hair growth, and reduce skin inflammation. Rather than pills, the doctor may also recommend other forms of birth control, such as a skin patch or vaginal ring that contains a blend of estrogen and progestin<a href="#accordion">[11]</a>.

b. Androgen Suppressants: Certain drugs can block the overproduction of the released androgens. This can help keep other symptoms at bay such as hormonal acne, cystic acne, and hirsutism<a href="#accordion">[1]</a>.&nbsp;

c. Diabetes Medication: Oral medication can assist in regulating and controling insulin, correspondingly reducing insulin resistance in individuals with PCOS. These can also promote healthy cell turnover to reduce the frequency of skin breakouts, maintain a normal range of androgens, and slow hair growth<a href="#accordion">[8]</a>.

Designated for synchronizing the menstrual cycle, these medications are also prescribed to manage visible symptoms. Discontinuing birth control can lead to more hormonal breakouts and weight gain.

&nbsp;

<ul>
	<li>
	<h5>Surgery</h5>
	</li>
</ul>

Since polycystic ovary syndrome (PCOS) does not have a definitive cure, the doctor will be able to suggest ways to alleviate discomfort and manage the symptoms of the condition in a manner that does not disrupt the routine of a patient.&nbsp;

A procedure known as ovarian drilling is used when other forms of treatment do not show positive results. It is intended to remove ovarian tissues responsible for producing androgen. This is seldom practiced due to the easy availability of more advanced medication, and a preference for minimally-invasive treatment procedures<a href="#accordion">[9]</a>.

<div>&nbsp;</div>

If a person has been diagnosed with polycystic ovary syndrome (PCOS) and has exceptionally high levels of androgen, then they might be vulnerable to further complications. Such adverse effects of PCOS may include:

&nbsp;

<ul>
	<li>Infertility: Cysts in the ovaries tend to obstruct and impede ovulation. If a healthy egg is not accessible to be fertilized by a sperm, the individual is unable to get pregnant. PCOS is one of the main sources of infertility in women. However, there are treatment options one can opt for to get pregnant if one faces infertility due to PCOS. They will need to take the necessary medication and work with an expert to ensure a successful, healthy, and safe pregnancy<a href="#accordion">[14]</a>.</li>
</ul>

&nbsp;

<ul>
	<li>Sleep Apnea: Sleep apnea is a condition that frequently hinders continuous and regular breathing rhythms during the night, which eventually causes restless sleep and fatigue. Sleep apnea is a common complication observed in women who are overweight or obese, particularly those who have been diagnosed with PCOS. There is a persistent concern for sleep apnea, with the risk being 5 to 10 times higher in individuals who have both obesity and PCOS, than in those without PCOS<a href="#accordion">[2]</a>.</li>
</ul>

&nbsp;

<ul>
	<li>Metabolic Syndrome: This gathering of side effects increases the threat of cardiovascular disease. The side effects encompass high fatty substances (triglyceride) and low HDL cholesterol levels (HDL is good cholesterol), hypertension, and high glucose levels<a href="#accordion">[14]</a>.</li>
</ul>

&nbsp;

<ul>
	<li>Endometrial Cancer: Endometrial cancer is a sort of uterine malignant growth that begins in the inward lining of the uterus. This lining is known as the endometrium. Varying levels of the sex hormones influence the endometrium lining. When the equilibrium shifts toward expanded degrees of estrogen, it makes endometrial cells partition and duplicate. During ovulation, the uterine coating sheds. Therefore, ensuring a specific thickness of the endometrium. However, if some individual does not ovulate consistently, the arrangement is changed and the construction of a thicker lining is promoted<a href="#accordion">[9]</a>.</li>
</ul>

&nbsp;

<ul>
	<li>Diabetes: Insulin resistance might stimulate the body to produce excessive androgens. If someone has insulin resistance, then the cells in their muscles, organs, and different tissues are unable to retain glucose effectively. Accordingly, they can have an excess of sugar traveling through the circulation system. This is called diabetes, and it can create issues with the cardiovascular and sensory systems of the body<a href="#accordion">[14]</a>.</li>
</ul>

&nbsp;

Complications due to PCOS are not uncommon. Therefore, it is necessary for individuals who have been diagnosed with the condition to monitor their symptoms regularly, to identify the situation before it exacerbates.

<div>&nbsp;</div>

Risk factors for PCOS in individuals above the age of 18 include <a href="https://www.merisehat.pk/disease/diabetes-type-1-and-2" target="_blank">type 1 diabetes</a>, <a href="https://www.merisehat.pk/disease/diabetes-type-1-and-2" target="_blank">type 2 diabetes</a>, and <a href="https://www.merisehat.pk/disease/diabetes-gestational" target="_blank">gestational diabetes</a>. Insulin resistance influences an estimated range of 50% to 70% of individuals diagnosed with PCOS prompting various comorbidities including metabolic syndrome, <a href="http://merisehat.pk/disease/hypertension">hypertension</a>, dyslipidemia, glucose intolerance, and diabetes<a href="#accordion">[19]</a>.

&nbsp;

Polycystic ovary syndrome (PCOS) while common, is tedious to treat and manage. Therefore, individuals who have been warned as likely to develop the condition should tread carefully. To assist with diminishing the impacts of PCOS, attempt to<a href="#accordion">[11]</a>:

&nbsp;

<ul>
	<li>Stay Within A&nbsp;Healthy Weight Range: Weight reduction can decrease insulin and androgen levels, and may establish and invigorate ovulation. Get some information about a weight-control program and consider meeting a dietitian to help reach your desired weight objectives within a healthy timeline.</li>
</ul>

&nbsp;

<ul>
	<li>Reduce Carbohydrate Intake: Low-fat, high-carb diets could increment insulin levels. Refer to licensed dieticians and healthcare professionals to gather the relevant information about a low-carbohydrate diet, if diagnosed with PCOS. Have lengthy discussions to discover what regimen works before jumping on fad diets and unhealthy diet schedules. Incorporate healthy carbs, which raise glucose levels by breaking down slowly.</li>
</ul>

&nbsp;

<ul>
	<li>Ditch The Sedentary Lifestyle: Physical activity assists in lowering blood sugar levels. If an individual is diagnosed with PCOS, they should contemplate building up their day-to-day action and partaking in a customary activity program to treat or try and forestall insulin resistance. This will in effect assist in monitoring their weight, and try not to foster diabetes.</li>
</ul>

&nbsp;

Such easy and modifiable changes in lifestyle can prevent the development of cysts and reduce the extent of symptoms one would normally expect if diagnosed with PCOS. Stay in constant communication with a doctor to inform them of any developments in your condition.&nbsp;&nbsp;

<div>&nbsp;</div>

The latest research has expanded knowledge into the guideline of hormones and cytokines in muscle and fat tissue that corroborate the idea that PCOS is a systemic condition. The well-thought-out treatment plan ought to be customized according to the patient&#39;s phenotype, grievances of discomfort, and reproductive preferences. The aromatase inhibitor letrozole is by all accounts more powerful than the reference drug clomiphene citrate for treating infertility caused by PCOS. A multidisciplinary approach is highly beneficial in assisting patients to adhere to lifestyle changes, taking regular medications, and consequently decreasing body adiposity and recuperating their metabolic and regenerative well-being<a href="#accordion">[16]</a>.

&nbsp;

Key Points

Polycystic Ovary Syndrome (PCOS) is a difficult syndrome to manage and treat. Signs and symptoms may increase an individual&rsquo;s discomfort and levels of irritation. For those who are diagnosed or have the risk of developing the condition, it is important to remember: 
&nbsp;

<ul>
	<li>PCOS is a common hormonal condition that restricts an individual&rsquo;s ability to bear children.</li>
	<li>This causes individuals to not ovulate, and develop excessive androgen, and cysts in ovaries.</li>
	<li>Typical symptoms include irregular periods, excessive hair growth, weight gain, and acne.</li>
	<li>Treatment differs according to age and preferences with people who wish to conceive whereas others are prescribed birth control.</li>
	<li>Changes in diet, regular exercise, and healthy lifestyle choices can mitigate and reduce symptoms.</li>
	<li>Individuals with PCOS are at a higher risk for other medical complications such as <a href="https://www.merisehat.pk/disease/diabetes-type-1-and-2" target="_blank">diabetes</a>, cardiovascular disease, and high blood pressure.</li>
	<li>A multidisciplinary approach is highly beneficial in assisting patients to adhere to the recommended lifestyle changes, taking regular medications, and consequently decreasing body adiposity and recuperating their metabolic and regenerative wellbeing.</li>
</ul>

<div>&nbsp;</div>

[1] Cleveland Clinic. (2021, September 21). Polycystic Ovary Syndrome (PCOS).

[2] Ehrmann, D. A. (2012). Metabolic dysfunction in PCOS: Relationship to obstructive sleep apnea. Steroids, Volume 77, Issue 4, 290-294

[3] Harrison, C. L., Lombard, C. B., Moran, L. J., & Teede, H. J. (2011). Exercise therapy in polycystic ovary syndrome: a systematic review. Human Reproduction Update, Volume 17, Issue 2, 171-183.

[4] Jensen, E. (2022, April 26). 4 Types of PCOS - and How to Know Which One You Have.

[5] Jo, J., Lee, Y. J., & Lee, H. (2017). Acupuncture for polycystic ovarian syndrome: A systematic review and meta-analysis. Medicine, 96(23).

[6] Johansson, J., & Stener-Victorin, E. (2013). Polycystic ovary syndrome: effect and mechanisms of acupuncture for ovulation induction. Evidence-based complementary and alternative medicine.

[7] Johansson, J., Redman, L., Veldhuis, P. P., Sazonova, A., Labrie, F., Holm, G., . . . Stener-Victorin, E. (2013). Acupuncture for ovulation induction in polycystic ovary syndrome: a randomized controlled trial. American journal of physiology. Endocrinology and metabolism, 304(9).

[8] John Hopkins. (2022). Polycystic Ovary Syndrome (PCOS).

[9] Kallen, A. (2021, April 19). Polycystic Ovary Syndrome (PCOS): Symptoms, Causes, and Treatment. Healthline.

[10] Legro, R. S., Arslanian, S. A., Ehrmann, D. A., Hoeger, K. M., Murad, M. H., Pasquali, R., . . . Society, E. (2013). Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. The Journal of clinical endocrinology and metabolism, 98(12), 4565–4592.

[11] Mayo Clinic. (2020, October 3). Polycystic Ovary Syndrome (PCOS).

[12] Moran, L. J., Ko, H., Misso, M., Marsh, K., Noakes, M., Talbot, M., . . . Teede, H. J. (2014). Dietary composition in the treatment of polycystic ovary syndrome: a systematic review to inform evidence-based guidelines. Human Reproduction Update, Volume 20, Issue 1, 432.

[13] NYU Langone Health. (2022). Lifestyle Changes for Polycystic Ovary Syndrome in Adults.

[14] Pathak, N. (2021, September 13). Polycystic Ovary Syndrome (PCOS). WebMD.

[15] Prapas, N., Karkanaki, A., Prapas, I., Kalogiannidis, I., Katsikis, I., & Panidis, D. (2009). Genetics of polycystic ovary syndrome. Hippokratia, 13(4), 216–223

[16] Rocha, A. L., Oliveira, F. R., Azevedo, R. C., Silva, V. A., Peres, T. M., Candido, A. L., . . . Reis, F. M. (2019). Recent advances in the understanding and management of polycystic ovary syndrome. F1000Research, 8.

[17] Rodriguez, P. V., & Bertoldo, M. J. (2019). The Mechanism of Androgen Actions in PCOS Etiology. Medical sciences (Basel, Switzerland), 7(9), 89.

[18] Rudnicka, E., Suchta, K., Grymowicz, M., Calik-Ksepka, A., Smolarczyk, K., Duszewska, A. M., . . . Meczekalski, B. (2021). Chronic Low Grade Inflammation in Pathogenesis of PCOS. International journal of molecular sciences, 22(7), 3789.

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