Polycystic ovary syndrome (PCOS)

The condition known as Polycystic ovary syndrome (PCOS)​ refers to the ovaries’ profusion of tiny cysts (fluid-filled sacs).

Introduction

The condition known as polycystic ovarian syndrome refers to the ovaries’ profusion of tiny cysts (fluid-filled sacs). While some women without the disease do develop cysts, other people with this illness do not. Anovulation, enlarged ovaries with many cysts, infertility, amenorrhea, and other menstrual abnormalities are some of the reproductive problems that define the disorder. Acne, hirsutism (excessive or irregular distribution of hair growth), male pattern baldness, obesity, and sleep apnea are examples of more universal symptoms.

Approximately 5–10% of women in wealthy nations suffer with PCOS. An estimated 3% to 12% of women in Western nations have polycystic ovarian syndrome (PCOS), a prevalent endocrine condition with no known etiology.


Etiology of Polycystic ovary syndrome (PCOS)

Androgen level

In the polycystic ovarian syndrome (PCOS), testosterone and other androgens—male sex hormones that are typically present in women in modest levels—are produced in abnormally high amounts by the ovaries.

Ovulation and Luteinizing hormone

Ovulation, which happens when a mature egg is produced from an ovary, is caused by luteinizing hormone (LH), which also stimulates the release of eggs from ovaries. This takes place so that a male sperm may fertilize it. During menstruation, the egg is expelled from the body if it is not fertilized.

Ovulation is prevented by a rise in LH in the body, and the ovaries may grow a lot of little cysts as a result. Androgen (testosterone)-producing hormones are produced by these cysts. Androgen levels are often elevated in women with PCOS. This may worsen a woman’s menstrual cycle issues. And many of the symptoms of PCOS may be brought on by it.

Insulin level

Insulin resistance is prevalent in PCOS patients. Increased insulin levels may lead to greater testosterone levels, which can impede follicle growth and prevent normal ovulation from occurring. Elevated insulin levels may lead to an increase in androgen levels. Additionally, obesity might raise insulin levels and exacerbate PCOS symptoms.

Causes of Polycystic ovary syndrome (PCOS)

Causes of PCOS includes:

  • Genetics
  • Childhood adrenal stimulation
  • Contraceptives
  • Hormonal imbalance
  • Stress

Sign and Symptoms

The symptoms of PCOS may include:

  • Missed or irregular cycles
  • Extra-large or heavily cystic ovaries
  • Weight increase, particularly around the abdomen (abdomen)
  • Excessive body hair on the chest, stomach, and back (hirsutism)
  • Small bits of extra skin on the neck or armpits (skin tags)
  • Dark or thick skin patches on the back of the neck, in the armpits, and beneath the breasts
  • Acne or oily skin
  • Male-pattern baldness or thinning hair
  • Infertility

Do PCOS women conceive?

PCOS women can become pregnant. Even if someone have PCOS, she may still get pregnant. One of the most prevalent but manageable reasons of infertility in women is PCOS. The hormonal imbalance in PCOS patients prevents the development and release of eggs from the ovaries (ovulation). Someone cannot get pregnant if she do not ovulate.

Pregnancy Complications include

  • Those with PCOS have a three times greater chance of miscarriage than those without the condition.
  • Small for gestational age (SGA) children
  • Pregnancy-induced hypertension
  • Gestational diabetes (GD) risk

Is there a treatment for PCOS?

  • Unfortunately, there are techniques to reduce these symptoms and postpone the development of consequences from PCOS. Treatments can assist in controlling PCOS symptoms and avoiding long-term health issues including diabetes and heart disease. Although there are drugs available to address the different symptoms, they should only be taken after speaking with a trained medical professional. Improving PCOS symptoms and maintaining appropriate weight are essential for maintaining regular bodily functions. The primary line of defense against PCOS is thought to be maintaining a healthy lifestyle. Positive adjustments may be made by eating a balanced diet, exercising frequently, getting enough sleep, and being composed and stress-free.

Diagnosis

  1. Diagnostic test includes:

    Ultrasound:

    This test examines the size of the ovaries and checks for cysts. The endometrium (uterine lining) can also be examined during the test to determine its thickness.

    Blood exams:

    These scan for elevated levels of the hormones testosterone and androgens. A healthcare professional may also assess the levels of triglycerides, cholesterol, and blood glucose.

Dietary Management

 

Food Allowed

Food not Allowed

Foods high in fiber include beans and legumes (lentils, chickpeas, soybeans, and kidney beans) as well as broccoli, cauliflower, lettuce, capsicum, sprouts, amla

Refined food includes white bread, Naan and other products made with white flour

Fruits like melon, apple, pear, plum, peach, orange, apricot, papaya, guava, mausami.

Consume banana, grapes, mango, pineapple, cheeku in limited amount.

 

Wheat, bran, brown rice, bajra, oats, pulses, and legumes are examples of whole grain foods. Veggies with dark green leaves, such as spinach mustard leaves

Baked goods such as custard, pudding, cakes, macaroni, noodles, pastries, muffins, burgers, pizza

Egg white, white meat such as chicken, fish

Processed and red meat and sausages

Antioxidants rich food such as berries, cheery, strawberry, blueberry and kiwi.

Carbonated beverages, high caffeine, energy drinks

Low fat milk, curd, yogurt, buttermilk, Olive oil, cannola oil, sunflower oil, mustard oil and MCT oil.

High fats butter, margarine, mayonnaise and trans fats

Whole grain cereals, wheat, bran, brown rice, bajra, oats, dalia, whole pulses and legumes

Canned and packed juices, fruits, sugary beverages, cold drinks and soda

Fresh homes made green/mint chutneys.

Sodium rich foods (sauces, chips, canned soups, canned vegetables)

Herbal Therapy

Soya beans:

50mg of soy isoflavones are present in 2 servings of soy beans. After receiving soy isoflavones for 12 weeks, PCOS women’s insulin resistance, hormonal state, lipids, and oxidative stress biomarkers all greatly improved.

Cinnamon:

Study conducted on mice with PCOS produced by dehydroepiandrosterone, oral doses of cinnamon extract (10 mg/100 g) reduce testosterone levels.

Studies indicated that an effective adjunct for PCOS-afflicted women’s menstrual dysfunction may be a cinnamon supplement (dose 1500 mg/day for 6 months).  

Another study shows that for eight weeks, one capsule containing 333 mg of cinnamon extract orally administered to PCOS women would increase their insulin sensitivity.

Flaxseeds:

Study reported that, 31-year-old PCOS patient treated with flaxseed (dose 30 g/day for 4 months), testosterone levels were decreased.

It was also reported that giving a 48-year-old postmenopausal lady 15 grams of flaxseed a day for 12 weeks decreased her testosterone levels without significantly altering her levels of estrogen or estradiol.

Fennel seeds:

Fennel seeds contain anti-hirsutism characteristics and are thought to help treat PCOS by lowering levels of androgen (male hormones).

Sesame seeds:

Sesame seeds provide nutrients that are good for people with PCOS. Its beneficial fats aid in controlling blood sugar levels.

Pumpkin Seeds: 

Pumpkin seeds also provide the beneficial omega-3 fatty acids that can help control the elevated insulin and cholesterol levels associated with PCOS. They also include beta-sitosterol, which can reduce too much androgen and cure PCOS symptoms including hirsutism, acne, and weight gain.

Green tea:

The strong antioxidants in green tea, called catechins, work to reduce the hormone levels that lead to ovarian cysts and their associated symptoms.  Green tea’s antioxidants also help to regulate insulin levels. Regularly consuming green tea has an effect on PCOS-related weight gain and aids in the loss of this extra weight.

Aloe-vera: 

Co-treatment of the inducing drug (letrozole) and the aloe vera gel (1 ml dosage daily for 45 days) prevented the emergence of the PCOS. By restoring the ovarian steroid status and changing important steroidogenic activity, aloe vera gel formulation has a preventive effect against the PCOS.

Licorice: 

Studies shows that, in the luteal phase of the menstrual cycle, nine healthy women between the ages of 22 and 26 examined the impact of licorice on androgen metabolism. They received 3.5 g of a commercial licorice preparation containing 7.6% W/W glycyrrhizic acid each day. Within two months, the total serum testosterone level progressively fell.

Licorice can lower blood testosterone levels, perhaps as a result of the enzymes 17-hydroxysteroid dehydrogenase and 17-20 lyase being blocked. Licorice may be used as a complementary treatment for hirsutism and polycystic ovary syndrome.

Tulsi: 

Tulsi can reduce insulin levels and control androgens. It works wonders as an antioxidant.  At least ten leaves should be chewed on an empty stomach in the early morning.

Ginger:

Using ginger (extract of ginger at dosages of 175 and 350 mg/kg daily for 60 and 89 days) orally as an herbal remedy that has no negative side effects at large doses may be a good and efficient alternative for treating PCOS.

References

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  3. Katulski K, Czyzyk A, Podfigurna-Stopa A, Genazzani AR, Meczekalski B. Pregnancy complications in polycystic ovary syndrome patients. Gynecological Endocrinology. 2015 Feb 1;31(2):87-91.
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  7. Jamilian M, Asemi Z. The effects of soy isoflavones on metabolic status of patients with polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism. 2016 Sep 1;101(9):3386-3394.
  8. Pachiappan S, Ramalingam K, Balasubramanian A. A review on phytomedicine and their mechanism of action on PCOS. Int. J. Cur. Res. Rev. 2020 Dec;12(23):81.
  9. Jelodar G, Masoomi S, Rahmanifar F. Hydroalcoholic extract of flaxseed improves polycystic ovary syndrome in a rat model. Iranian journal of basic medical sciences. 2018 Jun;21(6):645.
  10. Khanage SG, Subhash TY, Bhaiyyasaheb IR. Herbal drugs for the treatment of polycystic ovary syndrome (PCOS) and its complications. Pharm. Res. 2019;2(1):5-13.
  11. Atashpour S, Jahromi HK, Jahromi ZK, Maleknasab M. Comparison of the effects of Ginger extract with clomiphene citrate on sex hormones in rats with polycystic ovarian syndrome. International journal of reproductive biomedicine. 2017 Sep;15(9):561.