2. OBJECTIVES
As PCOS is the most common endocrinological and metabolic
disorder among the reproductive age of Female.
PCOS has been seen in most of the teenagers girl nowadays.
Percentage of having PCOS having increasing at high level.
PCOS involves many types of hormonal disbalance as like Insulin
ressitance,hyperandrogenism, Sleep apnea and low melatonin,
Ovarian and uterine dysfunction,Dyslipidamia and is the major
cause of female infertility and Spontaneous & Recurrent
miscarriage.
As I am Suffering from this disorder for 4 years.
Thus, I have taken PCOS as my Project work to know the causes,
treatment procedure and preventions to cope up with this
disorder.
3. WHAT IS PCOS ?
3
• DEFINITION: Polycystic ovary syndrome
(PCOS) is a common endocrine system disorder
among women of reproductive age. Women
with PCOS may have enlarged ovaries that contain
small collections of fluid — called cysts.
•PCOS was first identified by Stein and
Leventhal in 1935
•Prevalence 10-20% of normal population
•It’s a most common complex , endocrinological
disorder among women..
• DEFINITION: Polycystic ovary syndrome
(PCOS) is a common endocrine system disorder
among women of reproductive age. Women
with PCOS may have enlarged ovaries that contain
small collections of fluid — called cysts.
•PCOS was first identified by Stein and
Leventhal in 1935
•Prevalence 10-20% of normal population
•It’s a most common complex , endocrinological
disorder among women..
5. Potential causes:
The exact cause of polycystic ovary syndrome (PCOS) is unknown, but it's
thought to be related to abnormal hormone levels.
5
•Resistance to insulin( hyperinsulinemia)
Insulin is a hormone produced by the pancreas to control the amount
of sugar in the blood. It helps to move glucose from blood into cells,
where it's broken down to produce energy.
•Insulin resistance means the body's tissues are resistant to the effects
of insulin. The body therefore has to produce extra insulin to
compensate.
•High levels of insulin cause the ovaries to produce too much
testosterone, which interferes with the development of the follicles and
prevents normal ovulation.
•Insulin resistance can also lead to weight gain, which can make PCOS
symptoms worse, because having excess fat causes the body to produce
even more insulin…and leads to type 2 diabetes.
•Resistance to insulin( hyperinsulinemia)
Insulin is a hormone produced by the pancreas to control the amount
of sugar in the blood. It helps to move glucose from blood into cells,
where it's broken down to produce energy.
•Insulin resistance means the body's tissues are resistant to the effects
of insulin. The body therefore has to produce extra insulin to
compensate.
•High levels of insulin cause the ovaries to produce too much
testosterone, which interferes with the development of the follicles and
prevents normal ovulation.
•Insulin resistance can also lead to weight gain, which can make PCOS
symptoms worse, because having excess fat causes the body to produce
even more insulin…and leads to type 2 diabetes.
Need
sugar
free??
8. • Excessive levels of androgens leads to
HIRSUTISM, ACNE, HAIR THINNING etc.
Hyperandrogenism:
INSULIN RESISTANCEINSULIN RESISTANCE
HYPERINSULINEMIAHYPERINSULINEMIA
THECAL CELL PROLIFICATIONTHECAL CELL PROLIFICATION EXCESS ANDROGEN
PRODUCTION
EXCESS ANDROGEN
PRODUCTION
INHIBITION OF SYNTHESIS
OF SHBG
INHIBITION OF SYNTHESIS
OF SHBG
FREE ANDROGEN
LEVEL INCREASES
FREE ANDROGEN
LEVEL INCREASES
HYPERANDROGENISMHYPERANDROGENISM
9. Poor sleep and oxidative stress:
• MELATONIN is the hormone release from pineal gland. and at night in absence of light
its level is increased..and we fell asleep.
LOW LEVEL OF MELATONIN POOR SLEEP AT NIGHT
women with polycystic ovary
syndrome are less likely to have
quality sleep
High testosterone levels are
connected to the loss of
melatonin
New research from Yamaguchi University in Japan.
http://www.ovarian-cysts-pcos.com/news68.html
ROS generation,
p47phox
expression and TBARS are
increased in women with PCOS
https://academic.oup.com/jcem/article/
91/1/336/2843549/Reactive-Oxygen-
Species-Induced-Oxidative-Stress
PCOS women with high
8-OHdG levels in urine, and
thus high oxidative stress
levels
Good suppliment of
antioxidants and melatonin
agonist for treatment.
10. •PCOS has been strongly linked to sleep apnea. Sleep
apnea is a sleep disorder characterized by brief episodes
of stopped breathing during sleep. This disrupts sleep
and impacts oxygen delivery to the body. Sleep apnea can
lead to lower pain tolerance, high blood pressure, mood
changes, heart disease, and increased weight.
•PCOS causes chemical changes in the body that result in
anxiety. Additionally, the symptoms of PCOS (anxiety,
weight gain, hair loss or growth, sleep disturbances, skin
conditions, etc.) impact us physically and emotionally, and
could cause anxiety.
•It is also true that abnormal levels of androgens and other
hormones are related to mood disorders.
Obstructive Sleep Apnea And Depression
12. 1. Chronic estrogen exposure or
lack of progesterone due to
ovarian dysfunction can result in
endometrial hyperplasia
2. Progesterone resistance in
pcos.
PCOS have higher estrogen
levels and lower levels of
progesterone. The increase
in estrogen relative to
progesterone can increase
a woman's chance of
getting endometrial cancer
UTERINE DYSFUNCTION
14. HYPERTENSIVE DISEASE IN PREGNANCY new-
onset hypertension in pregnancy after 20 weeks
of gestation
First trimester
PCOS women are at increased risk
for early pregnancy loss (EPL).
30 to 50% of PCOS women
elevated LH levels with
EPL in women with
PCOS.
Polycystic ovary syndrome and spontaneous miscarriage
Hyperandrogenemia
high androgen levels
antagonize estrogen, which
may adversely affect
endometrial development and
implantation. Progesterone resistance
High plasminogen activator
inhibitor-1(PAI-1) activity
higher in women with PCOS
INSULIN RESISTANCE
ENDOMETRIAL DYSFUNCTI
ON
OBESITY
PREGNANCY AND PCOS : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659
904/
GDM complicates 40 to 50% of PCOS
pregnancies
Preterm births complicate 6 to 15% of
pregnancies of PCOS women
Preeclampsia,
High blood pressure
high level of protein in their urine and often
also have swelling in the feet, legs, and hands.
Second and third trimester
15. Elevation of LDL
cholesterol in all PCOS
patients.
Decreased
concentrations of HDL
cholesterol
While triglycerides
start to rise
Risk factor
for coronary
heart disease
PCOS-associated
oxidative stress
OBESE
Supplementation with omega-3 fatty acids,
α-lipoic acid and N-acetylcysteine is
considered
HYPERINSULINEMIA
METABOLIC DISORDER : DYSLIPIDEMIA
16. The pathogenesis of PCO may be due to a central
deficiency in dopaminergic activity at the basal
hypothalamus. The hyperprolactinemia observed in a
significant number of PCO patients may reflect a
greater deficiency of hypothalamic dopamine.
http://www.sciencedirect.com/science/article/pii/S00150282
16478386
DopamineDopamine
ProlactinProlactin
Ant. PituitaryAnt. Pituitary
GnRHGnRH
FSH/LHFSH/LHAMENORRHEAAMENORRHEA
ANOVULATIONANOVULATION
PCOSPCOS
HYPOTHALAMUSHYPOTHALAMUS
TRHTRH
Dopamine
agonist
CABERGOLIN
Dopamine
agonist
CABERGOLIN
MILK SECRETIONMILK SECRETION
HYPERPROLACTINEMIA
Normal levels are less than
500 mIU/L [20 ng/mL or µg/L]
for women
17. STEPHEN FRANKS,
MARK I MCCARTHY,
Development of polycystic ovary syndrome: involvement of genetic and environmental factors KATE HARDY
PCOS has its origin in fetal life. It is suggested that, in human females, exposure to excess androgen, at any
stage from fetal development of the ovary to the onset of puberty, leads to many of the characteristic
features of PCOS . At present, it is unclear whether the maternal environment directly influences the
development of PCOS in the offspring. The etiology of the syndrome remains uncertain but there is
increasing evidence for a genetic basis.
GENETIC BASIS :
•Some clinical genetic studies have
pointed to an autosomal dominant
inheritance while others showed that it
occurs oligogenic basis.
Several controversial genes involved:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2776334/
1.Mutation in CYP11,CYP21,CYP 19 GENE..encodes several enzymes in
streoidogenesis.
2. mutation in AR Gene, IRS1/IRS2 Gene
3.Lack of p450aromRNA .
4. Mutation in fibronectin and melatonin receptor.
5. Polymorphism in TNF-alpha and INS VNTR sequence
6. rs2479106 and rs10818854 polymorphisms in the DENND1A gene were
associated with increased risk of PCOS
Several controversial genes involved:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2776334/
1.Mutation in CYP11,CYP21,CYP 19 GENE..encodes several enzymes in
streoidogenesis.
2. mutation in AR Gene, IRS1/IRS2 Gene
3.Lack of p450aromRNA .
4. Mutation in fibronectin and melatonin receptor.
5. Polymorphism in TNF-alpha and INS VNTR sequence
6. rs2479106 and rs10818854 polymorphisms in the DENND1A gene were
associated with increased risk of PCOS
18. Diagnosis:
Ultrasound
An ultrasound of the uterus, ovaries and the pelvis can
be carried out to identify whether there are any cysts
on your ovaries and whether an ovary is enlarged.
Blood tests
Oestradiol (estrogen)
Follicle stimulating hormone (FSH)
luteinizing hormone (LH)
( Testosterone) and free androgen
MRI
Ultrasound
•Magnetic Resonance Imaging (MRI)
• To evaluate ovarian morphology using
three-Dimensional magnetic resonance
imaging (MRI)
BLOOD TEST
24. NAME SYMPTOMS TREATMENT
1. SURVEY 1 •NORMAL INSULIN
•NORMAL ANDROGEN
•MILD HIGH PROLACTIN
•OLIGOMENORRHEA
•NO PAIN
•OVERWEIGHT
•LACK OF SLEEP
•HIGH STRESS
•.CABERGOLIN
•REGISTRONE
•METFORMIN
Diagnosed PCOS at age of
21
WRONG TREATMENT
25. 2006-12-6 PCOS 25
NAME SYMPTOMS TREATMENT
2. SURVEY 2 IMMENSE PAIN,ACNE,
HYPERANDROGENISM,INSULIN
RESISTANCE,REGULAR PERIOD,LACK OF
SLEEP.,NON OBESE
Flutamide
Capsule,Metformin,Clomiphene
citrate.
3. SURVEY 3
OBESE,IRREGULARITY OF
PERIOD,IMMENSE
PAIN,HYPERANDROGENISM,INSULIN
HIGH,IGT,HAIRFALL,STRESS AND LACK
OF SLEEP.
Metformin,Clomid,Yasmin.
4. SURVEY 4 NO PAIN,INSULIN RESISTANCE
,HYPERANDROGENISM,OVERWEIGHT,
IRREGULARITY OF PERIOD.
Metformin,Clomiohene citrate,
Novelon
5. SURVEY 5 ECTOPIC PREGNENCY WITH
PCOD,ABORTION FOR THE FIRST
TIME,SECOND PREGNENCY WITH PCOD,
GESTATIONAL DIBATIES,PRETERM
DELIVERY,INSULIN
RESITANCE,HYPERANDROGENISM,OVER
WEIGHT.
Sulfonylureas,Biguanide,f
lutamide
tablets,metformin, PG
inhibitors,Ca blocker,
6. SURVEY 6 OBESE,LACK OF SLEEP,HIGH STRESS,PRIMARY
AMENORRHEA,IGT,
HYPERANDROGENISM.
Metformin,Clomiohene citrate,
No birth control pill,antidepressants,
chemotherapy
7. SURVEY 7
SPONTANEOUS MISCARIAGE(EPL) WITH
PCOS,HYPERINSULIMIA,GESTATIONAL
DIBATIES,PREECLAMPSIA,IGT
Letrozol, No NSAIDs,
Mg SULPHATE,Ca
tablets,METFORMIN
26. CONCLUSION:
•Following those survey, we concluded that there is several types of PCOS in population: mainly there
are 4 types of pcos based on symptoms variations. Pcos is not only a endocrinological disorder it also a
metabolic disorder. There are several polymorphism in SNPs that lead to the different types of pcos.
Percentage of having pcos in aldoscense girls are more frequent. There are no exact causes of having
pcos. There should be some environmental hazards that leads to increase the complexity of this
disorder.
27. CONCLUSION:
Moreover Polycystic ovary syndrome, the commonest endocrinopathy
among premenopausal women, is also associated with metabolic
dysfunction.
The phenotype of PCOS can vary widely throughout lifespan
By taking into account one must be followed by a complete gynaecologic
evaluation. Many researches are still going in this field to know about more.
At last we conclude that there is no exact cause of having PCOS. There
should be some environmental hazards that lead to the complexity of this
disorder.For thst reason we can say that PCOS IS STILL AN ENIGMA.
28. 1. Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term
health risks related to Polycystic Ovary Syndrome (PCOS) Human Reproduction. 2004;19:41–47. [PubMed]
2. Azziz R, Carmina E, Dewailly, et al. Criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an
androgen excess society guideline. Journal of Clinical Endocrinology & Metabolism. 2006;91:4237–4245. [PubMed]
3. Escobar-Morreale HF, Botella-Carretero JI, Alvarez-Blasco F, et al. The polycystic ovary syndrome associated with morbid obesity may
resolve after weight loss induced by bariatric surgery. Journal of Clinical Endocrinology & Metabolism. 2005;90:6364–6369. [PubMed]
4. http://emedicine.medscape.com/article/256806-overview
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3737989/a
6. J Pediatr Adolesc Gynecol. 2011 Aug;24(4):223-7. doi: 10.1016/j.jpag.2011.03.002. Epub 2011 May 19.Prevalence of polycystic ovarian
syndrome in Indian adolescents.Nidhi R1
, Padmalatha V, Nagarathna R, Amritanshu R.
7. Management of Polycystic Ovary Syndrome in India
8.PANEL DISCUSSION MANAGEMENT OF PCOS WOMB to TOMB . PANELISTS : Dr.Chitra setia Dr Puneet Arora Dr. Ila Gupta Dr. Rupam
Arora Dr. Archana Sharma Dr. Sangeeta Gupta
9. Endocr Rev. 1997 Dec;18(6):774-800.Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis.
Dunaif A1
10. Charron MJ, Brosius FD, Alper SL, Lodish HF. A glucose transport protein expressed predominately in insulin-responsive tissues. Proc Natl
Acad Sci USA. 1989;86:2535–2539. [PMC free article] [PubMed]
11. Zorzano A, et al. Insulin-regulated glucose uptake in rat adipocytes is mediated by two transporter isoforms present in at least two vesicle
populations. J Biol Chem. 1989;264:12358–12363. [PubMed]
12. http://www.webmd.com/baby/gestational-diabetes-you#1
13. J Endocrinol Invest. 1998 Oct;21(9):602-11.Insights into hypothalamic-pituitary dysfunction in polycystic ovary syndrome. Hall JE1
,
Taylor AE, Hayes FJ, Crowley WF Jr.
REFERENCES
29. 14. Chronic Anovulation and the Polycystic Ovary Syndrome. https://obgynkey.com/chronic-anovulation-and-the-
polycystic-ovary-syndrome/#R50-12
15. Role of Oxidative Stress in Polycystic Ovary SyndromeJoo Yeon Lee1, Chin-Kun Baw1, Sajal Gupta1, Nabil
Aziz2 and Ashok Agarwal1,*Center for Reproductive Medicine, Cleveland Clinic, Cleveland, USA; 2Liverpool Women’s
Hospital, Liverpool, UK
16. Sathyapalan T, Shepherd J, Coady AM, Kilpatrick ES, Atkin S. Atorvastatin reduces malondialdehyde
concentrations in patients with polycystic ovary syndrome, J Clin Endocrinol Metab , 2012, vol. 97 (pg. 3951-5)
https://doi.org/10.1074/jbc.274.31.21840.
17. Karihtala P, Soini Y. Reactive oxygen species and antioxidant mechanisms in human tissues and their relation
to malignancies, APMIS ,2007, vol. 115 (pg. 81-103) https://doi.org/10.1128/MCB.00696-07
18. Reactive Oxygen Species-Induced Oxidative Stress in the Development of Insulin Resistance and
Clin Endocrinol Metab (2006) 91 (1): 336-340. DOI: https://doi.org/10.1210/jc.2005-1696
19. Increased prevalence of obstructive sleep apnea syndrome in obese women with polycystic ovary syndrome.
Fogel RB, Malhotra A, Pillar G, Pittman SD, Dunaif A, White DP,J Clin Endocrinol Metab. 2001 Mar; 86(3):1175-80.
Polycystic ovary syndrome is associated with obstructive sleep
apnea and daytime sleepiness: role of insulin resistance.Vgontzas AN, Legro RS, Bixler EO, Grayev A, Kales A,
Chrousos GP,J Clin Endocrinol Metab. 2001 Feb; 86(2):517-20.
The role of obesity in the increased prevalence of obstructive sleep apnea syndrome in patientswith polycystic
ovarian syndrome.Gopal M, Duntley S, Uhles M, Attarian H.Sleep Med. 2002 Sep; 3(5):4014.
20. Polycystic Ovary Syndrome and Obstructive Sleep Apnea
Esra Tasali, MD, Assistant Professor of Medicine,a Eve Van Cauter, PhD, Professor of Medicine,b and David A.
Ehrmann, MD, Professor of Medicinec.
21. PCOS Symptoms — PCOS Awareness Association
www.pcosaa.org/pcos-symptoms/
22. https://en.wikipedia.org/wiki/Anovulation
23. Polycystic Ovary Syndrome (PCOS): Arguably the Most Common Endocrinopathy Is Associated with Significant
Morbidity in Women
Enrico Carmina Rogerio A. Lobo
J Clin Endocrinol Metab (1999) 84 (6): 1897-1899. DOI: https://doi.org/10.1210/jcem.84.6.5803
Published: 01 June 1999.
30. Acknowledgement
•I express my sincere gratitude to Dr. Subrata Sankar Bagchi(Principal
of Bangabasi College), Dr.Rupa Mukhopadhay(H.O.D of Dept. of
Zoology) for allowing me to do the review work.
• I also express my sincere thanks to my teachers, Dr. Prajna Paramita
Basu and Special thanks to Dr. Indraneel Saha for their constant
experienced guidance and help without which my review project
would not be possible.Their enriched knowledge provided me with
every details which is needed for preparing this review project.
•I feel highly acknowledged and honored to express my deep regard to
my project investigator, Dr. Kasturi Bhowmick.
•I extend my heart felt thanks to my parents to support me a lot and
lastly am thankful to all of my friends of Bangabasi college.
Editor's Notes
Vicious clycle of event, but why does it start?
See written physiology.
