Polycystic ovary syndrome (PCOS) is a common condition in women that affects the ovaries. It is characterized by enlarged ovaries with many small follicles, irregular or absent periods, excess androgen levels leading to symptoms like excess hair growth and acne. PCOS can cause infertility and increases the risk of conditions like diabetes and heart disease. While the exact cause is unknown, it tends to run in families and being overweight increases the risk. Treatment focuses on improving fertility, reducing androgen levels, and weight loss through lifestyle changes and medications.
Polycystic ovary syndrome (PCOS) is the most common hormone abnormality of reproductive-age women, the most common cause of infertility in women and an important harbinger of metabolic disorders such as diabetes and heart disease.
PCOS (Polycystic ovary syndrome) is one of that type of disorder, a reproductive endocrinological disorder which gets started among the females at reproductive age. TOO MANY WOMEN WITH PCOS GO UNDIAGNOSED
Polycystic ovary syndrome (PCOS) is the most common hormone abnormality of reproductive-age women, the most common cause of infertility in women and an important harbinger of metabolic disorders such as diabetes and heart disease.
PCOS (Polycystic ovary syndrome) is one of that type of disorder, a reproductive endocrinological disorder which gets started among the females at reproductive age. TOO MANY WOMEN WITH PCOS GO UNDIAGNOSED
The menopause may be
Natural or induced
Natural menopause - the permanent cessation of menstruation for 12 months caused by failure of ovarian function with elevated gonadotropins (FSH, LH).
Average is 51 years
PCOD occurs when a woman’s hormones are imbalanced and numerous cysts accumulate in the ovaries. The only way to identify PCOD is only through the symptoms. Because of the seriousness of the complications that can arise from PCOD, it is extremely important to seek treatment for it immediately. To know more about it, read on…
PCOS (Polycystic Ovary Syndrome) is a combined metabolic and hormonal disorder found in women. Incidences of PCOS appear to be rising and it is now being diagnosed more often.
Here are 5 facts to know about PCOS, which will help you in clarifying your doubts. The source of information is highly reliable as information is reviewed by doctors.
For more Info visit www.healthlibrary.com "Management of PCOS in Unani System of Medicine" by Dr. Shaikh Nikhat held on 11th June 2016.
Management of PCOS in Unani System of Medicine - Unani system have the holistic approach to treat the condition like PCOD / PCOS.
The menopause may be
Natural or induced
Natural menopause - the permanent cessation of menstruation for 12 months caused by failure of ovarian function with elevated gonadotropins (FSH, LH).
Average is 51 years
PCOD occurs when a woman’s hormones are imbalanced and numerous cysts accumulate in the ovaries. The only way to identify PCOD is only through the symptoms. Because of the seriousness of the complications that can arise from PCOD, it is extremely important to seek treatment for it immediately. To know more about it, read on…
PCOS (Polycystic Ovary Syndrome) is a combined metabolic and hormonal disorder found in women. Incidences of PCOS appear to be rising and it is now being diagnosed more often.
Here are 5 facts to know about PCOS, which will help you in clarifying your doubts. The source of information is highly reliable as information is reviewed by doctors.
For more Info visit www.healthlibrary.com "Management of PCOS in Unani System of Medicine" by Dr. Shaikh Nikhat held on 11th June 2016.
Management of PCOS in Unani System of Medicine - Unani system have the holistic approach to treat the condition like PCOD / PCOS.
Getting Unstuck: From Desktop to DeviceLiz Danzico
User experience doesn't stop at the desktop. Twitter, YouTube, Google all have strategies for mobile devices and beyond. Yes, the convergence culture is finally here, and people are consuming content when and where they want. How do we shift our thinking (and our skillsets) to keep up? Learn from a panel of experts how to get unstuck from the desktop to go mobile and beyond.
PCOS is a hormonal disorder. These days Every other woman is suffering from PCOS. PCOS is due to combination of genetic and environmental factors. Researches show PCOS has no cure. Only lifestyle changes can help in dealing with it.
In you have any question about infertility treatment so you should read these notes. I tried my best to mention all possible Q and A about infertility treatment.
Women's health is something that we all care about, but sometimes it can be a little bit hard to know where to start. We're here to help!
Women's health is so important because it affects every aspect of your life, from your mental health, to your physical health and body image to even the way you feel about yourself. But how do you know if something is affecting your wellbeing? How can you make sure that you're taking care of yourself? And what are the best ways for you to take care of others in your life? 👩😇
PCOS- An insight into polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) is extremely prevalent and probably constitutes the most frequently encountered endocrine (hormone) disorder in women of reproductive age
Polycystic Ovarian Syndrome (PCOS) is a prevalent hormonal disorder in women, yet it is one of the most underdiagnosed diseases. It adversely affects women at varying life stages, but unfortunately, half of the women with PCOS are unaware and ignorant about it. As it is a complex and multifaceted condition, it impacts women’s health and well-being in a multitude of ways. Therefore, it is imperative to create awareness and emphasize prevention strategies.
we had described 7 classical symptoms of pcos in simple language for patients. kindly visit your physician for detail diagnosis.
regards ayusanjivani ayurveada
PCOD Treatment in Odisha what patients should know dr aditya das ; dr kokil...Dr Aditya Keya
Clomifene encourages the monthly release of an egg from the ovaries (ovulation). If clomifene is unsuccessful in encouraging Lifestyle interventions are the first treatments doctors recommend for PCOS, and they often work well. Weight loss can treat PCOS symptoms and improve the odds of getting pregnant. Diet and aerobic exercise are two effective ways to lose weight. Medicines are an option if lifestyle changes don't work, another medication called Metformin may be recommended. Metformin is often used to treat type 2 diabetes, but it can also lower insulin and blood sugar levels in women with PCOS.
Now You Can Fight PCOD/PCOS Naturally!
Managing your life with Polycystic Ovarian Disease (PCOD), the excess weight, emotional stress, not being able to conceive, the hair problems, having no one to talk to and most importantly—dealing with the comments and snide remarks—all probably leave you feeling dejected and with no time for the most important person in your life—YOU!Explained by Dr. Cheng Mei Ling Theresa Nee Wong
In spite of all the pain and anxiety, if you find little or no improvement in the symptoms after undergoing several conventional treatments, going to the gym and being on crash diets, it’s time to change, to stop the suffering and start living your life to the fullest again!
PCOD,
Introduction.
What causes Of PCOS ?
Eight Common Symptoms of PCOS.
How PCOS is Diagnosed ?
Pregnancy and PCOS.
How we prevent problems from PCOS.
Medical & Surgery Treatment.
In summary
https://www.youtube.com/watch?v=ouvn20oFTls
Polycystic ovary syndrome (PCOS) is a common hormonal disorder that affects individuals with ovaries, typically during their reproductive years. PCOS is characterized by a combination of symptoms, and its exact cause is not fully understood.
PCOD stands for Polycystic Ovary Disease and PCOS stands for Polycystic Ovary Syndrome. Both the terms indicate a common hormonal disorder resulting in chronic anovulation in women when irregular menstrual cycle with increased male hormones are present in their body during their reproductive age.
Polycystic Ovary Syndrome (PCOS) is a common but complex hormonal disorder
worldwide. It is estimated to impact up to 10% of women of reproductive age. PCOS
is characterized by a range of symptoms, including irregular menstrual periods,
excessive hair growth, acne, and infertility. In this blog post, we will delve into PCOS,
exploring its symptoms, causes, the diagnostic process, and the various treatment options available.
Information about PCOS i.e. polycystic ovarian syndrome.
It is not same as the PCOD.
This presentation contain data about causes, treatments, etiology, diagnosis, symptoms and pathophysiology of PCOS
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Polycystic Ovary Syndrome
1. Polycystic ovary syndrome (PCOS)
What is polycystic ovary syndrome?
Polycystic (literally, many cysts) ovary syndrome (PCOS or PCO) is a complex condition that affects the ovaries
(the organs in a woman's body that produce eggs).
In PCOS, the ovaries are bigger than average, and the outer surface of the ovary has an abnormally large
number of small follicles (the sac of fluid that grows around the egg under the influence of stimulating
hormones from the brain).
In PCOS, these follicles remain immature, never growing to full development or ovulating to produce an egg
capable of being fertilised. For the woman this means that she rarely ovulates (releases an egg) and so is less
fertile. In addition, she does not have regular periods and may go for many weeks without a period. Other
features of the condition are excess weight and excess body hair.
The condition is relatively common among infertile women and particularly common among women with
ovulation problems (an incidence of about 75 per cent). In the general population, around 25 per cent of
women will have polycystic ovaries seen on ultrasound examination but most have no other symptoms or signs
of PCOS and are perfectly healthy. The ultrasound appearance is also found in up to 14 per cent of women on
the contraceptive pill.
What causes PCOS?
While it is not known if women are born with this condition, PCOS seems to run in families. This means that
something that induces the condition is inheritable, and thus influenced by one or more genes.
Interestingly, when PCOS is passed down the man's side of the family, the men are not infertile, but they do
have a tendency to become bald early in life, before the age of 30. Ongoing research is trying to clarify whether
there is a clearly identifiable gene for PCOS. It seems likely that in the future one or two genes will be identified
that play a fundamental role in determining a woman's likelihood of developing this condition.
Even if PCOS has a genetic basis, it is likely that not all women with the gene or genes will develop the
condition. It is more likely to develop if there is a family history of diabetes (especially Type 2, the less severe
type usually controlled by tablets), or if there is early baldness in the men in the family.
Women are also more at risk if they are overweight. Maintaining weight or body mass index (BMI) below a
critical threshold is probably very important to determine whether some women develop the symptoms and
physical features of the condition. Just how much weight (or what level of BMI) is difficult to say because it will
be different for each individual. Certainly, for patients who are considered obese (with BMI greater than 30) or
overweight (BMI 25 to 30), weight loss improves the hormonal abnormalities and improves the likelihood of
ovulation and thus pregnancy.
Can PCOS be prevented?
If there is a genetic influence, then some people are more likely to get PCOS than others. However, it seems
likely that you cannot alter your predisposition to PCOS. There is no current proof of any benefit of preventative
weight loss, but the best advice for overall health is to maintain a normal weight or BMI, especially if you have
strong indicators that PCOS could affect you. These indicators are:
• a tendency in the family towards non-insulin dependent (Type 2) diabetes.
• a tendency towards early baldness in the men in the family (before 30 years of age).
• the knowledge that a close relative already has PCOS.
What are the symptoms?
The ways in which PCOS shows itself include:
• absent or infrequent periods (oligomenorrhoea): a common symptom of PCOS. Periods can be as
frequent as every five to six weeks, but might only occur once or twice a year, if at all.
• increased facial and body hair (hirsutism): usually found under the chin, on the upper lip, forearms,
lower legs and on the abdomen (usually a vertical line of hair up to the umbilicus).
• acne: usually found only on the face.
• infertility: infrequent or absent periods are linked with very occasional ovulation, which significantly
reduces the likelihood of conceiving.
2. • overweight/obesity: a common finding in women with PCOS because their body cells are resistant to
the sugar-control hormone insulin. This insulin resistance prevents cells using sugar in the blood
normally and the sugar is stored as fat instead.
• miscarriage (sometimes recurrent): one of the hormonal abnormalities in PCOS, a raised level of
luteinising hormone (LH - a hormone produced by the brain that affects ovary function), seems to be
linked with miscarriage. Women with raised LH have a higher miscarriage rate (65 per cent of
pregnancies end in miscarriage) compared with those who have normal LH values (around 12 per cent
miscarriage rate).
These symptoms are related to several internal changes.
• Hormonal abnormalities, including:
• raised luteinising hormone (LH) in the early part of the menstrual cycle.
• raised androgens (male hormones usually found in women in tiny amounts).
• lower amounts of the blood protein that carries all sex hormones (sex-hormone-binding
globulin).
• a small increase in the amount of insulin and cellular resistance to its actions.
• Characteristic changes in the appearance of the ovaries on ultrasound scan. The ovaries are
polycystic, with many small follicles scattered under the surface of the ovary (usually more than 10 or
15 in each ovary) and almost none in the middle of the ovary. These follicles are all small and
immature, generally do not exceed 10mm in size and rarely, if ever, grow to maturity and ovulate.
Most women with PCOS will have the ultrasound findings, whereas the menstrual cycle abnormalities are found
in around 66 per cent of women and obesity is found in 40 per cent. The increase in hair and acne are found in
up to 70 per cent whereas the hormone abnormalities are found in up to 50 per cent of women.
It is likely that there are different stages of the disease throughout life. Younger women tend to have
substantial difficulties with their periods, whereas older women have other problems such as diabetes and
hypertension (high blood pressure), though their period patterns tend to become more regular.
Women with PCOS also have an increased risk of strokes and heart attacks, but their death rate from these
conditions is not increased (Wild et al, 2000).
Women with PCOS may also have an increased risk of endometrial cancer (cancer of the lining of the womb),
particularly if they have infrequent or absent periods.
How is PCOS diagnosed?
The diagnosis is based on the patient's symptoms and physical appearance. If the diagnosis seems likely
because the patient's history contains many of the symptoms described already, certain investigations are done
to provide confirmatory evidence or to indicate another cause for the symptoms.
These include:
• blood tests such as:
• female sex hormones (at a certain point in the cycle if possible)
• male sex hormones
• sex-hormone-binding globulin
• glucose
• thyroid function tests
• other hormones, eg prolactin.
3. • ultrasound examination.
Your own GP can do the initial blood investigations, ensuring they are carried out at the correct time of the
cycle if appropriate. Your GP may be able to arrange an ultrasound scan.
Once the diagnosis is made, nothing more needs to be done for some women, eg if their fertility is not an issue,
if their weight is within normal limits, and if they do not have excess body hair.
If any of the symptoms are an issue, then further advice and treatment, and possibly specialist referral is
needed.
What else could it be?
The other conditions likely to cause abnormal periods include raised levels of prolactin and of thyroid
stimulating hormone (TSH). Both these hormones are produced from a particular part of the brain, the anterior
pituitary.
Raised prolactin levels can occur together with headaches and some disturbances of vision whereas raised TSH
levels indicate low thyroid hormones (hypothyroidism). Both these conditions lead to suppressed ovulation and
infertility.
Increased hair and acne reflect an increase in male hormones (androgens) in the blood. Other conditions can
cause such an increase.
Rarely, adrenal disorders or tumours cause increased androgens. In these conditions, hirsutism usually
develops quite rapidly; previously normal periods may also stop and, occasionally, muscle weakness occurs.
Loss of, or changes in, female aspects of body shape and appearance (secondary sexual characteristics),
especially reduction in breast size, may also occur. As the androgen excess progresses, the voice can deepen
and the clitoris can increase in size (clitoromegaly). If these serious medical disorders are present, the male
hormone levels will be considerably increased, way above those found in PCOS, and specialist treatment should
be arranged.
What can you do for PCOS?
There are several things that an individual can do if they have a tendency towards developing some or all of the
elements of PCOS. Much of this involves lifestyle changes to ensure that your weight is kept within normal
limits (BMI between 19 and 25).
In addition, because there is a likelihood of developing diabetes in later life and a slightly higher risk of heart
disease, low-fat and low-sugar options should be considered when making choices about what to eat or to
drink.
Weight loss, or maintaining weight below a certain level, will have the short-term benefit of increasing the
likelihood of successful treatment and the long-term benefits of reducing the risk of diabetes and heart disease
(Galtier-Dereure et al, 1997).
What can your doctor do?
Your family doctor will be able to provide many of the drug treatments available (although these are probably
best taken in consultation with a specialist). Treatments aim to improve several aspects of PCOS, including:
• fertility, via the stimulation of ovulation
• reduction of the insulin resistance
• reduction of the increased hair.
Treatments
The range of treatments available and their application are listed in Tables 1 and 2.
Table 1 deals with the treatments for improving fertility in women with PCOS (Homberg, 1998; Pirwany et al,
1999; Farquhar et al, 2000; Hughes et al, 2000a; Hughes et al, 2000b; Hughes et al, 2000c).
Table 2 deals with the treatments for other features of PCOS including hirsutism, irregular or absent periods
and obesity. The evidence in favour of using of these medications to improve symptoms is not strong (Lee et al,
2000).
4. Table 1: Treatments to improve fertility in women with polycystic ovary syndrome
Drug and mode of action Benefits Risks Effects on life quality
Clomifene (eg Clomid): Effective method to achieve 1. Very low risk of ovarian 1. Simple easy method of
mild stimulant of ovarian ovulation. hyperstimulation syndrome. treatment with tablets to be
function (Hughes et al, taken by mouth, for five days
2000a). each month.
2. Possible risk of multiple 2. Minimal effects while taking
pregnancy if several mature follicles tablets, though some develop
develop. headaches.
3. Increased risk of ovarian 3. Obvious benefit if pregnancy
tumours in women having more ensues (pregnancy also lowers
than 12 cycles of treatment. the increased risk of ovarian
tumour back to that of the normal
population).
Gonadotrophin injections: Ovulation rates of over 90 per 1. Ovarian hyperstimulation 1. Require daily injections of hMG
direct stimulation of the cent in most women and syndrome. or FSH derived from urine or
ovarian follicles to grow. pregnancy rates of 20-25 per recombinant FSH (Hughes et al,
cent per cycle. 2000c).
2. Multiple pregnancy if many 2. Several studies suggest the
mature follicles develop. benefits of taking a second drug
in conjunction. This should
suppress LH and improves the
chances of an ongoing pregnancy.
Metformin (eg Improves the uptake of sugars No significant associated risk. Considerable gastrointestinal
Glucophage): many into cells by insulin. Ovulation upset reported - particularly
actions - eg reduction of rates up to 90 per cent of diarrhoea - which is somewhat
male steroid production by cycles (Pirwany et al, 1999, improved by reducing the daily
the ovaries. Galtier-Dereure et al, 1997). dose.
Gonadotrophin releasing Lowers LH concentrations and Needs to be used in conjunction .
hormone agonists: reduces the likelihood of with FSH injections and therefore all
stimulate the release of miscarriage (Homberg, 1998, the above risks also are present.
natural sex hormones from Hughes et al, 2000b). GnRH agonists themselves have
the brain. little risk in short-term use.
Table 2: Treatments for other features of polycystic ovary syndrome
PCOS feature Available treatment Comments
Raised androgen Metformin (eg Glucophage) 1. Metformin reduces the abnormal findings of raised androgens and
(male sex decreased sex-hormone binding protein in the blood, but it can cause
hormone) level considerable gastrointestinal upset - particularly diarrhoea - which is
somewhat improved by reducing the daily dose. It is less effective in women
of normal weight and does not improve hirsutism.
Irregular periods Metformin 1. Return of periods in 90-95 per cent of women.
Obesity Metformin 1. Several studies have examined the effect on weight loss; the majority
support its effectiveness.
Hirsutism Combined oral contraceptives, 1. These increase the levels of the sex hormone carrier in the blood, leaving
especially containing the anti- less androgen free to cause hirsutism.
androgen cyproterone acetate (eg 2. It may take six months before any noticeable improvement occurs and two
Dianette). to three years to achieve the maximum benefit from anti-androgens because
of the length of the growth-cycle of hair.
Hirsutism Finasteride 1. Finasteride reduces the amount of hair by preventing androgen getting into
cells. It can cause headache and depression, and contraception is essential to
avoid accidental exposure to a foetus. It is useful as a second-line drug for
the treatment of excess hair but is not licensed for this purpose, and some
pharmacies have made inappropriate comments to my patients when filling
prescriptions, affecting their likelihood of taking the treatment.
Endometrial Progestogens, 1. Stops endometrium (womb lining) from developing, and counteracts any
cancer (cancer of medroxyprogesterone acetate. tendency towards cell abnormalities and cancer. Occasional bloating and fluid
the womb lining) retention occur.
The increased risk of endometrial cancer is thought to be due to certain hormonal abnormalities that result in
continuous stimulation of the lining of the womb by oestrogen. However, the mild increase in insulin found in
these women may also have negative effects.
It does seem sensible to advise women with absent or very infrequent periods to take occasional progestogen
therapy to 'oppose' the oestrogen and minimise the risk of endometrial cancer.
Non-drug treatments
Ovarian diathermy (surgery that uses heat to alter ovarian function) is thought to reduce the amount of
androgen secreting tissue in the ovaries, leading to resumption of ovulation in up to 80 per cent of women. The
risks include those of having a laparoscopy and a theoretical risk of ovarian damage from the diathermy. The
benefits include resumption of ovulation in a simple manner, with effects lasting six to nine months (Farquhar
et al, 2000; Homberg, 1998).
There is a range of non-drug treatments available for hirsutism. Once a serious increase in male hormone levels
has been excluded, then local cosmetic options can safely be considered. These include:
5. • bleaching
• depilatory preparations
• waxing
• plucking
• laser hair removal
• electrolysis
• shaving.
Each is usually effective but expert advice should be taken, because each method has its own problems.
Bleaching and depilatory preparations can occasionally cause a local allergic reaction.
Waxing and plucking often break the hair shaft rather than actually remove it from the hair follicle and,
therefore, should be considered to be little more effective than shaving.
Electrolysis and laser hair removal usually give the most prolonged action but both are expensive and cannot
tackle large areas of the skin. Electrolysis is painful and laser removal may not be permanent.
Damage to skin or follicles can also occur with either. Waxing, plucking and shaving can lead to inflammation
and infection of hair follicles, requiring topical antibiotic creams.
Sugaring is less likely to provoke this result than waxing. Best results will be obtained from shaving if
hypoallergenic shaving soaps and razors are used. There is no evidence that plucking, waxing or shaving will
encourage increased hair growth.
What is the outlook?
Living with PCOS means different things for different women. This is because women experience the condition
in different ways and have more or less severe symptoms depending on their situation. In addition, as women
get older, some symptoms change with age; hirsutism become less as hair distribution patterns change with
advancing age and as the male hormones in the blood revert to more normal levels (Winters et al, 2000).
Women with PCOS are more prone to some serious conditions. These include an increase in the likelihood of
developing diabetes (usually Type 2 diabetes (non-insulin dependent diabetes) and of developing cancer of the
womb lining (endometrial cancer).
They also are more at risk of hypertension (high blood pressure) and high cholesterol, though if weight is
controlled, high blood pressure is less likely to occur (Wild et al, 2000). Therefore, it makes sense to watch for
symptoms suggestive of these conditions and to see your doctor should any suspicious symptoms be present.
For endometrial cancer, these include irregular spotting or bleeding in the 40 to 50 year age group or any
bleeding after themenopause. For diabetes, these include unusual thirst requiring large amounts of fluids,
tiredness, and passage of increased amounts of urine, particularly at night.
References
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88-96.
Homberg R (1998). Adverse effects of luteinizing hormone on fertility. London: Balliere Tindall, 1998.
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