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- 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 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- 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
Be that as it may, having vast ovaries does not really suggests having PCOD. Women with PCOD have symptoms of PCOD as well as having polycystic ovaries.
i. Indira IVF
ii. Dr. Sagarika Aggarwal
iii. Medicover Fertility Clinic
iv. Dr. Sweta Gupta
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
There are various things that affects or you can say PCOS Symptoms, The symptoms of PCOS are acne, obesity, infertility, being overweight, facial hair growth in excess, etc. Diet plays an essential role in reducing the PCOS Symptoms.
Medical Director of the North Carolina Center for Reproductive Medicine explains how Polycystic Ovary Syndrome (PCOS) affects fertility and how to diagnose and treat it.
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.
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…
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.
Polycystic Ovary Syndrome (PCOS) is the hormonal imbalance in females, producing cyst in the ovaries and making it the leading cause of infertility in females. PCOS contributes towards 75% of female infertility.
PCOS affects a woman’s ovaries, the reproductive organs that produce estrogen and progesterone — hormones that regulate the menstrual cycle. The ovaries also produce a small amount of male hormones called androgens.
Be that as it may, having vast ovaries does not really suggests having PCOD. Women with PCOD have symptoms of PCOD as well as having polycystic ovaries.
i. Indira IVF
ii. Dr. Sagarika Aggarwal
iii. Medicover Fertility Clinic
iv. Dr. Sweta Gupta
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
There are various things that affects or you can say PCOS Symptoms, The symptoms of PCOS are acne, obesity, infertility, being overweight, facial hair growth in excess, etc. Diet plays an essential role in reducing the PCOS Symptoms.
Medical Director of the North Carolina Center for Reproductive Medicine explains how Polycystic Ovary Syndrome (PCOS) affects fertility and how to diagnose and treat it.
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.
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…
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.
Polycystic Ovary Syndrome (PCOS) is the hormonal imbalance in females, producing cyst in the ovaries and making it the leading cause of infertility in females. PCOS contributes towards 75% of female infertility.
PCOS affects a woman’s ovaries, the reproductive organs that produce estrogen and progesterone — hormones that regulate the menstrual cycle. The ovaries also produce a small amount of male hormones called androgens.
This presentation briefly discuss the polycystic ovary syndrome in terms of pathogenesis, features and management. Then, It moves on to discuss the various guidelines laid down by Endocrine Society in 2013 for the management of patients with polycystic ovary syndrome.
Mark Perloe, M.D., Reproductive Endocrinologists, Georgia Reproductive Specialists, shares the latest information about PCOS. For more information, visit www.IVF.com/pcostreat.html.
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.
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.
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.
we had described 7 classical symptoms of pcos in simple language for patients. kindly visit your physician for detail diagnosis.
regards ayusanjivani ayurveada
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
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.
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? 👩😇
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.
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,
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.
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
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.
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.
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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
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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
2. 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.
• 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
3. 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.
• 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.
4. 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).
5. 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):
mild stimulant of ovarian
function (Hughes et al,
2000a).
Effective method to achieve
ovulation.
1. Very low risk of ovarian
hyperstimulation syndrome.
1. Simple easy method of
treatment with tablets to be
taken by mouth, for five days
each month.
2. Possible risk of multiple
pregnancy if several mature
follicles develop.
2. Minimal effects while taking
tablets, though some develop
headaches.
3. Increased risk of ovarian
tumours in women having more
than 12 cycles of treatment.
3. Obvious benefit if pregnancy
ensues (pregnancy also lowers
the increased risk of ovarian
tumour back to that of the
normal population).
Gonadotrophin injections:
direct stimulation of the
ovarian follicles to grow.
Ovulation rates of over 90 per
cent in most women and
pregnancy rates of 20-25 per
cent per cycle.
1. Ovarian hyperstimulation
syndrome.
1. Require daily injections of hMG
or FSH derived from urine or
recombinant FSH (Hughes et al,
2000c).
2. Multiple pregnancy if many
mature follicles develop.
2. Several studies suggest the
benefits of taking a second drug
in conjunction. This should
suppress LH and improves the
chances of an ongoing
pregnancy.
Metformin (eg
Glucophage): many
actions - eg reduction of
male steroid production
by the ovaries.
Improves the uptake of sugars
into cells by insulin. Ovulation
rates up to 90 per cent of
cycles (Pirwany et al, 1999,
Galtier-Dereure et al, 1997).
No significant associated risk. Considerable gastrointestinal
upset reported - particularly
diarrhoea - which is somewhat
improved by reducing the daily
dose.
Gonadotrophin releasing
hormone agonists:
stimulate the release of
natural sex hormones
from the brain.
Lowers LH concentrations and
reduces the likelihood of
miscarriage (Homberg, 1998,
Hughes et al, 2000b).
Needs to be used in conjunction
with FSH injections and therefore
all the above risks also are
present. GnRH agonists themselves
have little risk in short-term use.
.
Table 2: Treatments for other features of polycystic ovary syndrome
PCOS feature Available treatment Comments
Raised androgen
(male sex
hormone) level
Metformin (eg Glucophage) 1. Metformin reduces the abnormal findings of raised androgens and
decreased sex-hormone binding protein in the blood, but it can cause
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,
especially containing the anti-
androgen cyproterone acetate
(eg Dianette).
1. These increase the levels of the sex hormone carrier in the blood, leaving
less androgen free to cause hirsutism.
2. It may take six months before any noticeable improvement occurs and
two 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
cancer (cancer of
the womb lining)
Progestogens,
medroxyprogesterone acetate.
1. Stops endometrium (womb lining) from developing, and counteracts any
tendency towards cell abnormalities and cancer. Occasional bloating and
fluid 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).
6. 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:
• 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.
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