Polycystic Ovarian Syndrome

Polycystic ovarian syndrome (PCOS) is a common endocrinopathy typified by oligo ovulation or anovulation, signs of androgen excess, and multiple small ovarian cysts.

Causes

• Use of certain pain killer- Ibuprofen, diclofenac
• Nonsteroidal anti-inflammatory drugs (NSAIDs)- Paracetamol
• Smoking
• Alcohol
• Stress
• Use of antibiotic
• Lack of physical activity
• Insecticide,Pesticide,Rodenticide,Weedicide
• Eating high carbohydrate food
• Lack of fiber in food
• Eating fast food, junk food, confectionery
• Environment toxin
• Depression
• Emotional stress
• Coffee drinking
• Constant state of worry

PATHOPHYSIOLOGY

1.Gonadotropins

Anovulation in women with PCOS is characterized by inappropriate gonadotropin secretion .

Alterations in gonadotropin-releasing hormone (GnRH) pulsatility lead to preferential production of luteinizing hormone (LH) compared with follicle-stimulating hormone (FSH).

2.Insulin Resistance

Women with PCOS also display greater degrees of insulin resistance and compensatory hyperinsulinemia than nonaff ected women.

3.Androgens

Both insulin and LH stimulate androgen production by the ovarian theca cell. As a result, affected ovaries secrete elevated levels of testosterone and androstenedione. Elevated androstenedione levels contribute to an increase in estrone levels through peripheral conversion of androgens to estrogens by aromatase. Increased intrafollicular androgen levels result in follicular atresia. Increased circulating androgen levels contribute to abnormalities in patient lipid profiles and the development of hirsutism and acne. Increased circulating androgens can also be derived from the adrenal

gland.

4.Sex Hormone-Binding Globulin

Women with PCOS display decreased levels of sex hormonebinding globulin (SHBG). The synthesis of SHBG is suppressed by insulin as well as androgens, corticoids, progestins, and growth hormone.

5.Anovulation

Although androgen levels are typically elevated in women with PCOS, progesterone levels are low due to anovulation.

SIGNS AND SYMPTOMS

1.Menstrual Dysfunction

Amenorrhea and Oligomenorrhea result from anovulation. In this setting, failed ovulation precludes progesterone production. Amenorrhea may result from elevated androgen levels in those with PCOS. Specifically, androgens may counteract estrogen to produce an atrophic endometrium. It is therefore not uncommon to observe amenorrhea and a thin endometrial stripe in PCOS patients with elevated androgen levels

Menorrhagia In this setting progesterone is not produced due to anovulation, and chronic estrogen exposure results. This produces constant mitogenic stimulation of the endometrium. The instability of the thickened endometrium results in an unpredictable bleeding pattern.

2.Hirsutism In a female, hirsutism is defined as coarse, dark, terminal hairs distributed in a male pattern.Elevated androgen levels play a major role.

3.Acne The pathogenesis of acne vulgaris involves four factors: blockage of the follicular opening by hyperkeratosis, sebum overproduction, proliferation of commensal Propionibacterium acnes, and inflammation. In women with androgen excess, overstimulation of androgen receptors in the pilosebaceous unit results in increased sebum production that eventually leads to inflammation and comedone formation.

4.Acanthosis Nigricans. This skin condition is characterized by thickened, gray-brown velvety plaques seen in flexure areas such as the back of the neck, the axillae, the crease beneath the breast, the waist, and the groin. Insulin resistance leads to hyperinsulinemia, which is believed to stimulate keratinocyte and dermal fibroblast growth, producing the characteristic skin changes.

5.Dyslipidemia The classic atherogenic lipoprotein profile seen in PCOS is characterized by elevated low-density lipoprotein (LDL) and triglyceride levels and total cholesterol:high-density lipoprotein (HDL) ratios, and by depressed HDL levels.

6.Obesity-enlarged adipocytes, reduced serum adiponectin.

7.Obstructive Sleep Apnea  This is more common in women with PCOS and is likely related to central obesity and insulin resistance.

8.Metabolic Syndrome This syndrome is characterized by insulin resistance, obesity, atherogenic dyslipidemia, and hypertension.

9Endometrial Neoplasia In women with PCOS, a threefold increased risk of endometrial cancer has been reported. Endometrial hyperplasia and endometrial cancer are long-term risks of chronic anovulation, and neoplastic changes in the endometrium are felt to arise from chronic unopposed estrogen

10Infertility Infertility or subfertility is a frequent complaint in womenwith PCOS and results from anovulatory cycles.

11.Pregnancy Loss

12Psychologic Health Women with PCOS may present with various psychosocial problems such as anxiety, depression, low self-esteem, reduced quality of life, and negative body image.

Diagnosis

Blood-CBC, CRP

LIPID PROFILE

FBS,HBA1C

THYROID PROFILE

PROLACTIN

FSH

LH

TESTOSTERON

ESTROGEN

DHEAS

USG ABDOMEN

Prevention

• Avoid chemical pesticides, chemical fertilizer for farming
• Avoid herbicides
• Avoid weedicides
• Avoid rodenticide
• Eat organic fruits, vegetable
• Regular exercise
• Avoid smoking
• Eating foods high in fiber
• Drinking an adequate amount of fluids
• Avoid alcohol
• Avoid tobacco
• Avoid pain killer
• Avoid antibiotic

Treatment

Homeopathy medicine