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Kyle J. Norton
(Unaudited)
By Kyle J. Norton
Copy right 2015.Reprint, reproduction of parts and whole and translation to other languages are prohibited without written permission of the author
Author biography
Kyle J. Norton Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
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Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.
Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome is defined as endocrinologic diseases among reproductive-age women caused by undeveloped follicles clumping on the ovaries that interferes with the function of the normal ovaries associated with a high risk for metabolic disorder(1) as resulting of enlarged ovaries(2), leading to hormone imbalance(excessive androgen and anti-müllerian hormone (AMH) )(1)(3)(4)(5), induced Hirsutism(6)(7), reproductive disorder(10(12)), risks of type 2 diabetes(9)(10)(11), metabolic syndrome(10)(12) and early cardiovascular disease(8)(13), acne(10)(14), endometrial cancer(18)(19),weight gain and obesity(15)(16)(17). The syndrome effects over 5% of women population or 1 in 20 women.
Unfortunately, according to studies, women with PCOs after the reproductive age, are associated to continuously increase risk of type II diabetes, with no increasing altered glucose tolerance(20), CVD and hypertension(21)
The symptoms
Women with PCOs may experience some of the symptoms below
1. Irregular(22), oligomenorrhea(23)or absent menstrual periods(26)
2. Male pattern hair growth(22)
3. Acne(22)
4. Weight gain(22)
5. Obstructive sleep apnea(27)
Closure of the upper airway, causing stop breathing while sleeping
6. Difficult to conceive(22)
7. Anxiety(23)
8. Emotional disturbance(22)
9. Poor quality of life(22)
10. Menstrual cycle disturbances(22)
11. Depression(24)
12. Autonomic dysfunction(25)
13. Problematic eating(28) and general psychosocial dysfunction(28)
14. Etc.
The Risk factors
1. Family history
Risk of PCOs is increase if your mother or sister has PCOS(29). According to
North
Staffordshire
Hospital
, polycystic ovaries are highly prevalent within families as an autosomal dominant trait, in the analysis of 29 polycystic ovary syndrome and 10 control families(30).
2. Reproductive age women
Polycystic ovary syndrome (PCOS) affects 4% to 18% of reproductive-aged women(31)
3. Environment risks
a. Eating plastic-packaged food(32), fruit with pericarp(32) and drinking alcohol(32) were associated to the independent risk factors for PCOS. According to the Second Affiliated Hospital of Nanjing Medical University, risks of PCOs increased with the use of disposable plastic cup for drinking, cooking oil fume and indoor decoration(33).
b. Exposure to industrial products such as Bisphenol A (BPA)(36)were found to exacerbate the clinical course of PCOS(34) as they exhibited impairment of normal reproductive function and metabolic regulation(35).
4. Dietary factor
Over-nutrition with foods in advanced glycated end products (AGEs) is found to associated to risk of PCOs(34).
5. Metabolic perturbations begin early in adolescence are also found to elevate risk of PCOs(37).
6. Psychotropic medication
Prolonged period uses of psychotropic drugs such as mood stabilizers, lithium are also induced higher risk of PCOs(38). Women with epilepsy are also at risk of developed polycystic ovary syndrome (PCOS) if treated by valproate sodium (VPA) therapy(39)(40).
7. Genetic mutations
Although it is uncleared, genetic mutation of certain genes may be associated to the risk of PCOs, according to studies, such as the zona pellucida 4 (ZP4)(41) gene, polymorphism of FXIIIVal34Leu gene(42), C/T single nucleotide polymorphism at exon 17(43), single nucleotide polymorphism-56 of calpain-10 gene(44), vaspin rs2236242 polymorphism(45), etc.
The Diagnosis
If you have experienced some of above symptoms, it is for your benefit to visit your doctor or gynecologist immediately. PCOs is easy to identify through your
1. Medical history, including question of your symptoms, such as menstrual irregularity, weight change, skin and sleep patterns, as well as all symptoms may contribute to the susceptible PCOs.
a. History of pregnancy including difficulty to conceive, miscarriage, poor neonatal and maternal pregnancy outcomes(46)(47) ...
b. Medication may influence the development of PCOs
2. Physical exam
The aim of the physicam exam is to check for PCOs symptoms, such as pelvic exam for enlarge and abnormal ovaries, male pattern hair growth, acne, weight gain, body mass index (BMI)(48)(49) etc., and risk of diseases caused by PCOs, such as hypertension, thyroid abnormality(50)(51).
(Please check citations in the topics of symptoms and risk factors)
3. Pelvic ultrasound
The aim of the test is to check for enlarge ovaries(2) and cysts(52). Unfortunately, many women with PCOs do not show these abnormalities.
4. Blood test
The blood test includes testing of
a. Dehydroepiandrosterone(DHEA), is a test for excess adrenal precursor androgen (APA) production(53)(54) found in approximately 20-30% of women with PCOS(53).
b Abnormal testosterone(55) levels may interference with the follicle incubation medium(55)(56).
c. Sex hormone-binding globulin (SHBG)(57) is a surrogate marker of insulin resistance
Lower levels of SHBG are found in women with PCOs(58)
d. Follicle-stimulating hormone (FSH)/LH ratio(LH(58) and FSH ratio(58)(59)). Dr. Li Y and the research team at Second Affiliated Hospital of Sun Yat-sen University, said "PCOS patients with higher LH/FSH ratio are primarily caused by hypothalamic-pituitary dysfunction, while the PCOS patients with normal LH/FSH ratio are mainly caused by metabolic disorders"(60).
e. Thyroid-stimulating hormone (TSH)
The aim of the test is to check for levels of TSH (> or =2.5 mIU/l) as the hormone has shown to significantly alter endocrine and metabolic changes(64)
Thyroid dysfunctionis found to be associated to independent risks of ovarian failure and pregnancy related complications in women with Polycystic ovarian syndrome (PCOS)(61). It is said that both PCOS patients combined with SCH have higher risk of cardiovascular risk factors(62)and subclinical hypothyroidism (SCH) is more common in women with PCOs(63).
f. IGTT level (fasting insulin)(65)(66) and several other androgens(67)(68) are used to evaluate adrenal function. If there are abnormal secretion of certain hormones, you may be at a high risk of having PCOs.
Low birth weight may contribute the causation of hyperandrogenism and insulin resistance in adolescents with PCOS, according to the joint study in
Italy
(64).
The Causes
The causes of polycystic ovarian syndrome are still unknown(69)(70), but there are some suggestions
1. Genetic predisposition
A genetic predisposition is defined as a genetic mutation of some women who were born predisposed to certain health problems(75). In this case, it is polycystic ovarian syndrome(70)(71)(72)(73)(74) .
2. Insulin resistance(82)
Insulin resistance is defined as abnormal levels of insulin in the blood of a person found to be associated to women with PCOs(83). It may be caused by certain health problems such as diabetes(76)(77), abnormal function of pancreas(78)(79) or caused low numbers of the insulin sensitivity of cells(79)(80), which impair the process of glucose in energy conversion(81), induced high blood glucose levels in the body, cause of increasing the risks of ovarian cysts development(83).
3. Obesity(84)
Obesity is defined as a person whose BMI index is over 24. As we known, obesity women in most cases are associated to clinical feature of insulin resistance(76). According to Università Cattolica del Sacro Cuore, low 25(OH)D levels(86) accompanied with the degree of adiposity may induce the causation of PCOs(85).
4. Hyperandrogenism
Hyperandrogenism is a medical condition characterized by excessive production and/or secretion of androgens leading to male pattern hair growth, probably due to mutation in the polymorphism rs12720071 in women(88). According to
Erciyes
University
, there is a relation between IR(Insulin resistance) and androgenetic alopecia (AGA)(87), a male pattern baldness.
Hirsutism develops when follicles in androgen sensitive areas start to form thick, pigmented hair as opposed to thin, short, non-pigmented hair normally seen in those areas in women with PCOs(89). Evaluating terminal hair growth on the chin or lower abdomen may be a reliable source for predicting hirsutism, according to Ahvaz Jundishapur University of Medical Sciences(90).
5. Environmental chemicals
Environment chemicals endocrine disruptors(91)(92), such as such as xanoestrogen, and lifestyle(91)(92) can causes over production of certain hormone and reduction of others, leading to abnormal function of the reproductive organs including the development of follicles and increasing the risk of PCOs(93).
6. Food adulteration
Food adulteration, including mixing, substituting, concealing the quality of food by mislabeling, putting up decomposed or expired food, and adding toxic substances(94) can lead to hormone imbalance(98) and distort the natural process of women reproductive system(97) and in same cases, result in death(95)(96).
7. Chronic inflammation
Prolonged inflammation, known as chronic inflammation, leads to a progressive shift in the type of cells which are present at the site of inflammation and is characterized by simultaneous destruction and healing of the tissue from the inflammatory process(99)(100)(101).
8. Disorders of cortisol metabolism
Cortisol is usually referred to as the stress hormone, presented in high levels in patients with schizophrenia and bipolar disorder(104) as it is secreted in large volume for our body to response to stress and anxiety(103). Disorders of cortisol metabolism is defined as a condition of which cortisol hormone has lost its function in restoring glucose homeostasis(105) in balancing insulin and glucagon in the blood stream(106)(107). According to University College London Hospitals, altered cortisol metabolism does not seem to be the primary cause of PCOS(102).
Diseases associated to PCOs
1. Hyperprolactinemia
Hyperprolactinemia and polycystic ovary syndrome (PCOS) are on the list of the most frequent causes of female infertility(109).
Prolactin, produced by the anterior pituitary gland primarily plays important breast development during pregnancy and milk production after birth. Hyperprolactinaemia in women with polycystic ovary syndrome (PCOS) effects the normal function of the hypothalamus and pituitary gland(110), leading to ovulatory infertility(111), decreasing in menstruation and sometimes lost of menstruation(112) and sexual desire(114). In men, hyperprolactinemia has shown a reduction in seminal volume and total sperm count accompanied with a decrease in libido and lost spontaneous erections. and sexual desire(113). But according to Medical University of Lodz, and Medical Centre of Postgraduate Education, " Hyperprolactinemia does not seem to be more frequent in PCOS women than in healthy subjects and it should not be considered as characteristic feature of PCOS - both are distinct clinical entities...."(108).
Chinese medical herbs-Huiru Yizeng Yihao(NO.1 HRYZ), has shown effectively for treatment of sex hormone disorder of hyperprolactinemia and HMG mice models(149).
2. Vagina bleeding
Women with polycystic ovary syndrome (PCOS) associated to dysfunctional uterine bleeding (DUB) are more common in their extremes of reproductive life(115)(116). According to study, Oral contraceptive pill has a significantly therapeutic effect for treatment in DUB and metrorrhagic forms of PCOS(117)(118). Chinese formulated herbs product (Kuntai) has shown effectively in alleviating menopausal symptoms of irregular bleeding(150).
3. Ovarian cysts
Women with PCOs Have shown to susceptible to dysfunctional follicular development, with small follicles and cysts(119) of which may interfere with normal conception(120)(121)(122), probably due to angiogenic factors and factors of communication of the interactions between luteal vascular and nonvascular tissues(123). Oral contraceptive users have found to have a lower incidence of ovarian cysts(124)(125)(126). Chinese herbs, Penyan Kang (formula for treating pelvic inflammation) showed effectively in treating of ovarian cyst with no abnormality and adverse effect(127)(128).
Warming acupuncture plus moxibustion combined with oral administration of Quyu Decoction in Chinese traditional medicine therapy significantly increased the cured rate for ovarian cysts, according to Shandong Provincial Institute of TCM,(151).
4. Uterine cancer
According to a joint study, PCOS might increase the risk of uterine cancer in a PCOS cohort consisted of 3,566 patients, and the comparison cohort consisted of 14,264 matched control patients without PCOS(129). But according to David Geffen School of Medicine at UCLA, there are insufficient data to evaluate any association between PCOS and vaginal, vulvar and cervical cancer or uterine leiomyosarcoma(130). Therefore, a large-scale, well-designed studies are necessary to confirm the association between PCOS and gynecological cancer risk(129). Herbal Scutellaria barbata D. Don (SB) has been found effectively in anti-tumor proliferation against human uterine leiomyoma(152).
5. Fatty liver diseases(NAFLD)
Women with PCOs, especially to those women are BMI > 25 kg/m², glucose level > 80 mg/dL, E2/T < 80 and ALT > 19 IU/L (134) have shown to associated to nonalcoholic fatty liver disease(131)(132)(133) as a result of abnormal lipid handling by the liver, due to higher triglyceride and cholesterol and lower HDL level(133). Lifestyle interventions and weight loss, accompanied pharmacologic interventions have shown effectively for treatment of NAFL(129). Total alkaloids in herbal Rubus aleaefolius Poir (TARAP)(153), Celastrus orbiculatus Thunb. (COT(154), hawthorn fruit(155) showed effectively in ameliorating high-fat diet-induced NAFLD through antioxidant activities.
6. Hypertension
The prevalence of hypertension was 19.2% in the women with PCOS, which was much higher than healthy women, in a study of Han Chinese population(136). Young women with PCOS and higher BMI may be at an increased risk of hypertension, according to the from survey 4 in 2006 (n = 8,612, age of 28-33 years(135) but this result has been challenged by the study at Serviço de Endocrinologia do Hospital das Clínicas da Universidade de São Paulo(137). Certain medical herbs and spices, such as Molle (Schinus molle), Maca (Lepidium meyenii Walp), Caigua (Cyclanthera pedata) and ginger (Zingiber officinale) were found to have highest anti-hypertension through their phenolic profiles, antioxidant activities(156).
7. Insulin resistance(IR)
Epidemiologically(138)(139)(140)(141), strong evidences linking insulin resistance in women with PCOs
may be resulted of pathogenesis involved several associated hormonal pathways(139), including autoimmune thyroid disease(142)(143) or phenotypes(141). Life style interferences, including modest reduction in dietary carbohydrate may be beneficial on body composition, fat distribution, and glucose metabolism, according to
University
of
Alabama
at
Birmingham
(144). Traditional Chinese herbal formula containing Puerariae radix, Lycium barbarum, Crataegus pinnatifida, and Polygonati rhizoma (PLCP), alleviated IR in comparison to metformin, through its actions of phytochemicals puerarin, 3'-methoxypuerarin, daidzin, daidzein, and ononin(157).
8. Cushing's syndrome
PCO and PCOS are common in women with Cushing's syndrome(146). The mimic symptoms such as obesity and insulin resistance, menstrual abnormalities and hyperandrogenism in women with polycystic ovary syndrome (PCOS) and Cushing's syndrome (CS) have caused confusing in diagnosis(147). According to Charles Drew University of Medicine and Science, testosterone levels of <1.39 nmol/L may be useful to discriminate between mild CS and PCOS(148) and hirsutism and menstrual abnormalities were found more common in initial PCOS diagnosis than in CS(145).
(146).
9. Obesity
In US, 80% of women with PCOs are found be either over weight of obese, according to statistic(158). Obesity also exhibited complication of some features of PCOS including hyperandrogenism, hirsutism, infertility and pregnancy (159) and exacerbated many aspects of the phenotype, especially cardiovascular risk factors such as glucose intolerance and dyslipidemia(159). According to Karolinska Institutet, lifestyle interventions to induce weight loss and adjuvant pharmacologic treatments may be the most successful strategy to improve symptoms of PCOS(160). Pi transportation, dampness resolving and phlegm expelling herbs (PTDRPEH) in traditional Chinese effectively reduce body weight and TNF-alpha in the adipose tissue, inhibit fat diet-induced obesity and insulin resistance (IR), through attenuating leptin resistance, and elevating serum levels of leptin and adiponectin(161).
10. Amenorrhea
Polycystic ovary syndrome was found to be the most common cause of secondary amenorrhea in Korean women(163) and women in US.(164) with secondary of severe hyperthyroidism. Herbal extracts including Vitex agnus-castus, Cimicifuga racemosa, Tribulus terrestris, Glycyrrhiza spp., Paeonia lactiflora and Cinnamomum cassia in TCM has shown more efective in treating polycystic ovary syndrome (PCOS) associated oligo/amenorrhoea and hyperandrogenism than pharmaceutical agents bromocriptine (and Vitex agnus-castus) and clomiphene citrate (and Cimicifuga racemosa)(162).
11. Miscarriages
Epidemiologically, linking miscarriage and recurrent miscarriage to PCOs are inclusive(165)(166)(167), but some researchers still insisted that raising levels luteinising hormone (LH), one of the complications in women with PCOs may be associated with increased rates of miscarriage(168)(169)(170). According to Net doctor, Women with raised LH have a 4 fold increased risk of miscarriage(170).
12. Metabolic syndrome
Metabolic syndrome, a collection of symptoms that can lead to diabetes(174)(175) and heart disease(175)(176)(177) has found to be associated to women with PCOs, probably due to genetic mutation of certain genes(171)(172), increased accumulation of adipose tissue and insulin resistance(173). Herbal Coccinia indica and American ginseng, Gymnema sylvestre, Aloe vera, vanadium, Momordica charantia, and nopal and supplement Chromium may be the alternative options for glucose control in patients with diabetes(178), and TCM herbs and herbal formula Ligusticum chuanxiong Hort., Dalbergia odorifera T. Chen and Corydalis yanhusuo WT Wang may also be effective for the treatment of CVD(179).
13. Infertility
Infertility is condition of inability of a couple to conceive after 12 months of unprotected sexual intercourse or can not carry the pregnancy to full term. It effects over 7 millions couple alone in the
U. S.
and many times more in the world, because of unawareness of treatments, only 10% seeks help from professional specialist(181). In fact, approximately 21% - 30% of infertility of a couple is caused by male inability to fertilize(182) with men aged 40 years and older. (According to statistics from US Centers for Disease Control and Prevention
* Number of women ages 15-44 with impaired fecundity (impaired ability to get pregnant or carry a baby to term): 6.7 million
* Percent of women ages 15-44 with impaired fecundity: 10.9%
* Number of married women ages 15-44 that are infertile (unable to get pregnant after at least 12 consecutive months of unprotected sex with husband): 1.5 million
* Percent of married women ages 15-44 that are infertile: 6.0%
* Number of women ages 15-44 who have ever used infertility services: 7.4 million)(180).
The infertility rate of women with polycystic ovaries is very high, due to lack of ovulation and others unknown etiology. Medication used for treatment of PCOs infertility include clomiphene citrate(183)(184)(189), metformin(183)(186), letrozole(184)(85)(186)(189), tamoxifen(185)(189), anastrozole(187)(188)....... Traditional Chinese medicine (TCM) recipes formulated by Shen-replenishing herbs or acupuncture to reinforce Gan-Shen, regulate Chong-Ren Channels are found effectively in treating infertile and sub fertile PCOs women(191) when they are used alone or in conjunction with Western medicine(190).
14. Irregular menstruation
Menstrual irregularity and/or elevated androgen levels are found to be associated to women with PCOs(192)(193) due to hormone imbalance. According to a self questionnaire survey, irregular menstrual not only already presents in adolescence in women with PCOS and but also induced infertility in later life(194). Medication used for treatment of PCOs irregular menses include oral contraceptive pill(195) and metformin(195)(196). Herbal extracts such as Vitex agnus-castus, Cimicifuga racemosa, Tribulus terrestris, Glycyrrhiza spp., Paeonia lactiflora and Cinnamomum cassia, may be used for treatment in regulation of ovulation, improved metabolic hormone profile(196).
15. Diabetes
The prevalence of insulin resistance in women with polycystic ovary syndrome (PCOS), is found to be associated to the critical risk for Type 2 diabetes(198)(199)(200). Insulin-sensitizing medication, such as pioglitazone(202), metformin and thiazolidinediones(203). may be a promising and unique therapeutic option for chronic treatment of PCOS(201). Traditional Chinese acupuncture(204) and herbal formula danzhi xiaoyao pill have shown effectively in reduced PCOs complicated insulin resistance(IR)(205)
16. Acromegaly
Acromegaly is defined as over production of growth hormones caused by a benign(some may behave more aggressive(209) tumor of the pituitary gland(208) and in rare case, it may be caused by tumors of the pancreas, lungs, and adrenal glands, leading to excess GnRH(210), resulting in male pattern hair growth(207). According to
University
of
Athens
, polycystic ovary syndrome (PCOS) and PCOS phenotype (PCOSP) are relatively common in women with acromegaly and may account for some of the symptoms related to gonadal dysfunction due to hormone IGF-1 or in combination with growth hormone GH and/or insulin resistance(206).
17. Etc.
PCOs Complications
1. Cardiovascular diseases
Beside cancer, heart disease kills more than 2,000 Americans everyday. Approximately 60 million Americans have heart disease. Women with PCOs have found to have increased risk of CVD due to hyperandrogenism in aggravation of abdominal obesity(211), insulin resistance forming(211), metabolic syndrome(212), type 2 diabetes(212)(213), altered plasma lipid profile(215), sympathovagal imbalance(216),.... According to
University
of
Western Australia
, treatment in uncorrelated components, such as insulin resistance, dyslipidaemia/hypertension or hyperandrogenaemia may be effectively to reduce differing cardiometabolic outcomes(214). Non-medical (normalization of weight, healthy lifestyle) and medical (metformin, thiazolidinediones, spironolactone, and statins) interventions were found effectively in reduced long-term risk for cardiovascular morbidity and mortality in women with PCOs(217).
Conflictingly, according to the study by Division of General Internal Medicine, Mayo Clinic, although women with PCOS weighed more than controls, there was no increased prevalence of other CV risk factors(218). The study also insisted that data on the incidence of CV events are lacking in PCOs' population(218)
2. Stroke
Besides cancer and heart diseases, stroke is the third leading cause of death. Approximate 1/4 of all stroke victims die as a direct result of the stroke or it's complications. Epidemiological evidences suggested that women with PCOs are at increased risk of stroke(220)(221). According to the review of 1340 articles, 5 follow-up studies published between 2000 and 2008 conducted by
Leiden
University
Medical
Center
,, risk of stroke of women with PCOs was 2 folds higher in comparison of women with PCOS to women without PCOS(219).
3. Endometrial cancer
Endometrium is the inner lining of the mammalian uterus and very susceptible hormone change, particular to menstrual cycle. Endometrial cancer is a late adulthood cancer defined as a condition of which the cells of the endometrial lining of uterus have growth uncontrollable or become cancerous as a result of the alternation of cells DNA. It's the fourth most common cancer among women overall, after breast cancer, lung cancer, and bowel cancer.
women with polycystic ovary syndrome (PCOS) with altered estrogen and/or abnormality of levels progesterone (P4) at gene level(222), mutation gene(223)(227), abnormal levels of hormone (gonadotropins, estrogens, androgens, prolactin, andserotonin and progesterone),(228), hyperandrogenism(224), abnormal menstrual pattern(225), insulin resistance(228) associated with PCOS and obesity(226)(228), may contribute to increased endometrial cancer risk(222). Metformin(229) and combination of metformax, bromcriptine mesylate and metformin showed to improve clinical and metabolic syndrome in women with PCOS(230) with metformin alone through up-regulated tumor suppressor gene such as p53, cyclin D2 and BCL-2)(229).
4. Dyslipidemia
Dyslipidemia, one of metabolic syndrome has found to be associated to many patients with polycystic ovary syndrome (PCOS) risk factor(233), chracterized by elevated low-density lipoprotein (LDL), triglyceride levels and decreased high-density lipoprotein (HDL)(234), probably different metabolic aetiologies depending on DHEA-S metabolism, independent to insulin concentrations(235).
According to University of Brescia, Italy, use of the oral contraceptive for suppressed gonadotropin and androgen values and increased the levels of sex hormone binding globulin in women with PCOs showed a significant increase in triglycerides, high density lipoprotein (HDL) cholesterol system(232). Phytochemicals Berberine and monacolin showed effectively in a balanced lipid profile, through improve lipid metabolism in oral contraceptive induced hypercholesterolemia in women with or without PCOS(231).
5. Pregnancy risk
Women with PCOs are associated to higher rate of early pregnancy loss in comparison to women with reproductive problems(237). According to joint study conducted by
Norwegian
University
of Science and St Olavs Hospital, wone with PCOs are associated to pre term delivery in twin pregnancies(236). Treatment with N-acetylcysteine (NAC) showed to enhance higher odds of getting pregnant with a live birth(238). In subfertile women with anovulatory PCOS, letrozole improved live birth and pregnancy rates in comparison to clomiphene citrate(239).
Adding phytochemical Cimicifugae Racemosae to clomiphene-induction cycles with timed intercourse significantly improved cycle outcomes and pregnancy rates in women with polycystic ovarian(241). Traditional Chinese formula, Danzhi Xiaoyao Pill (DXP) effectively enhanced the ovulation rate and the clinical pregnancy rate of 60% in anovulation infertility patients with PCOS complicated IR(242).
Dr. Ried K. at National Institute of Integrative Medicine, Hawthorn,
Melbourne
, VIC,
Australia
said " Chinese herbal medicine can improve pregnancy rates 2-fold within a 3-6 month period compared with Western medical fertility drug therapy, including women with PCOS"(240).
6. Infertility(See diseases associated to PCOs)
7. Higher risk of Gestational diabetes
Epidemiologocal studies, linking higher incidence of gestational diabetes mellitus (GDM) for women with PCOs has porduced inconsistent result(243)(244). Aristotle University suggested a improve properly designed studies are necessary before any recommendation to pregnant women with PCOS in regard to the risk of GDM(245), But according to Imperial College School of Medicine, there is a higher prevalence of polycystic ovarian morphology in women with a history of gestational diabetes(246).
8. Depression
Women with PCOS are found to have a higher rate of depression in comparison group women without(247)(248)(250). Psychologically, according to
Institute
of
Psychology
,
Eötvös
Loránd
University
, women with PCOs are associated with a great number of psychological symptoms, including (e.g. depression, anxiety, body image dissatisfaction, eating and sexual disorders, and low life satisfaction) due to gynaecological disorder of endocrine origin(249).
9. Liver diseases
Women with PCOS are associated to high risk of NAFLD(251)(252)(253). The suggested that some women with PCOS particularly those with an evidence of metabolic syndrome. should be considered to be screened for liver disease at an earlier age(254).
10. Diabetes(See diseases associated to PCOs)
The prevention and management
Polycystic ovary syndrome (PCOS) is unpreventable in Western medicine. Early diagnosis and treatment may reduce risk of its complications, including infertility, metabolic syndrome, obesity, diabetes, cardiovascular diseases, stroke, etc.
The General Approaches to prevent the unpreventable?
Although PCOS cannot be completely avoided, strengthening immunity has shown a significant reduction of chronic inflammatory diseases(266)(267)(268).
1. Healthy lifestyle(255)(256)(257)(258)
According to Shahid Beheshti University of Medical Sciences, women with unhealthy life style are associated to increased risk of chronic diseases(260), including PCOs in comparison to those of healthy women(259), probably due to nutrient deficiency effects of immune functioning(261).
2. Balanced diet
Epidemiological data suggest that dietary patterns strongly affect inflammatory processes(265).
Balancing diet(257)(258) with high in veggies and fruits(257) and less in meats not only provides sufficient nutrients to your body but also enhances the immunity in fighting against inflammatory diseases(264), including PCOs(264), irregular cell growth(263) and oxidative stress(262). Reduced intake of trans and saturated fats and increased intake of omega-3 and omega-9 fatty acids(257) and eating anti-inflammatory foods (fiber(272)(273), omega-3 fatty acids(269), vitamin E(270), and red wine(271) should also be emphasized(255)(265).
3. Moderate exercise(257)
Moderate exercise not only increases blood flow to strengthen the body tissues(274)(275) and organs(276), including the reproductive system but also enhances the immunity(277) in fighting against inflammatory process(277)(278) due to irregular cell growth(281)(282) and foreign invasion(279)(280).
4. Yoga
Yoga is a physical, mental, and spiritual practice in Hinduism, Buddhism.
According to studies holistic yoga therapy showed a significant effects in reducing anti-müllerian hormone (AMH-primary outcome), luteinizing hormone (LH), testosterone, hirsutism, and improving menstrual frequency, glucose, lipid, and insulin values(284) with nonsignificant changes in body weight, FSH, and prolactin in adolescent PCOS(283).
The Vitamins
1. Vitamin B2
Vitamin B2 required for a wide variety of cellular processes, plays a key role in energy metabolism, enhances the digestive system in absorbing nutrients and supports the immune system(285)(286)(287)in fighting against irregular cell growth causes of chronic inflammatory disease(288).
2. Vitamin C
Vitamin C, a water-soluble vitamin and an antioxidant found in high concentrations in immune cells, is not only important in aiding the digestive system in absorbing nutrients, but also enhances the production of white blood cell(289)(290) of the immune system in protection of the body against oxidative stress, harmful bacteria(291) and virus induced inflammation.
3. Vitamin A
Retinoic acid, appears to maintain normal skin health by switching on genes and differentiating keratinocytes (immature skin cells)(292) into mature epidermal cells and helps to detoxify liver(293), and enhances the immune system(294)(295) in protecting our body through its anti tumor functions (296).
4. Vitamin E
Vitamin E is fat-soluble compounds included both tocopherols and tocotrienols. It besides is an polyphenol antioxidants(296)(297)(302) in scavenging free radicals, but also promotes the immune system in enhanced functions of B-cells(298)(299)(300), the immune cells(301)(303) in production of antibodies to destroy irregular cell proliferation.
5. Vitamin D
15 minutes in the the Sun daily has shown to provide necessary vitamin D for the body. Over 68% of women with PCOs had vitamin D deficiency.(304). According to Medical faculty of P.J.Šafarik University Košice, women with vitamin D deficient PCOs are exhibited a significantly higher body mass index (BMI), fasting insulin, and homeostasis model assessment-insulin resistance and borderline higher glycemia in comparison to controls(305).
The Top 5 Anti inflammatory Foods
According to Medical University Innsbruck, the interactions between diet, immunity, and the microbiota, may be necessary for the develop food-based approaches to prevent or treat many diseases(285).
1. Garlic
Garlic (Allium sativum) is a species in the onion genus, belongings to family Amaryllidaceae, native to central Asia, used popularly in traditional and Chinese medicine to treat common cold and flu(306), digestive disorders(313), diabetes(322)(323)(324), therosclerosis,(325), cardiovascular diseases(326)(327), strengthen immunity(319) against irregular cell growth suach as tumors(314)(315)(316)(317)(318), bacterias(310)(311)(312), fungii(310)(311) and virus(320)(321), lower blood pressure(328)(329)(330) and cholesterol levels(310)(331), etc. Recent studies also showed that garlic exhibits its anti-inflammatory effects against chronic inflammatory disease(307)(308)(309) through phytochemical allicin(307) and other machenisms(308)(309).
2. Ginger
Ginger (Zingiber officinale) or ginger root is the genus Zingiber, belongings to the family Zingiberaceae, native to Tamil, used in traditional and Chinese medicine to treat dyspepsia(332)(333), gastrointestinal disorder(334) such as nausea and vomiting(335), constipation(337), gastric ulcer(338),.... edema(339)(340), difficult urination(340), colic and diarrea(341), etc.... Strong evidences in Western studies also showed that ginger also induce some mechanisms for treatment of pschological symptoms, such as anxiety(342). depression(343),..., diabetes(344)(345), hypertension(346), irregular cell growth such as tumors(347)(348)(349), and rheumatoid arthritis(352) and osteoarthritis(336) through its anti inflammatory, antioxidant and immune-modulatory effects(346)(350)(351), speed up wounding healing(352)(353), etc.
3. Turmeric
Turmeric is a perennial plant in the genus Curcuma, belongings to the family Zingiberaceae, native to tropical
South Asia
. The herb has been used in traditional medicine as anti-oxidant(354)(355), hypoglycemic(356)(357), colorant(358), antiseptic(359)(360), wound healing(361) agents, and to treat flatulence(362), bloating(363), and appetite loss(364), ulcers(365), eczema(366), inflammations(367), etc. Epidemiological studies also found that the efficacy of turmeric for treatment for diabetes(369)(370), microbial infection(359)(371)(372), gastrointestinal diseases(359)(373) and irregular cell growth such as cancer(374)(375)(376) through its anti inflammatory(367)(368), antioxidant(377)(378) and immunmodulatory(379)(380) activities.
4. Green tea
Green tea contains more amount of antioxidants than any drinks or food with the same volume, and is the leaves of Camellia sinensis, undergone minimal oxidation during processing, originated from
China
. Green tea has been a precious drink in traditional Chinese culture and used exceptional in socialization for more than 4000 thousand years. Because of their health benefits, green tea has been cultivated for commercial purposes all over the world. Epidemiological studies suggested that green tea consists many pharmateutical properties, including anti cancers(381)(382), anti diabetes(383)(384), induced weight loss(385)(386)anti aging and longevity(387)(388), anti allergy(389)(390), anti micro-organisms(391)(392), anti lipidemic(393)(394). anti stroke(385)(396) and cardiovascular diseases, through its antioxidant(397)(398), anti inflammatory(399)(400) and immune modulatory(401)(402) activities.
5. Shiitake mushrooms
Shiitake mushroom is an edible mushroom, genus Lentinula, belonging to family Marasmiaceae,native to
East Asia
and widely cultivated for consumption for its health benefits and commercial purpose in many Asian countries. The herb has been used in traditional medicine as blood tonic agent and to strengthen immune system)403)(405), treat colds(407), measles(407), bronchial inflammations(407), etc. Recent studies showed that Shiitake mushrooms are also consisted properties of anti cancers(403)(404), anti microorganisms(407)(408) such as HIV)410)(411)and hepatitis virus(407)(412), enhanced immune system(403)(405)(406) against inflammation(413)(414) causes of chronic inflammatory diseases(415) and the development of free radicals(414)(416), lowering cholesterol levels(407)(417)(418), treating heart disease(407)(419), diabetes(407)(420), etc....
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