The Holistic prevention, management and treatment of Polycystic Ovarian Syndrome: The Complications

Posted by Chantel Martiromo, Research article By Kyle J. Norton

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Polycystic Ovarian Syndrome(PCOs)

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).

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)


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References
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