Polycystic ovary syndrome

1261:, which shrinks and disappears after approximately 12–14 days. In PCOS, there is a so-called "follicular arrest"; i.e., several follicles develop to a size of 5–7 mm, but not further. No single follicle reaches the preovulatory size (16 mm or more). According to the Rotterdam criteria, which are widely used for diagnosis of PCOS, 12 or more small follicles should be seen in a suspect ovary on ultrasound examination. More recent research suggests that there should be at least 25 follicles in an ovary to designate it as having polycystic ovarian morphology (PCOM) in women aged 18–35 years. The follicles may be oriented in the periphery, giving the appearance of a 'string of pearls'. If a high-resolution transvaginal ultrasonography machine is not available, an ovarian volume of at least 10 ml is regarded as an acceptable definition of having polycystic ovarian morphology. rather than follicle count. 4124:

PCOS who participated in a large, multicenter, randomized controlled infertility trial performed at academic health centers in the United States were run by varying assays, and results were compared. The median testosterone level by RIA was 50 ng/dl (25th–75th percentile, 34–71 ng/dl); by LC/MS at Mayo, 47 ng/dl (25th–75th percentile, 34–65 ng/dl); and by LC/MS at Quest, 41 ng/dl (25th–75th percentile, 27–58 ng/dl) (Fig. 1). The minimum and maximum values detected by RIA were 8 and 189 ng/dl, respectively; by LC/MS at Mayo, 12 and 184 ng/dl, respectively; and by LC/MS at Quest, 1 and 205 ng/dl, respectively. Our sample size was robust and the largest study to date examining quality control of total testosterone serum levels in women.

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added challenges of having their symptoms properly addressed and recognized. Lean women often go undiagnosed for years, and usually are diagnosed after struggles to conceive. Lean women are likely to have a missed diagnosis of diabetes and cardiovascular disease, these women also have an increased risk of developing insulin resistance, despite not being overweight. Lean women are often taken less seriously with their diagnosis of PCOS, and also face challenges finding appropriate treatment options. This is because most treatment options are limited to approaches of losing weight and healthy dieting.

1333:(GTT) in women with risk factors (obesity, family history, history of gestational diabetes) may indicate impaired glucose tolerance (insulin resistance) in 15–33% of women with PCOS. Frank diabetes can be seen in 65–68% of women with this condition. Insulin resistance can be observed in both normal weight and overweight people, although it is more common in the latter (and in those matching the stricter NIH criteria for diagnosis); 50–80% of people with PCOS may have insulin resistance at some level. 1920:

comprehensively examine racial differences discovered notable racial differences in risk factors for cardiovascular disease. African American women were found to be significantly more obese, with a significantly higher prevalence of metabolic syndrome compared to white adult women with PCOS. It is important for the further research of racial differences among women with PCOS, to ensure that every woman that is affected by PCOS has the available resources for management.

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1,741 women with PCOS, mean testosterone levels were 2.6 (1.1–4.8) nmol/L (75 (32–140) ng/dL). In a 1998 study which reviewed many studies and subjected them to meta-analysis, testosterone levels in women with PCOS were 62 to 71 ng/dL (2.2–2.5 nmol/L) and testosterone levels in women without PCOS were about 32 ng/dL (1.1 nmol/L). In a 2010 study of 596 women with PCOS which used

10070: 2070: 1170: 695:(LC–MS) to quantify testosterone, median levels of testosterone were 41 and 47 ng/dL (with 25th–75th percentiles of 34–65 ng/dL and 27–58 ng/dL and ranges of 12–184 ng/dL and 1–205 ng/dL) via two different labs. If testosterone levels are above 100 to 200 ng/dL, per different sources, other possible causes of 969:

Leventhal in 1935, the criteria of diagnosis, symptoms, and causative factors are subject to debate. Gynecologists often see it as a gynecological problem, with the ovaries being the primary organ affected. However, recent insights show a multisystem disorder, with the primary problem lies in hormonal regulation in the

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determined and compared with the symptoms and signs of PCOS. A rising serum concentration of testosterone was associated with an increased risk of hirsutism, infertility and cycle disturbance. If the serum testosterone concentration is >4.8 nmol/1, other causes of hyperandrogenism should be excluded.

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supplementation appears to be effective in improving several of the hormonal disturbances of PCOS. Myo-inositol reduces the amount of gonadotropins and the length of controlled ovarian hyperstimulation in women undergoing in vitro fertilization. A 2011 review found not enough evidence to conclude any

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If a regular menstrual cycle is not desired, then therapy for an irregular cycle is not necessarily required. Most experts say that, if a menstrual bleed occurs at least every three months, then the endometrium (womb lining) is being shed sufficiently often to prevent an increased risk of endometrial

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informs that it "takes time for medications to adjust hormone levels, and once those hormone levels are adjusted, it takes more time still for pores to be unclogged of overproduced oil and for any bacterial infections under the skin to clear up before you will see discernible results." (p. 138)

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and hence may produce conflicting results. General interventions that help to reduce weight or insulin resistance can be beneficial for all these aims, because they address what is believed to be the underlying cause. As PCOS appears to cause significant emotional distress, appropriate support may be

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in females; this means that each child has a 50% chance of inheriting the predisposing genetic variant(s) from a parent, and, if a daughter receives the variant(s), the daughter will have the disease to some extent. The genetic variant(s) can be inherited from either the father or the mother, and can

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Even though most women with PCOS are overweight or obese, it is important to acknowledge that non-overweight women can also be diagnosed with PCOS. Up to 30% of women diagnosed with PCOS maintain a normal weight before and after diagnosis. "Lean" women still face the various symptoms of PCOS with the

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The criteria for the diagnosis of the polycystic ovary syndrome (PCOS) have still not been agreed universally. A population of 1741 women with PCOS were studied, all of whom had polycystic ovaries seen by ultrasound scan. The frequency distributions of the serum concentrations of testosterone were

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A total of 5366 women with PCOS from 21 studies were included. Women with PCOS serum total testosterone level (2.34 ± 0.58 nmol/L vs 1.57 ± 0.60 nmol/L, p < 0.001) compared with women without PCOS. PCOS is characterized by high levels of androgens (dehydroepiandrosterone, androstenedione, and

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Lifestyle changes for people with PCOS have been proven to be difficult due to lack of intrinsic motivation, altered risk perception or other PCOS-related barriers. However, self management techniques and behavior change can be taught in a multidisciplinary approach with the goal of supporting those

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Design and Setting: We conducted a blinded laboratory study including masked duplicate samples at three laboratories—two academic (University of Virginia, RIA; and Mayo Clinic, LC/MS) and one commercial (Quest, LC/MS). Participants and Interventions: Baseline testosterone levels from 596 women with

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In 2005, 4 million cases of PCOS were reported in the US, costing $ 4.36 billion in healthcare costs. In 2016 out of the National Institute Health's research budget of $ 32.3 billion for that year, 0.1% was spent on PCOS research. Among those aged between 14 and 44, PCOS is conservatively estimated

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might get enlarged and comprise follicles surrounding the eggs. As result, ovaries might fail to function regularly. This disease is related to the number of follicles per ovary each month growing from the average range of 6–8 to double, triple or more. Women with PCOS have higher risk of multiple

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Diagnosis and treatment. The first diagnostic test is measurement of total testosterone and free testosterone by radioimmunoassay. If total testosterone is between 50 ng/dL and 200 ng/dL above normal (<2.5 ng/dL) PCOS is present. If >200 ng/dL then serum DHEA-S should be measured. If total

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estimates that it affects 116 million women worldwide as of 2010 (3.4% of women). Another estimate indicates that 7% of women of reproductive age are affected. Another study using the Rotterdam criteria found that about 18% of women had PCOS, and that 70% of them were previously undiagnosed.

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and diet adjustments, especially to reduce the intake of simple carbohydrates, are associated with resumption of natural ovulation. Digital health interventions have been shown to be particularly effective in providing combined therapy to manage PCOS through both lifestyle changes and medication.

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Although these agents have shown significant efficacy in clinical trials (for oral contraceptives, in 60–100% of individuals), the reduction in hair growth may not be enough to eliminate the social embarrassment of hirsutism, or the inconvenience of plucking or shaving. Individuals vary in their

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Even though the name suggests that the ovaries are central to disease pathology, cysts are a symptom instead of the cause of the disease. Some symptoms of PCOS will persist even if both ovaries are removed; the disease can appear even if cysts are absent. Since its first description by Stein and

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As opposed to women in the general population, women with PCOS experience higher rates of depression and anxiety. International guidelines and Indian guidelines suggest psychosocial factors should be considered in women with PCOS, as well as screenings for depression and anxiety. Globally, this

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among women between the ages of 18 and 44. It affects approximately 2% to 20% of this age group depending on how it is defined. When someone is infertile due to lack of ovulation, PCOS is the most common cause and could guide to patients' diagnosis. The earliest known description of what is now

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Women with PCOS are far more likely to have depression than women without. Symptoms of depression might be heightened by certain physiological manifestations of this disease such as hirsutism or obesity that can lead to low self-esteem or poor body image. Researchers suggest that there be

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above 25 be given metformin when other therapy has failed to produce results. Metformin may not be effective in every type of PCOS, and therefore there is some disagreement about whether it should be used as a general first line therapy. In addition to this, metformin is associated with several

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Not all people with PCOS have difficulty becoming pregnant. But some individuals with PCOS may have difficulty getting pregnant since their body does not produce the hormones necessary for regular ovulation. PCOS might also increase the risk of miscarriage or premature delivery. However, it is

1650:. Evidence from randomised controlled trials suggests that in terms of live birth, metformin may be better than placebo, and metform plus clomiphene may be better than clomiphene alone, but that in both cases women may be more likely to experience gastrointestinal side effects with metformin. 1341:

and insulin values do not predict who responds to an insulin-lowering medication, low-glycemic diet, and exercise. Many women with normal levels may benefit from combination therapy. A hypoglycemic response in which the two-hour insulin level is higher and the blood sugar lower than fasting is

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cells from women with the allele. The exact gene affected has not yet been identified. In rare instances, single-gene mutations can give rise to the phenotype of the syndrome. Current understanding of the pathogenesis of the syndrome suggests, however, that it is a complex multigenic disorder.

1746:" (puncture of 4–10 small follicles with electrocautery, laser, or biopsy needles), which often results in either resumption of spontaneous ovulations or ovulations after adjuvant treatment with clomiphene or FSH. (Ovarian wedge resection is no longer used as much due to complications such as 973:, with the involvement of many organs. The term PCOS is used due to the fact that there is a wide spectrum of symptoms possible. It is common to have polycystic ovaries without having PCOS; approximately 20% of European women have polycystic ovaries, but most of those women do not have PCOS. 1800:

When appropriate (e.g., in women of child-bearing age who require contraception), a standard contraceptive pill is frequently effective in reducing hirsutism. Progestogens such as norgestrel and levonorgestrel should be avoided due to their androgenic effects. Metformin combined with an oral

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Certain cosmetic procedures may also help alleviate symptoms in some cases. For example, the use of laser hair removal, electrolysis, or general waxing, plucking and shaving are all effective methods for reducing hirsutism. The primary treatments for PCOS include lifestyle changes and use of

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There are few studies that have investigated the racial differences in cardiometabolic factors in women with PCOS. There is also limited data on the racial differences in the risk of metabolic syndrome and cardiovascular disease in adolescents and young adults with PCOS. The first study to

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A review of international evidence found that the prevalence of PCOS could be as high as 26% among some populations, though ranges between 4% and 18% are reported for general populations. According to the World Health Organization (WHO), PCOS affects over 8-13% of reproductive-aged women.

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of sexual dysfunction related to PCOS which included 5,366 women with PCOS from 21 studies, testosterone levels were analyzed and were found to be 2.34 nmol/L (67 ng/dL) in women with PCOS and 1.57 nmol/L (45 ng/dL) in women without PCOS. In a 1995 study of

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diseases including infertility, type 2 diabetes mellitus (DM-2), cardiovascular risk, metabolic syndrome, obesity, impaired glucose tolerance, depression, obstructive sleep apnea (OSA), endometrial cancer, and nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH).

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Fasting insulin level or GTT with insulin levels (also called IGTT). Elevated insulin levels have been helpful to predict response to medication and may indicate women needing higher doses of metformin or the use of a second medication to significantly lower insulin levels. Elevated

1124:. The follicles have developed from primordial follicles, but this development has stopped ("arrested") at an early stage, due to the disturbed ovarian function. The follicles may be oriented along the ovarian periphery, appearing as a 'string of pearls' on ultrasound examination. 1396:

may help with improving the regularity of periods, excess hair growth, and acne. Combined oral contraceptives are especially effective, and used as the first-line of treatment to reduce acne and hirsutism, and regulate menstrual cycle. This is especially the case in adolescents.

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results from inflammation in the body that is caused by stress and or high inflammatory foods. With inflammatory PCOS because of the inflammation the body will not ovulate, that results in an imbalance in hormones that then causes the body to produce androgen at higher levels.

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can usually be regulated with a contraceptive pill. The purpose of regulating menstruation, in essence, is for the patient's convenience, and perhaps their sense of well-being; there is no medical requirement for regular periods, as long as they occur sufficiently often.

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Due to the scarcity of large-scale screening studies, the prevalence of endometrial abnormalities in PCOS remains unknown, though women with the condition may be at increased risk for endometrial hyperplasia and carcinoma as well as menstrual dysfunction and infertility.

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Laganà AS, Vitagliano A, Noventa M, Ambrosini G, D'Anna R (October 2018). "Myo-inositol supplementation reduces the amount of gonadotropins and length of ovarian stimulation in women undergoing IVF: a systematic review and meta-analysis of randomized controlled trials".

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examination may reveal a thickened, smooth, pearl-white outer surface of the ovary. (This would usually be an incidental finding if laparoscopy were performed for some other reason, as it would not be routine to examine the ovaries in this way to confirm a diagnosis of

1019:. Endocrine disruptors can cause adverse health impacts in animals. Additional research is needed to assess the role that endocrine disruptors may play in disrupting reproductive health in women and possibly triggering or exacerbating PCOS and its related symptoms. 612:: Estimates suggest that androgenic alopecia affects 22% of PCOS sufferers. This is a result of high testosterone levels that are converted into the dihydrotestosterone (DHT) hormone. Hair follicles become clogged, making hair fall out and preventing further growth. 1342:

consistent with insulin resistance. A mathematical derivation known as the HOMAI, calculated from the fasting values in glucose and insulin concentrations, allows a direct and moderately accurate measure of insulin sensitivity (glucose-level x insulin-level/22.5).

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The Rotterdam definition is wider, including many more women, the most notable ones being women without androgen excess. Critics say that findings obtained from the study of women with androgen excess cannot necessarily be extrapolated to women without androgen

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Balen AH, Morley LC, Misso M, Franks S, Legro RS, Wijeyaratne CN, et al. (November 2016). "The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance".

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Draper N, Walker EA, Bujalska IJ, Tomlinson JW, Chalder SM, Arlt W, et al. (August 2003). "Mutations in the genes encoding 11beta-hydroxysteroid dehydrogenase type 1 and hexose-6-phosphate dehydrogenase interact to cause cortisone reductase deficiency".

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Fukuoka M, Yasuda K, Fujiwara H, Kanzaki H, Mori T (November 1992). "Interactions between interferon gamma, tumour necrosis factor alpha, and interleukin-1 in modulating progesterone and oestradiol production by human luteinized granulosa cells in culture".

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Sharquie KE, Al-Bayatti AA, Al-Ajeel AI, Al-Bahar AJ, Al-Nuaimy AA (July 2007). "Free testosterone, luteinizing hormone/follicle stimulating hormone ratio and pelvic sonography in relation to skin manifestations in patients with polycystic ovary syndrome".

1820:, which can give some improvement in hirsutism. Metformin can reduce hirsutism, perhaps by reducing insulin resistance, and is often used if there are other features such as insulin resistance, diabetes, or obesity that should also benefit from metformin. 1311:

to designate abnormally high LH/FSH ratios are 2:1 or 3:1 as tested on day 3 of the menstrual cycle. The pattern is not very sensitive; a ratio of 2:1 or higher was present in less than 50% of women with PCOS in one study. There are often low levels of

1499:. Still, many women find it very difficult to achieve and sustain significant weight loss. Insulin resistance itself can cause increased food cravings and lower energy levels, which can make it difficult to lose weight on a regular weight-loss diet. A 2615:"American Association of Clinical Endocrinologists, American College of Endocrinology, and androgen excess and PCOS society disease state clinical review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome-part 1" 1923:

Ultrasonographic findings of polycystic ovaries are found in 8–25% of women non-affected by the syndrome. 14% women on oral contraceptives are found to have polycystic ovaries. Ovarian cysts are also a common side effect of levonorgestrel-releasing

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is the most common type and occurs due of high insulin levels in the body. Due to a resistance to insulin, the pancreas increases the amount of insulin it releases. The excess of insulin then signals the body to produce androgen at higher levels.

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Polycystic ovaries develop when the ovaries are stimulated to produce excessive amounts of androgenic hormones, in particular testosterone, by either one or a combination of the following (almost certainly combined with genetic susceptibility):

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A 2017 review concluded that while both myo-inositol and D-chiro-inositols may regulate menstrual cycles and improve ovulation, there is a lack of evidence regarding effects on the probability of pregnancy. A 2012 and 2017 review have found

1535:, and treatment of any such deficiency is indicated. However, a systematic review of 2015 found no evidence that vitamin D supplementation reduced or mitigated metabolic and hormonal dysregulations in PCOS. As of 2012, interventions using 9194: 1059:, which is a strong risk factor for insulin resistance, although insulin resistance is a common finding among women with PCOS in normal-weight women as well. Elevated insulin levels contribute to or cause the abnormalities seen in the 1970:

Most common names for this disease derive from a typical finding on medical images, called a polycystic ovary. A polycystic ovary has an abnormally large number of developing eggs visible near its surface, looking like many small

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Women with PCOS tend to have central obesity, but studies are conflicting as to whether visceral and subcutaneous abdominal fat is increased, unchanged, or decreased in women with PCOS relative to non-PCOS women with the same

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Johnstone E, Cannon-Albright L, Peterson CM, Allen-Brady K (July 2018). "Lean PCOS may be a genetically distinct from obese PCOS: lean women with polycystic ovary syndrome and their relatives have no increased risk of T2DM".

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Li XJ, Yu YX, Liu CQ, Zhang W, Zhang HJ, Yan B, et al. (March 2011). "Metformin vs thiazolidinediones for treatment of clinical, hormonal and metabolic characteristics of polycystic ovary syndrome: a meta-analysis".

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is taken. Stein and Leventhal first described PCOS as an endocrine disorder in the United States, and since then, it has become recognized as one of the most common causes of oligo ovulatory infertility among women.

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Clayton RN, Ogden V, Hodgkinson J, Worswick L, Rodin DA, Dyer S, et al. (August 1992). "How common are polycystic ovaries in normal women and what is their significance for the fertility of the population?".

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Although 80% of PCOS presents in women with obesity, 20% of women diagnosed with the disease are non-obese or "lean" women. However, obese women that have PCOS have a higher risk of adverse outcomes, such as

1610:(in the UK, US, AU and EU) to treat insulin resistance seen in PCOS. In many cases, metformin also supports ovarian function and return to normal ovulation. A newer insulin resistance medication class, the 1757:

led to more spontaneous ovulations than behavioral interventions combined with medical therapy in adult women with PCOS, raising the prospect that surgery could enhance prospects of spontaneous fertility.

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In each of these areas, there is considerable debate as to the optimal treatment. One of the major factors underlying the debate is the lack of large-scale clinical trials comparing different treatments.

606:: A rise in testosterone levels, increases the oil production within the sebaceous glands and clogs pores. For many women, the emotional impact is great and quality of life can be significantly reduced. 2708:

Khan MJ, Ullah A, Basit S. Genetic Basis of Polycystic Ovary Syndrome (PCOS): Current Perspectives. Appl Clin Genet. 2019 Dec 24;12:249-260. doi: 10.2147/TACG.S200341. PMID 31920361; PMCID: PMC6935309.

3405:"The effect of serum and intrafollicular insulin resistance parameters and homocysteine levels of nonobese, nonhyperandrogenemic polycystic ovary syndrome patients on in vitro fertilization outcome" 2581: 7078:

Huang G, Coviello A (December 2012). "Clinical update on screening, diagnosis and management of metabolic disorders and cardiovascular risk factors associated with polycystic ovary syndrome".

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Amoah-Arko A, Evans M, Rees A (20 October 2017). "Effects of myoinositol and D-chiro inositol on hyperandrogenism and ovulation in women with polycystic ovary syndrome: a systematic review".

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is a major diagnostic tool, it is not the only one. The diagnosis is fairly straightforward using the Rotterdam criteria, even when the syndrome is associated with a wide range of symptoms.

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to correct metabolic deficiencies in people with PCOS had been tested in small, uncontrolled and nonrandomized clinical trials; the resulting data are insufficient to recommend their use.

1249:. These are believed to be the result of disturbed ovarian function with failed ovulation, reflected by the infrequent or absent menstruation that is typical of the condition. In a normal 9902: 1131:, with several investigators correlating inflammatory mediators with anovulation and other PCOS symptoms. Similarly, there seems to be a relation between PCOS and an increased level of 4048:

Steinberger E, Ayala C, Hsi B, Smith KD, Rodriguez-Rigau LJ, Weidman ER, et al. (1998). "Utilization of commercial laboratory results in management of hyperandrogenism in women".

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testosterone or DHEA-S >700 μg/dL then rule out an ovarian or adrenal tumor. These tests should be followed by tests for hypothyroidism, hyperprolactinemia, and adrenal hyperplasia.

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Farquhar CM, Birdsall M, Manning P, Mitchell JM, France JT (February 1994). "The prevalence of polycystic ovaries on ultrasound scanning in a population of randomly selected women".

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Brutocao C, Zaiem F, Alsawas M, Morrow AS, Murad MH, Javed A (November 2018). "Psychiatric disorders in women with polycystic ovary syndrome: a systematic review and meta-analysis".

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aspect has been increasingly focused on because it reflects the true impact of PCOS on the lives of patients. Research shows that PCOS adversely impacts a patient's quality of life.

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Exclusion of other disorders that can result in menstrual irregularity and hyperandrogenism (e.g.: Congenital Suprarrenal Hyperplasia, androgen producer tumors, hyperprolactinemia).

1782:. Additionally, it has been found to significantly increase risk of eating disorders. Screening for these mental health conditions will also be helpful in treatment of PCOS. 574:(increased hair thinning or diffuse hair loss), or other symptoms. Approximately three-quarters of women with PCOS (by the diagnostic criteria of NIH/NICHD 1990) have evidence of 9923: 9695: 1684:. Like women without PCOS, women with PCOS that are ovulating may be infertile due to other causes, such as tubal blockages due to a history of sexually transmitted diseases. 6865:"American association of clinical endocrinologists and American college of endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity" 1631:

in women treated with metformin during the first trimester. Liraglutide may reduce weight and waist circumference in people with PCOS more than other medications. The use of

9112:"Black women with polycystic ovary syndrome (PCOS) have increased risk for metabolic syndrome (MET SYN) and cardiovascular disease (CVD) compared to white women with PCOS" 3297: 2697:

Around 20% of European women have polycystic ovaries (the prevalence is even higher in some other populations) but approximately two-thirds of these women do not have PCOS

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Hu S, Yu Q, Wang Y, Wang M, Xia W, Zhu C (May 2018). "Letrozole versus clomiphene citrate in polycystic ovary syndrome: a meta-analysis of randomized controlled trials".

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Balen AH, Conway GS, Kaltsas G, Techatrasak K, Manning PJ, West C, et al. (August 1995). "Polycystic ovary syndrome: the spectrum of the disorder in 1741 patients".

1507:, menstrual regularity, ovulation, hyperandrogenism, insulin resistance, lipids, and quality of life to occur with weight loss, independent of diet composition. Still, a 1511:, in which a significant portion of total carbohydrates is obtained from fruit, vegetables, and whole-grain sources, has resulted in greater menstrual regularity than a 7368:

Leeman L, Acharya U (August 2009). "The use of metformin in the management of polycystic ovary syndrome and associated anovulatory infertility: the current evidence".

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Muscogiuri G, Altieri B, de Angelis C, Palomba S, Pivonello R, Colao A, et al. (September 2017). "Shedding new light on female fertility: The role of vitamin D".

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Giallauria F, Palomba S, Vigorito C, Tafuri MG, Colao A, Lombardi G, et al. (July 2009). "Androgens in polycystic ovary syndrome: the role of exercise and diet".

1824:(Vaniqa) is a medication that is applied to the skin in cream form, and acts directly on the hair follicles to inhibit hair growth. It is usually applied to the face. 9812: 6305:

Banaszewska B, Spaczyński RZ, Pelesz M, Pawelczyk L (2003). "Incidence of elevated LH/FSH ratio in polycystic ovary syndrome women with normo- and hyperinsulinemia".

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Loh HH, Yee A, Loh HS, Kanagasundram S, Francis B, Lim LL (September 2020). "Sexual dysfunction in polycystic ovary syndrome: a systematic review and meta-analysis".

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The earliest published description of a person with what is now recognized as PCOS was in 1721 in Italy. Cyst-related changes to the ovaries were described in 1844.

1253:, one egg is released from a dominant follicle – in essence, a cyst that bursts to release the egg. After ovulation, the follicle remnant is transformed into a 737:, resulting in prolonged stimulation of uterine cells by estrogen. It is not clear whether this risk is directly due to the syndrome or from the associated obesity, 7766: 1372:

results from individuals stopping oral contraceptives. When you stop taking these pills the body will produce androgen at higher levels resulting in PCOS symptoms.

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Garvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley DL, Jastreboff AM, et al. (Reviewers of the AACE/ACE Obesity Clinical Practice Guidelines) (July 2016).

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Warning signs may include a change in appearance. But there are also manifestations of mental health problems, such as anxiety, depression, and eating disorders.

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unpleasant side effects: including abdominal pain, metallic taste in the mouth, diarrhoea and vomiting. Metformin is thought to be safe to use during pregnancy (

8930:"Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010" 7533:"Pharmacologic therapy to induce weight loss in women who have obesity/overweight with polycystic ovary syndrome: a systematic review and network meta-analysis" 1067:

pulse frequency, which in turn results in an increase in the LH/FSH ratio increased ovarian androgen production; decreased follicular maturation; and decreased

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Where PCOS is associated with being overweight or obesity, successful weight loss is the most effective method of restoring normal ovulation/menstruation. The

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Unfer V, Carlomagno G, Dante G, Facchinetti F (July 2012). "Effects of myo-inositol in women with PCOS: a systematic review of randomized controlled trials".

8201:"Bariatric surgery for spontaneous ovulation in women living with polycystic ovary syndrome: the BAMBINI multicentre, open-label, randomised controlled trial" 6699: 4453: 9967: 7313: 7123:"Efficacy and safety of anti-androgens in the management of polycystic ovary syndrome: a systematic review and meta-analysis of randomised controlled trials" 1916:

Prevalence also varies across countries due to lack of large-scale scientific studies; India, for example, has a purported rate of 1 in 5 women having PCOS.

1615: 755:. A review published in 2010 concluded that women with PCOS have an elevated prevalence of insulin resistance and type 2 diabetes, even when controlling for 621:

Polycystic ovaries: PCOS is a complicated disorder characterized by high androgen levels, irregular menstruation, and/or small cysts on one or both ovaries.

9606: 9873: 9358:"Classification of normogonadotropic infertility: polycystic ovaries diagnosed by ultrasound versus endocrine characteristics of polycystic ovary syndrome" 8380: 9426:"Comparison of metabolic syndrome elements in White and Asian women with polycystic ovary syndrome: results of a regional, American cross-sectional study" 8241:

Berni TR, Morgan CL, Berni ER, Rees DA (June 2018). "Polycystic Ovary Syndrome Is Associated With Adverse Mental Health and Neurodevelopmental Outcomes".

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response to different therapies. It is usually worth trying other medications if one does not work, but medications do not work well for all individuals.

3035:"Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan" 1750:

and the presence of frequently effective medications.) There are, however, concerns about the long-term effects of ovarian drilling on ovarian function.

3764:"Obese and Non-obese Polycystic Ovarian Syndrome: Comparison of Clinical, Metabolic, Hormonal Parameters, and their Differential Response to Clomiphene" 3327: 9665: 1488: 9834: 5662: 5164:

Faghfoori Z, Fazelian S, Shadnoush M, Goodarzi R (November 2017). "Nutritional management in women with polycystic ovary syndrome: A review study".

1287:(DHEA-S) levels above 700–800 μg/dL are highly suggestive of adrenal dysfunction because DHEA-S is made exclusively by the adrenal glands. The 2599: 6083:"Definition and significance of polycystic ovarian morphology: a task force report from the Androgen Excess and Polycystic Ovary Syndrome Society" 5464:

Hu X, Wang J, Dong W, Fang Q, Hu L, Liu C (November 2011). "A meta-analysis of polycystic ovary syndrome in women taking valproate for epilepsy".

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The condition was first described in 1935 by American gynecologists Irving F. Stein, Sr. and Michael L. Leventhal, from whom its original name of

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last option is the original name; it is now used, if at all, only for the subset of women with all the symptoms of amenorrhea with infertility,

2401: 10295: 892:, a lack of physical exercise, and a family history of someone with the condition. Diagnosis is based on two of the following three findings: 8496: 5856:"Reactive oxygen species-induced oxidative stress in the development of insulin resistance and hyperandrogenism in polycystic ovary syndrome" 2256: 1767:

mental health screenings performed in tandem with PCOS assessment in order to identify these complications early and treat them accordingly.

9195:"Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome (2023)" 7652: 5375:

Rutkowska A, Rachoń D (April 2014). "Bisphenol A (BPA) and its potential role in the pathogenesis of the polycystic ovary syndrome (PCOS)".

3668:

Corbould A (October 2008). "Effects of androgens on insulin action in women: is androgen excess a component of female metabolic syndrome?".

4690: 1105:. The excess of adipose tissue in obese women creates the paradox of having both excess androgens (which are responsible for hirsutism and 790:, with a meta-analysis estimating a 2-fold risk of arterial disease for women with PCOS relative to women without PCOS, independent of BMI. 9636: 9031: 8115:

Homburg R (October 2004). "Management of infertility and prevention of ovarian hyperstimulation in women with polycystic ovary syndrome".

4598: 3173: 1955:

Other names for this syndrome include polycystic ovarian syndrome, polycystic ovary disease, functional ovarian hyperandrogenism, ovarian

873:

twins and heritability of endocrine and metabolic features of PCOS. There is some evidence that exposure to higher than typical levels of

8152:"Clomiphene citrate co-treatment with low dose urinary FSH versus urinary FSH for clomiphene resistant PCOS: randomized controlled trial" 6139: 4424: 2149: 1672:

or infrequent ovulation is a common cause and PCOS is the main cause of anovulatory infertility. Other factors include changed levels of

1060: 692: 9746:"Chrisette Michele Opens Up About Living With PCOS & No Longer Being Vegan - BlackDoctor.org - Where Wellness & Culture Connect" 4368:"Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis" 2221: 1614:(glitazones), have shown equivalent efficacy to metformin, but metformin has a more favorable side effect profile. The United Kingdom's 1411:

may also help. Other typical acne treatments and hair removal techniques may be used. Efforts to improve fertility include weight loss,

404:

indicated PCOS to be present if any two out of three criteria are met, in the absence of other entities that might cause these findings:

10230: 10074: 8743:

Galazis N, Galazi M, Atiomo W (April 2011). "D-Chiro-inositol and its significance in polycystic ovary syndrome: a systematic review".

3222:

Hart R, Hickey M, Franks S (October 2004). "Definitions, prevalence and symptoms of polycystic ovaries and polycystic ovary syndrome".

9774: 8906: 10423: 9687: 4859:"Scientific Statement on the Diagnostic Criteria, Epidemiology, Pathophysiology, and Molecular Genetics of Polycystic Ovary Syndrome" 8656:

Zeng L, Yang K (January 2018). "Effectiveness of myoinositol for polycystic ovary syndrome: a systematic review and meta-analysis".

10338: 10333: 9753: 9514: 1659: 522: 9145:"Concerns and expectations in women with polycystic ovary syndrome vary across age and ethnicity: findings from PCOS Pearls Study" 6824:"Emotional distress is a common risk in women with polycystic ovary syndrome: a systematic review and meta-analysis of 28 studies" 10328: 7711:"Extra- and intra-ovarian factors in polycystic ovary syndrome: impact on oocyte maturation and embryo developmental competence" 3289: 10519: 8329:"Metformin versus the combined oral contraceptive pill for hirsutism, acne, and menstrual pattern in polycystic ovary syndrome" 4184:"Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis" 3353:"Prevalence of hyperandrogenemia in the polycystic ovary syndrome diagnosed by the National Institutes of Health 1990 criteria" 1869:

abnormalities or cancer. If menstruation occurs less often or not at all, some form of progestogen replacement is recommended.

1723:

For women not responsive to letrozole or clomiphene and diet and lifestyle modification, there are options available including

8475: 5736:"Ultrasound assessment of polycystic ovaries: Ovarian volume and morphology; which is more accurate in making the diagnosis?!" 5332:

Rasgon N (June 2004). "The relationship between polycystic ovary syndrome and antiepileptic drugs: a review of the evidence".

10514: 8900: 7420: 6653: 6133: 4418: 4153: 3916: 3545: 3464: 2593: 6909:"Dietary composition in the treatment of polycystic ovary syndrome: a systematic review to inform evidence-based guidelines" 1390:

Recent research suggests that daily exercise including both aerobic and strength activities can improve hormone imbalances.

1157: 1116:

The syndrome acquired its most widely used name due to the common sign on ultrasound examination of multiple (poly) ovarian

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Reducing intake of food groups that cause inflammation, such as dairy, sugars and simple carbohydrates, can be beneficial.

10045: 6288: 2341:

Diamanti-Kandarakis E, Kandarakis H, Legro RS (August 2006). "The role of genes and environment in the etiology of PCOS".

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are the principal treatments used to promote ovulation. Clomiphene can cause mood swings and abdominal cramping for some.

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is a PCOS caused by how our body reacts to stress. As a result DHEAS a type of androgens that form in the adrenal glands.

1291:

level is thought to be the best measure, with approximately 60 per cent of PCOS patients demonstrating supranormal levels.

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of some women with this condition, though this is not a universal symptom, and not the underlying cause of the disorder.

7532: 780: – disorders of lipid metabolism – cholesterol and triglycerides. Women with PCOS show a decreased removal of 10499: 3089:"Controversy in clinical endocrinology: diagnosis of polycystic ovarian syndrome: the Rotterdam criteria are premature" 17: 8200: 3133:"Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS)" 1742:

Though surgery is not commonly performed, the polycystic ovaries can be treated with a laparoscopic procedure called "

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The severity of PCOS symptoms appears to be largely determined by factors such as obesity. PCOS has some aspects of a

6351: 6152:

Ultrasound findings in PCOS include enlarged ovaries with peripheral follicles in a "string of pearls" configuration.

5897:"Circulating markers of oxidative stress and polycystic ovary syndrome (PCOS): a systematic review and meta-analysis" 5635:"The utility of the gonadotrophin releasing hormone (GnRH) test in the diagnosis of polycystic ovary syndrome (PCOS)" 4683:"Iron Deficiency Injectables Market: Global Industry Trends, Share, Size, Growth, Opportunity and Forecast 2020-2025" 4639:

Boomsma CM, Fauser BC, Macklon NS (January 2008). "Pregnancy complications in women with polycystic ovary syndrome".

1779: 814: 9716: 8035:"Role of metformin for ovulation induction in infertile patients with polycystic ovary syndrome (PCOS): a guideline" 5421:

Palioura E, Diamanti-Kandarakis E (December 2013). "Industrial endocrine disruptors and polycystic ovary syndrome".

5293:"Androgen excess fetal programming of female reproduction: a developmental aetiology for polycystic ovary syndrome?" 4327:"Hyperinsulinemia in polycystic ovary syndrome correlates with increased cardiovascular risk independent of obesity" 3260: 443:

In 2006, the Androgen Excess PCOS Society suggested a tightening of the diagnostic criteria to all of the following:

8837:"Effect of Acupuncture and Clomiphene in Chinese Women With Polycystic Ovary Syndrome: A Randomized Clinical Trial" 6695: 6369:"Role of Anti-Müllerian Hormone in pathophysiology, diagnosis and treatment of Polycystic Ovary Syndrome: a review" 4445: 1931:

There are few studies that have investigated the racial differences in cardiometabolic factors in women with PCOS.

1724: 542:(no menstrual periods for three or more consecutive months), but other types of menstrual disorders may also occur. 9953: 4955:

Strauss JF (November 2003). "Some new thoughts on the pathophysiology and genetics of polycystic ovary syndrome".

10529: 10509: 10478: 10443: 10318: 9598: 8528:"Inositol treatment of anovulation in women with polycystic ovary syndrome: a meta-analysis of randomised trials" 1193:(21-hydroxylase deficiency) (which may cause excessive body hair, deep tone voice and others symptoms similar to 9865: 9223:

Polson DW, Adams J, Wadsworth J, Franks S (April 1988). "Polycystic ovaries--a common finding in normal women".

8376: 2719: 10448: 10223: 2551: 1284: 1190: 700: 10534: 10453: 10418: 6691: 4085:"Total testosterone assays in women with polycystic ovary syndrome: precision and correlation with hirsutism" 2947: 2547: 2105:"Terms and thresholds for the ultrasound evaluation of the ovaries in women with hyperandrogenic anovulation" 1587:

do not show advantages over oral contraceptives, but could be an option for people who do not tolerate them.

1008: 7892:"Aromatase inhibitors (letrozole) for ovulation induction in infertile women with polycystic ovary syndrome" 4136:

Carmina E, Stanczyk FZ, Lobo RA (2019). "Evaluation of Hormonal Status". In Strauss JF, Barbieri RL (eds.).

3319: 10463: 10433: 6166:"Laparoscopic ovarian drilling for ovulation induction in women with anovulatory polycystic ovary syndrome" 5201:"Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls" 2083: 1732: 1596: 1556: 1313: 1300: 336:

The exact cause of PCOS remains uncertain, and treatment involves management of symptoms using medication.

10290: 9657: 7319:

11 Clinical guideline 11 : Fertility: assessment and treatment for people with fertility problems

5586:"Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications" 5020: 4558:"PCOS, coronary heart disease, stroke and the influence of obesity: a systematic review and meta-analysis" 3447:

Pasquali R (2018). "Lifestyle Interventions and Natural and Assisted Reproduction in Patients with PCOS".

10524: 9866:"Sasha Pieterse Wows on People's Ones to Watch Red Carpet as She Reveals Why She's 'So Thankful to DWTS'" 5634: 1892: 1825: 1242: 733:(cancer of the uterine lining) are possible, due to overaccumulation of uterine lining, and also lack of 9475:"Health care-related economic burden of the polycystic ovary syndrome during the reproductive life span" 8504: 7492:"First-trimester exposure to metformin and risk of birth defects: a systematic review and meta-analysis" 7412: 6726:"Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline" 10473: 10354: 5685:"Polycystic ovary syndrome, insulin resistance, and obesity: navigating the pathophysiologic labyrinth" 3994:

testosterone) and luteinizing hormone (LH), and increased LH/follicle stimulating hormone (FSH) ratio .

1720:

was recommended treatment for anovulation, but it appears less effective than letrozole or clomiphene.

1627:

B in the US). A review in 2014 concluded that the use of metformin does not increase the risk of major

7597:"Metformin for ovulation induction (excluding gonadotrophins) in women with polycystic ovary syndrome" 4231:

New MI (May 1993). "Nonclassical congenital adrenal hyperplasia and the polycystic ovarian syndrome".

2428: 2176: 10300: 10260: 10216: 5507: 4599:"Medical therapy in women with polycystic ovarian syndrome before and during pregnancy and lactation" 1996:

A number of celebrities and public figures have spoken about their experiences with PCOS, including:

1912: 1308: 636: 9835:"Sasha Pieterse Tears Up Over Health Problems, Opens Up About Losing 15 Pounds Since Joining 'DWTS'" 4083:

Legro RS, Schlaff WD, Diamond MP, Coutifaris C, Casson PR, Brzyski RG, et al. (December 2010).

2391: 1317: 878: 10428: 10139: 9063:"Racial influence on the polycystic ovary syndrome phenotype: a black and white case-control study" 6988:"The role of vitamin D in metabolic disturbances in polycystic ovary syndrome: a systematic review" 6319: 4282:

Hardiman P, Pillay OC, Atiomo W (May 2003). "Polycystic ovary syndrome and endometrial carcinoma".

1603: 1224: 1209:), androgen-secreting neoplasms, and other pituitary or adrenal disorders, should be investigated. 495: 126: 8278:"Providing lifestyle advice to women with PCOS: an overview of practical issues affecting success" 8033:

Penzias A, Bendikson K, Butts S, Coutifaris C, Falcone T, Fossum G, et al. (September 2017).

6724:

Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, et al. (December 2013).

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be passed along to both sons (who may be asymptomatic carriers or may have symptoms such as early

10458: 8150:

Ghanem ME, Elboghdady LA, Hassan M, Helal AS, Gibreel A, Houssen M, et al. (November 2013).

7644: 3827: 2894:"Geographical Prevalence of Polycystic Ovary Syndrome as Determined by Region and Race/Ethnicity" 1701:

For those women that after weight loss still are anovulatory or for anovulatory lean women, then

1459: 933: 726: 664: 503: 134: 121: 8074:

Legro RS, Barnhart HX, Schlaff WD, Carr BR, Diamond MP, Carson SA, et al. (February 2007).

4682: 4138:

Yen and Jaffe's Reproductive Endocrinology: Physiology, Pathophysiology, and Clinical Management

2849:

Lentscher JA, Slocum B, Torrealday S (March 2021). "Polycystic Ovarian Syndrome and Fertility".

1801:

contraceptive may be more effective than either metformin or the oral contraceptive on its own.

9628: 9061:

Ladson G, Dodson WC, Sweet SD, Archibong AE, Kunselman AR, Demers LM, et al. (July 2011).

6986:

Krul-Poel YH, Snackey C, Louwers Y, Lips P, Lambalk CB, Laven JS, et al. (December 2013).

6314: 5019:. McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine. 1736: 1698:

is an alternative medicine that raises FSH levels and promote the development of the follicle.

1665:

possible to have a normal pregnancy. Including medical care and a healthy lifestyle to follow.

1428: 1330: 862: 854: 826: 787: 422: 199: 10168: 9924:"Romee Strijd's Pregnancy Announcement Comes With an Honest Message About Reproductive Health" 9775:"Lea Michele On How PCOS Changed Her Relationship With Food: 'The Side Effects Can Be Brutal'" 8526:

Pundir J, Psaroudakis D, Savnur P, Bhide P, Sabatini L, Teede H, et al. (February 2018).

6123: 4408: 3904: 2145: 7334:"Metformin therapy for the management of infertility in women with polycystic ovary syndrome" 7029:"Serum Vitamin D Levels and Polycystic Ovary syndrome: A Systematic Review and Meta-Analysis" 5654: 4857:

Dumesic DA, Oberfield SE, Stener-Victorin E, Marshall JC, Laven JS, Legro RS (October 2015).

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It may be caused by a combination of genetic and environmental factors. Risk factors include

31: 10196: 8890: 4476:"Anxiety and depression in polycystic ovary syndrome: a systematic review and meta-analysis" 3130: 1387:

PCOS has no cure. Treatment may involve lifestyle changes such as weight loss and exercise.

10438: 9782: 8405: 4964: 4240: 3625:

Sam S (February 2015). "Adiposity and metabolic dysfunction in polycystic ovary syndrome".

1804:

In the case of taking medication for acne, Kelly Morrow-Baez PHD, in her exposition titled

1528: 1264: 1128: 820: 644: 615: 488: 310: 114: 9515:"RCDC Estimates of Funding for Various Research, Condition, and Disease Categories (RCDC)" 8928:

Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. (December 2012).

6969: 5832: 4022: 1770:

PCOS is associated with other mental health related conditions besides depression such as

8: 10468: 10398: 10117: 6775:"Management of the metabolic syndrome and type 2 diabetes through lifestyle modification" 6605: 6471:"Anti-Müllerian hormone: ovarian reserve testing and its potential clinical implications" 6418:

Dewailly D, Andersen CY, Balen A, Broekmans F, Dilaver N, Fanchin R, et al. (2014).

6164:

Bordewijk EM, Ng KY, Rakic L, Mol BW, Brown J, Crawford TJ, et al. (February 2020).

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Thriving with PCOS: Lifestyle Strategies to Successfully Manage Polycystic Ovary Syndrome

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appears to manifest itself at least partially via heightened androgen levels secreted by

905: 762: 609: 571: 235: 204: 9745: 9629:"'Teen Mom' Star Nails the 'Lose-Lose' Side of Chronic Illness Doctors Don't Always Get" 9522: 9171: 9144: 9143:

Elghobashy M, Lau GM, Davitadze M, Gillett CD, O'Reilly MW, Arlt W, et al. (2023).

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Alesi S, Forslund M, Melin J, Romualdi D, Peña A, Tay CT, et al. (September 2023).

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Fauser BC, Diedrich K, Bouchard P, Domínguez F, Matzuk M, Franks S, et al. (2011).

4244: 2772: 2745: 1642:. Medications to induce fertility when trying to conceive include the ovulation inducer 10391: 10020: 9995: 9575: 9548: 9450: 9425: 9338: 9326: 9295: 9283: 9248: 9087: 9062: 9012: 8954: 8929: 8861: 8836: 8812: 8787: 8768: 8725: 8681: 8638: 8558: 8448: 8423: 8353: 8328: 8304: 8277: 8176: 8151: 8015: 7916: 7891: 7867: 7840: 7816: 7789: 7763:

National Institute of Child Health and Human Development, National Institutes of Health

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Grover A, Yialamas MA (March 2011). "Metformin or thiazolidinedione therapy in PCOS?".

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production, which increases binding of free testosterone. This reduces the symptoms of

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Fraison E, Kostova E, Moran LJ, Bilal S, Ee CC, Venetis C, et al. (August 2020).

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Mortada R, Williams T (August 2015). "Metabolic Syndrome: Polycystic Ovary Syndrome".

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have been found to increase visceral fat deposition in both female animals and women.

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De Leo V, Musacchio MC, Cappelli V, Massaro MG, Morgante G, Petraglia F (July 2016).

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Wu XK, Stener-Victorin E, Kuang HY, Ma HL, Gao JS, Xie LZ, et al. (June 2017).

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Dewailly D, Lujan ME, Carmina E, Cedars MI, Laven J, Norman RJ, et al. (2013).

5493: 5450: 5361: 5277: 5150: 5107: 4992: 4311: 4268: 4163: 3851:"Debates Regarding Lean Patients with Polycystic Ovary Syndrome: A Narrative Review" 3713:"Debates Regarding Lean Patients with Polycystic Ovary Syndrome: A Narrative Review" 3697: 3654: 3514: 3174:"Diagnosis of polycystic ovary syndrome: from NIH criteria to ESHRE-ASRM guidelines" 2832: 2789: 2613:

Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E (November 2015).

2370: 1525:

is often very effective due to its anti-inflammatory and anti-oxidative properties.

1491:

guidelines recommend a goal of achieving 10–15% weight loss or more, which improves

989:

factors, environmental impacts (especially industrial endocrine disruptors, such as

10413: 10408: 10239: 10179: 10015: 10007: 9717:"Actress Jaime King on her investment in Allara, a chronic care platform for women" 9570: 9560: 9486: 9445: 9437: 9369: 9322: 9279: 9232: 9166: 9156: 9123: 9110:

Hillman JK, Johnson LN, Limaye M, Feldman RA, Sammel M, Dokras A (September 2013).

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Tanbo T, Mellembakken J, Bjercke S, Ring E, Åbyholm T, Fedorcsak P (October 2018).

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History-taking, specifically for menstrual pattern, obesity, hirsutism and acne. A

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McLuskie I, Newth A (January 2017). "New diagnosis of polycystic ovary syndrome".

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Somani N, Harrison S, Bergfeld WF (2008). "The clinical evaluation of hirsutism".

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Murri M, Luque-Ramírez M, Insenser M, Ojeda-Ojeda M, Escobar-Morreale HF (2013).

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Amato P, Simpson JL (October 2004). "The genetics of polycystic ovary syndrome".

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Not every person with PCOS has polycystic ovaries (PCO), nor does everyone with

784:-inducing remnants, seemingly independent of insulin resistance/type 2 diabetes. 566:(male pattern of hair growth, such as on the chin or chest), but it may produce 10182: 10042:

Eunice Kennedy Shriver National Institute of Child Health and Human Development

10037: 9963: 9441: 9424:

Chahal N, Quinn M, Jaswa EA, Kao CN, Cedars MI, Huddleston HG (December 2020).

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Wang FF, Wu Y, Zhu YH, Ding T, Batterham RL, Qu F, et al. (October 2018).

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Eunice Kennedy Shriver National Institute of Child Health and Human Development

2397:

Eunice Kennedy Shriver National Institute of Child Health and Human Development

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Eunice Kennedy Shriver National Institute of Child Health and Human Development

2182:

Eunice Kennedy Shriver National Institute of Child Health and Human Development

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Rasquin LI, Anastasopoulou C, Mayrin JV (2023). "Polycystic Ovarian Disease".

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7187: 7172:"Metformin in polycystic ovary syndrome: systematic review and meta-analysis" 6270: 4556:

de Groot PC, Dekkers OM, Romijn JA, Dieben SW, Helmerhorst FM (1 July 2011).

4517:"Insulin resistance, polycystic ovary syndrome, and type 2 diabetes mellitus" 3780: 3131:

Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group (January 2004).

1956: 1638:

It can be difficult to become pregnant with PCOS because it causes irregular

1607: 1512: 1408: 1258: 897: 842: 687: 511: 507: 247: 192: 142: 138: 81: 8599: 8546: 7726: 7687: 7508: 7491: 6925: 6908: 6840: 6823: 6645: 6487: 6470: 6436: 6419: 6099: 6082: 5913: 5896: 5633:

Lewandowski KC, Cajdler-Łuba A, Salata I, Bieńkiewicz M, Lewiński A (2011).

5309: 5292: 4976: 4834: 4817: 4736: 4574: 4557: 4492: 4475: 4384: 4367: 4199: 3867: 3729: 3638: 3197: 3149: 3132: 2121: 2104: 1320:(AMH) is increased in PCOS, and may become part of its diagnostic criteria. 10374: 10275: 10029: 9584: 9500: 9459: 9410: 9180: 9096: 9008: 8999: 8963: 8870: 8852: 8821: 8764: 8721: 8677: 8634: 8554: 8457: 8362: 8313: 8262: 8224: 8185: 8136: 8101: 8060: 8011: 7976: 7925: 7876: 7825: 7744: 7695: 7630: 7559: 7517: 7476: 7389: 7284: 7276: 7241: 7205: 7156: 7099: 7064: 7013: 6934: 6890: 6849: 6808: 6759: 6572: 6537: 6496: 6455: 6404: 6328: 6278: 6234: 6199: 6108: 6064: 5995: 5922: 5881: 5804: 5720: 5650: 5619: 5563: 5485: 5442: 5396: 5353: 5318: 5269: 5261: 5234: 5185: 5142: 5099: 5063: 4984: 4936: 4927: 4910: 4892: 4843: 4802: 4754: 4660: 4614: 4583: 4542: 4501: 4393: 4352: 4303: 4217: 4118: 4069: 3980: 3886: 3812: 3799: 3748: 3689: 3646: 3600: 3506: 3430: 3386: 3243: 3189: 3158: 3114: 3070: 3051: 2929: 2910: 2870: 2824: 2781: 2692: 2640: 2518: 2510: 2480: 2362: 2318: 2130: 2055: 2050: 2045: 2015: 2005: 1879: 1861: 1837: 1821: 1673: 1628: 1584: 1295:

Some other blood tests are suggestive but not diagnostic. The ratio of LH (

1280: 1254: 1144: 1106: 1076: 970: 777: 734: 679: 652: 597: 10011: 9383: 9334: 9291: 9244: 8254: 7790:"The Influence of Diet on Ovulation Disorders in Women-A Narrative Review" 6907:

Moran LJ, Ko H, Misso M, Marsh K, Noakes M, Talbot M, et al. (2013).

6635: 5840: 5785: 5701: 5216: 4652: 4260: 4030: 10163: 9491: 9474: 8092: 8075: 6741: 6039:"Polycystic ovary syndrome: validated questionnaire for use in diagnosis" 5872: 5855: 5601: 5134: 4874: 4100: 3528:

Devi T (2018). "Lifestyle Modifications in Polycystic Ovarian Syndrome".

3105: 3088: 2674: 2035: 2030: 1911:

The prevalence of PCOS depends on the choice of diagnostic criteria. The

1888: 1833: 1829: 1688: 1669: 1647: 1588: 1572: 1508: 1338: 1206: 990: 962: 893: 808: 803: 798: 549: 545: 484: 472: 413: 318: 306: 294: 169: 110: 98: 9895:"'Star Wars: The Force Awakens' Actress Opens Up About Painful Disorder" 9315:

The Australian & New Zealand Journal of Obstetrics & Gynaecology

7004: 6987: 6881: 6864: 6528: 6511: 6420:"The physiology and clinical utility of anti-Mullerian hormone in women" 5632: 2631: 2614: 1185:

Other causes of irregular or absent menstruation and hirsutism, such as

961:, since its symptoms are partly reversible. Even though considered as a 618:(AN): A skin condition where dark, thick and "velvety" patches can form. 10191: 7967: 7957: 7940: 7806: 6719: 6717: 5434: 5248:

Hoeger KM (May 2014). "Developmental origins and future fate in PCOS".

4856: 2020: 1643: 1420: 986: 941:

and/or excessive hair) and daughters, who will show signs of PCOS. The

901: 539: 230: 77: 10090: 9397:

Hardeman J, Weiss BD (March 2014). "Intrauterine devices: an update".

8990: 7551: 7458: 7318: 7045: 6446: 3403:

Nafiye Y, Sevtap K, Muammer D, Emre O, Senol K, Leyla M (April 2010).

2171: 2169: 2167: 1844:(the latter of which responsible for most hair growth alterations and 1083:, which is in turn converted to testosterone. The combined effects of 10174: 8410: 6974: 6821: 6025: 5948: 5894: 4061: 3681: 2992: 1964: 1891:, current studies are inconclusive and there's a need for additional 1813: 1795: 1747: 1717: 1706: 1695: 1639: 1576: 1560: 1552: 1452: 1424: 1412: 1400: 1102: 1094: 1016: 982: 942: 874: 870: 563: 491:, ovarian cysts, enlarged ovaries, excess androgen, and weight gain. 476: 458:

Exclusion of other entities that would cause excess androgen activity

401: 298: 239: 102: 59: 6714: 6304: 3905:"Type 2 Diabetes and Metabolic Syndrome in Children and Adolescents" 1635:

in the management of underlying metabolic syndrome remains unclear.

10208: 8117:

Best Practice & Research. Clinical Obstetrics & Gynaecology

7890:

Franik S, Le QK, Kremer JA, Kiesel L, Farquhar C (September 2022).

7343:. Royal College of Obstetricians and Gynaecologists. Archived from 6690: 5091: 5044:

Best Practice & Research. Clinical Obstetrics & Gynaecology

3224:

Best Practice & Research. Clinical Obstetrics & Gynaecology

2546: 2164: 1503:

in 2013 found similar improvements in weight, body composition and

1272: 1004: 938: 861:. Such evidence includes the familial clustering of cases, greater 704: 449: 363:

suggested that a person has PCOS if they have all of the following:

278:

disorder in women of reproductive age. The syndrome is named after

223: 188: 7595:

Sharpe A, Morley LC, Tang T, Norman RJ, Balen AH (December 2019).

6255: 5163: 3903:

Mazze R, Strock ES, Simonson GD, Bergenstal RM (11 January 2007).

2934:

indigenous Australian women could have a prevalence as high as 26%

2802: 2340: 1071:

binding. Furthermore, excessive insulin increases the activity of

7841:"Transtheoretical model-based mobile health application for PCOS" 6367:

Dumont A, Robin G, Catteau-Jonard S, Dewailly D (December 2015).

6366: 2898:

International Journal of Environmental Research and Public Health

2241: 2239: 1959:, sclerocystic ovary syndrome, and Stein–Leventhal syndrome. The 1771: 1632: 1098: 1012: 889: 722:

A diagnosis of PCOS suggests an increased risk of the following:

593: 499: 283: 174: 130: 10133: 8698: 8421: 10102: 10069: 9312: 8612: 8032: 6822:

Veltman-Verhulst SM, Boivin J, Eijkemans MJ, Fauser BJ (2012).

5010: 4718: 2496: 793: 9268: 8422:

van Zuuren EJ, Fedorowicz Z, Carter B, Pandis N (April 2015).

7489: 6772: 6417: 4777:"Molecular progress in infertility: polycystic ovary syndrome" 2280: 2236: 9473:

Azziz R, Marin C, Hoq L, Badamgarav E, Song P (August 2005).

9142: 5076: 4082: 4008: 3902: 3451:. Cham: Springer International Publishing. pp. 169–180. 1404: 1056: 759:(BMI). PCOS is also associated with higher risk for diabetes. 708: 622: 393: 360: 243: 8525: 8379:. United Kingdom: National Health Service. 17 October 2011. 7938: 5817: 4911:"Polycystic ovarian disease: heritability and heterogeneity" 3762:

Sachdeva G, Gainder S, Suri V, Sachdeva N, Chopra S (2019).

2892:

Wolf WM, Wattick RA, Kinkade ON, Olfert MD (November 2018).

2612: 2283:"Genetic, hormonal and metabolic aspects of PCOS: an update" 2102: 1836:) may also be used; they work by blocking the conversion of 1438:

Goals of treatment may be considered under four categories:

9109: 8149: 6985: 6723: 5420: 5015: 4721:"Contemporary genetic technologies and female reproduction" 4555: 3761: 3588: 3532:. Jaypee Brothers Medical Publishers (P) Ltd. p. 195. 1972: 1563:

caused by high testosterone and regulates return to normal

1117: 1068: 1064: 981:

PCOS may be related to or worsened by exposures during the

603: 559: 480: 397: 302: 279: 106: 9222: 9060: 8276:

Ee C, Pirotta S, Mousa A, Moran L, Lim S (November 2021).

7787: 7120: 6862: 6080: 6036: 3898: 3896: 3484: 2744:

Crespo RP, Bachega TA, Mendonça BB, Gomes LG (June 2018).

2743: 1431:

is used by some in whom other measures are not effective.

682:

levels are usually elevated in women with PCOS. In a 2020

53:

Hyperandrogenic anovulation (HA), Stein-Leventhal syndrome

9805:"Keke Palmer Says PCOS Causes Facial Hair and Adult Acne" 8400: 8398: 6563:. In Feingold KR, Anawalt B, Boyce A, Chrousos G (eds.). 6468: 6346:(40 ed.). Lanham, MD: Scarecrow Press. p. 496. 5854:

González F, Rote NS, Minium J, Kirwan JP (January 2006).

5583: 5538:"Environmental determinants of polycystic ovary syndrome" 5290: 4474:

Barry JA, Kuczmierczyk AR, Hardiman PJ (September 2011).

4473: 2848: 2386: 2384: 2382: 2380: 2218:"Polycystic Ovary Syndrome (PCOS): Condition Information" 1351:

PCOS diagnosis is categorized into four different types;

1227:

found that these four questions can diagnose PCOS with a

904:. Other conditions that produce similar symptoms include 527:

Common signs and symptoms of PCOS include the following:

356: 8834: 8326: 8073: 6964: 6561:"Assessing Insulin Sensitivity and Resistance in Humans" 5853: 4446:"Polycystic ovary syndrome (PCOS) - Symptoms and causes" 4047: 2891: 993:

and certain drugs) and the increasing rates of obesity.

857:

of uncertain cause. There is some evidence that it is a

313:. The primary characteristics of this syndrome include: 9996:"Polycystic ovary syndrome in the pediatric population" 9472: 8927: 8786:

Lim CE, Ng RW, Cheng NC, Zhang GS, Chen H (July 2019).

6962: 6960: 6958: 6956: 6954: 6952: 6950: 6948: 6946: 6944: 6773:

Magkos F, Yannakoulia M, Chan JL, Mantzoros CS (2009).

6037:

Pedersen SD, Brar S, Faris P, Corenblum B (June 2007).

4818:"Is foetal hyperexposure to androgens a cause of PCOS?" 4129: 3893: 3402: 2844: 2842: 2586:

Polycystic Ovary Syndrome Current and Emerging Concepts

1887:. There is insufficient evidence to support the use of 1458:

Restoration of regular menstruation, and prevention of

1047:) in women whose ovaries are sensitive to this stimulus 592:, including low energy levels and food cravings. Serum 558:: Known as hyperandrogenism, the most common signs are 9546: 9355: 8395: 7672: 7594: 7080:

Current Opinion in Endocrinology, Diabetes and Obesity

6558: 6212: 5760: 5740:

The Egyptian Journal of Radiology and Nuclear Medicine

5682: 5121:

Ehrmann DA (March 2005). "Polycystic ovary syndrome".

3958: 3911:(2nd ed.). John Wiley & Sons. pp. 213–. 3317: 2377: 27:

Set of symptoms caused by abnormal hormones in females

7314:

National Institute for Health and Clinical Excellence

4770: 4768: 4766: 4764: 4182:

Barry JA, Azizia MM, Hardiman PJ (1 September 2014).

3320:"Diagnosis of Hyperandrogenism in Female Adolescents" 1812:

Other medications with anti-androgen effects include

1616:

National Institute for Health and Clinical Excellence

999:

are defined as chemicals that can interfere with the

885:

increases the risk of developing PCOS in later life.

10080: 9479: