The Holistic prevention, management and treatment of Polycystic Ovarian Syndrome: The Diagnosis(Revised edition with Citations)

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                      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 cardiovasular disease(8)(13), acne(10)(14), endometrial cance(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 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).

Ovarian Cysts And PCOS Elimination
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References
(1) Adiposity and metabolic dysfunction in polycystic ovary syndrome by Sam S.(PubMed)
(2) A "kiss" before conception: triggering ovulation with kisspeptin-54 may improve IVF by Young SL.(PubMed)
(3.) Androgen hyperfunction and excessive heterosexual hair growth in women, with special attention to the polycystic ovarian syndrome by Lunde O¹.(PubMed)
(4) Expression of anti-Müllerian hormone in letrozole rat model of polycystic ovary syndrome by Du DF¹, Li XL, Fang F, Du MR.(PubMed)
(5) [Serum levels of anti-muller hormone in women with polycystic ovary syndrome and healthy women of reproductive age].[Article in Bulgarian] by Parahuleva N, Pehlivanov B, Orbecova M, Deneva T, Uchikova E.(PubMed)
(6) [Current opinions on the etiology and pathophysiology of hirsutism].[Article in Polish] by Krysiak R¹, Kedzia A, Okopień B.(PubMed)
(7) The clinical evaluation of hirsutism by Somani N¹, Harrison S, Bergfeld WF.(PubMed)
(8) Polycystic ovary syndrome and insulin: our understanding in the past, present and future by Mayer SB¹, Evans WS, Nestler JE.(PubMed)
(9) Association of mean platelet volume with androgens and insulin resistance in nonobese patients with polycystic ovary syndrome by Dogan BA¹, Arduc A², Tuna MM¹, Karakılıc E¹, Dagdelen I¹, Tutuncu Y¹, Berker D¹, Guler S¹.(PubMed)
(10) Approach to the patient: contraception in women with polycystic ovary syndrome by Yildiz BO¹.(PubMed)
(11) Polycystic ovarian syndrome (PCOS): a significant contributor to the overall burden of type 2 diabetes in women by Talbott EO¹, Zborowski JV, Rager JR, Kip KE, Xu X, Orchard TJ.(PubMed)
(12) Prevalence of vitamin D deficiency in Slovak women with polycystic ovary syndrome and its relation to metabolic and reproductive abnormalities by Figurová J¹, Dravecká I, Javorský M, Petríková J, Lazúrová I.(PubMed)
(13) Role of Insulin Sensitizers on Cardiovascular Risk Factors in Polycystic Ovarian Syndrome: A Meta-Analysis by Thethi TK¹, Katalenich B², Nagireddy P³, Chabbra P⁴, Kuhadiya N⁵, Fonseca V¹.(PubMed)
(14) Acne in hirsute women by Lumezi BG¹, Pupovci HL¹, Berisha VL¹, Goçi AU², Gerqari A³.(PubMed)
(15) Obesity and polycystic ovary syndrome by Naderpoor N¹, Shorakae S, Joham A, Boyle J, De Courten B, Teede HJ.(PubMed)
(16) Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan by Teede H¹, Deeks A, Moran L.(PubMed)
(17) Metabolic Evidence of Diminished Lipid Oxidation in Women With Polycystic Ovary Syndrome. by Whigham LD¹, Butz DE², Dashti H³, Tonelli M³, Johnson LK¹, Cook ME², Porter WP⁴, Eghbalnia HR⁵, Markley JL⁶, Lindheim SR⁷, Schoeller DA⁸, Abbott DH⁹, Assadi-Porter FM¹⁰.(PubMed)
(18) Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis by Barry JA¹, Azizia MM¹, Hardiman PJ².(PubMed)
(19) Risk of cancer among women with polycystic ovary syndrome: a Danish cohort study by Gottschau M¹, Kjaer SK², Jensen A¹, Munk C¹, Mellemkjaer L³.(PubMed)
(20) Polycystic ovary syndrome: metabolic consequences and long-term management by Carmina E¹.(PubMed)
(21) Arterial stiffness is increased in asymptomatic nondiabetic postmenopausal women with a polycystic ovary syndrome phenotype by Armeni E¹, Stamatelopoulos K, Rizos D, Georgiopoulos G, Kazani M, Kazani A, Kolyviras A, Stellos K, Panoulis K, Alexandrou A, Creatsa M, Papamichael C, Lambrinoudaki I.(PubMed)
(46) Female Obesity and Infertility by Talmor A¹, Dunphy B².(PubMed)
(47) [Reproductive problems in women with PCOS, the impact of PAL-1 CARRIERS OF 4G PAI -1 polymorphism and BMI].[Article in Bulgarian] by Komsa-Penkova R, Golemanov G, Georgieva G, Slavov N, Popovski K, Ivanov P, Kovacheva K, Atanasova M, Blajev A.(PubMed)
(48) Endothelial function in young women with polycystic ovary syndrome (PCOS): Implications of body mass index (BMI) and insulin resistance by El-Kannishy G¹, Kamal S², Mousa A², Saleh O², Badrawy AE², Farahaty RE², Shokeir T².(PubMed)
(49) Body Mass Index and Gonadotropin Hormones (LH & FSH) Associate With Clinical Symptoms Among Women With Polycystic Ovary Syndrome by Esmaeilzadeh S, Andarieh MG¹, Ghadimi R, Delavar MA.(PubMed)
(50) Thyroid disorders in polycystic ovarian syndrome subjects: A tertiary hospital based cross-sectional study from Eastern India by Sinha U¹, Sinharay K, Saha S, Longkumer TA, Baul SN, Pal SK.(PubMed)
(51) The evaluation and management of hirsutism by Azziz R¹.(PubMed)
(52) Pcos.[No authors listed](PubMed)
(53) DHEA, DHEAS and PCOS by Goodarzi MO¹, Carmina E², Azziz R³.(PubMed)
(54) Adrenal androgen excess and body mass index in polycystic ovary syndrome by Moran C¹, Arriaga M, Arechavaleta-Velasco F, Moran S.(PubMed)
(55) Superactive human leptin antagonist reverses leptin-induced excessive progesterone and testosterone secretion in porcine ovarian follicles by blocking leptin receptors by Gregoraszczuk EL¹, Rak A.(PubMed)
(56) Reproduction in hens: is testosterone necessary for the ovulatory process? by Rangel PL¹, Gutierrez CG².(PubMed)
(57) The value of sex hormone binding globulin (SHBG) in predicting treatment response in polycystic ovary syndrome (PCOS) by Wassell J¹, Michail M, Soliman N, Wardle PG.(PubMed)
(58) Effects of metformin treatment in women with polycystic ovary syndrome depends on insulin resistance by Nawrocka J¹, Starczewski A.(PubMed)
(59) Serum luteinizing hormone level and luteinizing hormone/follicle-stimulating hormone ratio but not serum anti-Müllerian hormone level is related to ovarian volume in Korean women with polycystic ovary syndrome by Chun S¹.(PubMed)
(60) [Effect of luteinizing hormone vs follicular stimulating hormone ratio on anti-Müllerian hormone secretion and folliculogenesis in patients with polycystic ovarian syndrome].[Article in Chinese] by Li Y¹, Wei LN, Xiong YL, Liang XY.(PubMed)
(61) Thyroid disorders in polycystic ovarian syndrome subjects: A tertiary hospital based cross-sectional study from Eastern India by Sinha U¹, Sinharay K, Saha S, Longkumer TA, Baul SN, Pal SK.(PubMed)

(62) Studies of cardiovascular risk factors in polycystic ovary syndrome patients combined with subclinical hypothyroidism by Pei YJ¹, Wang AM, Zhao Y, Yan L, Li M, White RE, Han GC.(PubMed)
(63) Polycystic ovary syndrome and chronic autoimmune thyroiditis by Novais Jde S¹, Benetti-Pinto CL, Garmes HM, Jales RM, Juliato CR.(PubMed)
(64) Association of thyroid-stimulating hormone with insulin resistance and androgen parameters in women with PCOS by Dittrich R¹, Kajaia N, Cupisti S, Hoffmann I, Beckmann MW, Mueller A.(PubMed)

(65) [Association between levels of serum leptin and insulin resistance in patients with polycystic ovary syndrome].[Article in Chinese]by Cheng X¹, Guo J², Xie J³.(PubMed)
(66) [Clinical study on treating insulin resistance and promoting ovulation in polycystic ovary syndrome].[Article in Chinese]by Liu ZA¹, Xue YM, Chen LX, Cai Q, Chen H, Zhang J, Cui QH, Ge J, Yuan T.(PubMed)
(67) Randomized clinical trial evaluating metformin versus oral contraceptive pills in the treatment of adolescents with polycystic ovarian syndrome by Al-Zubeidi H, Klein KO.(PubMed)
(68) Randomized controlled trial evaluating response to metformin versus standard therapy in the treatment of adolescents with polycystic ovary syndrome by Allen HF¹, Mazzoni C, Heptulla RA, Murray MA, Miller N, Koenigs L, Reiter EO.(PubMed)