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Sunday, 5 July 2015

The Holistic Prevention, Management and Treatment of PCOs analysed through Conventional Medicine Research and Studies(Part I)

"The Holistic Prevention, Management and Treatment of PCOs analysed through Conventional Medicine Research and Studies" provides you the accurate information of the use of natural sources to prevent, management and treatment of Polycystic Ovarian Syndrome, because all presentations are proven through convention research and studies found in PubMed. This is the second time, a research paper has been written this way to general public that you will not find any where in the net. We would like to provide more of this kind the research, but unfortunately, it is time consuming and burdened financially, we have run out of time and the site will be shut down Monday(July 6, 2015). If you like what you read, please donate generously to our site.
Kyle J. Norton

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 Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
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).

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....

                The Immunity Boosting Minerals

Recent studies showed that deficiencies of zinc, iron, copper, and selenium lower resistance to disease either due to impaired immune response or faulty white blood cells' function(421)
1. Magnesium
The mineral, magnesium plays a key role in the immune response, by acting as a co-factor for immunoglobulin synthesis(422) that significantly increases for both IgA and IgG, the antibody molecules that protect our body against bacterial and viral infections(423) and the lining of the respiratory passages, gastrointestinal and genitourinary tract(423).
The mineral also found to increase neutrophil function and enzyme peroxidase activity and reduce the incidence of health disorders by boosting immunity(424), including chronic inflammatory disease(425)(426). Low serum magnesium (Mg) is often associated with  incidences of insulin resistance (IR), cardiovascular problems, diabetes mellitus, hypertension and other components of metabolic syndrome(428) in patients with polycystic ovary syndrome (PCOS)(427).

2. Selenium
Selenium, a trace mineral plays an important and indirect role as an antioxidant(429)(430) by fulfilling its function as a necessary constituent of glutathione peroxidase(431)(432) and in production of glutathione(432), that inhibits the damage caused by oxidation of free radical hydrogen peroxide(433).
Extensively epidemiological studies suggested that selenium also benefits to health aspects, including anti cancers(434)(435), lowering cholesterol(436)(438), hypertension(439)(440), treating heart disease(427)(438), boosting immunity(441)(442) against microbial invasion(443)(444) and anti chronic inflammatory disease(445)(446).

3. Zinc
Zinc besides is an important mineral in boosting immune system activity(447)(449). Its nano-structure zinc(II) coordination compounds, has been used in zinc therapy to treat candida overgrowth(449) by promoting metallothionein (MT)(found in high concentration in intestinal mucosa)synthesis(450) through its anti inflammatory activity(451), including chronic inflammation(453)(454) via immune modulatory effects(452)(453)(454).

4. Manganese
Manganese is an essential trace nutrient in all forms of life. It is well known for its role in helping the body to maintain healthy skin(455)(456) and bone structure(457)(458), but also acts as cofactors for a number of enzymes(459) in higher organisms, where they are essential in iexhibting its antioxidant effects against free radicals(450)(451). Recent studies suggested that manganese also benefits in controlling bood glucose(452)(453), alleviating neuro symptoms such as anxiety, and depression(454) and treatment of high cholesterol levels(456), hypertension(455), infertility(457), cardiomyopathy(458), reduced oxidative stress, amyloid deposition, and memory(459) and boosting immune system anti microbial infections and inflammation(460).
In larger amounts, manganese can be poisoning to neurological damage(451)(462).

5. Iron
A mineral plays a vital role for production of hemoglobin(463)(464)utilised by the body for oxygen transport and energy production(467), for maintaining healthy bones(465) and neurotransmission(466), synthesizing of some hormones and connective tissue(467)(468)(469) and maintaining heart health(470). Deficiency of iron causes low level of hemoglobin, nervous tension((473)(474)), cognitive dysfunction(471)(476), heart disorders(472)(475), heavy menstrual bleeding(479)(480), iron deficiency anemia, etc.,.. Recent studies suggested that trace mineral iron improves immunity(481)(482) fighting against  microbial infection(481) and inflammatory disease(483)(484), including certain types of chronic inflammatory diseases(486)(485) due to low levels of hemoglobin impaired cell-mediated immune response and bacterial activity of leukocytes(421).

3. Copper
Copper is vital in maintaining the production of antibodies(487)(488), white blood cells(489)(490), antioxidant enzymes(491)(492), for increasing the immune function in fighting against infection(487)(488) and inflammation(493)(494), including certain chronic inflammatory diseases(495)(496). The mineral also acts as a modulator of neuronal transmission(497), regulates production of certain hormones(498). Deficiency of copper may cause metabolic liver disease(502), copper deficiency anemia(503),.... Excess of copper levels can induce cognitive disorders(504)(505), reduced antioxidant status(506) and deficiency and excess can may persuade infertile(499), low libido and sexual issues(500), low quality sperm production(499)(500), disrupted nervous function(501), etc.,...

                     The Antioxidants

1. Bilirubin
Bilirubin is a prosthetic group helped to break down molecules into smaller units in releasing energy, excreted in bile and urine. It is a cellular antioxidant(511), by reverting to biliverdin, a green tetrapyrrolic bile pigment, once again when oxidized, it  inhibits the effects of mutagens(512). The antioxidant showed to inhibit digestive proteases like trypsin and chymotrypsin(504), benefit heart health(505) and nonalcoholic fatty liver disease(507), reduce risk of diabetes(506). Recent studies also found that the antioxidant exhibits its anti inflammatory effects(511) against certain chronic inflammatory diseases, including psoriasis(508), chronic obstructive pulmonary disease(509), .... and enhances immunity activities(510)

2. Carotenoids
Carotenoids are organic pigments, occurring in the chloroplasts and chromoplasts(513) of plants and some photosynthetic organisms like algae and bacteria(514).
a. Beta-carotene
Beta-carotene, an organic compound classified as a terpenoid, is a strongly-coloured red-orange pigment in plants and fruits, stored in liver for the production of vitamin A. Epidemiological evidences sugested that beta-carotene neutralizes singlet oxygen before giving rise of free radicals(515) which can damage of DNA, leading to improper cell DNA replication(516)(517), causing irregual cells growth, such as cancers(518)(519)(520). The phytochemical also promotes immunity(521)(522) against foreign invasion and symptoms of chronic inflammatory disease(523)(524) and improve low-density lipoprotein cholesterol resistance to oxidation causes of cardiovascular disease related to atherosclerosis(527) through its antioxidant anti inflammatory activities(525)(526).....

b. Alpha-carotene
Alpha-carotene, one of the most abundant carotenoids in the North American diet, is a form of carotene with a β-ring at one end and an ε-ring at the other, not only protects cells from the damaging effects of free radicals(526)  and enhances the immune system(528) in fighting against bacteria and virus infection and inflammation(529)(530), but also inhibits irregular cell growth(531)(532) cause of benign tumors(531) and cancers(532).

c. Beta-cryptoxanthin
Chemically Beta-cryptoxanthin is a xanthophyll which protects our cells from oxidation(538) and provides a source of vitamin A. The phytochemical showed to  enhances the immune system functioning(533)(534) against infectious(537) and inflammatory diseases(535)(536) and reduces insulin resistance(536) and cancers(539)(540) risks

d. Lycopene
Lycopene is a red carotene of the carotenoids group found in tomatoes, watermelons, and grapefruits. This antioxidant is believed to be a powerful fighter against irregular growth(543), such as prostate cancer(541)(542), breast cancer(544)(545) and liver diseases(546)(547). Lycopene has many anti-aging(549) capabilities as well as enhancing immune function(548) against oxidative stress(550)(551) and inflammatory diseases(551)(552).

3. Flavonoids
Flavonoids also known as Vitamin P and citrin are a yellow pigments having a structure similar to that of flavones occurred in varies plants. used in human history for over thousands of years for breakage of capillaries causes of swelling and obstruction of blood flow(553).
Flavonoids process a property as antioxidants for neutralization of many of reactive oxygen species (ROS)(554)(555), including singlet oxygen(556), hydroxyl(557) radicals involved chronic inflammatory diseases(558)(559).
Although nitric oxide is considered a free radical produced by immune system to destroy bacteria induced infection(561), over production can cause increased peroxynitrite which may attack protein, lipid and DNA(560). Flavonoids inhibit NO production of peroxynitrite through various antioxidant enzymes(562).

a. Quercetin
Quercetin is a plant-derived flavonoid found in fruits, vegetables, leaves and grains and studies show that quercetin may have anti-inflammatory(563)(564) and antioxidant(565)(566) properties as a antioxidant, quercetin scavenges free radicals(567), which damage cells (568) and cause mutation of cells with tampering DNA(569)(570).

b. Rutin
Rutin is a citrus flavonoid glycoside found in buckwheat and glycoside of the flavonoid quercetin. It inhibits platelet aggregation(571), decreases the capillary permeability(572), makes blood thinner and improves circulation. As an antioxidant, it also reduces the cytotoxicity of oxidized LDL cholesterol(573) triggered atherogenesis and the risks of other chronic inflammatory diseases(574)(575)(576).

c. Catechin
Catechin is a natural phenol antioxidant and natural anti-bacterial substance. Study showed catechin as good free radical scavenging power inhibits ROS production(577), may be be useful to the development of alimentary strategies to prevent ochratoxin A (OTA) cytotoxicity in human(578). As an antixidant, catchin also process anti inflammatory effects against many chronic inflammatory illness(579)(580)(581)(582).

d. Etc.

4. Coenzyme Q10
Coenzyme Q10 is discovered by Dr. Karl Folfers in 1957, serves as fuel for the cells(583) and acts an antioxidant to prevent the generation of free radicals during this process(584) induced numbers of chronic inflammatory diseases, such as diabetes(585)(586), cardiovascular(587)(588) and Parkinson's disease(589)(590). The antioxidanr also was  found effectivetively in the treatment of clomiphene-citrate-resistant PCOS patients through improving ovulation and clinical pregnancy rates when use combination with clomiphene citrate(591).

                              The Phytochemicals

1. Tanshinone
Tanshinones, a class of phytochemicals found abundantly in Salvia miltiorrhiza (Danshen or Tanshen in Chinese) has shown to process several pharmacological effects including anti-inflammatory(596), antioxidative stress(595)(597), antisenile dementia(598), antiplatelet aggregation(593), anti atherosclerosis(599), hypertension(600), and ischemic stroke(594) and anticancer activities(592)(593), etc. Recent study if a total of 100 eligible women with PCOs meeting certain criteria recruited from four centers in China, conducted by First Affiliated Hospital of Heilongjiang University of Chinese Medicine, suggested that tanshinones ameliorate excessive androgens by inhibiting steroid hormone produced by the theca cells in the ovary(601)(602) and improve insulin resistance and glucose metabolism(602)(603). Dr. Wenjuan Shen and the research team also said " CHM can regulate and strengthen the hormonal systems of the whole body and is a natural approach for treating PCOS. The significant advantages of CHM are that it provides several options for the safe, effective, multitargeted treatment of various aspects of PCOS including hyperandrogenism and poor quality of life"(604).

2. Berberine
Berberine, a phytochemical found in many herbs, including Berberis aquifolium (Oregon grape), Berberis vulgaris (barberry), Berberis aristata (tree turmeric)], Hydrastis canadensis, etc., has been used in traditional medicine over thousand years for treatment of microbial infections(605)(606)(607)(608),  trachoma(609), ,leishmaniasis(610).. Epedemiological studies suggested that the phytochemicals may also be effective for treatment of diabetes(611)(612), dyslipidemias(613)(614), hypertention(615), insulin resistance and the metabolic syndrome(616). cancers(617)(618)(619), etc. 
Recent studies also showed that berberine also exerts its health benefits by improving some of the metabolic and hormonal derangements in a group of Eighty-nine subjects with PCOS and IR Chinese women with PCOS(620). When compare to metformin (MET), the phytochemical Berberine  showed  decrease in waist circumference and waist-to-hip ratio, fasting plasma glucose, fasting insulin, homeostasis model assessment for IR, area under the curve of insulin, cholesterol and triglycerides as well as increase in high-density lipoprotein cholesterol and sex hormone-binding(621).  In combination with Letrozole for treatment of PCOs, the phytochemical showed the effectiveness in lowering  blood sugar levels in db/db mice and exerted anti-dyslipidemia in human(622)

3. Curcimin
Turmeric is a perennial plant in the genus Curcuma, belonging to the family Zingiberaceae, native to tropical South Asia. (See Turmeric in the top 5  anti inflammation foods for the use of the herb in traditional medicine).
Immunohistochemical expression of VEGF may be associated to the pathophysiology of PCOS(623) as VEGF concentrations are found to increase in women with polycystic ovaries(624). Curcumin, according to  the First Affiliated Hospital, Chongqing Medical University, lower the expression of VEGF in ovarian tissues of PCOS in high- and low-dose administrative rat model, and may have certain therapeutic effect on PCOS(625).

                           The differentiation of Possible PCOs Diet

1. High Protein Diet with Low-Glycemic-Load Hypocaloric Diet
Diet with 30% of protein is now considered reasonable, high protein diet is the term reserved for consumption of 50% or more.
Suggestions in linking High Protein Diet with Low-Glycemic-Load Hypocaloric Diet to control and combat polycystic ovary syndrome (PCOS) have drawn attention in scientific community over last decade. It may be due to its effect in lowing density lipoprotein cholesterol( LDL-C ), reduction of insulin sensitive and androgen levels in PCO patients(626a). But epidemiological studies focusing the benefit of diets in treating obese and overweight patients have produced an inclusive results. The National Nutrition and Food Technology Research Institute showed that both composition may lead to significantly  reduced body weight and androgen levels.  Compared with a conventional diet, the combination of high-protein and low-glycemic-load foods and Hypocaloric diett also found to be effective in enhanced insulin sensitivity and decreased hsCRP level (626). But the alternation of metabolic rate of hypocaloric diet  in glucose utilization and decreased antioxidant defenses, in some cases may result in life-threatening(634).

2. Hypocaloric diet
 Comparison with Metformin in the same subjects, hypocaloric(low calories) diet showed a reduction of 5-10% of weight on markers of insulin resistance with  equal efficacy with Metformin in decreasing serum hs-CRP levels(627) and improving inflammatory biomarkers and adipokines independently of dietary composition(628). A 20 weeks of a high-protein energy-restricted diet to evaluate the Markers of endothelial dysfunction, including elevated markers of endothelial dysfunction, presented in overweight and obese women with polycystic ovary syndrome, showed an significant weight loss, improved testosterone, sex hormone-binding globulin and the free androgen index (FAI) and insulin resistance(629). Sibutramine(the hydrochloride monohydrate salt) removed from the market because of the concerns of risk of heart attack and stroke. A comparison test with hypocaloric diet, showed a significant weight loss in overweight and obese women with PCOS andimprovement in hyperandrogenemia and insulin sensitivity after 6 months of treatment(630). Clomiphene citrate (CC) used conjunction with hypocaloric diet with structured exercise training (SET) after 6 weeks in overweight and obese CC-resistant PCOS patients, enhanced the probability of ovulation under CC treatment, through a significant improvement in clinical and biochemical androgen and insulin sensitivity indexes(631).
A comparison of  a hypocaloric low-fat diet with those of a very low carbohydrate diet, showed the positive effects in both diets in significant improvements in BMI, WC, and menstrual function and induced weight loss through targeting both the menstrual dysfunction and risk factors for long-term morbidity associated with PCOS in adolescents(632). Short-term hypocaloric diet including high protein (HP: 30% protein, 40% carbohydrate, and 30% fat) or high carbohydrate (HC: 15% protein, 55% carbohydrate, and 30% fat) showed a significant weight loss reduction and  improvement in their reproductive and metabolic abnormalities with no increased benefit to a high-protein diet(633).
Some researchers suggested that Hypocaloric (low-calorie) diets can alter your metabolic rate in glucose utilization and decreased antioxidant defenses, in some case may result in life-threatening(634).

3. Low-carbohydrate diet
  A high-fat, adequate-protein, low-carbohydrate diet has been used in medicine primarily to treat difficult-to-control (refractory) epilepsy in children with purpose to induce the body to burn fat other than carbohydrate. A PCOs women 24 weeks study with  limit carbohydrate intake to 20 grams or less per day, showed non-significant decreases in insulin, glucose, testosterone, HgbA1c, triglyceride, and perceived body hair but improvement in weight, percent free testosterone, LH/FSH ratio, and fasting insulin in women with obesity(635). According to the University of Padova study, "Epidemiological studies over last decade or so has provided evidence of the therapeutic potential of ketogenic diets in many pathological conditions, such as diabetes, polycystic ovary syndrome, acne, neurological diseases, cancer and the amelioration of respiratory and cardiovascular disease risk factors"(636). Some researchers insisted that the presence of high levels of insulin in the blood causes  unnecessary water retention in the body(637) and the diet may produce a short term effect through eliminating excess body fat but may cause dehydration as an early-onset complication(638)

4. Low glycemic index diet
Glycemic index diet originally is developed to help improve blood sugar control in diabetes by choosing foods Low-GI foods (55 and under) for steadier rise in blood sugar. A Twenty-six participants recruited at baseline, 22 commenced and 21 participants completed the low-GI dietary intervention phase, low glycemic diet improved insulin sensitivity, changes of lipids(639). Comparison of low glycemic index with a conventional healthy diet in overweight and obese premenopausal women, low glycemic index attendants showed to improve more in glucose tolerance through oral-glucose-tolerance test (ISI(OGTT)), menstrual cyclicity, with serum fibrinogen concentrations significant differences between diets(640). Researchers also suggested that longer term compliance needs more evaluation in subsequent studies to reduced long term health risks to women with PCOS on a low GI diet(642). In comparison of low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus, some researchers suggested that the diet containing fewer carbohydrates, the low-carbohydrate, ketogenic diet, was more effective for improving glycemic control than the low glycemic diet(641).

5. High-protein diet
High-protein diet is a diet mostly recommended for people who want to build muscle and lose fat. A comparison of a high protein (HP) and a normal protein (NP) diet on patients with polycystic ovary syndrome (PCOS) in 8-week randomized trial, showed a significantly reduced body weight, body mass index (BMI), waist circumference, percent of body fat,  decreased total testosterone in PCOs(643).  In fact, increased dietary protein-to-carbohydrate ratios showed no differences in testosterone, sex hormone-binding globulin, and blood lipids between the groups after 6 months, but adjustment for weight changes led to significantly lower testosterone concentrations in the standard-protein (SP) diet group, according to the University of Copenhagen(644). Unfortunately, some studies showed that consumption of HP diets may cause alterations in renal health status and some metabolic parameters(645) and reduce the level of osteocalcin(646)

7. High monounsaturated fat diet
High monounsaturated fat diet is a diet high in monounsaturated fatty acids (HMUFA)  for  a replacment of daily intake of bad fat. In a comparison of Carbohydrate-restricted diets high in either monounsaturated fat or protein, showed that magnitude of weight loss was smaller in the LF-HP group than in the HF-SP(647). The Mediterranean diet, a High monounsaturated fat diet is characterized by a high intake of olive oil, plant products, fish and seafood; a low intake of dairies, meat and meat products; and a moderate ethanol intake, but unfortunately, exploring the relationship between the Mediterranean diet and overweight/obesity is complex with inclusive results. Some studies indicated a significantly related to less overweight/obesity or more weight loss but many found no evidence of this association(648).

8. Low fat diet 
Low fat diet restricts consumption of fat and stresses foods high in carbohydrates, mostly recommended to patients with some gallbladder conditions. A comparison of hormonal and metabolic markers after a high-fat, Western meal versus a low-fat, high-fiber meal in women with polycystic ovary syndrome, showed a reduction of free testosterone within 2 hours after both meals, however, the levels of testosterone remained below premeal values for 4 hours after the isocaloric low-fat, high-fiber meal (HIFIB) meal and 6 hours after the a high-fat, Western meal (HIFAT) meal. Levels of glucose was higher for 1 hour after the HIFIB meal compared with the HIFAT meal. DHEAS decreased 8%-10% within 2-3 hours after both meals, then increased during the remainder of the study period. Cortisol decreased during the 6-hour period after both meals(649). Suggestion of individuals on a low-fat vegan must ensure adequate intakes of  of vitamin D, vitamin K, folic acid, calcium, magnesium, zinc, vitamin B12, phosphorous, and selenium(650).

Taking all together, there are subtle differences but correlation between diets, a monounsaturated fat-enriched diet induced greater weight loss, a low-glycemic index diet enhanced menstrual regularity, a high-carbohydrate diet increased free androgen index, a low-carbohydrate or low-glycemic index diet induced greater reductions in insulin resistance, fibrinogen, total testosterone, and high-density lipoprotein cholesterol, a low-glycemic index diet improved quality of life, a high-protein diet.improved depression and self-esteem for a high-protein diet. Maximize weight loss control is important for women with PCOS regardless of dietary composition which should target all overweight women with PCOS through reducing calories with adequate nutritional intake and healthy food choices irrespective of diet composition(651).

(See the references page for citations)

1. The Holistic Prevention, Management of PCOs analysed through Conventional Medicine Research and Studies(Part I) - The Prevention
2. The Holistic Prevention, Management of PCOs analysed through Conventional Medicine Research and Studies (Part II)- The Conventional Supplement page
3. The Holistic Prevention, Management of PCOs analysed through Conventional Medicine Research and Studies(Part III) - The Weight loss approach
5. The Holistic Prevention, Management of PCOs analysed through Conventional Medicine Research and Studies(Part V) - The TCM approach
7. The Holistic Prevention, Management of PCOs analysed through Conventional Medicine Research and Studies(References page of 700 -1499)