Polycystic ovary syndrome (PCOS) is an endocrine and reproductive disorder with a prevalence ranging from 5% to 13% in women of reproductive age. INFERTILITY AND ITS COMPLICATIONS – POLY CYSTIC OVARIAN SYNDROME
PCOS is the primary cause of hyperandrogenism and oligo-anovulation at the reproductive age and is often associated with infertility and clinical and metabolic disorders. The prevalence of infertility in women with PCOS varies between 70 and 80%. According to the American Society for Reproductive Medicine, the evaluation of infertility in women with PCOS or other causes of subfertility should start after six months of attempting pregnancy without success if the couple has regular sexual intercourse (2 to 3 times/week) without using contraceptive methods. To optimize the efficacy of the treatment of infertile women with PCOS, evaluations of tubal patency (hysterosalpingography or laparoscopy with chromotubation) and semen analysis (spermogram) are mandatory before deciding on treatment.
The choice of the most appropriate treatment depends on the patient’s age, presence of other factors associated with infertility, experience and duration of previous treatments and the level of anxiety of the couple.
NORMAL ANDROGEN PHYSIOLOGY
Understanding of the normal biochemical and molecular basis of steroidogenesis and of normal androgen physiology is necessary to understand the pathophysiology of PCOS.
Under normal circumstances, the ovaries and adrenal glands contribute about equally to testosterone production (58 – 60). Approximately half of testosterone originates from direct testosterone secretion by the ovaries and adrenal glands, whereas half is produced by peripheral conversion of circulating androstenedione, which itself arises from approximately equal ovarian and adrenal secretion.
Androgen production is not under direct negative feedback regulation by the neuroendocrine system in females, as is the case for estradiol and cortisol secretion. Indeed, modest androgen excess interferes with female sex hormone negative feedback according to recent research.
Androgens are secreted by both the ovaries and adrenal glands in response to their respective tropic hormones, LH and ACTH. Intraglandular paracrine and autocrine mechanisms seem to play a major role in modulating androgen secretion in response to tropic hormone stimulation.
HORMONES AND PCOS
With PCOS, the reproductive hormones are out of balance. This can lead to problems with the ovaries, such as not having period on time, or missing it entirely.
Hormones are substances the body makes to help different processes happen. Some are related to the ability to have a baby, and also affect the menstrual cycle. Those that are involved in PCOS include.
-Androgens: Often called “male” hormones, women have them, too. Those with PCOS tend to have higher levels, which can cause symptoms like hair loss, hair in places you don’t want it (such as on your face), and trouble getting pregnant.
-Insulin: This hormone manages blood sugar. When diagnosed with PCOS, the body might not react to insulin the way that it should.
Progesterone: With PCOS, the body may not have enough of this hormone. This can result in missed periods for a long time, or periods that are hard to predict.
SYMPTOMS OF PCOS
If you have things such as oily skin, missed periods, or trouble losing weight, you may think those issues are just a normal part of your life. But those frustrations could actually be signs that you have polycystic ovary (or ovarian) syndrome, also known as PCOS.
The condition has many symptoms, and you may not have all of them. It’s pretty common for it to take women a while — even years — to find out they have this condition.
You might be most bothered by some of the PCOS symptoms that other people can notice. These include:
-Hair growth in unwanted areas. Your doctor may call this “hirsutism” (pronounced HUR-soo-tiz-uhm). You might have unwanted hair growing in places such as on your face or chin, breasts, stomach, or thumbs and toes.
-Hair loss. Women with PCOS might see thinning hair on their head, which could worsen in middle age.
-Weight problems. About half of women with PCOS struggle with weight gain or have a hard time losing weight.
-Acne or oily skin. Because of hormone changes related to PCOS, you might develop pimples and oily skin. (You can have these skin problems without PCOS, of course).
-Problems sleeping, feeling tired all the time. You could have trouble falling asleep. Or you might have a disorder known as sleep apnea. This means that even when you do sleep, you do not feel well-rested after you wake up.
-Headaches. This is because of hormone changes with PCOS.
-Trouble getting pregnant. PCOS is one of the leading causes of infertility.
-Period problems. You could have irregular periods. Or you might not have a period for several months. Or you might have very heavy bleeding during your period.
CAUSES OF PCOS
No one is quite sure what causes PCOS, and it is likely to be the result of a number of both genetic (inherited) as well as environmental factors. Women with PCOS often have a mother or sister with the condition, and researchers are examining the role that genetics or gene mutations might play in its development. The ovaries of women with PCOS frequently contain a number of small cysts, hence the name poly=many cystic ovarian syndrome. A similar number of cysts may occur in women without PCOS. Therefore, the cysts themselves do not seem to be the cause of the problem.
A malfunction of the body’s blood sugar control system (insulin system) is frequent in women with PCOS, who often have insulin resistance and elevated blood insulin levels, and researchers believe that these abnormalities may be related to the development of PCOS. It is also known that the ovaries of women with PCOS produce excess amounts of male hormones known as androgens. This excessive production of male hormones may be a result of or related to the abnormalities in insulin production.
Another hormonal abnormality in women with PCOS is excessive production of the hormone LH, which is involved in stimulating the ovaries to produce hormones and is released from the pituitary gland in the brain.
Other possible contributing factors in the development of PCOS may include a low level of chronic inflammation in the body and fetal exposure to male hormones.
The PCOS diagnosis is generally made through clinical signs and symptoms. The doctor will want to exclude other illnesses that have similar features, such as low thyroid hormone blood levels (hypothyroidism) or elevated levels of a milk-producing hormone (prolactin). Also, tumors of the ovary or adrenal glands can produce elevated male hormone (androgen) blood levels that cause acne or excess hair growth, mimicking symptoms of PCOS.
Other laboratory tests can be helpful in making the diagnosis of PCOS. Serum levels of male hormones ( DHEA and testosterone ) may be elevated. However, levels of testosterone that are highly elevated are not unusual with PCOS and call for additional evaluation. Additionally, levels of a hormone released by the pituitary gland in the brain (LH) that is involved in ovarian hormone production are elevated.
The cysts (fluid filled sacs) in the ovaries can be identified with imaging technology. (However, as noted above, women without PCOS can have many cysts as well.) Ultrasound , which passes sound waves through the body to create a picture of the kidneys, is used most often to look for cysts in the ovaries. Ultrasound imaging employs no injected dyes or radiation and is safe for all patients including pregnant women. It can also detect cysts in the kidneys of a fetus. Because women without PCOS can have ovarian cysts , and because ovarian cysts are not part of the definition of PCOS, ultrasound is not routinely ordered to diagnose PCOS. The diagnosis is usually a clinical one based on the patient’s history, physical examination, and laboratory testing.
More powerful and expensive imaging methods such as computed tomography (CT scan) and magnetic resonance imaging (MRI) also can detect cysts, but they are generally reserved for situations in which other conditions that may cause related symptoms, such as ovarian or adrenal gland tumors are suspected. CT scans require X-rays and sometimes injected dyes, which can be associated with some degree of complications in certain patients.
Women with PCOS are at a higher risk for a number of illnesses, including high blood pressure, diabetes, heart disease, and cancer of the uterus(endometrial cancer).
Because of the menstrual and hormonal irregularities, infertility is common in women with PCOS. Because of the lack of ovulation, progesterone secretion in women with PCOS is diminished, leading to long-term unopposed estrogen stimulation of the uterine lining. This situation can lead to abnormal periods, breakthrough bleeding, or prolonged uterine bleeding in some women. Unopposed estrogen stimulation of the uterus is also a risk factor for the development of endometrial hyperplasia and cancer of the endometrium (uterine lining). However, medications can be given to induce regular periods and reduce the estrogenic stimulation of the endometrium.
Obesity is associated with PCOS. Obesity not only compounds the problem of insulin resistance and type 2 diabetes (see below), but also imparts cardiovascular risks. PCOS and obesity are associated with a higher risk of developing metabolic syndrome , a group of symptoms, including high blood pressure, that increase the chances of developing cardiovascular disease. It has also been shown that levels of C-reactive protein (CRP), a biochemical marker that can predict the risk of developing cardiovascular disease, are elevated in women with PCOS. Reducing the medical risks from PCOS-associated obesity is possible.
The risk of developing prediabetes and type 2 diabetes is increased in women with PCOS, particularly if they have a family history of diabetes. Obesity and insulin resistance, both associated with PCOS, are significant risk factor for the development of type 2 diabetes. Several studies have shown that women with PCOS have abnormal levels of LDL (“bad”) cholesterol and lowered levels of HDL (“good”) cholesterol in the blood. Elevated levels of blood triglycerides have also been described in women with PCOS.
Changes in skin pigmentation can also occur with PCOS. Acanthosis nigricans refers to the presence of velvety, brown to black pigmentation often seen on the neck, under the arms, or in the groin. This condition is associated with obesity and insulin resistance and occurs in some women with PCOS.
STANDARD TREATMENT PRACTICE
Treatment of PCOS depends partially on the woman’s stage of life. For younger women who desire birth control, the birth control pill, especially those with low androgenic (male hormone-like) side effects can cause regular periods and prevent the risk of uterine cancer. Another option is intermittent therapy with the hormone progesterone. Progesterone therapy will induce menstrual periods and reduce the risk of uterine cancer, but will not provide contraceptive protection.
For acne or excess hair growth, a water pill (diuretic) called spironolactone (Aldactone) may be prescribed to help reverse these problems. The use of spironolactone requires occasional monitoring of blood tests because of its potential effect on the blood potassium levels and kidney function. Eflornithine (Vaniqa) is a cream medication that can be used to slow facial hair growth in women.Electrolysis and over-the-counter depilatory creams are other options for controlling excess hair growth.
For women who desire pregnancy, a medication called clomiphene (Clomid) can be used to induce ovulation (cause egg production). In addition, weight loss can normalize menstrual cycles and often increases the possibility of pregnancy in women with PCOS. Other, more aggressive, treatments for infertility (including injection of gonadotropin hormones and assisted reproductive technologies) may also be required in women who desire pregnancy and do not become pregnant on Clomid therapy.
Metformin(Glucophage) is a medication used to treat type 2 diabetes. This drug affects the action of insulin and is useful in reducing a number of the symptoms and complications of PCOS. Metformin has been shown to be useful in the management of irregular periods, ovulation induction, weight loss, prevention of type 2 diabetes, and prevention of gestational diabetes mellitus in women with PCOS.
Obesity that occurs with PCOS needs to be treated because it can cause numerous additional medical problems. The management of obesity in PCOS is similar to the management of obesity in general. Weight loss can help reduce or prevent many of the complications associated with PCOS, including type 2 diabetes and heart disease. Consultation with a dietician on a frequent basis is helpful until just the right individualized program is established for each woman.
Finally, a surgical procedure known as ovarian drilling can help induce ovulation in some women who have not responded to other treatments for PCOS. In this procedure a small portion of ovarian tissue is destroyed by an electric current delivered through a needle inserted into the ovary.
ALTERNATIVE TREATMENT PRACTICE
The treatment of PCOS depends on the woman’s goal for therapy. Lifestyle modification is often used to treat the metabolic consequences of PCOS. Pharmacological agents such as metformin (Mt), oral contraceptive pills (OCPs), and antiandrogen agents (AA) are also frequently used. Mt is associated with fatal and nonfatal lactic acidosis even though the incidence ranges from 1 to 17 cases per 100,000 patients-years. OCPs have been associated with weight gain and cardiovascular and thromboembolic events. AA use has been associated with hepatic toxicity that could be fatal. The risk and nature of these side effects must be considered when choosing therapies.
Mechanistically, the abnormal oxidative stress in polycystic ovary syndrome (PCOS) patients could cause genetic instability and raise the risk of cancers. Oxidative stress has been demonstrated to be significantly associated with obesity, insulin resistance (IR), inflammation, and hyperandrogenemia, which are the common characteristics and potential inducers of PCOS and endometrial cancer and could participate and be induced in an interweaving way during disease physiology
The key to improving the condition is getting rid of the root cause. Immunocal provides a good strategy because it contains bonded Cysteine the precursor of the very powerful antioxidant glutathione. Findings of many studies indicate that glutathione enhancing therapy using IMMUNOCAL® represents an effective therapeutic tool in a wide range of hormonal imbalance challenges in men and women
Building on this cause, and on an understanding of the effect of Glutathione on oxidative stress, the use of IMMUNOCAL, as Glutathione enhancer in treating hormonal imbalance challenges. IMMUNOCAL a patented product, modulate intracellular glutathione (GSH) to perform the following function:
Prevention of oxidative cell damage by scavenging ROS
- DNA synthesis and repair
- Amino acid transport and protein synthesis
- Metabolism of toxins and carcinogens
- Immune system response enhancement
Remember, Immunocal simply REPAIRS damaged body cells. Hence, cells of the ovaries can use insulin better with the use of Immunocal overtime thus getting rid of the poly cyst. Some diet modification is also required. In other words, Immunocal has the potential to help considerably.
IMMUNOCAL would be helpful to reduce the adverse side effects from usage of conventional drugs in the treatment of PCOS such as maintaining the acid base balance of the body and preventing the build up of lactic acid and subsequent acidification of the blood caused by metformin usage. IMMUNOCAL also help to maintain a healthy body weight preventing excessive weight gain and also ensures adequate vascular flow preventing cardiovascular and thromboembolic events induced by oral contraceptive pills.
Medical science has long known that a GSH deficiency invariably accompanies liver damage. When toxicity occurs as a result of hepatotoxic pharmaceutical drugs such as antiandrogen agents, the GSH-enhancing product IMMUNOCAL (a cysteine isolate) is used to raise GSH levels rapidly. This eliminates the toxic breakdown products of the drug.
There’s no limitation to daily dosage or duration of using Immunocal. However, we recommend minimum of 1-2 sachets daily and the patient can keep using until desired result is achieved and even beyond to maintain health. Though, the more the patient can afford to use daily, the faster and better it works. Some people observe improvement within days while others take longer. It all depends on how their body respond.
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