Polycystic Ovary Syndrome

Stress

Absence of menstruation

Hair thinning and loss

Irregular menstruation Facial hair

Skin discoloration

Acne

High blood pressure Depression Weight gain

PCOS treatment focuses on managing your individual concerns, such as infertility, hirsutism, acne, or obesity. Specific treatment might involve lifestyle changes or medication.

MEDICATIONS

- To regulate your menstrual cycle, your doctor might recommend: Combination birth control pills: Pills that contain estrogen and progestin decrease androgen production and regulate estrogen.

Regulating your hormones can lower your risk of endometrial cancer and correct abnormal bleeding, excess hair growth and acne. Instead of pills, you might use a skin patch or vaginal ring that contains a combination of estrogen and progestin.

Progestin therapy : Taking progestin for 10 to 14 days every one to two months can regulate your periods and protect against endometrial cancer. Progestin therapy doesn't improve androgen levels and won't prevent pregnancy. The progestin-only mini pill or progestin-containing intrauterine device is a better choice if you also wish to avoid pregnancy.

- To help you ovulate, your doctor might recommend: Clomiphene : This oral anti-estrogen medication is taken during the first part of your menstrual cycle.

Letrozole (Femara) : This breast cancer treatment can work to stimulate the ovaries.

Metformin : This oral medication for type 2 diabetes improves insulin resistance and lowers insulin levels. If you don't become pregnant using clomiphene, your doctor might recommend adding metformin. If you have prediabetes, metformin can also slow the progression to type 2 diabetes and help with weight loss.

Gonadotropins : These hormone medications are given by injection.

- To reduce excessive hair growth, your doctor might recommend: Birth control pills: These pills decrease androgen production that can cause excessive hair growth.

Spironolactone (Aldactone) : This medication blocks the effects of androgen on the skin. Spironolactone can cause birth defects, so effective contraception is required while taking this medication. It isn't recommended if you're pregnant or planning to become pregnant.

Eflornithine (Vaniqa) : This cream can slow facial hair growth in women.

Electrolysis : A tiny needle is inserted into each hair follicle. The needle emits a pulse of electric current to damage and eventually destroy the follicle. You might need multiple treatments.

"Research has shown that healthy eating habits and regular physical activity help in the management of PCOS. Fat storage in PCOS patients primarily affects the abdomen, especially the lower part "belly fat".

Hydrogenated fats can increase estrogen production, which can make PCOS symptoms worse, and can lead to weight gain. Focusing on whole-grains, fruits, vegetables, lean protein foods and low-fat milk, cheese or yogurt can help to manage both weight and blood glucose."

“ Women with PCOS seem to face unique challenges: yo-yo dieting, intense cravings, increased hunger, hypoglycemia, eating disorders, mood swings and exposure to inaccurate nutrition information. Reduction in insulin resistance has been suggested as the principal goal of PCOS. Losing 5-10% of body weight, in addition to increasing physical activity level are proposed to ameliorate insulin resistance, free testosterone levels, and ovulatory function. The size of caloric deficit to achieve weight loss should be determined according to individuals’ needs. Gluten free diets could be considered for patients presenting with constipation, diarrhea, bloating, fatigue and brain fog. Nutritional counseling that tackle carbohydrate distribution, meal frequency and timing, adequate intake of omega 3 fatty acids and/or vitamin D supplementation can offer additional benefits. Taking inositol to help regulate insulin and cravings can be helpful, too. Among other strategies to help manage PCOS is to avoid long hours without eating, practice mindful eating by trusting body cues and coping with emotions pertaining to foods, managing stress and having enough good quality sleep.”

Is there any association with gut microbiome?

Recent studies in humans and rodent models have shown an association between changes in the gut microbiome and the metabolic and clinical parameters of PCOS. In addition, it has been proposed that dysbiosis of gut microbiota may be a potential pathogenetic factor in the development of PCOS. In this context, modification of gut microbiota with probiotic, prebiotic, and synbiotic agents suggests that these products may serve as new treatment options for PCOS. Is there any link between PCOS and auto-immune disease?

Different autoantibodies have been documented in PCOS, for example, anti-nuclear (ANA), anti-thyroid, anti-spermatic, anti-SM, anti-histone, anti-carbonic anhydrase, anti-ovarian, and anti-islet cell antibodies. There is an association between PCOS and autoimmune diseases such as ANA and anti-TPO that have been documented in systemic lupus erythematosus and Hashimoto thyroiditis, respectively, and it is suspected that there are autoantibodies that might affect the long-term clinical management of these patients.

Therefore, fluctuating levels of autoantibodies in different PCOS patients give us the way to open new chapter for future research on molecular level. This may lead to discovery of better treatment options for PCOS in near future Does L-Carnitine have a role to play in PCOS Management?

Carnitine is a quaternary amine synthesized in the body from amino acids lysine and methionine. In living cells, this chemical agent can transfer fatty acids from the cytosol to the mitochondria to produce energy from fatty acids. Carnitine is often used as a micronutrient and is divided into two types: L-carnitine (active form) and D-carnitine (inactive form). L-carnitine plays an important role in glucose metabolism and oxidative stress. It can also stabilize the mitochondrial membranes and prevent cell apoptosis.

L-Carnitine plays an important role in the oxidative process within the mitochondria and has a beneficial role in glucose metabolism. Women with PCOS have lower plasma concentrations of L-Carnitine levels compared to healthy non-PCOS women. Whether PCOS in itself or the associated obesity is the causative factor is unclear at present. However, administration of L-Carnitine in women with PCOS is shown to reduce insulin resistance and to improve the androgen and lipid profile, with weight loss and improvements in anthropometric measurements. A single study has shown an improvement in ovulation and pregnancy rate in CC resistant women receiving L-Carnitine. It is important to evaluate whether its beneficial effects surpass that of lifestyle modification and metformin in PCOS and effective dose and duration of therapy. This requires large randomized controlled trials with adequate sample size replicating the initial evidence.