Polycystic Ovary Syndrome, a modern epidemic: An overview
Abstract
Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting women, but can be very difficult to diagnose and treat due to vague presentation of symptoms and a lack of standardization in treatment. PCOS is characterized by hyperandrogenic manifestation like acne, hirsutism and chronic anovulation and is associated with metabolic derangement such as hyperlipidemia, hyperinsulinemia, insulin resistance and Type 2 diabetes mellitus.The cause of polycystic ovary syndrome is still unclear due to its multifactorial complexity; however, it has been observed and understood that there are several environmental and genetic factors, such as genetic variations like mutations and polymorphisms, differential regulation of genes, and pathways, may contribute to the pathogenesis of PCOS.The occurrence of considerable heterogeneity in clinical symptoms and endocrine features associated with PCOS implies that some women with Polycystic Ovaries on ultrasound scan may even exhibit none of the other features of PCOS.There is a spectacular increase in the prevalence of PCOS all over the world especially in Asia. The condition seems to be on a rise in Kashmir valley although systematic studies on the subject are still underway. In this review article, we will briefly provide an overview about the polycystic ovary syndrome.
Keywords: Polycystic ovary syndrome, Genetic basis, clinical presentation
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References
1. Maqbool M, Gani I and Geer MI: Polycystic ovarian syndrome- a multifaceted disease: a review. Int J Pharm Sci& Res 2019; 10(3):1072-79.
2. Allahbadia GN and R Merchant. Polycystic Ovary Syndrome in the Indian Subcontinent. Seminars in Reproductive Medicine 2008; 26(1):22-34.
3. Pasquali R, A Gambineri and U Pagotto. The Impact of Obesity on Reproduction in Women with Polycystic Ovary Syndrome. BJOG: An International Journal of Obstetrics and Gynaecology 2006; 113(10):1148-1159.
4. WHO 2009 World Health Organization. Electronic document, http://www.who.int, accessed 4/28/2009, 2009.
5. Abbott DH, DA Dumesic and S. Franks. Developmental Origin of Polycystic Ovary Syndrome - A Hypothesis. Journal of Endocrinology 2002; 174(1):1-5.
6. Xita N and A Tsatsoulis. Fetal Programming of Polycystic Ovary Syndrome by Androgen Excess: Evidence from Experimental, Clinical, and Genetic Association Studies.Journal of Clinical Endocrinology and Metabolism 2006; 91(5):1660-1666.
7. Balen A, R Homburg and S Franks. Defining Polycystic Ovary Syndrome. BMJ 2009; (Clinical Research Ed.) 338.
8. Mudasir Maqbool et al., Polycystic In Ovarian Syndrome and Its Various Treatment Strategies, Indo Am. J. P. Sci, 2018; 05(09);8670-8678.
9. Farquhar C. Introduction and history of polycystic ovary syndrome. In: Kovacs G, Norman R, editors. Polycystic Ovary Syndrome. 2nd ed. Cambridge, UK. Cambridge University Press 2007:4–24.
10. Balen A, Conway G, Kaltsas G. Polycystic ovary syndrome: the spectrum of the disorder in 1741 patients. Hum Reprod 1995; 10:2107–11.
11. Hart R. Definitions, prevalence and symptoms of polycystic ovaries and the polycystic ovary syndrome. In: Allahbadia GN, Agrawal R, editors. Polycystic Ovary Syndrome. Kent, UK: Anshan, Ltd 2007:15–26.
12. Hart R. Definitions, prevalence and symptoms of polycystic ovaries and the polycystic ovary syndrome. In: Allahbadia GN, Agrawal R, editors. Polycystic Ovary Syndrome. Kent, UK: Anshan, Ltd 2007:15–26.
13. Ferriman D, Gallwey J. Clinical assessment of body hair growth in women. J ClinEndocrinolMetab 1961; 21:1440–47.
14. Cook H, Brennan K, Azziz R. Reanalyzing the modified Ferriman-Gallwey score: is there a simpler method for assessing the extent of hirsutism?. Fertility and sterility. 2011; 96(5):1266-70.
15. Adams J, Polson D, Franks S. Prevalence of polycystic ovaries in women with anovulation and idiopathic hirsutism. Br Med J 1986; 293(6543):355–59.
16. Souter I, Sanchez L, Perez M, Bartolucci A, Azziz R. The prevalence of androgen excess among patients with minimal unwanted hair growth. Am J ObstetGynecol 2004; 19:1914–20.
17. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J ClinEndocrinolMetab 2004; 89:2745–49.
18. Wijeyaratne CN, Balen AH, Barth JH, Belchetz PE. Clinical manifestations and insulin resistance (IR) in polycystic ovary syndrome (PCOS) among south Asians and Caucasians: is there a difference? ClinEndocrinol (Oxf). 2002; 57:343–50.
19. Lowenstein E. Diagnosis and management of the dermatologic manifestations of the polycystic ovary syndrome. DermatolTher 2006; 19(4):210–23.
20. Eden J. The polycystic ovary syndrome presenting as resistant acne successfully treated with cyproterone acetate. Med J Aust 1991; 155(10): 677– 80.
21. Teede H, Deeks A, Moran L. Polycystic ovary syndrome: a complex conditions with psychological, reproductive and metabolic manifestations that impact on health across the lifespan. BMC Med 2010; 8:41.
22. Brassard M, AinMelk Y, Baillargeon JP. Basic infertility including polycystic ovary syndrome. Med Clin North Am 2008; 92:1163–92.
23. Glueck C, Phillips H, Cameron D, Sieve-Smith L, Wang P. Continuing metformin throughout pregnancy in women with polycystic ovary syndrome appears to safely reduce first-trimester spontaneous abortion: a pilot study. FertilSteril 2001; 75(1):46–52.
24. Jakubowicz DJ, Iuorno MJ, Jakubowicz S, Roberts K, Nestler JE. Effects of metformin on early pregnancy loss in the polycystic ovary syndrome. J ClinEndocrinolMetab 2002; 87(2):524–29.
25. Zawadski JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome. In: Givens JHF, Merriman G, editors. The Polycystic Ovary Syndrome. Cambridge, MA: Blackwell Scientific 1992:377–84.
26. Maqbool M, Dar MA, Gani I, Geer MI, Insulin Resistance and Polycystic ovary Syndrome: A Review, Journal of Drug Delivery and Therapeutics. 2019; 9(1-s):433-436.
27. Lindholm, A, Andersson, L, Eliasson, M, Bixo, M &Sundström-Poromaa, I 2008, ‘Prevalence of symptoms associated with polycystic ovary syndrome’,International Journal of Gynaecology& Obstetrics, vol. 102, no. 1, pp. 39-43.
28. Jesintha Mary, M, Deecaraman, M, Vijayalakshmi, M &Umashankar, V 2015a,‘A systemic review on differential regulation of genes in polycystic ovarian syndrome disease’, International Journal of Pharma and Biosciences, vol. 6, no. 2, pp. 893- 900
29. Mohamed-Hussein, ZA &Harun, S 2009, ‘Construction of a polycystic ovary syndrome (PCOS) pathway based on the interactions of PCOS-related proteins retrieved from bibliomic data’, Theoretical Biology & Medical Modelling, vol. 1, no. 6, pp. 6-18
30. Mikola, M, Hiilesmaa, V, Halttunen, M, Suhonen, L &Tiitinen 2001, ‘Obstetric outcome in women with polycystic ovary syndrome’ Human Reproduction, vol. 16, no. 2, pp. 226-229
31. Gregory, CW, Wilson, EM, Apparao, KB, Lininger, RA, Meyer, WR &Kowalik, A 2002, ‘Steroid receptor coactivator expression throughout the menstrual cycle in normal and abnormal endometrium’, Journal of Clinical Endocrinology & Metabolism, vol. 87, no. 6, pp. 2960-2966
32. Cermik, D, Selam, B & Taylor, HS, ‘Regulation of HOXA-10 expression by testosterone in vitro and in the endometrium of patients with polycystic ovary syndrome’, Journal of Clinical Endocrinology & Metabolism, 2003; 88(1):238-243
33. Jesintha Mary, M, Deecaraman, M, Vijayalakshmi, M &Umashankar, V ,‘Genetic variations in polycystic ovarian syndrome disease’, Asian Journal of Pharmaceutical and Clinical Research, 2015; 8(30:62-67
34. Thathapudi, S, Kodati, V, Erukkambattu, J, Addepally, U &Qurratulain, H, ‘Association of luteinizing hormone chorionic gonadotropin receptor gene polymorphism (rs2293275) with polycystic ovary syndrome’, Genetic Testing and Molecular Biomarkers, 2015; 19(3):128-132
35. Movahed, Z, Kohan, L, Fallahi, S &Tabiee, O, ‘Influence of chemerin rs17173608 polymorphism on polycystic ovary syndrome susceptibility’, Taiwan Journal of Obstetrics & Gynecology, 2015; 54(30:280-283
36. Sun, L, Lv, H, Wei, W, Zhang, D & Guan, Y, ‘Angiotensin-converting enzyme D/I and plasminogen activator inhibitor-1 4G/5G gene polymorphisms are associated with increased risk of spontaneous abortions in polycystic ovary syndrome’, Journal of Endocrinological Investigation, 2010; 33(20:77-82
37. Rogenhofer, N, Engels, L &Bogdanova, N, ‘Independent association of theM2/ANXA5 haplotype with recurrent pregnancy loss (RPL) in PCOS patients’, Metabolism, 2013; 62(8):1057-1060
38. The Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Consensus on infertility treatment related to polycystic ovary syndrome. FertilSteril 2008; 89(3):505-52.
39. The Rotterdam ESHRE/ASRM sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long term health risks related to polycystic ovary syndrome. FertilSteril 2004; 8:19-25.
40. Azziz R, Carmina E, Dewailily D. Criteria for Defining Polycystic Ovary Syndrome as a Predominantly Hyper androgenic Syndrome: an androgen excess society guideline. J ClinEndocrinolMetab 2006; 91:4237-45.
41. Legro RS, Chiu P, Kunselman AR, Bentley CM, Dodson WC, Dunaif A. Polycystic ovaries are common in women with hyperandrogenic chronic anovulation but do not predict metabolic or reproductive phenotype. J ClinEndocrinolMetab 2005; 90(5):2571–79.
42. Legro RS, Gnatuk CL, Kunselman AR, Dunaif A. Changes in glucose tolerance over time in women with polycystic ovary syndrome: a controlled study. J ClinEndocrinolMetab 2005; 90(6):3236–42.
43. Halperin IJ, Kumar SS, Stroup DF, Laredo SE. The association between the combined oral contraceptive pill and insulin resistance, dysglycemia and dyslipidemia in women with polycystic ovary syndrome: a systematic review and meta-analysis of observational studies. Hum Reprod 2011; 26:191–201.
2. Allahbadia GN and R Merchant. Polycystic Ovary Syndrome in the Indian Subcontinent. Seminars in Reproductive Medicine 2008; 26(1):22-34.
3. Pasquali R, A Gambineri and U Pagotto. The Impact of Obesity on Reproduction in Women with Polycystic Ovary Syndrome. BJOG: An International Journal of Obstetrics and Gynaecology 2006; 113(10):1148-1159.
4. WHO 2009 World Health Organization. Electronic document, http://www.who.int, accessed 4/28/2009, 2009.
5. Abbott DH, DA Dumesic and S. Franks. Developmental Origin of Polycystic Ovary Syndrome - A Hypothesis. Journal of Endocrinology 2002; 174(1):1-5.
6. Xita N and A Tsatsoulis. Fetal Programming of Polycystic Ovary Syndrome by Androgen Excess: Evidence from Experimental, Clinical, and Genetic Association Studies.Journal of Clinical Endocrinology and Metabolism 2006; 91(5):1660-1666.
7. Balen A, R Homburg and S Franks. Defining Polycystic Ovary Syndrome. BMJ 2009; (Clinical Research Ed.) 338.
8. Mudasir Maqbool et al., Polycystic In Ovarian Syndrome and Its Various Treatment Strategies, Indo Am. J. P. Sci, 2018; 05(09);8670-8678.
9. Farquhar C. Introduction and history of polycystic ovary syndrome. In: Kovacs G, Norman R, editors. Polycystic Ovary Syndrome. 2nd ed. Cambridge, UK. Cambridge University Press 2007:4–24.
10. Balen A, Conway G, Kaltsas G. Polycystic ovary syndrome: the spectrum of the disorder in 1741 patients. Hum Reprod 1995; 10:2107–11.
11. Hart R. Definitions, prevalence and symptoms of polycystic ovaries and the polycystic ovary syndrome. In: Allahbadia GN, Agrawal R, editors. Polycystic Ovary Syndrome. Kent, UK: Anshan, Ltd 2007:15–26.
12. Hart R. Definitions, prevalence and symptoms of polycystic ovaries and the polycystic ovary syndrome. In: Allahbadia GN, Agrawal R, editors. Polycystic Ovary Syndrome. Kent, UK: Anshan, Ltd 2007:15–26.
13. Ferriman D, Gallwey J. Clinical assessment of body hair growth in women. J ClinEndocrinolMetab 1961; 21:1440–47.
14. Cook H, Brennan K, Azziz R. Reanalyzing the modified Ferriman-Gallwey score: is there a simpler method for assessing the extent of hirsutism?. Fertility and sterility. 2011; 96(5):1266-70.
15. Adams J, Polson D, Franks S. Prevalence of polycystic ovaries in women with anovulation and idiopathic hirsutism. Br Med J 1986; 293(6543):355–59.
16. Souter I, Sanchez L, Perez M, Bartolucci A, Azziz R. The prevalence of androgen excess among patients with minimal unwanted hair growth. Am J ObstetGynecol 2004; 19:1914–20.
17. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J ClinEndocrinolMetab 2004; 89:2745–49.
18. Wijeyaratne CN, Balen AH, Barth JH, Belchetz PE. Clinical manifestations and insulin resistance (IR) in polycystic ovary syndrome (PCOS) among south Asians and Caucasians: is there a difference? ClinEndocrinol (Oxf). 2002; 57:343–50.
19. Lowenstein E. Diagnosis and management of the dermatologic manifestations of the polycystic ovary syndrome. DermatolTher 2006; 19(4):210–23.
20. Eden J. The polycystic ovary syndrome presenting as resistant acne successfully treated with cyproterone acetate. Med J Aust 1991; 155(10): 677– 80.
21. Teede H, Deeks A, Moran L. Polycystic ovary syndrome: a complex conditions with psychological, reproductive and metabolic manifestations that impact on health across the lifespan. BMC Med 2010; 8:41.
22. Brassard M, AinMelk Y, Baillargeon JP. Basic infertility including polycystic ovary syndrome. Med Clin North Am 2008; 92:1163–92.
23. Glueck C, Phillips H, Cameron D, Sieve-Smith L, Wang P. Continuing metformin throughout pregnancy in women with polycystic ovary syndrome appears to safely reduce first-trimester spontaneous abortion: a pilot study. FertilSteril 2001; 75(1):46–52.
24. Jakubowicz DJ, Iuorno MJ, Jakubowicz S, Roberts K, Nestler JE. Effects of metformin on early pregnancy loss in the polycystic ovary syndrome. J ClinEndocrinolMetab 2002; 87(2):524–29.
25. Zawadski JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome. In: Givens JHF, Merriman G, editors. The Polycystic Ovary Syndrome. Cambridge, MA: Blackwell Scientific 1992:377–84.
26. Maqbool M, Dar MA, Gani I, Geer MI, Insulin Resistance and Polycystic ovary Syndrome: A Review, Journal of Drug Delivery and Therapeutics. 2019; 9(1-s):433-436.
27. Lindholm, A, Andersson, L, Eliasson, M, Bixo, M &Sundström-Poromaa, I 2008, ‘Prevalence of symptoms associated with polycystic ovary syndrome’,International Journal of Gynaecology& Obstetrics, vol. 102, no. 1, pp. 39-43.
28. Jesintha Mary, M, Deecaraman, M, Vijayalakshmi, M &Umashankar, V 2015a,‘A systemic review on differential regulation of genes in polycystic ovarian syndrome disease’, International Journal of Pharma and Biosciences, vol. 6, no. 2, pp. 893- 900
29. Mohamed-Hussein, ZA &Harun, S 2009, ‘Construction of a polycystic ovary syndrome (PCOS) pathway based on the interactions of PCOS-related proteins retrieved from bibliomic data’, Theoretical Biology & Medical Modelling, vol. 1, no. 6, pp. 6-18
30. Mikola, M, Hiilesmaa, V, Halttunen, M, Suhonen, L &Tiitinen 2001, ‘Obstetric outcome in women with polycystic ovary syndrome’ Human Reproduction, vol. 16, no. 2, pp. 226-229
31. Gregory, CW, Wilson, EM, Apparao, KB, Lininger, RA, Meyer, WR &Kowalik, A 2002, ‘Steroid receptor coactivator expression throughout the menstrual cycle in normal and abnormal endometrium’, Journal of Clinical Endocrinology & Metabolism, vol. 87, no. 6, pp. 2960-2966
32. Cermik, D, Selam, B & Taylor, HS, ‘Regulation of HOXA-10 expression by testosterone in vitro and in the endometrium of patients with polycystic ovary syndrome’, Journal of Clinical Endocrinology & Metabolism, 2003; 88(1):238-243
33. Jesintha Mary, M, Deecaraman, M, Vijayalakshmi, M &Umashankar, V ,‘Genetic variations in polycystic ovarian syndrome disease’, Asian Journal of Pharmaceutical and Clinical Research, 2015; 8(30:62-67
34. Thathapudi, S, Kodati, V, Erukkambattu, J, Addepally, U &Qurratulain, H, ‘Association of luteinizing hormone chorionic gonadotropin receptor gene polymorphism (rs2293275) with polycystic ovary syndrome’, Genetic Testing and Molecular Biomarkers, 2015; 19(3):128-132
35. Movahed, Z, Kohan, L, Fallahi, S &Tabiee, O, ‘Influence of chemerin rs17173608 polymorphism on polycystic ovary syndrome susceptibility’, Taiwan Journal of Obstetrics & Gynecology, 2015; 54(30:280-283
36. Sun, L, Lv, H, Wei, W, Zhang, D & Guan, Y, ‘Angiotensin-converting enzyme D/I and plasminogen activator inhibitor-1 4G/5G gene polymorphisms are associated with increased risk of spontaneous abortions in polycystic ovary syndrome’, Journal of Endocrinological Investigation, 2010; 33(20:77-82
37. Rogenhofer, N, Engels, L &Bogdanova, N, ‘Independent association of theM2/ANXA5 haplotype with recurrent pregnancy loss (RPL) in PCOS patients’, Metabolism, 2013; 62(8):1057-1060
38. The Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Consensus on infertility treatment related to polycystic ovary syndrome. FertilSteril 2008; 89(3):505-52.
39. The Rotterdam ESHRE/ASRM sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long term health risks related to polycystic ovary syndrome. FertilSteril 2004; 8:19-25.
40. Azziz R, Carmina E, Dewailily D. Criteria for Defining Polycystic Ovary Syndrome as a Predominantly Hyper androgenic Syndrome: an androgen excess society guideline. J ClinEndocrinolMetab 2006; 91:4237-45.
41. Legro RS, Chiu P, Kunselman AR, Bentley CM, Dodson WC, Dunaif A. Polycystic ovaries are common in women with hyperandrogenic chronic anovulation but do not predict metabolic or reproductive phenotype. J ClinEndocrinolMetab 2005; 90(5):2571–79.
42. Legro RS, Gnatuk CL, Kunselman AR, Dunaif A. Changes in glucose tolerance over time in women with polycystic ovary syndrome: a controlled study. J ClinEndocrinolMetab 2005; 90(6):3236–42.
43. Halperin IJ, Kumar SS, Stroup DF, Laredo SE. The association between the combined oral contraceptive pill and insulin resistance, dysglycemia and dyslipidemia in women with polycystic ovary syndrome: a systematic review and meta-analysis of observational studies. Hum Reprod 2011; 26:191–201.
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Mohd M, Maqbool M, Dar MA, Mushtaq I. Polycystic Ovary Syndrome, a modern epidemic: An overview. JDDT [Internet]. 15May2019 [cited 14Apr.2021];9(3):641-4. Available from: http://jddtonline.info/index.php/jddt/article/view/2661
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