Volume : 10, Issue : 06, June – 2023

Title:

28.POLYCYSTIC OVARY SYNDROME-A REVIEW ON EPIDEMIOLOGY, PATHOPHYSIOLOGY & HERBAL TREATMENT

Authors :

Vivek kumar, Palak Panjwal,Kanika Sharma, Pravesh Kumar,Swati Kashyap, Neelam Sharma*

Abstract :

The heterogeneous illness known as polycystic ovarian syndrome (PCOS) affects females and is connected to an endocrine reproductive disorder. It affects girls of 18-44 age. Complexities like many cysts and an irregular menstrual cycle are caused by the ongoing hormonal imbalance, which eventually makes it difficult for women to conceive. Several potential genes have been shown to be one of the factors contributing to PCOS. To determine the genetic linkage of PCOS, numerous investigations have been conducted. It is crucial to conduct research that pinpoint the hormone imbalance, and PCOS’s precise etiology. This review has emphasized on epidemiology, genetics, diagnosis and treatment of PCOS, which causes hormonal imbalance. Yet, this study was only a superficial attempt to understand the pathophysiology and genetic basis of PCOS.
Keywords: PCOS, AMH, hyperandrogenism, oligomenorrhea, Infertility.

Cite This Article:

Please cite this article in press Neelam Sharma et al, Polycystic Ovary Syndrome-A Review On Epidemiology, Pathophysiology & Herbal Treatment., Indo Am. J. P. Sci, 2023; 10 (06).

Number of Downloads : 10

References:

1. Akre, Shivani, et al. “Recent advances in the management of polycystic ovary syndrome: a review article.” Cureus 14.8 (2022).
2. Rosenfield, Robert L; Ehrmann, David A (2016). The Pathogenesis of Polycystic Ovary Syndrome (PCOS). Endocrine Reviews.2015-1104
3. Spritzer, P.M. (2002) Revisitando o hirsutismo. ArquivosBrasileiros de Endocrinologia&Metabologia, 46,127-136.
4. Mykhalchenko, Kateryna, et al. “Genetics of polycystic ovary syndrome.” Expert review of molecular diagnostics 17.7 (2017): 723-733.
5. Ovalle F, AzzizR2002 Insulin resistance, polycystic ovary syndrome, and type 2 diabetes mellitus. FertilSteril 77:1095–1105.
6. Wild RA2002 Long-term health consequences of PCOS. Hum Reprod Update 8:231–241.
7. Legro RS2003 Polycystic ovary syndrome and cardiovascular disease: a premature association? Endocr Rev 24:302–312
8. Hardiman, Paul, Ouma S. Pillay, and William Atiomo. “Polycystic ovary syndrome and endometrial carcinoma.” The lancet 361.9371 (2003): 1810-1812.
9. Fauser BC, et al. Serum bioactive and immunoreactive luteinizing hormone and follicle-stimulating hormone levels in women with cycle abnormalities, with or without polycystic ovarian disease. J Clin Endocrinol Metab. 73(4):811–817.
10. Van Santbrink EJ, Hop WC, Fauser BC (1997) Classification of normogonadotropic infertility: polycystic ovaries diagnosed by ultrasound versus endocrine characteristics of polycystic ovary syndrome. FertilSteril. 67(3):452–458.
11. lbáñez L, et al. An international consortium update: pathophysiology, diagnosis, and treatment of polycystic ovarian syndrome in adolescence. Horm Res Paediatr. 2017;88:371–395.
12. Hsueh AJW, et al. Intraovarian control of early Folliculogenesis. Endocr Rev. 2015;36:1–24.
13. Franks S, Stark J, Hardy K. Follicle dynamics and anovulation in polycystic ovary syndrome. Hum Reprod Update. 2008;14:367–378.
14. Boomsma, C. M., et al. “A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome.” Human reproduction update 12.6 (2006): 673-683.
15. Qin, Jun Z., et al. “Obstetric complications in women with polycystic ovary syndrome: a systematic review and meta-analysis.” Reproductive Biology and Endocrinology 11.1 (2013): 1-14.
16. Kjerulff, Lucinda E., Luis Sanchez-Ramos, and Daniel Duffy. “Pregnancy outcomes in women with polycystic ovary syndrome: a metaanalysis.” American journal of obstetrics and gynecology 204.6 (2011): 558-e1.
17. Soni, Abhishek, Shivali Singla, and Sachin Goyal. “Polycystic ovary syndrome: Pathogenesis, treatment and secondary associated diseases.” Journal of Drug Delivery and Therapeutics 8.5 (2018): 107-112.
18. C Muhas, et al. “Polycystic ovarian syndrome – an overview ”, Int J Curr Pharm Res 2018;10(6):5-9.
19. Nagarathna PKM. A detailed study on polycystic ovarian syndrome and its treatment with natural products. Int J ToxicolPharmacol Res 2014; 5:109-20.
20. AmeetPatki. Polycystic ovarian syndrome in infertility, Sri Lanka. J Obstetrics Gynaecol2012;34:112-9.
21. Baillie, Peter. “Understanding the importance of polycystic ovaries.” ISRA Med J 9 (2010): 27-29.
22. Vink, J. M., et al. “Heritability of polycystic ovary syndrome in a Dutch twin-family study.” The Journal of Clinical Endocrinology & Metabolism 91.6 (2006): 2100-2104.
23. Diamanti-Kandarakis, Evanthia, et al. “Therapeutic effects of metformin on insulin resistance and hyperandrogenism in polycystic ovary syndrome.” European Journal of Endocrinology 138.3 (1998): 269-274.
24. Azziz, Ricardo, et al. “Health care-related economic burden of the polycystic ovary syndrome during the reproductive life span.” The Journal of Clinical Endocrinology & Metabolism 90.8 (2005): 4650-4658.
25. Christin‐Maitre, S., and J. N. Hugues. “A comparative randomized multicentric study comparing the step‐up versus step‐down protocol in polycystic ovary syndrome.” Human Reproduction 18.8 (2003): 1626-1631.
26. March, Wendy A., et al. “The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria.” Human reproduction 25.2 (2010): 544-551.
27. Kumar, Pratap, and Kashif Khan. “Effects of metformin use in pregnant patients with polycystic ovary syndrome.” Journal of human reproductive sciences 5.2 (2012): 166.
28. Franks, Stephen. “Polycystic ovary syndrome.” New England Journal of Medicine 333.13 (1995): 853-861.
29. Ehrmann, David A. “Polycystic ovary syndrome.” New England Journal of Medicine 352.12 (2005): 1223-1236.
30. Hatziagelaki, Erifili, et al. “Association between biomarkers of low-grade inflammation and sex hormones in women with polycystic ovary syndrome.” Experimental and Clinical Endocrinology & Diabetes 128.11 (2020): 723-730.
31. Diamanti-Kandarakis, Evanthia, et al. “A survey of the polycystic ovary syndrome in the Greek island of Lesbos: hormonal and metabolic profile.” The journal of clinical endocrinology & metabolism 84.11 (1999): 4006-4011.
32. Engmann, Lawrence, et al. “The outcome of in-vitro fertilization treatment in women with sonographic evidence of polycystic ovarian morphology.” Human Reproduction 14.1 (1999): 167-171.
33. Balen AH, Conway GS, Kaltsas G, et al. Polycystic ovary syndrome: the spectrum of the disorder in 1741 patients. Hum Reprod.1995;10:2107–2111.
34. Hochberg, Ze’ev, et al. “Child health, developmental plasticity, and epigenetic programming.” Endocrine reviews 32.2 (2011): 159-224.
35. Fenichel, Patrick, et al. “Which origin for polycystic ovaries syndrome: genetic, environmental or both?.” Annales d’endocrinologie. Vol. 78. No. 3. Elsevier Masson, 2017.
36. Carmina, Enrico, Sharon E. Oberfield, and Rogerio A. Lobo. “The diagnosis of polycystic ovary syndrome in adolescents.” American journal of obstetrics and gynecology 203.3 (2010): 201-e1.
37. 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 Clin Endocrinol Metab. 2004;89:2745–2749.
38. Asuncion M, Calvo RM, San Millan JL, Sancho J, Avila S, EscobarMorrealeHF. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metab. 2000;85:2434–2438.
39. Knochenhauer ES, Key TJ, Kahsar-Miller M et al. Prevalence of the polycystic ovary syndrome inunselected black and white women of the southeastern United States: a prospective study. The Journal ofClinical Endocrinology and Metabolism 1998; 83: 3078–3082.
40. Azziz R, Woods KS, Reyna R et al. The prevalence and features of the polycystic ovary syndrome in anunselected population. The Journal of Clinical Endocrinology and Metabolism 2004; 89: 2745–2749.
41. Legro, Richard S., et al. “Effects of gastric bypass surgery on female reproductive function.” The Journal of Clinical Endocrinology & Metabolism 97.12 (2012): 4540-4548.
42. Michelmore, K. F., et al. “Polycystic ovaries and associated clinical and biochemical features in young women.” Clinical endocrinology 51.6 (1999): 779-786. For women who have variation in DNA repair genes such as BRIPI, RAD51C, or RAD51D the evaluated lifetime risks are 5.8%, 5.2%, and 12%, respectively.
43. Herrinton LJ, Stanford JL, Schwartz SM, Weiss NS. Ovarian cancer incidence among Asian migrants to the United States and their descendants. J Natl Cancer Inst. 1994;86:1336–9.
44. Kliewer EV, Smith KR. Ovarian cancer mortality among immigrants in Australia and Canada. Cancer Epidemiol Biomarkers Prev. 1995;4:453–8.
45. US census bureau. Census 2000 Summary File 1, QT-P3. http://factfinder.census.gov/servlet/ DatasetMainPageServlet?_programZDEC&_langZen. Stepto, Nigel K., et al. “Women with polycystic ovary syndrome have intrinsic insulin resistance on euglycaemic–hyperinsulaemic clamp.” Human reproduction 28.3 (2013): 777-784.
46. Herzog, Andrew G. “Menstrual disorders in women with epilepsy.” Neurology 66.66 suppl 3 (2006): S23-S28.
47. Kiddy, D. S., et al. “Differences in clinical and endocrine features between obese and non‐obese subjects with polycystic ovary syndrome: an analysis of 263 consecutive cases.” Clinical endocrinology 32.2 (1990): 213-220.
48. Kuang, Hongying, et al. “Acupuncture and clomiphene citrate for live birth in polycystic ovary syndrome: study design of a randomized controlled trial.” Evidence-Based Complementary and Alternative Medicine 2013 (2013).
49. Mohamed-Hussein, Zeti-Azura, and Sarahani Harun. “Construction of a polycystic ovarian syndrome (PCOS) pathway based on the interactions of PCOS-related proteins retrieved from bibliomic data.” Theoretical Biology and Medical Modelling 6 (2009): 1-7.
50. CHANG, R. JEFFREY, et al. “Insulin resistance in nonobese patients with polycystic ovarian disease.” The Journal of Clinical Endocrinology & Metabolism 57.2 (1983): 356-359.50.
51. Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes 1989;38:1165-74.
52. Wang, Yunhui, et al. “Risks for gestational diabetes mellitus and pregnancy-induced hypertension are increased in polycystic ovary syndrome.” BioMed research international 2013 (2013)
53. BahriKhomami, Mahnaz, et al. “Increased maternal pregnancy complications in polycystic ovary syndrome appear to be independent of obesity—A systematic review, meta‐analysis, and meta‐regression.” Obesity Reviews 20.5 (2019): 659-674.
54. Garg, D.; Tal, R. The role of AMH in the pathophysiology of polycystic ovarian syndrome. Reprod. Biomed. Online 2016, 33, 15–28. Wiweko, B.; Indra, I.; Susanto, C.; Natadisastra, M.; Hestiantoro, A. The correlation between serum AMH and HOMA-IR amongPCOS phenotypes. BMC Res. Notes 2018, 11, 114.
55. Berga SL, Daniels TL. Use of the laboratory in disorders of re-productive neuroendocrinology. J Clin Immunoassay 1991;14:23-8.
56. Yildirim, Basak, Nuran Sabir, and Babur Kaleli. “Relation of intra-abdominal fat distribution to metabolic disorders in nonobese patients with polycystic ovary syndrome.” Fertility and sterility 79.6 (2003): 1358-1364.
57. Ferriman, D., and A. W. Purdie. “The inheritance of polycystic ovarian disease and a possible relationship to premature balding.” Clinical endocrinology 11.3 (1979): 291-300.
58. Louwers, Yvonne V., et al. “Variants in SULT2A1 affect the DHEA sulphate to DHEA ratio in patients with polycystic ovary syndrome but not the hyperandrogenic phenotype.” The Journal of Clinical Endocrinology & Metabolism 98.9 (2013): 3848-3855.
59. Conway, Gerard S., et al. “Risk factors for coronary artery disease in lean and obese women with the polycystic ovary syndrome.” Clinical endocrinology 37.2 (1992): 119-125.
60. Kuang, Hongying, et al. “Acupuncture and clomiphene citrate for live birth in polycystic ovary syndrome: study design of a randomized controlled trial.” Evidence-Based Complementary and Alternative Medicine 2013 (2013).
61. Garg, Deepika, and Reshef Tal. “The role of AMH in the pathophysiology of polycystic ovarian syndrome.” Reproductive biomedicine online 33.1 (2016): 15-28.
62. VM, Gaware, et al. “Female infertility and its treatment by alternative medicine: a review.” Journal of Chemical and Pharmaceutical Research 1.1 (2009): 148-162.
63. Carmina, Enrico, et al. “Does ethnicity influence the prevalence of adrenal hyperandrogenism and insulin resistance in polycystic ovary syndrome?.” American journal of obstetrics and gynecology 167.6 (1992): 1807-1812.
64. Chen, Zi-Jiang, et al. “Genome-wide association study identifies susceptibility loci for polycystic ovary syndrome on chromosome 2p16. 3, 2p21 and 9q33. 3.” Nature genetics 43.1 (2011): 55-59.
65. Day, Felix R., et al. “Causal mechanisms and balancing selection inferred from genetic associations with polycystic ovary syndrome.” Nature communications 6.1 (2015): 8464.
66. Goodarzi, Mark O., et al. “Polycystic ovary syndrome: etiology, pathogenesis and diagnosis.” Nature reviews endocrinology 7.4 (2011): 219-231.
67. Govind, A., M. S. Obhrai, and R. N. Clayton. “Polycystic ovaries are inherited as an autosomal dominant trait: analysis of 29 polycystic ovary syndrome and 10 control families.” The Journal of Clinical Endocrinology & Metabolism 84.1 (1999): 38-43.
68. Pall, Marita, Kelley Stephens, and Ricardo Azziz. “Family size in women with polycystic ovary syndrome.” Fertility and sterility 85.6 (2006): 1837-1839.
69. AR androgen receptor [Homo sapiens (human)] [database on the Internet].2018. . Available from: https://www.ncbi.nlm.nih.gov/gene/367.
70. Chen, Zi-Jiang, et al. “Genome-wide association study identifies susceptibility loci for polycystic ovary syndrome on chromosome 2p16. 3, 2p21 and 9q33. 3.” Nature genetics 43.1 (2011): 55-59.
71. Shi, Yongyong, et al. “Genome-wide association study identifies eight new risk loci for polycystic ovary syndrome.” Nature genetics 44.9 (2012): 1020-1025.
72. Gharani, Neda, et al. “Association of the steroid synthesis gene CYP11a with polycystic ovary syndrome and hyperandrogenism.” Human Molecular Genetics 6.3 (1997): 397-402.
73. Diamanti-Kandarakis, Evanthia, et al. “Microsatellite polymorphism (tttta) n at− 528 base pairs of gene CYP11α influences hyperandrogenemia in patients with polycystic ovary syndrome.” Fertility and Sterility 73.4 (2000): 735-741.
74. Rice, S., et al. “Impaired insulin-dependent glucose metabolism in granulosa-lutein cells from anovulatory women with polycystic ovaries.” Human Reproduction 20.2 (2005): 373-381.
75. Stewart, D. R., et al. “Fine mapping of genetic susceptibility to polycystic ovary syndrome on chromosome 19p13. 2 and tests for regulatory activity.” The Journal of Clinical Endocrinology & Metabolism 91.10 (2006): 4112-4117.
76. Editorial. Freely associating. Nat Genet 1999; 22: 1–2.
77. Cardon, Lon R., and John I. Bell. “Association study designs for complex diseases.” Nature Reviews Genetics 2.2 (2001): 91-99.
78. Menke, Marie Nam, and JEROME F. STRAUSS III. “Genetics of polycystic ovarian syndrome.” Clinical obstetrics and gynecology 50.1 (2007): 188-204.
79. Harada, Nobuhiro, et al. “Genetic studies to characterize the origin of the mutation in placental aromatase deficiency.” American journal of human genetics 51.3 (1992): 666.
80. Johnson, T., et al. “National Institutes of Health evidence-based methodology workshop on polycystic ovary syndrome (PCOS).” NIH EbMW Report. Bethesda, National Institutes of Health 1 (2012): 1-14.
81. Azziz, Ricardo, et al. “Criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an androgen excess society guideline.” The Journal of Clinical Endocrinology & Metabolism 91.11 (2006): 4237-4245
82. Yang, Fang, et al. “Follicular hyperandrogenism downregulates aromatase in luteinized granulosa cells in polycystic ovary syndrome women.” Reproduction 150.4 (2015): 289-296.
83. Pall, Marita, et al. “The phenotype of hirsute women: a comparison of polycystic ovary syndrome and 21-hydroxylase–deficient nonclassic adrenal hyperplasia.” Fertility and sterility 94.2 (2010): 684-689.
84. Azziz, Ricardo, et al. “Criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an androgen excess society guideline.” The Journal of Clinical Endocrinology & Metabolism 91.11 (2006): 4237-4245.
85. Azziz, Ricardo, et al. “The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report.” Fertility and sterility 91.2 (2009): 456-488.
86. Azziz, Ricardo, et al. “The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report.” Fertility and sterility 91.2 (2009): 456-488.
87. Brassard, Maryse, Youssef AinMelk, and Jean-Patrice Baillargeon. “Basic infertility including polycystic ovary syndrome.” Medical Clinics of North America 92.5 (2008): 1163-1192.
88. Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, Piltonen T, Norman RJ; InternationalPCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Clin Endocrinol (Oxf). 2018;89(3):251–268.
89. Gibson-Helm, Melanie, et al. “Delayed diagnosis and a lack of information associated with dissatisfaction in women with polycystic ovary syndrome.” The Journal of Clinical Endocrinology & Metabolism 102.2 (2017): 604-612.
90. Cree-Green, Melanie. “Worldwide dissatisfaction with the diagnostic process and initial treatment of PCOS.” The Journal of Clinical Endocrinology & Metabolism 102.2 (2017): 375-378.
91. Witchel, Selma F., et al. “The diagnosis of polycystic ovary syndrome during adolescence.” Hormone research in paediatrics 83.6 (2015): 376-389.
92. Azziz, Ricardo, et al. “Criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an androgen excess society guideline.” The Journal of Clinical Endocrinology & Metabolism 91.11 (2006): 4237-4245
93. Johnson, T., et al. “National Institutes of Health evidence-based methodology workshop on polycystic ovary syndrome (PCOS).” NIH EbMW Report. Bethesda, National Institutes of Health 1 (2012): 1-14
94. Kuhl, Herbert. “Comparative pharmacology of newer progestogens.” Drugs 51 (1996): 188-215.
95. Moran, Lisa J., et al. “Treatment of obesity in polycystic ovary syndrome: a position statement of the Androgen Excess and Polycystic Ovary Syndrome Society.” Fertility and sterility 92.6 (2009): 1966-1982
96. Galletly, C., et al. “A group program for obese, infertile women: weight loss and improved psychological health.” Journal of Psychosomatic Obstetrics & Gynecology 17.2 (1996): 125-128.
97. Poitras, Veronica Joan, et al. “Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth.” Applied physiology, nutrition, and metabolism 41.6 (2016): S197-S239.
98. Teede, Helena J., et al. “Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome.” Human reproduction 33.9 (2018): 1602-1618.
99. Harrison CL, et al.Exercise therapy in polycystic ovary syndrome: asystematic review. Hum Reprod Update. 2011;17(2):171–183.
100. Badawy A, Elnashar A. Treatment options for polycystic ovary syndrome. Int J Womens Health. 2011;3:25–35.
101. ACOG Committee on Practice Bulletins – Gynecology ACOG Practice Bulletin No 108: Polycystic ovary syndrome. Obstet Gynecol. 2009;114(4):936–949.
102. Vandermolen DT, et al. Metformin increases the ovulatory rate and pregnancy rate from clomiphene citratein patients with polycystic ovary syndrome who areresistant to clomiphene citrate alone. FertilSteril2001;75:310-5.
103. Coulam CB, Annegers JF, Kranzs JS. Chronic anovulation syndrome and associated neoplasia. Obstet Gynecol. 1983; 61:403–407.
104. Radha MH, Laxmipriya NP. The role of Aloe Barbadensis Mill. as a Possible Pre- Conceptive Herb for the Management of Polycystic Ovarian Syndrome : A Rodent Model Study. Austin Journal of Reproductive medicine and Infertility. 2016; 3(2).
105. Zhou J, Qu F, Barry JA, Pan J, Wang F, Fu Z et al. An Atractylodesmacrocephalakoidz extract alleviates hyperandrogenism of polycystic ovarian syndrome. International Journal of Clinical Experimental Medicine.2016; 9(2):2758-2767.
106. Kavitha A, Narendra Babu A, Sathish Kumar M, Veena Kiran S. Evaluation of effect ofCommiphorawightii in Dehydroepiandrosterone (DHEA) induced Polycystic Ovary Syndrome (PCOS) In Rats.Pharma Tutor. 2016;4(1).
107. Demirel MA, et al. Activity of Corylus avellana seed oil in letrozole-induced polycystic ovary syndrome model in rats. RevistaBrasileira de Farmacognosia. 2016; 26(1):83-8.
108. Reddy PS, Begum N, Mutha S, Bakshi V. Beneficial Effect of Curcumin in Letrozole Induced Polycystic Ovary Syndrome. Asian Pacific Journal of Reproduction.2016; 5(2):116-22.

</div8