Instant Remedies for Polycystic Ovary Syndrome

The Natural Pcos Diet

The Natural Pcos Diet, By Jenny Blondel, A Leading Australian Naturopath In Response To Thousands Of Requests For Professional Information To Help Women Suffering From Pcos. Real Solutions To Naturally Overcome PCOS. Naturally balance your hormones Increase your chances of conceiving Help you lose weight and feel good Curb your cravings for sugary foods Turn your fatigue around Achieve clearer, glowing skin See improvements in your mood. Do You Feel PCOS Is. Ruling Your Life? At Last! The Natural PCOS Diet. A Naturopath’s Easy Step-by-Step Guide to Overcoming PCOS Is. Now Available! Continue reading...

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Polycystic ovary syndrome and gestational diabetes mellitus

PCOS is a heterogeneous disorder affecting 5-10 of women of reproductive age. It is characterized by chronic anovulation with oligo- amenorrhea, infertility, typical sonographic appearance of the ovaries, and clinical or biochemical hyper-androgenism. Insulin resistance is present in 40-50 of patients, especially in obese women.23 Holte et al.24 reported a higher rate of ultrasonographic, clinical, and endocrine signs of PCOS in 34 women who had had GDM 3-5 years before, compared to 36 matched controls with uncomplicated pregnancies. Five of the women (15 ) with previous GDM had developed manifest diabetes. The authors concluded that women with previous GDM and PCOS may form a distinct subgroup from women with normal ovaries and previous GDM, who may be more prone to develop features of insulin-resistance syndrome. Many other researchers reported similar results. Kousta et al.25 found a higher prevalence of PCOS in 91 women with previous GDM compared to 73 normoglycemic control women...

Insulin resistance and polycystic ovary syndrome

PCOS is a heterogeneous disorder affecting 5-10 of women of reproductive age.28 It is characterized by chronic anovula-tion with oligo amenorrhea, infertility, typical sonographic appearance of the ovaries, i.e. multiple small follicles distributed around the ovarian periphery or throughout the echodense stroma29 and clinical or biochemical hyperandro-genism. As anovulation accounts for an estimated 40 of all cases of female infertility, PCOS, being the most common cause of anovulation, is the most important cause of this type of infertility.30 Insulin resistance is present in 40-50 of patients, especially in obese women,31 making PCOS a prediabetic state. The prevalence of impaired glucose tolerance (IGT) in PCOS is 31-35 , and the prevalence of Type 2 diabetes mellitus is 7.5-10 .32 The conversion rate from IGT to overt Type 2 diabetes is increased 5- to 10-fold in women with PCOS.33 Women with PCOS are at increased risk of pregnancy and neonatal complications a recent...

Stacey Chillemis Experience

Many women with epilepsy have polycystic ovary syndrome, a condition characterized by irregular ovulation and menses. The ovaries of women with this condition fail to release an egg at a regular time each month, making conception difficult. The infertility caused by this syndrome is treatable. Polycystic ovary syndrome may be more common in women with epilepsy, and there is some evidence that one particular medication that is used to control seizures (sodium valproate) may also bring on this syndrome. If this is true and not all experts agree this effect may be reversible. It is worth noting that many doctors warn women who stop taking sodium valproate that they may get pregnant easily, and that they should use contraception if they do not wish to become immediately pregnant. The policy of some doctors is to screen all adolescent girls with epilepsy as well as women seeking preconception counseling for the presence of polycystic ovaries and the associated hormonal changes, and advise...

Endocrine Disorders During Pregnancy

In this issue, I have selected topics that cover each of the main subspecialties (adrenal, pituitary, diabetes, thyroid, and calcium bone) within adult endocrinology. For each area, the authors have delineated the current understanding of its physiology and pathophysiology during gestation as well as outlined the maternal therapy to optimize pregnancy outcome. In addition, I have included an article on the impact of polycystic ovarian syndrome on fertility, relevant because of its prevalence and the availability of therapy. Cardiovascular endocrinology, a newer subspecialty within our discipline, is well-represented by the article on pregnancy and hypertensive disorders. There are two other nontraditional articles. Recently, we have gained understanding of the effects of the intrauterine milieu on the future endocrine development of the child and this is presented in the section on imprinting. Lastly, the conclusion of pregnancy, parturition, represents a complex hormonal interplay...

531 Infertility and Risk of Miscarriage

Menstrual irregularities Hyperandrogenism Oligo- amenorrhea Chronic anovulation In overweight women conceiving after in vitro fertilization (IVF) or intracytoplasmic sperm injection, miscarriage rate is also reportedly higher in obese compared with lean or average weight women. A systematic review of the literature by Maheshwari et al. 11 found that when compared with women with a BMI < 25 kg m2, women with a BMI > 25 kg m2 had a 29 lower likelihood of pregnancy and a 33 higher risk of miscarriage following IVF. In this same study, obese women were found to have a reduced number of oocytes retrieved despite requiring higher doses of gonadotropins. Mechanisms for the relationship between obesity and infertility are unknown. Suggested roles of hyper-androgenism, insulin resistance, high leptin levels, and polycystic ovarian syndrome are currently under investigation 12 . Regardless of mechanism, these data suggest that obesity may delay or prevent conception in women who want to...

Hypertensive disorders

Conditions associated with increased insulin resistance, such as GDM, PCOS and obesity, may predispose patients to essential hypertension, hypertensive pregnancy, hyperinsu-linemia, hyperlipidemia and high levels of plasminogen activator inhibitor-1, leptin, and tumor necrosis factor-alpha. These findings may also be associated with a possible increased risk of cardiovascular complications in these women.74 Joffe et al.75 provided further support for the role of insulin resistance in the pathogenesis of hypertensive disorders of pregnancy. In a prospective study of 4589 healthy nulliparous women, they found that the women with GDM had an increased relative risk of pre-eclampsia and all hypertensive disorders (RR 1.67, 95 CI 0.92-3.05 and RR 1.54, 95 CI 1.28-2.11, respectively). RR were not substantially reduced after further adjustment for race and BMI (OR 1.41 and 1.48, respectively). Furthermore, even within the normal range, multivariate analysis demonstrated that the level of...

Nonpregnancy Treatment And Care

With time it is often necessary to use oral antidiabetic agents. Metformin is the drug of choice for overweight patients and is increasingly used in polycystic ovarian syndrome (PCOS) to augment ovulation induction. Other agents include sulphonylureas (e.g. glibenclamide, gliclazide, glip-izide) and thiazolidinediones (rosiglitazone and pioglita-zone). If oral agents alone or in combination are ineffective then insulin injections are added or substituted, and management of this is as for T1DM.

Preconception Issues And Care

Oral antidiabetic hypoglycaemic agents should be discontinued and treatment with insulin started as for T1DM. Increasing evidence indicates metformin is not teratogenic, and some clinicians advise women with PCOS who conceive whilst receiving it to continue to take it at > 12 weeks.

Pregestational diabetes

Vanky E, Salvesen KA, Heimstad R, et al. Metformin reduces pregnancy complications without affecting androgen levels in pregnant polycystic ovary syndrome women results of a randomized study. Human Reprod 2004 19 1 734-40. 50. Brock B, Smidt K, Ovesen P, Schmitz O, Rungby J. Is metformin therapy for polycystic ovary syndrome safe during pregnancy Basic Clin Pharmacol Toxicol 2005 96 410- 2.

2151 Hypothalamic releasing hormones

Releasing hormones are responsible for regulating the synthesis and secretion of FSH and LH. Many synthetic human GnRH agonists are marketed, including buserelin, gonadorelin, goserelin, leuprore-lirt, nafarelin, and triptorelin. Cetrorelix and ganirelix are inhibitors of GnRH. In women, GnRH agonists have been used to treat estrogen-dependent breast cancer, endometriosis, hirsutism, and polycystic ovarian syndrome, but the widespread use of protocols using GnRH agonists antagonists in assisted reproductive technologies has led to an increasing number of pregnant women being exposed to these types of drugs. Most of the data concerning the safety of the GnRH analogs have not demonstrated serious side effects, such as increase in the incidence of miscarriage, birth defects, or fetal growth restriction, in human pregnancies exposed to GnRH (Tarlatzis 2004,

Conflicting data suggesting the same GDM rate in multiples

The potential relationship of GDM and antecedent conditions was evaluated by Mikola et al.28 in 99 pregnancies of woman with polycystic ovarian syndrome (PCOS) compared to an unselected control population. Patient with PCOS often need infertility treatments and a high incidence of multiples is expected. Indeed, this study shows that twin and GDM rates were both increased (9.9 vs. 1.1 and 20 vs. 8.9 , in the PCOS group and in controls, respectively). At the same time, the BMI, a potential confounder for GDM, was also greater in PCOS patients than in controls (25.6 vs. 23). These results may suggest that the higher rate of GDM in patients with PCOS, often related to insulin resistance and hyperinsulinemia, may be attributed to the antecedent PCOS and not to the multiple pregnancies.

4119 Insulin and oral antidiabetics

Only small amounts of metformin are found in mothers' milk the weight-adjusted dose for a fully breastfed child is 0.1-0.7 (Briggs 2005, Gardiner 2003, Hale 2002). Hypoglycemia was not reported in breastfed infants. Metformin concentrations in breast milk remained stable over the time of observation. Growth, motor-social development, and illness requiring a pediatrician's visit were assessed in 61 nursing infants (21 male, 40 female) and 50 formula-fed infants (19 male, 31 female) born to 92 mothers with polycystic ovary syndrome (PCOS) taking a median of 2.55 g metformin per day throughout pregnancy and lactation. At 3 and 6 months of age, the weight, height, and motor-social development did not differ between breast- and formula-fed infants. No infants had retardation of growth, or of motor or social development. Intercurrent illnesses did not differ (Glueck 2006).

Other monogenic forms of diabetes

Patients with many other monogenic forms of diabetes may occur in pregnant women (Table 61.3). In some patients the likelihood of pregnancy is reduced patients with severe insulin resistance may have reduced fertility as a result of the associated polycystic ovarian syndrome and some of the multi-system syndromes that include diabetes suffer from severe neurological defects. The commonest form of mono-genic diabetes in the diabetic pregnancy clinic outside the MODY genes is maternally inherited diabetes and deafness due to the mitochondrial 3243tRNA leucine mutation. Permanent neonatal diabetes has recently been shown to frequently result from mutations in the Kir6.2 gene. These are dealt with in more detail below.

Hyperinsulinemic insulin resistance

The peripheral insulin resistance in PCOS is uniquely due to a defect beyond the activation of the receptor kinase, namely, reduced tyrosine autophosphorylation of the insulin receptor.37,38 The reduced signal transmission caused by excessive phosphorylation of serine residues on the insulin receptor also explains the hyperandrogenism caused by the concomitant serine phosphorylation of P450c17, the key enzyme in ovarian and adrenal androgen biosynthesis, which increases the 17,20-lyase activity and androgen production.38,39 Thus, insulin resistance may be causally related to overactivity of cytochrome P450c17.40 Insulin, by acting via its own receptors, appears to promote ovarian and adrenal androgen biosynthesis,41,42 amplifying LH-induced androgen production by theca cells and resulting in hyperandrogene-mia.43,44 Amelioration of the hyperinsulinemia leads to a dramatic decline in circulating androgens to normal levels.45 Hyperinsulinemia may also upregulate IGF-I receptors, which...

Hyperinsulinemia and impaired ovulation

Dale et al.59 examined the correlation between insulin metabolism and outcome of gonadotropin stimulation in 42 infertile, CC-resistant women with PCOS. Using continuous infusion of glucose with the model assessment test, they identified 17 patients with insulin resistance who required higher doses of gonadotropins and a longer duration of treatment to achieve follicular maturation. In this group, 35 of the cycles were cancelled due to a multifollicular response compared to 2.5 in the noninsulin-resistant PCOS group. Moreover, although the ovulation rate in completed cycles was similar between the groups, the conception rate was significantly better in the women with noninsulin-resistant PCOS. Hyperinsulinemia and obesity correlate directly with the failure to ovulate in response to CC, or with the need for multiple repeated courses and increasing doses of CC.60,61 Thus, women with PCOS and severe insulin resistance are more likely to fail to respond to CC.62 BMI is a major...

Metformin treatment and ovulation induction with CC

CC-resistant and obese women have a high prevalence of insulin resistance. This subgroup may benefit more from treatment with metformin. In a large prospective trial, an oral glucose tolerance test (OGTT) was performed in 61 obese women with PCOS before and after administration of metformin 500 mg or placebo three times daily for 35 days.87 Those who failed to ovulate spontaneously were given CC 50 mg daily for 5 days, concomitant with metformin or placebo. This regimen was successful in 19 of 21 women (90 ) in the metformin group and two of 25 women (8 ) in the placebo group. Overall, 31 of the 35 women (89 ) treated with metformin ovulated spontaneously or in response to CC, compared with only three of the 26 untreated women (12 ). This finding agrees with other studies reporting an increase in pregnancy rate with combined metformin-CC treatment.88-92 In a comparative study,93 154 infertile women with oligomen-orrhea and hyperandrogenism were studied. Patients receiving metformin...

Metformin treatment in pregnancy

In addition to poor conception rates, pregnancy loss rates are high (30-50 ) in the first trimester in women with PCOS. Hyperinsulinemia may contribute to the early pregnancy loss by adversely affecting endometrial function and environment. Serum glycodelin, a putative biomarker of endometrial function, is decreased in women with early pregnancy loss. IGF-BPI may also play an important role in pregnancy by facilitating adhesion processes at the feto-maternal interface. Jakubowicz et al.103 studied 48 women with PCOS before and after administration of metformin 500 mg (n 26) or placebo (n 22) three times daily for 4 weeks. OGTT were performed, and serum glycodelin and IGF-BPI were measured during the follicular and CC-induced luteal phases of menses. The authors found a decrease in mean area under the serum insulin curve after glucose administration. In the metformin group, follicular and luteal phase serum gly-codelin and IGF-BPI concentrations were significantly increased, as was the...

Ovarian hyperstimulation syndrome

The most common time for this to occur would be near to egg collection or after embryo transfer. The IVF cycle may be abandoned completely or slowed down by 'coasting' - FSH drugs are withdrawn until oestrogen levels drop to a safe level. The higher risk patients for OHSS are younger women and those diagnosed with poly-cystic ovary syndrome (PCOS).

Pheochromocytoma in pregnancy

Couples at risk for an affected infant may choose to undergo prenatal treatment with dexamethasone coupled with prenatal diagnosis. The goal of the treatment is to inhibit fetal ACTH and so prevent hyperandrogenism and virilization of an affected female fetus. Thus, dexamethasone, at a divided daily dose of 20 mg kg of prepregnancy weight, is started when pregnancy is diagnosed. Dexamethasone is the agent of choice because it is not a ready substrate for 11-b-hydroxysteroid dehydrogenase type 2. Chorionic vil-lous sampling is performed at 9 to 11 weeks for the evaluation of the fetus' sex and CYP21 gene. Dexamethasone is discontinued if the fetus is male or an unaffected female. As a result of this strategy, treatment would continue in only one of eight pregnancies. The initiation of therapy before 9 weeks has resulted in normal genitalia in 11 of 25 affected females and only mild virilization in another 11, but later treatment or the use of a lower dose of dexamethasone has resulted...

Bibliography Of Epilepsy

The polycystic ovary syndrome nature or nurture Fertil Steril. 1995 63 953-954. Clayton RN, Ogden V, Hodgkinson J, et al. How common are polycystic ovaries in normal women and what is their significance for the fertility of the population Clin Endocrinol. (Oxf) 1992 37 127-134. Isojarvi JIT, Laatikainen TJ, Pakarinen AJ, et al. Polycystic ovaries and hyperandrogen-ism in women taking valproate for epilepsy. N Engl J Med. 1993 329 1383-1388. Lobo RA. A disorder without identity HCA, PCO, PCOD, PCOS, SLS. What are we to call it Fertil Steril. 1995 63 158-160.

Of North America

Nestler approaches the patient with polycystic ovarian syndrome (PCOS) one of the commonest causes of infertility. As is now commonly appreciated, PCOS is associated with insulin resistance and often has features related to this metabolic disorder. Therapy with metformin (a biguanide) or thiazolidinediones reduces insulin resistance, restores menstruation, and often is associated with restoration of fertility.

21011 Gabapentin

Lamotrigine seems to increase the probability of getting pregnant compared to valproate in a study by Isojarvi (1998), lamotrigine was substituted for valproate because of frequent occurrence of polycystic ovaries and hyperandrogenism associated with weight gain and hyperinsulinemia in women taking valproate. Twelve such patients were observed for 12 months, and the total number of polycystic ovaries in these women decreased from 20 during valproate medication to 11, 1 year after replacing valproate with lamotrigine. Lamotrigine also seems to interact with hormonal contraception Sabers (2001) reported seven cases in which the plasma levels of lamotrigine were significantly decreased by oral contraceptives (mean 49 , range 41-64 ). The interaction was of clinical relevance in most of the patients, who either experienced increased seizure frequency recurrence of seizures after oral contraceptives had been added, or adverse effects following withdrawal of oral contraceptives. Because the...

Epilogue

First, some of the available studies are old and do not include multiples resulting from the current epidemic of iatrogenic conceptions. The remarkable difference between mothers, particularly in terms of age, before and after the 1990s1,2 cast serious doubts if the prevalence cited in older studies is still valid today. Second, most, if not all information are hospital-based and not population-based data. Accordingly, prospective studies on maternal adaptation to carbohydrate metabolism during a multiple pregnancy are flawed by a small sample size and lack of sufficient statistical power. Moreover, time-lead bias, which overlooks changes in management over time have not been considered. For example, it would be interesting to know how the rate of PCOS in mothers of multiple pregnancies influences insulin resistant and GDM rates and how recommendations for excess weight gain during early stages of a multiple pregnancy17 would influence carbohydrate metabolism.

Metformin

Figure 63.1 Presents the potential mechanisms of insulin resistance in PCOS. Figure 63.1 Presents the potential mechanisms of insulin resistance in PCOS. Metabolic and endocrine effects of metformin Women with PCOS and fasting hyperinsulinemia who were treated with metformin showed a significant decrease in fasting insulin and total testosterone levels, and an increase in SHBG, leading to a decrease in the free testosterone index. In addition, there was a significant decline in mean BMI, the waist-to-hip ratio, hirsutism, and acne, as well as an improvement in menstrual cyclicity. No changes in the LH level or in LH-to-follicle-stimulating hormone (FSH) ratio were observed. The greatest decline in testosterone and its free index occurred in the patients with the most pronounced hyperandrogenemia. Women with high levels of dehydroepi-anosterone sulfate (DHEAS) exhibited less improvement in menstrual cycle regularity, no change in hirsutism, and an increase in levels of IGF-I.78 In...

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