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Thursday, 19 December 2013

Women' health: Obesity and Policystc Ovary Syndrome (PCOs)

A. Obesity is defined as a medical condition of excess body fat has accumulated overtime, while overweight is a condition of excess body weight relatively to the height. According to the Body Mass Index(BMI), a BMI between 25 to 29.9 is considered over weight, while a BMI of over 30 is an indication of obesity. According to the statistic, 68% of American population are either overweight or obese.

B. How do calculate your BMI index
BMI= weight (kg)/ height (m2)

C. Policystc Ovary Syndrome (PCOs) is defined as endocrinologic diseases caused by undeveloped follicles clumping on the ovaries that interferes with the function of the normal ovaries as resulting of enlarged ovaries, leading to hormone imbalance( excessive androgen), resulting in male pattern hair development, acne,irregular period or absence of period, weight gain and effecting fertility. It effects over 5% of women population or 1 in 20 women.

D. How Obesity associates with Policystc Ovary Syndrome (PCOs)
1. In a study of 453 women who fulfilled diagnostic criteria for PCOS were classified by age into two groups: Group A (20-29 years old, n= 294) and Group B (30-40 years old, n= 159). Group A had significantly higher total testosterone levels than Group B. Group B had higher fasting insulin and glucose levels, triglycerides, body mass index and waist measurements and a higher incidence of obesity than Group A, conducted by Taipei Medical University, posted in PubMed, researchers found that increased age is accompanied by a decrease in the prevalence of both clinical and biochemical hyperandrogenism in women. Hyperandrogenism is the important factor for young women with PCOS; however, abdominal obesity and certain metabolic disturbances became major concerns for older women with PCOS.

2. In a study of "[Exploration of the classification of polycystic ovarian syndrome]" [Article in Chinese], by Lin JF, Li X, Zhu MW., posted in PubMed, researchers filed the conclusion that The classification according to the revised 2003 consensus on diagnosis reflects the basic characteristics of PCOS; while the classification based on obesity shows the severity of hyperandrogenism and degree of IR, and thus has substantial significance for evaluation of metabolic complications.

3. According to the study of "Common Genetic Aspects between Polycystic Ovary Syndrome and Diabetes Mellitus" by Mendoza N., posted in PubMed, researchers found that So, the interest of the diagnosis of the PCOS is, not only improve fertility but to prevent possible future medical complications like the diabetes mellitus and the obesity. Due to the classical definition of PCOS as functional hyperandrogenism, the race to discover genetic alterations that could lead to the development of PCOS started with the androgen metabolism genes. However, the list of candidates was later expanded to other genes outside this hormonal pathway, and it now includes genes involved in carbohydrate and lipid metabolism as well as those involved in inflammatory processes.

4. In the study of "Homocysteine metabolism in polycystic ovary syndrome" by Grodnitskaya EE, Kurtser MA., posted in PubMed, researchers wrote that women with PCOS are more likely to develop components of the metabolic syndrome such as disturbances of carbohydrate metabolism, obesity, hypertension and dyslipidemia, which in turn are risk factors for cardiovascular disease. A number of studies confirmed the presence of increased serum homocysteine concentration in PCOS patients and the possible determinants of this observation are still debated. PCOS treatment options can influence homocysteine levels.

5. According to the study of 136 adolescent girls from a cohort of 301 girls between 15 and 17 years of age with confirmed menstrual irregularity, with or without ultrasound diagnosed polycystic ovaries, were assessed in detail after a gap of 2 years, conducted by Child Development Centre, Medical College, Thiruvananthapuram, posted in PubMed, showed that The results of this study support screening for menstrual irregularity, obesity and signs of clinical hyperandrogenism for early diagnosis of PCOS in an effort to improve the reproductive health of adolescent girls.

6. Etc.

E. treatments of Obesity and Policystc Ovary Syndrome (PCOs)
1. According to the study of "Current approaches to the diagnosis and treatment of polycystic ovarian syndrome in youth" by Harwood K, Vuguin P, DiMartino-Nardi J., posted in PubMed, researchers indicated that Antiandrogens are usually required for a substantial improvement in hirsutism score. Insulin sensitizers such as metformin are a new class of drugs utilized in treatment of PCOS. By improving insulin sensitivity and decreasing insulin levels, they improve the unfavorable metabolic profile of patients with PCOS. Metformin also helps to increase SHBG, decrease androgen levels and induce ovulation. Despite all the available medications, life-style changes are the mainstay of therapy as weight loss and exercise improve all parameters of PCOS without the potential side effects of medication.

2. In the study of "Polycystic ovary syndrome" by Goudas VT, Dumesic DA., posted in PubMed, researchers wrote that . A careful history and physical examination guide the extent of diagnostic testing. Slowly progressive hirsutism with anovulation of peripubertal onset usually reflects hyperandrogenic anovulation. This type of clinical presentation requires an evaluation to rule out other endocrinopathies (e.g., virilizing tumors, adult-onset CAH, hyperprolactinemia, and Cushing's syndrome). Virilization or severe rapidly progressive hirsutism requires immediate investigation to rule out a possible virilizing tumor. The ultimate goals of therapy for hyperandrogenic anovulatory women are to normalize the endometrium, antagonize androgen action at target tissues, reduce insulin resistance, and correct anovulation, if necessary.

3. In the abstract of study conducted by The University of Chicago Pritzker School of Medicine with the title of "What every physician should know about polycystic ovary syndrome", posted in PubMed, researcher concluded that Ultrasonography helps in the differential diagnosis and may demonstrate the polycystic ovaries that have recently been vetted as an alternative to oligo-anovulation as a diagnostic criterion. Management of PCOS is determined by symptomatology. For those women not desiring pregnancy, the most common therapies are oral contraceptive pills, antiandrogens (contraindicated in the absence of adequate contraception), and insulin-lowering treatments (which have little effect on hirsutism).

4. According to the study of "Polycystic ovary syndrome" by Goudas VT, Dumesic DA., posted in PubMed, researshers indicated that Virilization or severe rapidly progressive hirsutism requires immediate investigation to rule out a possible virilizing tumor. The ultimate goals of therapy for hyperandrogenic anovulatory women are to normalize the endometrium, antagonize androgen action at target tissues, reduce insulin resistance, and correct anovulation, if necessary.

5. Etc.
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