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Best Treatment Specialist for PCOS Polycystic Ovaries

Best Gynaecologist doctors in Bhubaneswar

ODISHA CENTRE FOR L.I.F.E

(LAPAROSCOPY, INFERTILITY, FIBROIDS & ENDOMETRIOSIS)


Life Member, The PCOS Society, India

ALL U WANNA KNOW ON INOSITOLS MYOINOSITOL & D CHIROINOSITOL IN PCOS:DR G S S MOHAPATRA BHUBANESWAR

Talk on PCOS by Dr GSS Mohapatra on NDTV News

Talk on PCOS by Dr GSS Mohapatra in ODIYA

Polycystic ovarian syndrome ( PCOS), also known as PCOD ( polycystic ovarian disease) is one of the commonest causes of infertility. It is characterised by multiple small cysts in the ovaries. The ovary is enlarged; and it produces excessive amounts of androgen and estrogenic hormones. This condition is also called Polycystic Ovarian Syndrome (PCOS) or the Stein-Leventhal Syndrome. PCOS produces symptoms in 10% of women of reproductive age .It is the most frequent endocrine problem in women of reproductive age. Insulin resistance and elevated serum LH levels are also common features in PCOS. PCOS is associated with an increased risk of type 2 diabetes and cardiovascular events.

Signs and symptoms

  • Menstrual disorders: patient typically presents with history of delayed cycles ie., oligomenorrhea (few menstrual periods) or amenorrhea (no menstrual periods)
  • High levels of masculinizing hormones: leading to acne and hirsutism (male pattern of hair growth), hypermenorrhea (heavy and prolonged menstrual periods).
  • Insulin resistance

The typical NECKLACE PATTERN OF CYSTS as seen on ultrasound.



CAUSE

  • Cause is uncertain with a strong genetic predisposition
  • Obesity plays a major role


CRITERIA FOR DIAGNOSIS

Since the 1990 NIH-sponsored conference on polycystic ovary syndrome (PCOS), it has become appreciated that the syndrome encompasses a broader spectrum of signs and symptoms of ovarian dysfunction than those defined by the original diagnostic criteria which had included oligoovulation ,signs of androgen excess (clinical or biochemical) and exclusion of other disorders that can result in menstrual irregularity and hyperandrogenism In 2003 a consensus workshop sponsored by ESHRE/ASRM in Rotterdam indicated PCOS to be present if any 2 out of 3 criteria are met, in the absence of other entities that might cause these findings

  • oligoovulation and/or anovulation
  • excess androgen activity
  • polycystic ovaries (by gynecologic ultrasound).

The 2003 Rotterdam consensus workshop concluded that PCOS is a syndrome of ovarian dysfunction along with the cardinal features hyperandrogenism and polycystic ovary (PCO) morphology. PCOS remains a syndrome and, as such, no single diagnostic criterion (such as hyperandrogenism or PCO) is sufficient for clinical diagnosis. It may manifest as : menstrual irregularities, signs of androgen excess, and obesity.



LH: FSH ratio in pcos

LH-FSH ratio refers to the relative values of two gonadotropin hormones produced by the pituitary gland in women. Luteinizing hormone (LH) and follicle stimulating hormone (FSH) stimulate ovulation by working in different ways. In pre-menopausal women, the normal ratio is 1:1 as measured on day three of the menstrual cycle. It used to be believed that an elevated LH-FSH ratio of greater than 2:1 or 3:1 was indicative of PCOS, but recently, researchers have discovered that many women with PCOS have normal levels. As many as half of all women with PCOS may not have high ratios

STANDARD DIAGNOSIS METHODS

  • History of oligomenorrheic cycles,acne, obesity
  • ultrasound
  • laparoscopy


How to manage PCOS

  • Restore normal menses
  • restore fertility
  • treat acne
  • treat insulin resistance

TREATMENT

  • LIFESTYLE MODIFICATION
  • WEIGHT REDUCTION OF ATLEAST 15 PERCENT
  • AVOID CARBOHYDRATES AND FATTY FOOD
  • FOR A SPECIALISED INDIVIDUALISED TREATMENT FOR PCOS CUSTOMISED EXCLISIVELY FOR YOU, KINDLY CONSULT IN OPD
  • First and foremost is WEIGHT REDUCTION
  • Drugs like metformin,ocp combinations of ethinyl oestradiol and spironolactone derivative like drospirenone
  • They should be warned of developing endometrial carcinoma,type II diabetes mellitus and dyslipidemia


Comprehensive Treatment for PCOS

  • Insulin Sensitizers – Myo-inositol (MI) & D-Chiroinositol (DCI) :
  • Combined administration of MI & DCI in physiological plasma ratio (40:1), is first line treatment in PCOS, as it has the potential to improve all symptoms, signs and anomalies of PCOS.
  • Myo-inositol increases PI3 kinase activation, helps corrects insulin resistance (reduces insulin blood levels). Improves cycle regularization, fertility rates in females trying to conceive.
  • D-chiroinositol increases glycogen synthesis will create a healthy intra-ovarian milieu, which will correct hyperandrogenism.
  • Ensures better clinical results, such as reduction of insulin resistance, androgens’ blood levels, regularization of menstrual cycle with spontaneous ovulation and reduction of cardiovascular risk, reduction in acne & hirsutism.
  • Mitochondrial Antioxidant – Melatonin:
  • Melatonin is mitochondrial antioxidant, which protects oocyte from reactive oxygen species & increases the oocyte maturation rate. It regulates the circadian rhtyms & acts as sleep inducer.
  • Melatonin promotes follicular maturation & ovulation through the protection of follicles against oxidative stress and their rescue form atresia.
  • Combination of Melatonin with Myo-insitol therapy has offers high quality of oocyte & embryo, better clinical pregnancy rates and improved implantation rates.
  • It also shows beneficial results in cases of age related fertility decline.
  • Antioxidants – Astaxanthin, Lycopene:
  • Polycystic ovary syndrome (PCOS) females have ∼20 fold increase in reactive oxygen species (ROS) generation in Follicular fluid (FF) and granulosa cells, leading to poor quality of oocytes.
  • Astaxanthin is super antioxidant, which along with lycopene reduces ROS damage in Follicular Fluid.
  • Amino Acid – L-Arginine:
  • Nitric oxide (NO) plays a wide spectrum of biological actions including a positive role in oocyte maturation and ovulation.
  • Free radicals during PCOS are responsible for quenching NO that, in turn, would play a role in determining oligo- or amenorrhea connoting PCOS. L-arginine treatment restores gonadal function in PCOS. This leads to an improvement in insulin sensitivity.
  • L-arginine also improves circulation to reproductive organs & endometrial receptivity.
  • Minerals – Zinc, Iron :
  • These important minerals are required for proper functioning of reproductive organs.
  • Iron corrects iron deficiency.
  • Studies have shown that women with PCOS have lower zinc levels, & this gives rise to diabetes, obesity, glucose intolerance, lipidaemia, hyperglycaemia, and hypertriglyceridemia.
  • Several studies suggested that Zinc supplementation has therapeutic effects for the prevention of type 2 diabetes, also improves follicle & embryo development.
  • Zinc also helps in boosting immunity.
  • Vitamins – Folic Acid, Mecobalamin, Pyridoxine :
  • Elevated total plasma Homocysteine levels lead to an increased risk for reproductive symptoms in PCOS. These vitamins helps in reduction of homocysteine levels.
  • Further helps in Oocyte maturation, Improves oocyte quality leading to Improved ovulation.
  • Folic acid improves ovarian response to FSH.

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