PCOS Clinical Trial
Official title:
To Study the Efficacy and Safety of Furocyst in Poly Cystic Ovary Syndrome Patients (PCOS)
Poly cystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, affecting approximately 5%-10% of all females worldwide . PCOS is a hormonal disorder that involves multiple organ systems within the body. Its cardinal features are Hyperandrogenism and polycystic ovary (PCO) morphology. Women with PCOS may complains about irregular menstrual periods or heavy menstrual bleeding, infertility, excessive growth of coarse facial and body hair, obesity, oiliness of the skin, seborrhea, and cystic acne.
The symptoms of PCOS are anovulation, resulting in irregular menstruation (amenorrhea and
oligomenorrhea) ovulation-related infertility, and polycystic ovaries, often associated with
obesity, Type 2 diabetes, and high cholesterol levels. The level of serum insulin and insulin
resistance are higher in women with PCOS (Hyperinsulinemia).Insulin resistance, defined as
the decreased insulin mediated glucose utilization it is more common in women with PCOS up to
50 % in both obese and non obese women . It has also been recognized that some women with
this syndrome will have PCO without clinical evidence of androgen excess, but will display
evidence of ovarian dysfunction .
It is believed to be that, the Hyperinsulinemia of PCOS stimulates the androgens production
and increase the activity by decreasing the sex hormone binding globulin (SHBG) thus
increasing the free active testosterone level and by the activating the cytochrome P 450 C 17
alpha enzymatic system that controls androgens production.
The diagnosis of PCOS is based on Hyperandrogenism and chronic anovulation in the absence of
specific pituitary or adrenal disease , and have disrupted ovulatory function with chronic
oligomenorrhea (cycle length > 35 day) or amenorrhea (cycle length > 12 week) and typical
appearance of polycystic ovaries by ultrasound according to the criteria of the Rotterdam
consensus meeting 2003 for diagnosis of PCOS. The different diagnostic tests needed to
adequately assess for the possibility of PCOS e.g. Pregnancy test, TSH level (for
Hyperthyroidism), Prolactin test (for Hyperprolactinemia), Total testosterone (for ovarian
tumor) and some tests forevaluating the insulin resistance syndrome in women: Waist
circumference (>88 cm), Triglycerides (>150 mg/dL), HDL Cholesterol (<50 mg/dL), Blood
pressure (>130/85) and Fasting glucose (>110 mg/dL). Fasting glucose- to- insulin ratio and 2
hour oral glucose tolerance test (2h- OGTT 140 - 199 mg/dL) may be better predictor of
insulin resistance .
The management of the PCOS is symptoms specific e.g.
1. Oral contraceptives, periodic progesterone withdrawal for the control of irregular
menstruation.
2. Oral contraceptives, Metformin and anti-androgens (Spironolactone) for the
Hirsutism.
3. Clomiphene citrate, Metformin and thiazolidinediones for infertility. A recent study
shown that, the combination of Metformin plus Clomiphene citrate should be considered as
the First line treatment for infertile women with PCOS .
4. Metformin and lifestyle modification for the insulin resistance and diabetes mellitus.
All these management options are only for "acute" not for "chronic". The long-term management
approach for the PCOS is needed which will be based on management of most affecting factor
insulin resistance.
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