Furocyst - Poly Cystic Ovary Syndrome Study
Furocyst - Poly Cystic Ovary Syndrome Study
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.
Inclusion Criteria:

 -  Premenopausal women between 18-45 years of age and BMI less than 42

 -  Diagnosed with PCOS by Rottadom Criteria

 -  Adequate hepatic, renal, Cardiac and hematological functions.

 -  Patients willing to Participate and give informed consent in writing as well as in
 audio-visual form for the study.

 -  Stable weight for last two months (Change of weight<3kg)

 Exclusion Criteria:

 -  Male

 -  Post menopausal women

 -  Women with hysterectomy

 -  Hyperprolactinemia

 -  Patients with congenital adrenal hyperplasia

 -  Patients suffering from Cushing's syndrome

 -  Acute or chronic Medical illness including Hepatic, Cardiac or renal insufficiency,
 COPD,Gastrointestinal Disorders

 -  Uncontrolled Hypertensive or known Diabetics on drugs

 -  Use of oral contraceptives or HRT for last three months

 -  Smoking or drug addicts or with psychiatric illness

 -  Patients diagnosed with androgen secreting tumors.

 -  Patients with thyroid dysfunction (T3, T4 level is higher than that in normal women of
 reproductive age)

 -  Patients with Hypo-gonadotropic and Hypo-gonadism (central origin of ovarian
 dysfunction)

 -  Pregnant or lactating mothers