Treatment Of Polycystic Ovarian Disease Research Articles

Clinical intervention of poly herbal Siddha preparation Karpa nei in the treatment of polycystic ovarian disease

Background: Polycystic ovarian disease (PCOD) is one of the most common gynecological disorders of women with sedentary lifestyle. It is considered as a problem of anovulation and infertility, which is characterized by irregular menstruation, insulin resistance, hirsutism, and obesity. PCOD affects 5%–10% of women population all over the world and in India depending upon the diagnostic criteria used, the prevalence estimates vary between 8.2% and 22.5%. It is the most common cause of infertility. The classic clinical features of PCOD such as hyperandrogenism, amenorrhea, dysmenorrhea, oligomenorrhea, hirsutism, acne, acanthosis nigricans and infertility can be compared with the Sinnaippai neerkattigal in various traditional Siddha literatures. Many herbal, polyherbal, herbo-mineral formulations are indicated for the disease in ancient Siddha texts. One of such polyherbal formulation is Karpa nei, which is mentioned in the text of Marundhu vagadam (Ettu murai) for treating Sinnaipai neerkatti. The main aim of the study is to evaluate the therapeutic efficacy of Karpa nei, as internal medicine in treating PCOD. Materials and Methods: The trial medicine Karpa nei is administered to 8 female patients with Sinnaipai neerkatti who attended the Sool Magalir Maruthuvam outpatient department of Sri Sairam Siddha Medical College and Research Centre. Results: This clinical study shows the reduction of symptoms and regulation of menstrual disturbance. The efficacy of Karpa nei is depending upon the active principles present in the ingredients of the poly herbal preparation. Conclusion: It was concluded that the trial medicine Karpa nei provided a positive end point in treating PCOD.

Ameliorative effects of Withania coagulans and Metformin on Ovarian morphology in Polycystic ovarian disease induced rats

Background: Various medicinal herb plants are being used in place of metformin for treatment of polycystic ovarian disease for their less harmful effects. Withania coagulans (WC) is a herb known for its insulin sensitizing and weight reducing properties. The present study was done to determine the influence of aqueous extract of Withania coagulans (aqWC) and metformin on ovarian weight and ovarian folliculogenesis in polycystic ovarian disease-induced rats.
 Material and Methods: An experimental animal study was carried out at the Physiology Department of Islamic International Medical College, Rawalpindi from April 2016 to March 2017. Forty female Sprague Dawley rats were divided initially into two groups. Group A (Normal Control) and Disease induced group. Standardized laboratory diet was fed to Group A while the disease induced group was given standardized laboratory diet and letrozole solution orally (1mg/kg) for 21 days to induce Polycystic ovary syndrome, which was established by observing estrous cycle of rats. Disease induced group was then split into group B (PCOS control), C (Aqueous Withania coagulans treated) and D (Metformin treated) and observed after 14 days. Groups A and B underwent ovarian dissection after 21 days and groups C and D underwent dissection at the end of experiment (after 35 days). Independent sample t-test was used for the comparison between the control and disease induced group.
 Results: Group B showed a significant increase in ovarian weight in comparison to group A rats (P < .05). Treatment with Withania coagulans and metformin significantly decreased ovarian weight (P < .05) and increased primary, Graafian, antral follicular count and corpus luteum along with reduction in cystic follicular count in letrozole-induced polycystic ovarian disease rats. Improved folliculogenesis was also observed in the same groups (groups C & D).
 Conclusions: Withania coagulans can be a substitute for improvement of ovarian follicular development in polycystic ovarian disease.

Metformin: A Possible Option in Cancer Chemotherapy.

Metformin has been used for a long time as an antidiabetic medication for type 2 diabetes. It is used either as a monotherapy or in combination with other antidiabetic medications. The drug came into prominence in diabetes and other conditions with cardiovascular risk after the landmark study of 1995 by the United Kingdom Prospective Diabetes Study which emphasized its importance. However, the drug has been used in experimental trials in various aspects of medicine and pharmacology such as in reproductive medicine, cancer chemotherapy, metabolic diseases, and neurodegenerative diseases. It has been in use in the treatment of polycystic ovarian disease and obesity and is being considered in type 1 diabetes. This study seeks to evaluate the relevance of metformin in cancer management. Different mechanisms have been proposed for its antitumor action which involves the following: (a) the activation of adenosine monophosphate kinase, (b) modulation of adenosine A1 receptor (ADORA), (c) reduction in insulin/insulin growth factors, and (d) the role of metformin in the inhibition of endogenous reactive oxygen species (ROS); and its resultant damage to deoxyribonucleic acid (DNA) molecule is another paramount antitumor mechanism.

Usefulness of individualised homoeopathic medicines in treatment of polycystic ovarian disease: An evidence based case series

Usefulness of individualised homoeopathic medicines in treatment of polycystic ovarian disease: An evidence based case series

Angiogenic Dysregulation in Pregnancy-Related Hypertension-A Role for Metformin.

In the face of escalating maternal and fetal health threats, hypertensive pregnancy disorders (HPDs) is one of the leading cause of maternal and fetal morbidity and mortality. The range of HPDs include white-coat hypertension, chronic hypertension, gestational hypertension, mild-to-moderate and severe preeclampsia and eclampsia. Current evidence implicates an imbalance of circulating anti- and angiogenic factors in HPDs emanating from the placental vasculature, impacting on angiogenesis. Delivery of the fetus is thus far the only curative measure, albeit with increased risk. Resultant endothelial dysfunction caused by the excessive production of placental soluble fms-like tyrosine kinase-1 has been the basis of many studies to find a safer treatment strategy. Metformin, used historically in the treatment of diabetes mellitus has also found its therapeutic reach in many other disease states. These include, but are not limited to, improving blood flow in certain cancer types, treatment of polycystic ovarian disease, improving vasodilation, and reducing inflammation. Metformin is used to treat hyperglycemic endothelial dysfunction through the enhancement of the nitric oxide system, endothelin-derived hyperpolarizing factor and sirtuin 1. Similarly, endothelial dysfunction in preeclampsia and other HPDs leads to a hypoxic state and elevated blood pressures. Dubbed as the new "aspirin" of current times, the retardation of the antiangiogenic status by metformin provides an exciting and promising alternate strategy in treating these pregnancy disorders.

Pattern of dermatologic manifestations in polycystic ovarian disease cases from a tertiary care hospital

Background: Dermatologists often play a significant role in its management. Cutaneous features of hyperandrogenism in Polycystic ovarian syndrome (PCOS) have varied presentation. Aim of this study was the pattern of dermatologic manifestations in polycystic ovarian disease in northern Indian females.Methods: Patients registering for treatment of polycystic ovarian disease at Dermatology outpatients department during April 2016 to March 2017 formed the study population. Residents interviewed the study subjects at the OPD. General physical examination, systemic examination, breast and pelvic examination, along with detailed dermatological examination were conducting after taking the history. Hormonal analysis was performed after an overnight fasting using enzyme immunoassay.Results: FSH and LH levels were 5.05±1.86 IU/L and 8.14±5.21 IU/L respectively. Testosterone levels were found to be 61.01±25.32 ng/dl. DHEAS levels among them were 130.05±41.21μg/dl. Two commonest cutaneous manifestations were hirsutism and acne seen in 83.8% and 59.5% of subjects. Female pattern hair loss was seen in 45.6% females. Three most frequent hormonal abnormalities noted in our study subjects were raised L/H ratio, testosterone and LH levels seen in approximately 45%, 35% and 21% cases.Conclusions: The cutaneous manifestations of PCOS reserve a major role in its management by dermatologists. A lifestyle modification along with systemic treatment remains mainstay of treatment. Monitoring for the foreseen cardiovascular risks should start early to downgrade the morbidity.

Comparison of efficacy and safety of metformin, oral contraceptive combination of ethinyl estradiol and drospirenone alone or in combination in polycystic ovarian syndrome

Introduction: Polycystic ovarian syndrome (PCOS) is a common endocrine disorder, which can cause various reproductive complications and is associated with metabolic syndrome. In India, strong comparative evidence of oral contraceptive pills (OCP), metformin or their combination in treatment of polycystic ovarian disease is lacking. Objectives: The objective of this study is to compare the efficacy and safety of metformin alone, OCP containing drospirenone or a combination of OCP and metformin in patients with PCOS. Materials and Methods: This was an open-label, randomized, parallel group, and comparative three-arm prospective study, in 60 patients. Patients either received OCPs containing etinyl estradiol plus drospirenone, metformin or combination of OCPs plus metformin for 6 months. Luteinizing hormone: Follicle stimulating hormone (LH:FSH) ratio, serum insulin level, ovarian morphology, body mass index (BMI), acceptance of treatment, regularization of the menstrual cycle and improvement in acne and hirsuitism were evaluated. Results: In patients receiving metformin either as monotherapy or in combination showed significant improvement in BMI. All the study medicines were effective in significantly decreasing ovarian volume, LH/FSH ratio and serum insulin level. Improvement in acne was better in patients receiving OCPs either as monotherapy or in combination with metformin. Improvement in hirsuitism and regularization of the menstrual cycle was highest in patients receiving combination treatment. Acceptance of treatment was maximum in patients receiving monotherapy of OCPs. The total incidence of adverse events was 16.7% (15%, 15% and 20% in OCP, metformin, and combination group, respectively). Conclusion: OCPs containing ethinylestradiol plus drospirenone, metformin, and combination of both are effective and well tolerated in the management of PCOS. Metformin either as monotherapy or combination can be preferred in cases with high BMI. Combination of metformin plus OCP regularizes menstrual cycle better than monotherapy of either drug.

A Case of Successful Treatment of Comorbid Obesity and Polycystic Ovarian Disease With Add-On Metformin in Bipolar Disorder

To the Editor: The association between bipolar disorder and polycystic ovarian disease has been a matter of considerable debate.1 It has been hypothesized that a genetic overlay may explain co-occurrence of both disorders.2 Treatment of bipolar disorder with valproate has also been described to be associated with increased incidence of polycystic ovarian disease.3 The co-occurrence of both disorders significantly enhances risk of associated metabolic complications, especially since bipolar disorder, by itself, has been reported to be associated with increased risk of obesity.4 In this report, we describe successful treatment of polycystic ovarian disease and obesity with add-on metformin in a female patient with DSM-IV bipolar disorder.

O101 Role of Metformin in the treatment of polycystic ovarian disease

International Journal of Gynecology & ObstetricsVolume 107, Issue S2 p. S121-S121 Free communication (oral) presentations O101 Role of Metformin in the treatment of polycystic ovarian disease A. Batra, A. BatraSearch for more papers by this authorP. Saxena, P. SaxenaSearch for more papers by this authorS. Salhan, S. SalhanSearch for more papers by this authorP. Mittal, P. MittalSearch for more papers by this authorM. Sharma, M. SharmaSearch for more papers by this author A. Batra, A. BatraSearch for more papers by this authorP. Saxena, P. SaxenaSearch for more papers by this authorS. Salhan, S. SalhanSearch for more papers by this authorP. Mittal, P. MittalSearch for more papers by this authorM. Sharma, M. SharmaSearch for more papers by this author First published: 20 November 2009 https://doi.org/10.1016/S0020-7292(09)60473-2Citations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume107, IssueS2Abstracts of XIX FIGO World Congress of Gynecology and ObstetricsOctober 2009Pages S121-S121 RelatedInformation

Laparoscopic intraovarian injection of bee venom in the treatment of polycystic ovarian disease: a new modality

Background: Based on our previous work, polycystic ovary syndrome represents an autoimmune disease that demonstrates high concentrations of antiovarian antibodies. Bee venom works in an immune mechanism, and its antiinflammatory-like action works 100 times as a hydrocortisone.Objective: To use for the first time in the literature laparoscopic intraovarian injection of bee venom in the treatment of polycystic ovarian disease.Materials and methods: Fifteen patients with polycystic ovarian disease resistant to medical treatment were treated by laparoscopic injection of 0.1 mL of bee venom injected directly into the ovarian stroma.Results: A statistically significant decrease in luteinizing hormone, androstenedione, and testosterone was observed (P <0.001). Ovulation occurred in 75% of cases. The pregnancy rate was 50% in those who ovulated. No complications were observed with this new technique.Conclusion: Laparoscopic intraovarian injection of bee venom in the treatment of polycystic ovarian disease is a new method for the induction of ovulation in patients with resistant polycystic ovarian disease that is safe, easy to use, and free of complications.

PII: S0029-7844(00)00598-6

Background: There are several laparoscopic techniques for the treatment of polycystic ovarian disease (ovarian biopsy, ovarian drilling, electrosurgery, and laser). Misoprostol is a synthetic 15- oxy-16 hydroxy-16 methyl analogue of naturally occurring prostaglandin E, which has been used for prophylaxis of peptic ulcer. On the cervix, it acts to induce ripening of the cervix by acting on interstitial collagenase (MMP-1), which has been discovered recently in the ovarian tissue.Objective: To use laparoscopic intraovarian injection of misoprostol for induction of ovulation in polycystic ovarian disease.Methods: Twenty cases with polycystic ovarian disease were enrolled in the study. Diagnosis of polycystic ovarian disease was based on an endocrinological basis and vaginal ultrasonography. We measured the ovarian volume of both ovaries. A new equation had been born as: Volume of polycytovary ÷ Volume of normal ovary. This gives the number of tablets that will be injected in both ovaries. Tablet content was 200 mg, the average number of the tablets was 3–6, with a mean number of 4 tablets.Results: A statistically significant difference (P <0.05) in hormonal profile after laparoscopic intraovarian misoprostol (testosterone, androsterone, dehydroepiandrosterone sulfate, estradiol, prolactin, luteinizing hormone, and follicle-stimulating hormone). Pregnancy rate = 80% and ovulation rate = 92%.Conclusion: Misoprostol is an effective new line of treatment that is inexpensive, with no maternal complications, and can be used for polycystic ovarian disease.

Bilateral or Unilateral KTP Laser Ovarian Drilling in Polycystic Ovarian Disease

Bilateral or Unilateral KTP Laser Ovarian Drilling in Polycystic Ovarian Disease

Combined laparoscopic cryosurgery in the treatment of polycystic ovarian disease

This paper presents the results of treating 32 infertile women afflicted with polycystic ovarian disease by combined laparoscopic cryosurgery. Each of these patients had been resistant to the induction of ovulation with clomiphene. Cryosurgery was performed under laparoscopic control with a special cryosurgical probe. Prior to freezing, we did a biopsy of each patient's ovaries and, in 13 cases, enucleation of the cyst. In 6 to 14 months after surgery, normalization of the menstrual cycle occurred in 24 women. The level of steroid hormones, which were studied in the first and second parts of the menstrual cycle before and after surgery, rose to normal (P<0.05; P<0.01). Of the total number of women, 5 had conceived after 3 months, 12 after 6 months, and 3 after 14 months. We conclude that combined laparoscopic cryosurgery is an effective method of treatment for polycystic ovarian disease.

Laparoscopic treatment of polycystic ovarian disease

There has been a recent surge of interest in laparoscopic treatment of polycystic ovarian disease (PCOD) that is unresponsive to first-line ovulation-inducing agents. Laparoscopic treatment options include multiple ovarian punch biopsy, ovarian electrocauterization and laser vaporization or photo-coagulation. These procedures are relatively easy to perform, devoid of major complications, and yield satisfactory ovulation and conception rates. Adhesion formation, however, is a potential complication following such procedures. Furthermore, women subjected to laparoscopic destructive ovarian procedures also need to be critically assessed regarding other long-term risks, such as premature ovarian failure. Laparoscopic treatment of PCOD, at present, should be viewed as experimental awaiting further trials assessing its long-term safety.

Treatment of polycystic ovarian disease during adolescence with ethinylestradiol/cyproterone acetate versus a d-tr-6-lhrh analog

OBJECTIVE: This study was undertaken to compare the clinical and endocrinological results of two kinds of treatment on adolescents with polycystic ovarian disease (PCOD). METHOD: Forty-five adolescents with PCOD were randomly allocated into two groups, treated either with ethinylestradiol (EE)/ cyproterone acetate (group A) or the GnRH analog D-Tr-6-LHRH (group B). RESULT: No significant changes were detected on the body mass index and waist-hip circumference. A significant improvement of hirsutism was noticed in both groups of patients. A normal menstrual period was recorded in group A adolescents while all group B patients became amenorrheic. A favorable decrease of ovarian volume was detected in both groups. LH/FSH ratio and Δ4-androstenedione serum levels were found significantly reduced in both groups in comparison to pre-treatment levels. The comparison between the two groups, after 6 months, showed significantly lower values of LH/FSH ratio in group B cases. CONCLUSION: Both forms of treatment are safe and effective to a various degree for the management of PCOD adolescents.

Selected Aspects of Polycystic Ovarian Disease

Although there is general agreement about the polycystic ovary as an anatomic entity, a classic description of an associated syndrome remains elusive. This lack of definition, however, has not impeded clinical investigation. This article focuses on the diagnosis, pathogenesis, hypotheses, and treatment of polycystic ovarian disease.

妊孕性を考慮した婦人科腹腔鏡下レーザー治療

The feasibility and efficacy of laparoscopic laser surgery for the treatment of polycystic ovarian disease (PCOD) and ectopic pregnancy were evaluated in 9 PCOD patients (treated with CO2 laser) and 5 tubal pregnancy patients (treated with KTP/YAG laser). Seven of 9 patients with PCOD resistant to standard clomiphene citrate therapy ovulated after laparoscopic laser vaporization. Serum LH concentrations declined, while FSH levels did not change following laser treatment. Decline of serum testosterone concentration was noted in these patients. Four out of 5 patients with unruptured tubal pregnancy were successfully removed the ectopic chorionic tissues by laparoscopic laser treatment. Postoperative hysterosalpingography revealed the patency of the operated tubes. These results suggest that endoscopic laser surgery is useful method for the treatment of both PCOD and ectopic pregnancy patients.

Evaluation of adhesion formation after laparoscopic treatment of polycystic ovarian disease

The incidence and fertility effects of postoperative adhesion formation after laparoscopic ovarian electrocautery or laser photocoagulation of polycystic ovaries has not been adequately analyzed. Short-interval second-look laparoscopy appears to be a useful method for addressing this issue. Employing short-interval second-look laparoscopy 3 to 4 weeks after the initial laparoscopic intervention, we were able to demonstrate adhesions in 6 of 7 patients (85%) treated with ovarian electrocautery and 8 of 10 patients (80%) submitted to laser therapy. The adhesions were amenable to laparoscopic lysis in 12 of 14 patients (85%). The subsequent conception rates within 6 months of second-look laparoscopy that were 57% and 40% in the electrocautery and the Nd:YAG laser groups, respectively, may in part be attributed to the restoration of normal pelvic anatomy during this procedure.

The effect of laparoscopic treatment of polycystic ovarian disease by CO2-laser or Nd:YAG laser

The feasibility and efficacy of laparoscopic CO2 laser and Nd:YAG non-contact laser application for the treatment of polycystic ovarian disease (PCOD) were evaluated in 30 patients (19 patients treated with the CO2 laser, and 11 with the Nd:YAG laser). The criteria for inclusion of PCOD in our study were: amenorrhea or oligomenorrhea with chronic anovulation, failure to ovulate in response to clomide or human menopausal gonadotropin, elevated serum levels of luteinizing hormone (LH) or an elevated LH/follicle-stimulating hormone ratio, exaggerated LH response to gonadotrophin-releasing hormone (GnRH), elevated serum androgen levels, and ultrasonographic features of polycystic ovaries. Eight pregnancies after CO2 laser and three after Nd:YAG laser were achieved. Decline of serum androgen concentrations was noted in both groups, but was significantly higher in the Nd:YAG laser group (from 3.4 +/- 0.4 ng/ml to 2.2 +/- 0.2 ng/ml). Nine patients checked before and after laser treatment showed a decrease in the characteristically exaggerated pituitary response to exogenous GnRH injection. There were no consistent findings of the pattern in LH pulsatility studied in 5 patients after Nd:YAG laser treatment. Ovarian status was investigated in 11 patients by second-look laparoscopy or cesarian section. There were absolutely no adhesions after Nd:YAG laser coagulation. Filmy adhesions were seen in 3 patients in the CO2 laser group.

Polycystic Ovarian Disease.

1 Neuroendocrine Regulation of Gonadal Function.- 2 Hormonal Control of Folliculogenesis.- 3 Androgen Transport and Plasma Levels in the Normal Female.- 4 The Pathologic Anatomy of Polycystic Ovarian Disease.- 5 Genetics of Polycystic Ovarian Disease.- 6 Pathophysiology of Polycystic Ovarian Disease.- 7 Clinical Features of Polycystic Ovarian Disease.- 8 Hyperprolactinemia and Polycystic Ovarian Disease.- 9 Laboratory Diagnosis and Differential Diagnosis of Polycystic Ovarian Disease.- 10 Treatment of Polycystic Ovarian Disease.- 11 Hypothesis and Summary.- References.