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30 August 2022

Therapeutic Advancement in the Treatment of Poly Cystic Ovarian Syndrome

PCOS is an endocrine condition that affects the ovaries. In contrast to other ovulation diseases when the ovaries are dysfunctional, this syndrome is characterised by prolonged hormonal changes and ovarian malfunction. The patient's main complaint is now the focus of most therapies.

 

Treating symptoms of hyperandrogenism and reestablishing monthly regularity while encouraging pregnancy are the main goals of treatment. Letrozole, an aromatase inhibitor, is more effective than clomiphene citrate, an anti-estrogen, and a reference infertility drug, in managing infertility brought on by polycystic ovarian syndrome. It can assist patients in maintaining suitable lifestyle modifications, such as lowering body fat, boosting metabolism, and improving reproductive health. When monthly irregularities occur in PCOS patients who do not wish to become pregnant, compound oral contraceptives-the most popular type of androgen inhibitor-are the treatment of choice. 

 

Women struggling with PCOS should prioritise losing weight, as it is a safer alternative to raise insulin sensitivity, speed up metabolism, and improve overall health. Other PCOS-related indications related to reproduction include metabolic syndrome (MS), persistent low-grade inflammation, and insulin resistance (IR). Recent years have seen improvements in our knowledge of the pathophysiological mechanism, diagnosis, and treatment of PCOS.

 

WHO-Approved Therapeutic Drugs For Managing PCOS Clomid Citrate

Clomid citrate (CC) is the medicine of choice for stimulating ovulation in adult females with polycystic ovarian syndrome. CC functions as an anti-estrogen by blocking oestrogen receptors in the hypothalamus, raising the pulse width of gonadotropin-releasing hormone (GnRH) in the pituitary gland, and boosting the synthesis of follicle-stimulating hormone (FSH). 

 

Between the second and fifth day of the cycle, CC is typically administered for five days, starting at 50 mg per day and gradually increasing to 150 mg per day. For women with PCOS resistant to Clomid Citrate, it can be used in conjunction with metformin. Clomid has increased the chance of successful pregnancies in over 30% of the cases with PCOS; yet, it's imperative to note that some patients may have complications. 

 

Clomid Citrate has the following documented side effects.                                                                         

  • hyperstimulation syndrome, 
  • ovarian enlargement,
  • multiple pregnancies, 
  • hot bloating, 
  • hot flushes, 
  • lethargy

 

Letrozole the Aromatase Inhibitors (AI)

Androgens are converted to oestrogen via aromatase. Letrozole, a non-steroidal selective ovulation inducer, has reportedly been effective in ovarian estradiol secretion. As the pituitary gland releases more FSH, the follicles become more sensitive to it, boosting the rate of ovulation. It results from a transient increase in androgens in the ovary as the negative feedback from the brain.

 

Insulin Sensitisers

Individuals with PCOS have abnormal insulin production and activity. Patients with PCOS have long been known to have elevated testosterone levels due to insulin resistance and hyperinsulinemia. Insulin regulates ovarian function, and high insulin levels can harm the ovary. In reaction to excessive insulin, muscle cells release large amounts of androgens, inhibiting follicular development and causing the polycystic ovarian shape, a hallmark of PCOS.

 

Insulin resistance has traditionally been denoted by acanthosis nigricans. Patients with PCOS who have insulin resistance are more prone to potentially lethal long-term health problems such as type 2 diabetes and heart problems. Therefore, managing insulin resistance with drugs and lifestyle changes is crucial for PCOS treatment.Long-term insulin sensitivity may result in harmful systemic consequences. Therefore, therapy for insulin resistance, including medication and lifestyle modifications, is essential for PCOS management.

 

Inositol

Supplemental Inositol promotes insulin action. Its function in controlling the biochemical and metabolic elements of PCOS is still under research. A recent study suggests that ovulation and menstrual cycles can be regulated with supplemental Inositol. While Inositol has few benefits, it has a minimal risk of side effects and is inexpensive.

 

Oral Contraceptives

Menstrual cycle regulation is the primary mode of action of Oral contraceptives in managing PCOS. These medications also reduce testosterone production, which regulates hormonal imbalance, and reduces acne and excessive hair growth. Theoretically, these drugs are more effective in alleviating androgenic symptoms than earlier medications. Most women with hirsutism have improved symptoms after a few months of Oral contraceptive treatment.

 

PCOS treatment should be made available in addition to symptom relief to prevent long-term consequences. Doctors commonly recommend a combo of oral contraceptives and antigens to reduce testosterone levels and long-term management of PCOS while conserving the reproductive organs.

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