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International Journal of Current Research in Physiology and Pharmacology
Review Articles
Submitted: 2023-08-09
Published: 2023-09-30

Beyond the Surface: The Hidden Struggles of PCOS

Department of Pharmacology, CT Institute of Pharmaceutical Sciences, PTU, Jalandhar Punjab, India.
Senior Resident, Department of Pharmacology, Government Medical College Baramulla, India.
Department of Pharmacology, CT Institute of Pharmaceutical Sciences, PTU, Jalandhar Punjab, India.
PCOS, fertility, miscarriage, infertility.

Abstract

ABSTRACT

Polycystic Ovary Syndrome (PCOS) presents more than just physical symptoms; beneath the surface lie hidden struggles that profoundly impact those affected. While irregular periods and hormonal imbalances are recognized, the emotional toll is often overlooked. Elevated androgens can trigger mood disturbances, anxiety, and depression, creating a silent battle within. Fertility challenges add another layer of complexity. Conception difficulties, miscarriages, and fertility treatments expose individuals to a rollercoaster of hope and heartache. PCOS also inflicts a psychological burden, eroding self-esteem due to weight gain and societal beauty standards. Healthcare disparities and cultural stigmatization amplify the struggle, hindering proper diagnosis and treatment access. To address these hidden challenges, a holistic approach is imperative. Healthcare providers must acknowledge the emotional aspects, and awareness campaigns should dispel stigma. Empowering support networks can provide solace, while education fosters better self-care. By uncovering and addressing these concealed battles, we pave the way for comprehensive care, improved well-being, and a deeper understanding of the complex reality that PCOS entails.

Keywords: PCOS, fertility, miscarriage, infertility.

References

  1. R.J.R.b.o. Azziz, PCOS: a diagnostic challenge, 8(6) (2004) 644-648.
  2. S.F. Witchel, H.J. Teede, A.S.J.P.r. Peña, Curtailing pcos, 87(2) (2020) 353-361.
  3. M.D. Kahsar-Miller, C. Nixon, L.R. Boots, R.C. Go, R.J.F. Azziz, sterility, Prevalence of polycystic ovary syndrome (PCOS) in first-degree relatives of patients with PCOS, 75(1) (2001) 53-58.
  4. R.L. Rosenfield, D.A.J.E.r. Ehrmann, The pathogenesis of polycystic ovary syndrome (PCOS): the hypothesis of PCOS as functional ovarian hyperandrogenism revisited, 37(5) (2016) 467-520.
  5. M. Zehravi, M. Maqbool, I.J.I.j.o.a.m. Ara, health, Polycystic ovary syndrome and infertility: an update, 34(2) (2021) 1-9.
  6. E. Diamanti-Kandarakis, C.D.J.D. Christakou, m.o.p.o. syndrome, Insulin resistance in PCOS, (2009) 35-61.
  7. A.M. Venkatesan, A. Dunaif, A.J.R.p.i.h.r. Corbould, Insulin resistance in polycystic ovary syndrome: progress and paradoxes, 56 (2001) 295-308.
  8. R.S. Legro, V.D. Castracane, R.P.J.O. Kauffman, g. survey, Detecting insulin resistance in polycystic ovary syndrome: purposes and pitfalls, 59(2) (2004) 141-154.
  9. E. Diamanti-Kandarakis, A.G.J.T.i.m.m. Papavassiliou, Molecular mechanisms of insulin resistance in polycystic ovary syndrome, 12(7) (2006) 324-332.
  10. A. Galluzzo, M.C. Amato, C.J.N. Giordano, Metabolism, C. Diseases, Insulin resistance and polycystic ovary syndrome, 18(7) (2008) 511-518.
  11. K. Polak, A. Czyzyk, T. Simoncini, B.J.J.o.e.i. Meczekalski, New markers of insulin resistance in polycystic ovary syndrome, 40 (2017) 1-8.
  12. M. Mohd, M. Maqbool, M.A. Dar, I.J.J.o.D.D. Mushtaq, Therapeutics, Polycystic ovary syndrome, a modern epidemic: an overview, 9(3) (2019) 641-644.
  13. H. Farshchi, A. Rane, A. Love, R.J.J.o.o. Kennedy, gynaecology, Diet and nutrition in polycystic ovary syndrome (PCOS): pointers for nutritional management, 27(8) (2007) 762-773.
  14. X. Zhang, Y. Zheng, Y. Guo, Z.J.I.J.o.E. Lai, The effect of low carbohydrate diet on polycystic ovary syndrome: a meta-analysis of randomized controlled trials, 2019 (2019).
  15. J. Frary, K. Bjerre, D. Glintborg, P.J.M.E. Ravn, The effect of dietary carbohydrates in women with polycystic ovary syndrome, 10(10) (2014).
  16. K. Papavasiliou, E.J.N. Papakonstantinou, d. supplements, Nutritional support and dietary interventions for women with polycystic ovary syndrome, (2017) 63-85.
  17. M. Boyd, J.J.T.i.C.N. Ziegler, Polycystic ovary syndrome, fertility, diet, and lifestyle modifications: a review of the current evidence, 34(1) (2019) 14-30.
  18. L.J. Moran, C.B. Lombard, S. Lim, M. Noakes, H.J.J.W.s.h. Teede, Polycystic ovary syndrome and weight management, 6(2) (2010) 271-283.
  19. J. Kataoka, E.C. Tassone, M. Misso, A.E. Joham, E. Stener-Victorin, H. Teede, L.J.J.N. Moran, Weight management interventions in women with and without PCOS: a systematic review, 9(9) (2017) 996.
  20. B. Ozgen Saydam, B.O.J.E.r.o.e. Yildiz, metabolism, Weight management strategies for patients with PCOS: current perspectives, 16(2) (2021) 49-62.
  21. M. Zehravi, M. Maqbool, I.J.I.j.o.a.m. Ara, health, Polycystic ovary syndrome and reproductive health of women: a curious association, 33(6) (2021) 333-337.
  22. P. Moghetti, F.J.J.o.e.i. Tosi, Insulin resistance and PCOS: chicken or egg?, 44 (2021) 233-244.
  23. H. Zhao, J. Zhang, X. Cheng, X. Nie, B.J.J.o.O.R. He, Insulin resistance in polycystic ovary syndrome across various tissues: An updated review of pathogenesis, evaluation, and treatment, 16(1) (2023) 9.
  24. M. Khmil, S. Khmil, M.J.O.A.M.J.o.M.S. Marushchak, Hormone imbalance in women with infertility caused by polycystic ovary syndrome: is there a connection with body mass index?, 8(B) (2020) 731-737.
  25. R. Shahid, Mahnoor, K.A. Awan, M.J. Iqbal, H. Munir, I.J.J.o.F.B. Saeed, Diet and lifestyle modifications for effective management of polycystic ovarian syndrome (PCOS), 46(7) (2022) e14117.
  26. E. Rudnicka, K. Suchta, M. Grymowicz, A. Calik-Ksepka, K. Smolarczyk, A.M. Duszewska, R. Smolarczyk, B.J.I.j.o.m.s. Meczekalski, Chronic low grade inflammation in pathogenesis of PCOS, 22(7) (2021) 3789.
  27. M. Rostamtabar, S. Esmaeilzadeh, M. Tourani, A. Rahmani, M. Baee, F. Shirafkan, K. Saleki, S.S. Mirzababayi, S. Ebrahimpour, H.R.J.J.o.c.p. Nouri, Pathophysiological roles of chronic low‐grade inflammation mediators in polycystic ovary syndrome, 236(2) (2021) 824-838.
  28. D. Liu, Y. Huang, C. Huang, S. Yang, X. Wei, P. Zhang, D. Guo, J. Lin, B. Xu, C.J.N.E.J.o.M. Li, Calorie restriction with or without time-restricted eating in weight loss, 386(16) (2022) 1495-1504.
  29. J.Y.J.J.o.o. Kim, m. syndrome, Optimal diet strategies for weight loss and weight loss maintenance, 30(1) (2021) 20.
  30. R.J.N. Freire, Scientific evidence of diets for weight loss: Different macronutrient composition, intermittent fasting, and popular diets, 69 (2020) 110549.
  31. P.J.O. Piaggi, Metabolic determinants of weight gain in humans, 27(5) (2019) 691-699.
  32. J. Moon, G.J.J.o.o. Koh, m. syndrome, Clinical evidence and mechanisms of high-protein diet-induced weight loss, 29(3) (2020) 166.
  33. A.W. Lin, D. Siscovick, B. Sternfeld, P. Schreiner, C.E. Lewis, E.T. Wang, S.S. Merkin, M. Wellons, L. Steffen, R.J.B.P.H. Calderon-Margalit, Associations of diet, physical activity and polycystic ovary syndrome in the Coronary Artery Risk Development in Young Adults Women’s Study, 21 (2021) 1-10.
  34. S. Cowan, S. Lim, C. Alycia, S. Pirotta, R. Thomson, M. Gibson-Helm, R. Blackmore, N. Naderpoor, C. Bennett, C.J.B.E.D. Ee, Lifestyle management in polycystic ovary syndrome–beyond diet and physical activity, 23(1) (2023) 14.
  35. X. Che, Z. Chen, M. Liu, Z.J.A.o.N. Mo, Metabolism, Dietary interventions: a promising treatment for polycystic ovary syndrome, 77(6) (2021) 313-323.
  36. A. Ullah, M.-J. Wang, J.-P. Yang, E.A. Adu-Gyamfi, A. Czika, S.K. Sah, Q. Feng, Y.-X.J.R.B.O. Wang, Ovarian inflammatory mRNA profiles of a dehydroepiandrosterone plus high-fat diet-induced polycystic ovary syndrome mouse model, 44(5) (2022) 791-802.
  37. R.I. Cincione, F. Losavio, F. Ciolli, A. Valenzano, G. Cibelli, G. Messina, R.J.I.j.o.e.r. Polito, p. health, Effects of mixed of a ketogenic diet in overweight and obese women with polycystic ovary syndrome, 18(23) (2021) 12490.
  38. M. Maqbool, I. Ara, I.J.I.J.o.C.R.i.P. Gani, Pharmacology, The Story of Polycystic Ovarian Syndrome: A Challenging Disorder with Numerous Consequences for Females of Reproductive Age, (2022) 19-31.
  39. S. Mei, J. Ding, K. Wang, Z. Ni, J.J.F.i.n. Yu, Mediterranean diet combined with a low-carbohydrate dietary pattern in the treatment of overweight polycystic ovary syndrome patients, 9 (2022) 876620.
  40. A. Nadjarzadeh, A. Ghadiri-Anari, N. Ramezani-Jolfaie, M. Mohammadi, A. Salehi-Abargouei, S.M. Namayande, H. Mozaffari-Khosravi, E.J.C.T.i.M. Hosseini-Marnani, Effect of hypocaloric high-protein, low-carbohydrate diet supplemented with fennel on androgenic and anthropometric indices in overweight and obese women with polycystic ovary syndrome: A randomized placebo-controlled trial, 56 (2021) 102633.
  41. J.M. Aly, A.H.J.C.o. Decherney, gynecology, Lifestyle modifications in PCOS, 64(1) (2021) 83-89.
  42. L. Barrea, A. Arnone, G. Annunziata, G. Muscogiuri, D. Laudisio, C. Salzano, G. Pugliese, A. Colao, S.J.N. Savastano, Adherence to the mediterranean diet, dietary patterns and body composition in women with polycystic ovary syndrome (PCOS), 11(10) (2019) 2278.
  43. M.E. Çıtar Dazıroğlu, N.J.C.N.R. Acar Tek, The Effect on Inflammation of Adherence to the Mediterranean Diet in Polycystic Ovary Syndrome, 12(1) (2023) 191-202.
  44. Z.M. Younossi, K.E. Corey, J.K.J.G. Lim, AGA clinical practice update on lifestyle modification using diet and exercise to achieve weight loss in the management of nonalcoholic fatty liver disease: expert review, 160(3) (2021) 912-918.
  45. A. Bruci, D. Tuccinardi, R. Tozzi, A. Balena, S. Santucci, R. Frontani, S. Mariani, S. Basciani, G. Spera, L.J.N. Gnessi, Very low-calorie ketogenic diet: a safe and effective tool for weight loss in patients with obesity and mild kidney failure, 12(2) (2020) 333.
  46. A.A. Weaver, D.K. Houston, S.A. Shapses, M.F. Lyles, R.M. Henderson, D.P. Beavers, A.C. Baker, K.M.J.T.A.J.o.C.N. Beavers, Effect of a hypocaloric, nutritionally complete, higher-protein meal plan on bone density and quality in older adults with obesity: a randomized trial, 109(2) (2019) 478-486.
  47. E.A. Hu, V. Nguyen, J. Langheier, D.J.J.o.m.I.r. Shurney, Weight reduction through a digital nutrition and food purchasing platform among users with obesity: longitudinal study, 22(9) (2020) e19634.
  48. C.T. Tay, R. Garrad, A. Mousa, M. Bahri, A. Joham, H.J.J.o.E. Teede, Polycystic ovary syndrome (PCOS): international collaboration to translate evidence and guide future research, 257(3) (2023).
  49. C.T. Tay, R. Garad, A. Mousa, M.B. Khomami, A. Joham, H.J.T.J.o.E. Teede, PCOS: international collaboration to translate evidence and guide future research, (2023) JOE-22.
  50. R.M. Garad, H.J.J.C.O.i.E. Teede, M. Research, Polycystic ovary syndrome: improving policies, awareness, and clinical care, 12 (2020) 112-118.
  51. T. Copp, D.M. Muscat, J. Hersch, K.J. McCaffery, J. Doust, A. Dokras, B.W. Mol, J.J.P.e. Jansen, counseling, The challenges with managing polycystic ovary syndrome: a qualitative study of women’s and clinicians’ experiences, 105(3) (2022) 719-725.
  52. D. Achipa, J. Nteziyaremye, Polycystic Ovarian Syndrome Diagnosis in a Patient Undergoing Treatment for Bipolar Affective Disorder at Mbale Regional Referral Hospital, Uganda, (2020).
  53. C.T. Tay, A.E. Joham, L.J. Moran, H.J.C.O.i.E. Teede, Diabetes, Obesity, Better care for women with polycystic ovary syndrome–a proposal for an international evidence based best practice framework to improve care, 29(6) (2022) 514-520.
  54. P. Luo, J. Li, P. Li, G. Wang, W. Li, Z. Song, X. Sun, Z. Fu, H. Zhou, X.J.F.i.E. Yi, A bibliometric and visual analysis of obesity and polycystic ovary syndrome from 2012 to 2022, 13 (2022) 1011105.
  55. S. Aboeldalyl, C. James, E. Seyam, E.M. Ibrahim, H.E.-D. Shawki, S.J.I.j.o.m.s. Amer, The role of chronic inflammation in polycystic ovarian syndrome—a systematic review and meta-analysis, 22(5) (2021) 2734.
  56. S.A. Dabravolski, N.G. Nikiforov, A.H. Eid, L.V. Nedosugova, A.V. Starodubova, T.V. Popkova, E.E. Bezsonov, A.N.J.I.j.o.m.s. Orekhov, Mitochondrial dysfunction and chronic inflammation in polycystic ovary syndrome, 22(8) (2021) 3923.
  57. A. Mancini, C. Bruno, E. Vergani, C. d’Abate, E. Giacchi, A.J.I.J.o.M.S. Silvestrini, Oxidative stress and low-grade inflammation in polycystic ovary syndrome: controversies and new insights, 22(4) (2021) 1667.
  58. M. Maqbool, M. Khan, M. Mohammad, M.A. Adesina, G.J.J.o.A.P.S. Fekadu, Research, Awareness about reproductive health in adolescents and youth: a review, (2019) 1-5.
  59. M. Popovic, G. Sartorius, M. Christ-Crain, Chronic low-grade inflammation in polycystic ovary syndrome: is there a (patho)-physiological role for interleukin-1?, Seminars in immunopathology, Springer, 2019, pp. 447-459.
  60. S.F. de Medeiros, M.A.S. de Medeiros, B.B. Barbosa, A.K.L.W. Yamamoto, M.M.W.J.J.o.O. Yamamoto, G. Research, The connection of alpha‐1 acid glycoprotein inflammatory marker with anthropometric, hormonal, and metabolic characteristic of women with polycystic ovary syndrome, 47(10) (2021) 3571-3582.
  61. Y.D. Prabhu, A. Borthakur, A. Subeka, B. Vellingiri, A.V.J.J.o.R.I. Gopalakrishnan, Increased pro-inflammatory cytokines in ovary and effect of γ-linolenic acid on adipose tissue inflammation in a polycystic ovary syndrome model, 146 (2021) 103345.
  62. Q. Zhang, R. Ye, Y.-Y. Zhang, C.-C. Fan, J. Wang, S. Wang, S. Chen, X.J.F.i.E. Liu, Brown adipose tissue and novel management strategies for polycystic ovary syndrome therapy, 13 (2022) 847249.
  63. J.V. Kolhe, A.S. Chhipa, S. Butani, V. Chavda, S.S.J.R.S. Patel, PCOS and depression: Common links and potential targets, (2021) 1-18.
  64. T.O.J.B.b.r. Tobore, Towards a comprehensive theory of obesity and a healthy diet: The causal role of oxidative stress in food addiction and obesity, 384 (2020) 112560.
  65. H. Yaribeygi, F.R. Farrokhi, A.E. Butler, A.J.J.o.c.p. Sahebkar, Insulin resistance: Review of the underlying molecular mechanisms, 234(6) (2019) 8152-8161.
  66. A.R.J.T.J.o.c.i. Saltiel, Insulin signaling in health and disease, 131(1) (2021).
  67. M.A. Sanchez-Garrido, M.J.M.m. Tena-Sempere, Metabolic dysfunction in polycystic ovary syndrome: Pathogenic role of androgen excess and potential therapeutic strategies, 35 (2020) 100937.
  68. S.J.C.O.i.E. Franks, M. Research, Androgen production and action in the ovary, 18 (2021) 48-53.
  69. K.M. Brennan, L.L. Kroener, G.D. Chazenbalk, D.A.J.O. Dumesic, g. survey, Polycystic ovary syndrome: impact of lipotoxicity on metabolic and reproductive health, 74(4) (2019) 223.
  70. C. Haudum, L. Lindheim, A. Ascani, C. Trummer, A. Horvath, J. Münzker, B.J.N. Obermayer-Pietsch, Impact of short-term isoflavone intervention in polycystic ovary syndrome (PCOS) patients on microbiota composition and metagenomics, 12(6) (2020) 1622.
  71. M. Shilo, A. Mayo, U.J.F.i.E. Alon, A Mechanism for Ovulation Number Control, 13 (2022) 816967.
  72. I. Chudzicka-Strugała, I. Gołębiewska, B. Banaszewska, G. Brudecki, B.J.N. Zwoździak, The Role of Individually Selected Diets in Obese Women with PCOS—A Review, 14(21) (2022) 4555.
  73. L. Barrea, E. Frias-Toral, L. Verde, F. Ceriani, G. Cucalón, E. Garcia-Velasquez, D. Moretti, S. Savastano, A. Colao, G.J.M.O. Muscogiuri, PCOS and nutritional approaches: Differences between lean and obese phenotype, 12 (2021) 100123.
  74. D. Szukiewicz, S. Trojanowski, A. Kociszewska, G.J.I.J.o.M.S. Szewczyk, Modulation of the Inflammatory Response in Polycystic Ovary Syndrome (PCOS)—Searching for Epigenetic Factors, 23(23) (2022) 14663.
  75. F. Komal, M.K. Khan, M. Imran, M.H. Ahmad, H. Anwar, U.A. Ashfaq, N. Ahmad, A. Masroor, R.S. Ahmad, M.J.J.o.T.M. Nadeem, Impact of different omega-3 fatty acid sources on lipid, hormonal, blood glucose, weight gain and histopathological damages profile in PCOS rat model, 18 (2020) 1-11.
  76. Y. Xia, Y. Wang, M. Cui, D.J.A.o.p.m. Su, Efficacy of omega-3 fatty acid supplementation on cardiovascular risk factors in patients with polycystic ovary syndrome: a systematic review and meta-analysis, 2021, pp. 6425-6437.
  77. M. Salek, C.C. Clark, M. Taghizadeh, S.J.E.j. Jafarnejad, N-3 fatty acids as preventive and therapeutic agents in attenuating PCOS complications, 18 (2019) 558.
  78. L. Lu, X. Li, L. Lv, Y. Xu, B. Wu, C.J.F.i.N. Huang, Associations between omega-3 fatty acids and insulin resistance and body composition in women with polycystic ovary syndrome, 9 (2022) 1016943.
  79. M.A. Dar, M. Maqbool, I.J.J.o.E.o.M. Ara, D. Sciences, Patterns of Drug Use in Geriatric Patients at a Tertiary Care Teaching Hospital in Jammu and Kashmir, (2023) 182-186.
  80. M. Szczuko, J. Kikut, U. Szczuko, I. Szydłowska, J. Nawrocka-Rutkowska, M. Ziętek, D. Verbanac, L.J.N. Saso, Nutrition strategy and life style in polycystic ovary syndrome—Narrative review, 13(7) (2021) 2452.
  81. C. Ee, S. Pirotta, A. Mousa, L. Moran, S.J.B.e.d. Lim, Providing lifestyle advice to women with PCOS: an overview of practical issues affecting success, 21(1) (2021) 1-12.
  82. K. Herawati, D.J.E.c. Gayatri, The correlation between sleep quality and levels of stress among students in Universitas Indonesia, 29 (2019) 357-361.
  83. P.-Y. Wang, K.-L. Chen, S.-Y. Yang, P.-H.J.P.o. Lin, Relationship of sleep quality, smartphone dependence, and health-related behaviors in female junior college students, 14(4) (2019) e0214769.
  84. T. Sathyapalan, J.P. Hobkirk, Z. Javed, S. Carroll, A.-M. Coady, P. Pemberton, A. Smith, K. Cianflone, S.L.J.F.i.E. Atkin, The effect of atorvastatin (and subsequent metformin) on adipose tissue acylation-stimulatory-protein concentration and inflammatory biomarkers in overweight/obese women with polycystic ovary syndrome, 10 (2019) 394.
  85. K.D. Hall, I.S. Farooqi, J.M. Friedman, S. Klein, R.J. Loos, D.J. Mangelsdorf, S. O'Rahilly, E. Ravussin, L.M. Redman, D.H.J.T.A.J.o.C.N. Ryan, The energy balance model of obesity: beyond calories in, calories out, 115(5) (2022) 1243-1254.
  86. Q. Xia, W. Wang, Z. Liu, J. Xiao, C. Qiao, Y. Zhao, B. Li, Y. Liu, Y. Peng, X.J.E.J.o.P. Yang, New insights into mechanisms of berberine in alleviating reproductive disorders of polycystic ovary syndrome: Anti-inflammatory properties, (2022) 175433.
  87. Y. Zhai, Y.J.J.o.R.I. Pang, Systemic and ovarian inflammation in women with polycystic ovary syndrome, 151 (2022) 103628.
  88. D. Armanini, M. Boscaro, L. Bordin, C.J.I.j.o.m.s. Sabbadin, Controversies in the pathogenesis, diagnosis and treatment of PCOS: focus on insulin resistance, inflammation, and hyperandrogenism, 23(8) (2022) 4110.
  89. Y. Zhang, Y. Ran, L. Kong, L. Geng, H. Huang, H. Zhang, J. Hu, H. Qi, Y.J.J.o.O.R. Chen, Decreased SFRP5 correlated with excessive metabolic inflammation in polycystic ovary syndrome could be reversed by metformin: implication of its role in dysregulated metabolism, 14 (2021) 1-10.
  90. L. Della Corte, V. Foreste, F. Barra, C. Gustavino, F. Alessandri, M.G. Centurioni, S. Ferrero, G. Bifulco, P.J.E.O.o.I.D. Giampaolino, Current and experimental drug therapy for the treatment of polycystic ovarian syndrome, 29(8) (2020) 819-830.
  91. K. Lejman-Larysz, A. Golara, M. Baranowska, M. Kozłowski, P. Guzik, I. Szydłowska, J. Nawrocka-Rutkowska, E. Sowińska-Przepiera, A. Cymbaluk-Płoska, A.J.N. Brodowska, Influence of Vitamin D on the Incidence of Metabolic Syndrome and Hormonal Balance in Patients with Polycystic Ovary Syndrome, 15(13) (2023) 2952.
  92. M.A. Dar, M. Maqbool, I.J.J.o.E.o.M. Ara, D. Sciences, Metformin and Other Sulfonylureas for Glycemic Control in Type 2 Diabetic Patients at a Tertiary Care Hospital in Jammu & Kashmir, (2023) 197-201.
  93. A. Balkrishna, M. Rana, S. Mishra, D. Srivastava, R. Bhardwaj, S. Singh, S.K. Rajput, V.J.E.-B.C. Arya, A. Medicine, Incredible Combination of Lifestyle Modification and Herbal Remedies for Polycystic Ovarian Syndrome Management, 2023 (2023).
  94. Z. Guleken, H. Bulut, B. Bulut, W. Paja, B. Orzechowska, M. Parlinska-Wojtan, J.J.S.A.P.A.M. Depciuch, B. Spectroscopy, Identification of polycystic ovary syndrome from blood serum using hormone levels via Raman spectroscopy and multivariate analysis, 273 (2022) 121029.
  95. R. Azziz, K. Kintziger, R. Li, J. Laven, L. Morin-Papunen, S.S. Merkin, H. Teede, B.O.J.H.r. Yildiz, Recommendations for epidemiologic and phenotypic research in polycystic ovary syndrome: an androgen excess and PCOS society resource, 34(11) (2019) 2254-2265.
  96. P. Kempegowda, E. Melson, K.N. Manolopoulos, W. Arlt, M.W.J.T.a.i.e. O’Reilly, metabolism, Implicating androgen excess in propagating metabolic disease in polycystic ovary syndrome, 11 (2020) 2042018820934319.
  97. V. De Oliveira, J. Schaefer, B. Abu-Rafea, G.A. Vilos, A.G. Vilos, M. Bhattacharya, S. Radovick, A.V.J.M.h.r. Babwah, Uterine aquaporin expression is dynamically regulated by estradiol and progesterone and ovarian stimulation disrupts embryo implantation without affecting luminal closure, 26(3) (2020) 154-166.
  98. J.A. MacLean, K.J.C. Hayashi, Progesterone actions and resistance in gynecological disorders, 11(4) (2022) 647.
  99. M. Régnier, M. Van Hul, C. Knauf, P.D.J.J.o.E. Cani, Gut microbiome, endocrine control of gut barrier function and metabolic diseases, 248(2) (2021) R67-R82.
  100. F.M. Gribble, F.J.N.R.E. Reimann, Function and mechanisms of enteroendocrine cells and gut hormones in metabolism, 15(4) (2019) 226-237.
  101. I. Domínguez-López, M. Yago-Aragón, A. Salas-Huetos, A. Tresserra-Rimbau, S.J.N. Hurtado-Barroso, Effects of dietary phytoestrogens on hormones throughout a human lifespan: A review, 12(8) (2020) 2456.
  102. M. Bahmani, S. Shokri, Z.N. Akhtar, S. Abbaszadeh, A.J.J.a.r. Manouchehri, The effect of pomegranate seed oil on human health, especially epidemiology of polycystic ovary syndrome; a systematic review, 26(4) (2022) 631.
  103. R. Gharaei, F. Mahdavinezhad, E. Samadian, J. Asadi, Z. Ashrafnezhad, L. Kashani, F.J.J.o.a.r. Amidi, genetics, Antioxidant supplementations ameliorate PCOS complications: a review of RCTs and insights into the underlying mechanisms, (2021) 1-15.
  104. E. Rudnicka, A.M. Duszewska, M. Kucharski, P. Tyczyński, R.J.R. Smolarczyk, Oxidative Stress and Reproductive Function: Oxidative stress in polycystic ovary syndrome, 164(6) (2022) F145-F154.
  105. G. Eslamian, A.J.J.o.r. Hekmatdoost, infertility, Nutrient patterns and risk of polycystic ovary syndrome, 20(3) (2019) 161.
  106. A. Hestiantoro, B.P.K. Astuti, E.O. Joyo, R.R. Febri, V. Silvana, R.J.J.o.t.T.G.G.A. Muharam, Vitamin B 3 (niacin), B 6, C, and iron intake are associated with the free androgen index, especially in normoandrogenic polycystic ovary syndrome, 23(3) (2022) 130-136.
  107. Y. Mu, D. Cheng, T.-l. Yin, J.J.R.S. Yang, Vitamin D and polycystic ovary syndrome: a narrative review, 28 (2021) 2110-2117.
  108. E.A. Sulaiman, S. Dhiaa, M.M.J.M. Merkhan, Overview of vitamin D role in polycystic ovarian syndrome, 91(1) (2022) 37-43.
  109. J. Yin, X. Hong, J. Ma, Y. Bu, R.J.F.i.e. Liu, Serum trace elements in patients with polycystic ovary syndrome: a systematic review and meta-analysis, 11 (2020) 572384.
  110. J. Aaseth, S. Ellefsen, U. Alehagen, T.M. Sundfør, J.J.B. Alexander, Pharmacotherapy, Diets and drugs for weight loss and health in obesity–An update, 140 (2021) 111789.
  111. A.R. Kansra, S. Lakkunarajah, M.S.J.F.i.p. Jay, Childhood and adolescent obesity: A review, 8 (2021) 866.
  112. I. Ara, M. Maqbool, I.J.I.J.o.C.R.i.P. Gani, Pharmacology, Reproductive Health of Women: implications and attributes, (2022) 8-18.
  113. E.K. Farhat, E.K. Sher, A. Džidić-Krivić, I. Banjari, F.J.T.J.o.N.B. Sher, Functional biotransformation of phytoestrogens by gut microbiota with impact on cancer treatment, (2023) 109368.
  114. B. Aftab, M. Imran, S.I.J.J.o.F. Shahrukh, N. Research, Effect of Phytoestrogens in the Treatment of Polycystic Ovary Syndrome in Rat Model, 10(7) (2022) 518-525.
  115. B. Banaszewska, L. Pawelczyk, R.J.R.b. Spaczynski, Current and future aspects of several adjunctive treatment strategies in polycystic ovary syndrome, 19(4) (2019) 309-315.
  116. J.A. Lentscher, B. Slocum, S.J.C.o. Torrealday, gynecology, Polycystic ovarian syndrome and fertility, 64(1) (2021) 65-75.
  117. V. Calcaterra, E. Verduci, H. Cena, V.C. Magenes, C.F. Todisco, E. Tenuta, C. Gregorio, R. De Giuseppe, A. Bosetti, E.J.N. Di Profio, Polycystic ovary syndrome in insulin-resistant adolescents with obesity: the role of nutrition therapy and food supplements as a strategy to protect fertility, 13(6) (2021) 1848.
  118. M.F. Costello, M.L. Misso, A. Balen, J. Boyle, L. Devoto, R.M. Garad, R. Hart, L. Johnson, C. Jordan, R.S.J.A. Legro, N.Z.J.o. Obstetrics, Gynaecology, A brief update on the evidence supporting the treatment of infertility in polycystic ovary syndrome, 59(6) (2019) 867-873.
  119. M. Li, X. Ruan, A.O.J.G.H.J. Mueck, Management strategy of infertility in polycystic ovary syndrome, 6(2) (2022) 70-74.
  120. J. Collée, M. Mawet, L. Tebache, M. Nisolle, G.J.G.E. Brichant, Polycystic ovarian syndrome and infertility: overview and insights of the putative treatments, 37(10) (2021) 869-874.
  121. Y. Shang, H. Zhou, R. He, W.J.F.i.E. Lu, Dietary modification for reproductive health in women with polycystic ovary syndrome: a systematic review and meta-analysis, 12 (2021) 735954.
  122. N. Saadati, F. Haidari, M. Barati, R. Nikbakht, G. Mirmomeni, F.J.H. Rahim, The effect of low glycemic index diet on the reproductive and clinical profile in women with polycystic ovarian syndrome: A systematic review and meta-analysis, 7(11) (2021).
  123. G. Li, D. Zhao, Q. Wang, M. Zhou, L. Kong, M. Fang, P.J.J.o.P.R. Li, Infertility-related stress and quality of life among infertile women with polycystic ovary syndrome: Does body mass index matter?, 158 (2022) 110908.
  124. J.M. Hazlehurst, P. Singh, G. Bhogal, S. Broughton, A.A.J.C.e. Tahrani, How to manage weight loss in women with obesity and PCOS seeking fertility?, 97(2) (2022) 208-216.
  125. I. Ara, M. Maqbool, M.J.O.H. Zehravi, Psychic consequences of infertility on couples: A short commentary, 3(1) (2022) 114-119.
  126. M.A.d. Castro, M.d.M. Fontanelli, C.A. Nogueira-de-Almeida, M.J.N. Fisberg, Food insecurity reduces the chance of following a nutrient-dense dietary pattern by Brazilian adults: insights from a nationwide cross-sectional survey, 14(10) (2022) 2126.
  127. B.M. Perzia, J.L. Dunaief, D.M.J.B.C.R.C. Dunaief, Chronic migraine reversal and prevention with the LIFE diet: A nutrient dense whole food plant-based diet (WFPBD), 14(12) (2021) e243987.
  128. A.J.F.i.N. Melse-Boonstra, Bioavailability of micronutrients from nutrient-dense whole foods: zooming in on dairy, vegetables, and fruits, 7 (2020) 101.
  129. J.A.J.C.O.i.O. Grieger, Gynecology, Preconception diet, fertility, and later health in pregnancy, 32(3) (2020) 227-232.
  130. M. Bahri Khomami, H.J. Teede, A.E. Joham, L.J. Moran, T.T. Piltonen, J.A.J.C.E. Boyle, Clinical management of pregnancy in women with polycystic ovary syndrome: An expert opinion, 97(2) (2022) 227-236.
  131. K. Deepak Kumar, R. Huntriss, E. Green, S. Bora, C.J.J.o.H.N. Pettitt, Dietetics, Development of a nutrition screening tool to identify need for dietetic intervention in female infertility, 36(1) (2023) 154-168.
  132. Z. Zhang, C. Shi, Z.J.N. Wang, Therapeutic Effects and Molecular Mechanism of Chlorogenic Acid on Polycystic Ovarian Syndrome: Role of HIF-1alpha, 15(13) (2023) 2833.
  133. M. Zehravi, M. Maqbool, I.J.O.H. Ara, Healthy lifestyle and dietary approaches to treating polycystic ovary syndrome: a review, 3(1) (2022) 60-65.
  134. M. Zafar, K. Mills, J. Zheng, M. Peng, X. Ye, L.J.O.R. Chen, Low glycaemic index diets as an intervention for obesity: a systematic review and meta‐analysis, 20(2) (2019) 290-315.
  135. J.Z. Goldenberg, A. Day, G.D. Brinkworth, J. Sato, S. Yamada, T. Jönsson, J. Beardsley, J.A. Johnson, L. Thabane, B.C.J.b. Johnston, Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: systematic review and meta-analysis of published and unpublished randomized trial data, 372 (2021).
  136. K. Rees, A. Takeda, N. Martin, L. Ellis, D. Wijesekara, A. Vepa, A. Das, L. Hartley, S.J.G.h. Stranges, Mediterranean-style diet for the primary and secondary prevention of cardiovascular disease: A Cochrane review, 15(1) (2020).
  137. R.B. Singh, J. Fedacko, G. Fatima, A. Magomedova, S. Watanabe, G.J.N. Elkilany, Why and how the Indo-Mediterranean diet may be superior to other diets: the role of antioxidants in the diet, 14(4) (2022) 898.
  138. N. Parletta, D. Zarnowiecki, J. Cho, A. Wilson, S. Bogomolova, A. Villani, C. Itsiopoulos, T. Niyonsenga, S. Blunden, B.J.N.n. Meyer, A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED), 22(7) (2019) 474-487.
  139. A. Nani, B. Murtaza, A. Sayed Khan, N.A. Khan, A.J.M. Hichami, Antioxidant and anti-inflammatory potential of polyphenols contained in Mediterranean diet in obesity: Molecular mechanisms, 26(4) (2021) 985.
  140. E. Wawrzyniak-Gramacka, N. Hertmanowska, A. Tylutka, B. Morawin, E. Wacka, M. Gutowicz, A.J.N. Zembron-Lacny, The association of anti-inflammatory diet ingredients and lifestyle exercise with inflammaging, 13(11) (2021) 3696.
  141. V. Rodriguez Paris, S.M. Solon-Biet, A.M. Senior, M.C. Edwards, R. Desai, N. Tedla, M.J. Cox, W.L. Ledger, R.B. Gilchrist, S.J.J.N.c. Simpson, Defining the impact of dietary macronutrient balance on PCOS traits, 11(1) (2020) 5262.
  142. K. Gayathri, V. Supriya, N.J.I.J.o.N. Palaniappan, Pharmacology, Neurological Diseases, Nutritional Composition and Sensory Evaluation of Phytoestrogen-Rich Supplement for Women with PCOS, 11(4) (2021) 303-308.
  143. S. Cienfuegos, S. Corapi, K. Gabel, M. Ezpeleta, F. Kalam, S. Lin, V. Pavlou, K.A.J.N. Varady, Effect of intermittent fasting on reproductive hormone levels in females and males: a review of human trials, 14(11) (2022) 2343.
  144. M. Xenou, K.J.M. Gourounti, Dietary patterns and polycystic ovary syndrome: a systematic review, 16(3) (2021) 516.
  145. C. Kite, I.M. Lahart, I. Afzal, D.R. Broom, H. Randeva, I. Kyrou, J.E.J.S.r. Brown, Exercise, or exercise and diet for the management of polycystic ovary syndrome: a systematic review and meta-analysis, 8 (2019) 1-28.
  146. E. Frias-Toral, E. Garcia-Velasquez, M. de Los Angeles Carignano, D. Rodriguez-Veintimilla, I. Alvarado-Aguilera, N.J.M.E. Bautista-Litardo, Polycystic ovary syndrome and obesity: clinical aspects and nutritional management, 47(2) (2021) 215-241.
  147. L. Barrea, L. Verde, E. Camajani, S. Cernea, E. Frias-Toral, D. Lamabadusuriya, F. Ceriani, S. Savastano, A. Colao, G.J.C.N.R. Muscogiuri, Ketogenic diet as medical prescription in women with polycystic ovary syndrome (PCOS), 12(1) (2023) 56-64.
  148. G. Muscogiuri, M. El Ghoch, A. Colao, M. Hassapidou, V. Yumuk, L.J.O.f. Busetto, European guidelines for obesity management in adults with a very low-calorie ketogenic diet: a systematic review and meta-analysis, 14(2) (2021) 222-245.
  149. M. Mizgier, R. Watrowski, J. Opydo-Szymaczek, E. Jodłowska-Siewert, G. Lombardi, W. Kędzia, G.J.N. Jarząbek-Bielecka, Association of Macronutrients Composition, Physical Activity and Serum Androgen Concentration in Young Women with Polycystic Ovary Syndrome, 14(1) (2021) 73.
  150. R. Kaur, R. Kumar, M.J.E. Gupta, Predicting risk of obesity and meal planning to reduce the obese in adulthood using artificial intelligence, 78(3) (2022) 458-469.
  151. C.C. Douglas, R. Jones, R. Green, K. Brown, G. Yount, R.J.A.J.o.H.E. Williams, University students with PCOS demonstrate limited nutrition knowledge, 52(2) (2021) 80-91.
  152. T.A.J.T.P. Chakravorty, Understanding Polycystic Ovary Syndrome (PCOS):: Symptoms, Diagnosis, Treatment and Future Directions, 8(2) (2023) 1-8.
  153. T.M. Barber, S. Franks, Developmental origins and genetic basis of polycystic ovary syndrome, Human Reproductive and Prenatal Genetics, Elsevier2023, pp. 505-530.
  154. E. Bagatin, M.A.D.d. Rocha, T.H.P. Freitas, C.S.J.E.R.o.C.P. Costa, Treatment challenges in adult female acne and future directions, 14(6) (2021) 687-701.
  155. S.J.I.j.o.w.s.h. Pramodh, Exploration of lifestyle choices, reproductive health knowledge, and polycystic ovary syndrome (Pcos) awareness among female emirati university students, (2020) 927-938.
  156. X. Yin, Y. Ji, C.L.W. Chan, C.H.Y.J.A.o.W.s.M.H. Chan, The mental health of women with polycystic ovary syndrome: a systematic review and meta-analysis, 24 (2021) 11-27.
  157. S. Wei, Y.-Y. Tang, F. Wang, Y. Wang, X.J.F.i.P. Geng, Neural circuits and neuroendocrine mechanisms of depression and premenstrual dysphoric disorder: towards precise targets for translational medicine and drug development, volume II, 14 (2023) 1216689.
  158. S. Shabbir, E. Khurram, V.S. Moorthi, Y.T.H. Eissa, M.A. Kamal, A.E.J.J.o.T.M. Butler, The interplay between androgens and the immune response in polycystic ovary syndrome, 21(1) (2023) 1-26.
  159. M. Ntumy, E. Maya, D. Lizneva, R. Adanu, R.J.G.E. Azziz, The pressing need for standardization in epidemiologic studies of PCOS across the globe, Taylor & Francis, 2019, pp. 1-3.

How to Cite

Bashir Malik, A., Qadrie, Z., & Altaf Dar, M. (2023). Beyond the Surface: The Hidden Struggles of PCOS. International Journal of Current Research in Physiology and Pharmacology, 10–23. Retrieved from https://ijcrpp.com/index.php/ijcrpp/article/view/81