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Polycystic Ovary Syndrome: PCOS Analysis

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Introduction
Polycystic ovary syndrome (PCOS) is a condition that is estimated to effect between 6% and 10% of reproductive age women (Andreou, Barber, Dimitriadis, & Franks, 2016). In this paper we will define PCOS, examine the pathogenesis, identify ways to assess for the condition and review the treatment options on a mock patient.
PCOS Defined
There is still not a consensus among everyone on the medical community on the exact diagnosis criteria for PCOS, especially since criteria vary based on genetics and ethnicity. Since 2003 the Rotterdam European Society for Human Reproduction and Embryology and the American Society of Reproductive Medicine have agreed that PCOS can be diagnosed based on the following criteria:
1) All other conditions
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Nearly all of the recent research points out that there is a high comorbidity with PCOS, insulin resistance, and obesity. Obese women with insulin resistance are at the highest risk for developing PCOS. A 2015 research paper found that if conception is achieved (typically with the assistance of ovulation-inducing agents as we discussed) while the patient is diagnosed with PCOS the only notable increased health risk is GDM (Hayata, et al., 2015). However, a 2013 meta-analysis of 21 studies involving a combined 4,841 women with PCOS, and 1,196,705 control woman without PCOS found “women with PCOS demonstrated significantly elevated risk of gestational diabetes mellitus (3.5x), pregnancy-induced hypertension (3.4x), preeclampsia (2.2x), premature delivery (1.9x), caesarean section rate (1.7x), (and) admission to an NICU pregnancy (2.3x)” (Chen, et al., 2013) This research is supported by a recent article “Pregnancy Complications In Women With Polycystic Ovary Syndrome” which looked at this same meta-analysis as well as two other previous meta-analysis which came to similar conclusions. It is worth noting that in my research all of these complications with the exception of GDM, and pregnancy-induced hypertension can also be attributed to side effects of the fertility drug clomiphene citrate, especially if multiple eggs are fertilized. This statement is summed up well in the Pregnancy Complications article just mentioned: “infertility treatments are considered to be potential confounders in the evaluation of pregnancy complications” (Battista LaSala, et al., 2015). GDM is clearly the most common side effect that can be directly linked to PCOS therefore screening should be performed during the first trimester to allow for adequate insulin control which can typically be easily achieved with dietary modifications or insulin therapy such as
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