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Exercise in polycystic ovarian syndrome: An evidence-based review



Polycystic ovarian syndrome (PCOS) is a common endocrine disorder affecting female adolescent and adulthood globally. The most annoying complications of PCOS are obesity and infertility. Exercise is proved to be a best therapeutic and supportive management in PCOS patients in reducing infertility. Exercise reduces the risk and restores fertility and quality of life in PCOS patients through inducing hormonal changes of testosterone, androstenedione, combating obesity, metabolic syndrome, reducing inflammatory markers, and increasing immunity. Earlier systematic reviews and metaanalyses have proved the effectiveness of exercise in PCOS. This current systematic review will add to the current evidence of cumulative effects on exercise and shall be an update to the current proof of physical activity in PCOS patients
© 2017 Saudi Journal of Sports Medicine | Published by Wolters Kluwer - Medknow
Alva’s College of Physiotherapy and Research Center, 2Department of
Physiotherapy, Alva’s College of Physiotherapy, Moodbidri, Mangalore,
1Center for Sport Science Medicine and Research, School of Allied
Health Sciences, Manipal University, Manipal, Karnataka, India
Mr. Baskaran Chandrasekaran,
Center for Sport Science Medicine and Research, School of Allied
Health Sciences, Manipal University, Manipal, Karnataka, India.
Polycystic ovarian syndrome (PCOS) is a common endocrine
disorder affecting chiefly the women at reproductive
ages (late adolescent and early adulthood). It is caused by the
imbalance of female sex hormones.[1] The prevalence rate is
about 9.13% in Indian adolescents and 3.7% in young women.[2]
A study carried out in an urban population in India showed
a prevalence rate of about 22.5% of Rotterdam classification
and 10.7% by Androgen Excess Society criteria.[3] The clinical
features comprise of reproductive manifestations such as
reduced frequency of ovulation, menstrual irregularity,
reduced fertility, abdominal obesity, sonographic evidence
of ovarian cysts, and high levels of male hormones such as
testosterone and androstenedione.[1]
PCOS is associated with metabolic features including
elevated levels of insulin secretion and resistance, diabetes
and cardiovascular disease risk factors such as abnormal
cholesterol levels and free plasma lipids.[1] The causative
factors behind PCOS are unknown. The probable cause
may be related to the dysregulation in female reproductive
hormones as demonstrated in earlier studies.[1,2] Insulin
resistance (IR) and its compensatory hyperinsulinemia are
proposed as significant etiological factors of PCOS.[4] All these
factors are said to be substantial cause for hyperandrogenism
in PCOS patients.[1] Overweight and obesity worsen these
underlying hormonal imbalances by increasing androgen and
excess blood insulin levels thus making the clinical features
very evident in women with PCOS.[5]
The exact etiology of metabolic syndrome is unknown, but
the excessive visceral fat contributes to the development
of clinically significant disorders such as IR, dyslipidemia,
high blood pressure, impaired fibrinolysis, glucose
Exercise in polycystic ovarian syndrome: An
evidence-based review
Polycystic ovarian syndrome (PCOS) is a common endocrine disorder affecting female adolescent and adulthood globally. The most annoying
complications of PCOS are obesity and infertility. Exercise is proved to be a best therapeutic and supportive management in PCOS patients
in reducing infertility. Exercise reduces the risk and restores fertility and quality of life in PCOS patients through inducing hormonal changes
of testosterone, androstenedione, combating obesity, metabolic syndrome, reducing inflammatory markers, and increasing immunity. Earlier
systematic reviews and meta‑analyses have proved the effectiveness of exercise in PCOS. This current systematic review will add to the current
evidence of cumulative effects on exercise and shall be an update to the current proof of physical activity in PCOS patients.
Keywords: Depression, exercise, fertility, physical activity, polycystic ovarian syndrome, quality of life, resistance
and endurance training
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Oliverraj J. Exercise in polycystic ovarian syndrome: An evidence-based
review. Saudi J Sports Med 2017;17:123-8.
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Shetty, et al.: Evidence of exercise in PCOS
124 Saudi Journal of Sports Medicine / Volume 17 / Issue 3 / September-December 2017
intolerance, and endothelial dysfunction.[6] Pathogenesis
of multiple sclerosis (MS) in PCOS women may be due to
(i) IR, (ii) hyperinsulinemia and (iii) glucose intolerance, which
are caused mainly due to dysregulation of insulin signal
transduction pathways, and (iv) failure in fatty acid uptake
in muscle and liver.[6]
PCOS, Polycystic Ovarian Syndrome (COS) is associated with the
development of cardiovascular disorders and type 2 diabetes.
IR, one of the dynamic components of MS, is observed in
about 50%–80% of women with PCOS.[7] Insulin receptors
are present in significant amount in ovaries and impairment
of insulin signaling in theca cells increases the production
of androgens.[8] IR impairs insulin action in tissues, such as
skeletal muscle, adipocytes, and liver. In skeletal muscle, the
primary effect of insulin is to stimulate glucose uptake and
metabolism. In insulin‑resistant state, the glucose uptake is
markedly reduced in skeletal muscle. Hence, poor exercise
capacity due to reduced muscular efficiency, early fatigue,
and hence exercise tolerance are inevitable in PCOS patients.[9]
Obese individuals exhibit marked skeletal muscle IR as
compared that of lean individuals who are related to higher
body mass index in PCOS women.[10] Weight loss in obese
individuals improves or reverses IR in skeletal muscle of PCOS
women. Obesity tends to aggravate the clinical presentation
of PCOS. Indeed, the incidence of hirsutism and menstrual
irregularity is greater in the obese population as compared
to nonobese PCOS.[11] Owing to the above reasons, quality of
life with PCOS individual might get worse as it progresses.
Weight reduction may lead to a decrease in glucose intolerance
which in turn may lead to improvement in reproductive and
metabolic derangements in PCOS.[12] Exercise training has
shown significant improvement in irregularity of menstrual
cycles and ovulation in about 50% women diagnosed
with PCOS which improves body composition.[13] Further
weight loss may reduce pulse amplitude of luteinizing
hormone (LH) in turn reducing androgen production.[14] The
key factor responsible for these effects is the reduction of
hyperinsulinemia and IR.
Exercise has shown to modulate insulin sensitivity and lipid
metabolism in skeletal muscle. Exercise improves insulin
sensitivity by increasing intramyocellular triacylglycerol
concentration.[15] Improvement in insulin sensitivity could
be due to more efficient lipid turnover resulting in increased
muscle lipid uptake, transport, utilization, and oxidation.
The literature states the efficacy of exercise training in
combating metabolic syndrome in PCOS patients by marking
improvements in apolipoprotein, adiponectin in the process
of lipid turnover, and uptake in skeletal muscles.[16]
Endurance exercise also increases capillary density,
mitochondrial density, number, hyperplasia of muscle
fibers, neural sensitization, motor learning, and adaptations
thereby increasing exercise capacity and reducing exercise
intolerance in PCOS individual.[17] Improved blood flow
to skeletal muscles, mitochondrial proliferation, and
sensitivity to activity enhance the stability of essential
protein involved in insulin signal transduction in PCOS
The literature claiming the effectiveness of exercise in PCOS
is searched through electronic databases such as ProQuest
and Ovid and public databases such as PubMed Central and
Biomed Central. The MeSH items used for searching online
are exercise training AND PCOS, physical activity AND PCOS,
exercise AND fertility OR ovulation. Only full‑text articles
published in English are reviewed. Two authors (DS and AW)
hand searched the articles, and any consensus among the
authors was solved through third author (JO). The research
findings are shown in Table 1.
Based on the literature reviewed in Table 1, the dosage of
exercise recommended in PCOS for potential health benefits
may be as follows:
Exercise training session
Warm‑up: At least 5–10 min.
Conditioning phase:
Aerobic training:
• Frequency:5days/weekfor12–24weeks
• Intensity:20–60minofaerobic(high‑intensityinterval
training 70%–70% VO2 peak repetitive exercise bouts
of10 min, six episodes/sessionwith 15 min ofactive
pause 55%–60% VO2 peak between the bouts. Continuous
practice sessions 60%–70% heart rate (HR) max inculcating
large muscles such as running or cycling for 30–60 min)
• Time:30–45min.Fatigue‑freelevel
• Mode:Treadmillorbicycle
• Progression:10% VO2 peak or HR max every 2 weeks.
After 4 weeks, new VO2 peak test to be determined from
maximal or submaximal exercise testing.
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Table 1: The current evidence behind effects of exercise on Polycystic Ovarian Syndrome women
Source Study design Participants Method Exercise intervention Inference Evidence
Intensity Duration Freq uency
Aerobic exercise training on PCOS
et al., 2015[18]
Pilot three-arm
parallel RCT
Assigned to
interval training,
strength training,
and control
HITT - 4 sessions of
4 min. With 90% HR
maximum: 3 min of
70% HR
Resistance training:
8 exercise/three
sets/10 reps
10 week
Control group:
>150 min of
3 days/week Insulin resistance
reduced and improved
Kong et al.,
Parallel RCT 31 PCOS
HITT compared
to moderate
to vigorous,
HITT - 8 s cycle:
12 s rest. Continuous
exercise 60%-80%
VO2 peak
HITT - 20:40 min
Both 4 days/
week for
5 weeks
No difference in body
weight reduction
Testosterone and
estradiol reduced in
Physical enjoyment
more in HITT and less
Miri et al.,
Animal RCT 30 PCOS rats
versus ten
Relation between
exercise and sex
hormones in rats
Moderate (70%-75%)
and low (50%-55%
VO2 peak)
60 min Six sessions/
8 weeks
Higher testosterone
and androstenedione
in PCOS rate
No difference in body
et al., 2012[16]
Dual-arm RCT 44 individuals
(16 PCOS,
13 non-PCOS
and lipid after
exercise in
overweight PCOS
and normal
Moderate (70%) or
vigorous (90%-95%
VO2 max)
60 min Six 5 min
intervals with
2 min
improvement in
insulin resistance
whereas no change
in mitochondrial
biogenesis and lipids
Brown et al.,
Two-arm RCT
compared with
usual care)
prescription from
versus usual care
50% VO2 peak in
60 min/session 12 weeks Decreased large VLDL
Improvement in HDL
Improvement in insulin
Abazar et al.,
Case-control 24 PCOS
Compared with
aerobic exercise
and usual care
60%-70% HR
60 min 3 weeks for
12 weeks
Reduced body
composition and lipid
profile in PCOS
et al., 2013[23]
Case controlled
animal trial
Not specified
alone and with
Ran on treadmill
1-1.5 km/day
Not available 5 days/week
and 5 weeks
Exercise decrease
adipose and insulin
resistance than
Both did not reduce
the bone mass loss in
PCOS individuals
et al., 2015[24]
(8 PCOS and
eight control)
16 individuals
(8 PCOS and
eight control)
Effect of aerobic
exercise on
55% VO2 ma x
(progressive energy
16 we ek s 5 days/week Improved lipolysis
and lipid uptake
Improved insulin
Resistance exercise training on PCOS
Vizza et al.,
Two-arm parallel
pilot RCT
Assigned to
exercise and no
exercise (usual
Not specified 60 min for
12 weeks
Increased BMI, lean
body mass, and
reduced HbA1C
Reduction in
Cheema et
al., 2014[26]
108 PCOS Relation to
hormones, and
insulin resistance
60% 1 RM (15 reps)
progress to 70%-85%
1 RM (8-12 reps)
Two sets of
5-8 types
of 3 sets for
12 weeks
PRT improves insulin
Regulates weight and
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126 Saudi Journal of Sports Medicine / Volume 17 / Issue 3 / September-December 2017
Resistance exercise training:
• Frequency:2–3days/weekfor12–24weeks
• Intensity: Initial 60%–70% of 1 repetition maximum
comprising three sets of 8–10 resistance stations
(lateral pull down, military press, chest press, biceps
and triceps curl, abdominal curl ups, split squats, leg
1 min rest between set. Avoid Valsalva maneuver during
• Time:30–45min.Fatigue‑freelevel
Table 1: Contd...
Source Study design Participants Method Exercise intervention Inference Evidence
Intensity Duration Freq uency
Lara et al.,
exercise over
sexual function
and emotional
70%-90% (1 RM) for
8-15 reps
16 weeks Increases sexual
lubrication, and
emotional status
Ramos et al.,
versus 51
Quality of Life
after resistance
exercise training
for 16 weeks
60% 1 RM with 5%
every week 3 series
of 10 reps/set
Not specified 16 weeks Improved functional
capacity domain of
Physical activity and li festyle modifications on PCOS
et al., 2016[29]
parallel group
41 overweight/
obese PCOS
Assigned to one
of three groups:
Diet, combined
diet and aerobic
combined diet,
aerobic and
resistance training
(not specified)
25 min 5 days/week Diet with aerobic or
combined aerobic and
resistance exercise
is better than diet
alone in reducing
depression, improved
exercise barriers
Conte et al.,
456 PCOS
compared with
usual care
Not available Not available Not available Of 73 studies initially
recruited, only
seven studies were
included. Though
training seemed to
be antidepressive,
inconclusive evidence
et al., 2015[31]
Meta-analysis of
18 RCTS (1994
Physical activity
with no physical
Not available Not available Not available Significant
reduction in sex
hormones (estradiol,
androstenedione) after
physical activity in
PCOS patients
Victorin et al.,
Two-arm RCT 72 PCOS Individual effects
of acupuncture
and exercise
over usual care
Self-paced brisk
walk, cycle faster
than normal walk
>120 beats/min
30 min Three days/
week for
16 weeks
Anxiety and
depression reduced
across all the group
Fertility domain
improved with
exercise group
Banting et al.,
Cross-sectional 217 women
(154 PCOS)
Relation between
physical activity
and mental
health in PCOS
Not available Not available Not available PCOS women are
better in physical
activity but more
anxious than non-
Costa et al.,
2015 [34]
Single time
14 o b e se
Effect of A RE
in aerobic
capacity. GPS
and HR monitors
were used to
gauge physical
Warm- up - 5 min
Pleasurable intensity
- 40 min
Cool dow n - 5 min
40 min 1 day GPS and HR monitor
with affective words
through phones
improved physical
activity intensity and
joy in PCO S patients
ARE=Affect regulated exercise, PCOS=Polycystic ovarian syndrome, RCT=Randomized controlled trial, HR=Heart rate, RM=Repetition maximum, Reps=Repetition, GPS=Global positioning system,
HITT=High intensity interval training, VLDL=Very low density lipoprotein, HDL=High-density lipoprotein, BMI=Body mass index, HbA1C=Glycated hemoglobin, PRT=Progressive resistance training
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• Mode: Dumbbell, barbell, thera tubes, and weighted
pulley machines
• Progression:Repetitionsorsetscanbeincreasedbased
on the rating of perceived exertion or maximal voluntary
contraction using the weights.
Cool down: Calisthenics 5–10 min, active recovery.
Exercise training and physical activity in PCOS have shown
to have a good impact on improving the anthropometric
measurements such as body mass index, waist circumference,
and metabolic parameters such as total cholesterol, IR, and
lipid profile thus reducing metabolic syndrome and other
risk factors associated with PCOS. Exercise training should be
included in the routine medical management to augment the
benefits of ovulation chances, reducing cardiovascular risks
and improving the quality of life in PCOS women.
The author Baskaran Chandrasekaran would like to thank
Dr. Fiddy Davis Ph.D., Associate Professor/Head, Center
for Sport Science Medicine and Research for the valuable
suggestion and passion toward research in the field of health
promotion and physical activity.
Financial support and sponsorship
Conicts of interest
There are no conflicts of interest.
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... 12 Improvement in menstrual cycles and ovulation along with better body composition are found to be achieved by 50% women diagnosed with PCOS with exercise training. 22 It also improves insulin sensitivity by increasing the concentration of intramyocellular triacylglycerol, leading to increased lipid uptake by muscles, utilization and oxidation. 22 Improved blood supply to skeletal muscles though physical exercise also aid in improving insulin sensitivity. ...
... 22 It also improves insulin sensitivity by increasing the concentration of intramyocellular triacylglycerol, leading to increased lipid uptake by muscles, utilization and oxidation. 22 Improved blood supply to skeletal muscles though physical exercise also aid in improving insulin sensitivity. 23 It is found that obesity commonly occur in women with PCOS, which may lead to decrease in strength, postural control and altered biomechanics of lower limbs. ...
Full-text available
Aims: Polycystic ovarian syndrome (PCOS) is a common disorder seen in women at their reproductive age. Oligomenorrhea, hyperinsulinaemia, obesity, and hyoerandrogenism are common in individuals with PCOS. Lifestyle modification through exercises and diet modifications are the major non-pharmacological strategies in PCOS management. There is a paucity of evidence supporting the role of Swiss ball exercises in the management of PCOS. We intended to identify the effect of Swiss ball exercises in addition to aerobic exercises in the management of PCOS among college girls in their fertile period. Settings and Design: We recruited 20 college girls with the diagnosis of PCOS and were divided into two equal groups. The mean age of the participants for the study were 23.05±1.2 years, with mean BMI of 28.5±1.5 kg/m 2. Methods and Material: Group A received combined aerobic and Swiss ball exercise programme whereas Group B received only aerobic training. Interventions were given for 12 weeks, 6 days per week. Changes in body weight, abdominal fat measured using girth measurement, and menstrual irregularity questionnaire (MIQ) were used as outcome measures. Statistical analysis used: Descriptive statistics were done to analyse demographic details. The group wise comparison were performed using t test analysis. Results: We identified a significant reduction in body weight, abdominal fat and MIQ values in group A (p<0.05), whereas group B also demonstrated significant change except for body weight. Conclusions: Addition of Swiss ball exercise programme along with aerobic training is beneficial in women with PCOS in reducing body weight, abdominal fat and irregular menses. Key Messages: Swiss ball exercise along with aerobic exercise training provides beneficial effects in women with PCOS in reducing body weight, abdominal fat and in improving menstrual irregularities.
... [12] In a pilot case-control study about the Evaluation of homoeopathic treatment in polycystic ovary syndrome, it was found that homoeopathic interventions with lifestyle modification showed better results when compared to the placebo group. [13] In this case series, 3 PCOS cases registered and treated at the out patient department (OPD) of the National Homoeopathy Research Institute in Mental Health, Kottayam, were evaluated. Symptomatic and significant improvement in USG report after unsuccessful treatment history for more than 5 years in cases of irregular menses since menarche was the prior consideration. ...
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Polycystic ovarian syndrome (PCOS) is a common endocrine disorder that affects multiple aspect of women's health during the reproductive age group. PCOS exerts a negative impact on female identity and contributes to deterioration of Quality of life. Homoeopathy is a complementary system of medicine that can be used safely without any known side-effects. This article mainly highlights the importance of using individualized homoeopathic medicines in PCOS. Three cases of women in reproductive age with PCOS were treated with individualized homeopathic medicines. Each case was reported according to the criteria set out in the HOM-CASE guidelines. The improvement is evaluated from the regularity of the menstrual cycle by assessing with the PCOS questionnaire, Modified Naranjo Criteria for Homoeopathy (MONARCH), and also from the ultrasonography (USG) reports. Marked improvement was observed in all three cases of PCOS. The irregular menstrual cycles and other associated symptoms became normal, along with a resolution of cysts in ovaries as noticed in ultrasonography. All cases improved within 6 to 18 months of treatment. The Modified Naranjo Criteria total score was +8/13, +9/13, +8/13 for the cases, which indicates a positive causal attribution of homeopathy in relieving the symptoms of PCOS. These case reports suggest a significant role of individualized homeopathic medicines in PCOS. The improvement is evident at the symptomatic level, and also in Ultrasonography.
... Subjects who had excessive BMI (overweight and obese) in this study did not do the exercise as recommended i.e. more than 3 times a week with a duration of approximately 30 minutes. Stenervictorin et al. 17 stated that light exercise such as brisk walking for 30 minutes with a frequency of 3 days a week may influence the BMI while Shetty et al. 18 proposed that it can be achieved through aerobic exercise for 20-60 minutes with a frequency of 5 days a week for 12-24 weeks. ...
... Polycystic ovarian syndrome (PCOS) is a common endocrine disorder and abnormality in the ovaries at reproductive ages and caused by the imbalance of female sex hormones (1) . Levels of the sex hormones progesterone and estrogen are out of balance in the condition of PCOS, this can cause problems with women's menstrual cycle (2) . ...
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The aim of the study was to detect the level of anti-follicle stimulating hormone antibody in polycystic women and compared to normal control group. A cross‑sectional study was carried out in Erbil city from January 15th of October 2018, to 15th of March 2019. The number of polycystic ovary syndrome (PCOS) women under study was 60 women whose ages were between 15 and 45 years old. These patients admitted to Gynecology and Obstetrics Teaching Hospital. The control group who were matched to the patients studied included 30 individuals. The study showed that there is the significant difference between PCOS women and the control group concerning Anti FSH Antibodies level and the highest mean of Anti FSH Ab level occurred in PCOS women (1.61± 0.14 vs. 0.92 ± 0.04). There was a non-significant relation between each one of LH, FSH, LH/FSH ratio with Anti FSH Ab, in this study. The highest rate of PCOS women had irregular menstrual cycle. The study showed that most PCOS women included in the study had hirsutism. The rate of acne recorded among PCOS women in the study was 48.4 while 51.6 without acne. Conclusion: It was concluded that there was a highly statistically significant relation of Anti FSH Ab with PCOS.
... [8,9] Numerous studies demonstrate that weight loss can restore the menstrual cycle and ovulation in women with PCOS, making it an important element to consider in the management of reproductive function. [8][9][10] Multiple systematic reviews and meta-analyses [11][12][13][14] highlight the beneficial effect of exercise for PCOS symptom management. However, discordant and limited findings on exercise characteristics lead to challenges for its prescription for women with PCOS. ...
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Background:Polycystic ovary syndrome (PCOS) affects reproductive-aged women and is associated with increased prevalenceof serious clinical problems including: reproductive implications, metabolic dysfunction, and cardiovascular risk. Physical activityoffers several health benefits for women with PCOS. The aim of this systematic review was to synthesize evidence on the effect ofdifferent types of exercise on reproductive function and body composition for women with PCOS. Methods:This was a systematic review and meta-analysis of randomized controlled trials (RCTs) following recommended reviewmethods. We searched 6 databases: Cumulative Index of Nursing and Allied Health Literature; Embase; MEDLINE (viaOvid);PubMed; Sport Discus; and Web of Science; and we developed search strategies using a combination of Medical Subject Headingsterms and text words related to exercise interventions for women with PCOS. There was no restriction on language or publicationyear. The search was conducted on April 16, 2019 and updated on November 15, 2019. Two authors independently screenedcitations, determined risk of bias and quality of evidence with Grading of Recommendations Assessment, Development andEvaluation. We conducted meta-analyses following recommended guidelines, and report results using standardized mean difference(SMD). Results:Ten RCTs (n=533) were included in this review. Studies tested the following interventions: aerobic, resistance, andcombined (aerobic/resistance) training programs. Most studies were small (average 32, range 15–124 participants), and of relativelyshort duration (8–32 weeks). There was high heterogeneity for outcomes of reproductive function (menstrual cycle, ovulation, andfertility). We noted low certainty evidence for little to no effect of exercise on reproductive hormones and moderate certainty evidencethat aerobic exercise reduced body mass index (BMI) in women with PCOS: BMI SMD�0.35, 95% confidence interval�0.56 to�0.14,P=.001. Conclusion:For women with PCOS, evidence is limited to discern the effect of exercise on major health outcomes (e.g.,reproductive function). There is moderate certainty evidence that aerobic exercise alone is beneficial for reducing BMI in women withPCOS. Future studies should be conducted with longer duration, larger sample sizes, and should provide detailed information onmenstrual cycle and fertility outcomes.PROSPERO Systematic review registration: 2017 CRD42017058869
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Polycystic Ovarian Syndrome is one of the most serious medical conditions associated with pregnant women, particularly young women, and It is linked to miscarriage, erratic menstrual cycle, and a disturbed body mass index. Disease incidence increases mostly day by day because of undisciplined living style, diet, depression, etc. This leads to both physical and mental disorders of the patient and, if not cared for and treated, can also lead to miscarriage or frequent abortion. PCOD is one of that condition which typically affects second or third decade of life in females. It is important to know thoroughly about this disease as modern science has no root cause cure to treat it even the treatment of modern science implicated leads to severe side effects and dependence on the drugs. PCOD is diagnosed in Ayurveda according to its presentation in so many ways like hetu, lakshana, dosha- dushya, samprapti, associated features of PCOS are closely resembling with vandhya yonivyapada, artava-vahastrotas- viddha lakshana, nastartava and ksheena- artava described by acharya Sushruta and pushpaghni jatharini and vikruta jatharini mentioned by acharya Kashyap.
For clinical psychologists and other psychological therapists, this chapter is likely to be the one of most interest. After all, for many people, the value of a science of psychology is most clearly demonstrated if something of clinical value comes of it. Although there is lots of room for the development of psychological interventions in this field, this chapter reveals that the few studies that have been done are so far innovative and show promise. This chapter explores how CBT and relaxation therapies can be adapted for women with PCOS, and how other interventions—medication, weight loss, and treating PCOS symptoms—can also be used to improve mental health in PCOS.
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Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive aged women and is characterized by two of the following three features: oligoovulation or anovulation, clinical and/or biochemical signs of hyperandrogenism, or polycystic ovaries. Summary: It has been demonstrated that PCOS includes a complex number of systemic symptoms in addition to symptoms related to the reproductive apparatus. It has been associated with obesity, metabolic syndrome, type 2 diabetes and an increased risk of cardiovascular disease. Several clinical and basic studies have investigated the link between PCOS and the cardiovascular disease risk, which seems to be due to blunted lipid/glucose metabolism, hypertension, and systemic inflammatory and coagulation disorders. Therefore, the current manuscript aims to review the main findings on PCOS and obesity/obesity-related disease (glucose derangements and cardiovascular disease risk factors). Key message: Although there are no long-term data on the morbidity and mortality for cardiovascular disease in PCOS, it is advisable to perform a careful metabolic and cardiovascular assessment in women with PCOS in order to tailor the most suitable strategy to prevent cardiovascular disease.
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Introduction: Polycystic ovarian syndrome (PCOS) constitutes most cases of endocrine disorder among females. Objectives: This study was done to assess the proportion of university students with PCOS and to study its risk factors. Materials and methods: Data were collected from students of a private medical, dental, and nursing college using a self-administered questionnaire. Height and weight of all participants were recorded by standard procedures. Results: The mean age of students was 20.4 ΁ 1.5 years. Of the 480 participants, 39 (8.1%) were already diagnosed with PCOS. Out of the remaining 441 participants, 40 (9.1%) were at high risk, and 401 (90.9%) were at low risk for PCOS. Greater proportion of PCOS cases was seen in the age group 23-25 years (P = 0.026), among those with family history of PCOS (P = 0.002), among those who were permanent residents of urban areas (P = 0.048), and among those who were overweight or obese (P = 0.004). About 90% of PCOS cases and those at high risk for PCOS, each had difficulty in controlling excess weight or were experiencing difficulty in maintaining ideal weight. About 36 (92.3%) of PCOS cases and all those at high risk had emotional problems such as feeling moody or experiencing fatigability over the previous 2 weeks. Conclusion: PCOS is a common disorder among young women in this settings and this warrants periodic screening activities. A multidisciplinary approach is required to bring about lifestyle modification and help those with emotional problems due to this endocrine disorder.
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Objective: The aim of this study was to compare the effects of 5-week high-intensity interval training (HIIT) and moderate-to-vigorous intensity continuous training (MVCT) on cardiometabolic health outcomes and enjoyment of exercise in obese young women. Methods: A randomized controlled experiment was conducted that involved thirty-one obese females (age range of 18-30) randomly assigned to either HIIT or MVCT five-week training programs. Participants in HIIT condition performed 20 min of repeated 8 s cycling interspersed with 12 s rest intervals, and those in MVCT condition cycled continuously for 40 min at 60-80% of peak oxygen consumption ([Formula: see text]O2peak), both for four days in a week. Outcomes such as [Formula: see text]O2peak, body composition estimated by bioimpedance analysis, blood lipids, and serum sexual hormones were measured at pre-and post-training. The scores of Physical Activity Enjoyment Scale (PAES) were collected during the intervention. Results: After training, [Formula: see text]O2peak increased significantly for both training programs (9.1% in HIIT and 10.3% in MVCT) (p = 0.010, η2 = 0.41). Although MVCT group had a significant reduction in total body weight (TBW, -1.8%, p = 0.034), fat mass (FM, - 4.7%, p = 0.002) and percentage body fat (PBF, -2.9%, p = 0.016), there were no significant between-group differences in the change of the pre- and post-measures of these variables. The HIIT group had a higher score on PAES than the MVCT group during the intervention. For both conditions, exercise training led to a decline in resting testosterone and estradiol levels, but had no significant effect on blood lipids. Conclusion: Both HIIT and MVCT are effective in improving cardiorespiratory fitness and in reducing sexual hormones in obese young women; however, HIIT is a more enjoyable and time-efficient strategy. The mild-HIIT protocol seems to be useful for at least maintaining the body weight among sedentary individuals.
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Data derived principally from peripheral tissues (fat, muscle and liver) show that insulin signals via diverse interconnecting, intracellular pathways and that some of the major intersecting points (known as critical nodes) are the IRSs (insulin receptor substrates), PI3K (phosphatidylinositol 3-kinase)/Akt and MAPK. Most of these insulin pathways are probably also active in the ovary and their ability to interact with each other and also with follicle stimulating hormone (FSH) and luteinizing hormone (LH) signalling pathways enables insulin to exert direct modulating influences on ovarian function. This paper reviews the intracellular actions of insulin and the uptake of glucose by ovarian tissues (granulosa, theca and oocyte) during the oestrous/menstrual cycle of some rodent, primate and ruminant species. Insulin signals through diverse pathways and these are discussed with specific reference to follicular cell types (granulosa, theca and oocyte). The signalling pathways for FSH in granulosa cells and LH in granulosa and theca cells are summarized. The roles of glucose and of insulin-mediated uptake of glucose in folliculogenesis are discussed. It is suggested that glucose in addition to its well established role of providing energy for cellular function may also have insulin-mediated signalling functions in ovarian cells, involving AMPK and/or hexosamine. Potential interactions of insulin signalling with FSH or LH signalling at critical nodes are identified and the available evidence for such interactions in ovarian cells is discussed. Finally the action of the insulin sensitizing drugs, metformin and the thiazolidinedione, rosiglitazone on follicular cells is reviewed
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Background To evaluate the feasibility of executing a randomized controlled trial of progressive resistance training (PRT) in women with polycystic ovary syndrome (PCOS). Methods Women with PCOS were randomized to an experimental (PRT) group or a no-exercise (usual care) control group. The PRT group was prescribed two supervised and two unsupervised (home-based) training sessions per week for 12 weeks. Feasibility outcomes included recruitment and attrition, adherence, adverse events, and completion of assessments. Secondary outcomes, collected pre and post intervention, included a range of pertinent physiological, functional and psychological measures. ResultsFifteen participants were randomised into the PRT group (n = 8) or control group (n = 7); five women (n = 2 in PRT group and n = 3 in control group) withdrew from the study. The most successful recruitment sources were Facebook (40 %) and online advertisement (27 %), while least successful methods were referrals by clinicians, colleagues and flyers. In the PRT group, attendance to supervised sessions was higher (95 %; standard deviation ±6 %) compared to unsupervised sessions (51 %; standard deviation ±28 %). No adverse events were attributed to PRT. Change in menstrual cycle status was not significantly different between groups over time (p = 0.503). However, the PRT group significantly increased body weight (p = 0.01), BMI (p = 0.04), lean mass (p = 0.01), fat-free mass (p = 0.005) and lower body strength (p = 0.03), while reducing waist circumference (p = 0.03) and HbA1c (p = 0.033) versus the control group. The PRT group also significantly improved across several domains of disease-specific and general health-related quality of life, depression, anxiety and exercise self-efficacy. ConclusionA randomized controlled trial of PRT in PCOS would be feasible, and this mode of exercise may elicit a therapeutic effect on clinically important outcomes in this cohort. The success of a large-scale trial required to confirm these findings would be contingent on addressing the feasibility hurdles identified in this study with respect to recruitment, attrition, compliance, and collection of standardized clinical data. Trial registrationAustralia New Zealand Clinical Trials Registry; ACTRN12614000517673 Registered 15 May 2014.
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Purpose Aerobic exercises may improve quality of life (QoL) in women with polycystic ovary syndrome (PCOS). However, there is no data on the effect of resistance exercise training (RET) programs on the QoL of women with PCOS. Thus, this study aimed to assess the effect of a 16-week RET program on QoL in PCOS women. Methods This 16-week case-control study enrolled 43 women with PCOS (PCOS group, PCOSG) and 51 healthy pre-menopausal controls aged 18 to 37 years (control group, CG). All women underwent a supervised RET program for 16 weeks, and were evaluated in two different occasions: week-0 (baseline), and week-16 (after RET). Quality of life was assessed using the 36-Item Short Form Health Survey (SF-36). Results Testosterone reduced significantly in both groups after RET (p < 0.01). The PCOSG had improvements in functional capacity at week-16 relative to week-0 (p = 0.02). The CG had significant improvements in vitality, social aspects, and mental health at week-16 relative to week-0 (p ≤ 0.01). There was a weak correlation between social aspects of the SF-36 domain and testosterone levels in PCOS women. Conclusion A 16-week RET program modestly improved QoL in women with PCOS. Thieme Publicações Ltda Rio de Janeiro, Brazil.
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Lipids stored in skeletal muscle cells are known as intramyocellular lipid (IMCL). Disorders involving IMCL and its causative factor, circulatory free fatty acids (FFAs), induce a toxic state and ultimately result in insulin resistance (IR) in muscle tissue. On the other hand, intramuscular triglyceride (IMTG), the most abundant component of IMCL and an essential energy source for active skeletal muscle, is different from other IMCLs, as it is stored in lipid droplets and plays a pivotal role in skeletal muscle energy homeostasis. This review discusses the association of FFA-induced ectopic lipid accumulation and IR, with specific emphasis on the relationship between IMCL/IMTG metabolism and IR.
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Introduction Exposure to high levels of endogenous estrogens is a main risk factor for breast cancer in women, and in observational studies was found to be inversely associated with physical activity. The objective of the present study is to determine the effect of physical activity interventions on sex hormone levels in healthy women. Methods Electronic databases (MEDLINE, EMBASE, CENTRAL), from inception to December 2014, and reference lists of relevant reviews and clinical trials were searched, with no language restrictions applied. Randomized controlled trials (RCTs) were included if they compared any type of exercise intervention to no intervention or other interventions, and assessed the effects on estrogens, androgens or the sex hormone binding globulin (SHBG) in cancer-free women. Following the method described in the Cochrane Handbook for Systematic Reviews of Interventions, data on populations, interventions, and outcomes were extracted, and combined using the inverse-variance method and a random-effects model. A pre-established protocol was drawn up, in which the primary outcome was the difference in circulating estradiol concentrations between the physical activity (experimental) and the control groups after intervention. Pre-specified subgroup analyses and sensitivity analysis according to the risk of bias were conducted. Results Data suitable for quantitative synthesis were available from 18 RCTs (1994 participants) for total estradiol and from 5 RCTs (1245 participants) for free estradiol. The overall effect of physical activity was a statistically significant decrease of both total estradiol (standardized mean difference [SMD] -0.12; 95 % confidence interval [CI] -0.20 to −0.03; P = 0.01; I² = 0 %) and free estradiol (SMD −0.20; 95 % CI −0.31 to −0.09; P = 0.0005; I² = 0 %). Subgroup analyses suggest that this effect is independent of menopausal status and is more noticeable for non-obese women and for high intensity exercise. Meta-analysis for secondary outcomes found that physical activity induces a statistically significant decline of free testosterone, androstenedione, dehydroepiandrosterone–sulfate and adiposity markers, while a significant increase of SHBG was observed. Conclusions Although the effect is relatively modest, physical activity induces a decrease in circulating sex hormones and this effect is not entirely explained by weight loss. The findings emphasize the benefits of physical activity for women.
Executive Summary Polycystic ovary syndrome (PCOS) is recognized as the most common endocrine disorder of reproductive-aged women around the world. This document, produced by the collaboration of the American Association of Clinical Endocrinologists and the Androgen Excess Society aims to highlight the most important clinical issues confronting physicians and their patients with PCOS. It is a summary of current best practices in 2014. Insulin resistance is believed to play an intrinsic role in the pathogenesis of PCOS. The mechanism by which insulin resistance or insulin give rise to oligomenorrhea and hyperandrogenemia, however, is unclear. Hyperinsulinemic-euglycemic clamp studies have shown that both obese and lean women with PCOS have some degree of insulin resistance. Insulin resistance is implicated in the ovulatory dysfunction of PCOS by disrupting the hypothalamic- pituitary-ovarian axis. Given the association with insulin resistance, all women with PCOS require evaluation for the risk of metabolic syndrome (MetS) and its components, including type 2 diabetes, hypertension, hyperlipidemia, and the possible risk of clinical events, including acute myocardial infarction and stroke. Obese women with PCOS are at increased risk for MetS with impaired glucose tolerance (IGT; 31 to 35%) and type 2 diabetes mellitus (T2DM; 7.5 to 10%). Rates of progression from normal glucose tolerance to IGT, and in turn to T2DM, may be as high as 5 to 15% within 3 years. Data suggest the need for baseline oral glucose tolerance test every 1 to 2 years based on family history of T2DM as well as body mass index (BMI) and yearly in women with IGT. Compared with BMI- and age-matched controls, young, lean PCOS women have lower high-density lipoprotein (HDL) size, higher verylow- density lipoprotein particle number, higher low-density lipoprotein (LDL) particle number, and borderline lower LDL size. Statins have been shown to lower testosterone levels either alone or in combination with oral contraceptives (OCPs) but have not shown improvement in menses, spontaneous ovulation, hirsutism, or acne. Statins reduce total and LDL cholesterol but have no effect on HDL, C-reactive protein, fasting insulin, or homeostasis model assessment of insulin resistance in PCOS women, in contrast to the general population. There have been no long-term studies of statins on clinical cardiac outcomes in women with PCOS. Coronary calcification is more prevalent and more severe in PCOS than in controls. In women under 60 years of age undergoing coronary angiography, the presence of polycystic ovaries on sonography has been associated with more arterial segments with >50% stenosis, but the relationship between PCOS and actual cardiovascular events remains unclear. Therapies for PCOS are varied in their effects and targets and include both nonpharmacologic as well as pharmacologic approaches. Weight loss is the primary therapy in PCOS—reduction in weight of as little as 5% can restore regular menses and improve response to ovulation- inducing and fertility medications. Metformin in premenopausal PCOS women has been associated with a reduction in features of MetS. Clamp studies using ethinyl estradiol/drosperinone combination failed to reveal evidence of an increase in either peripheral or hepatic insulin resistance. Subjects with PCOS have a 1.5-times higher baseline risk of venous thromboembolic disease and a 3.7-fold greater effect with OCP use compared with non-PCOS subjects. There is currently no genetic test to screen for or diagnose PCOS, and there is no test to assist in the choice of treatment strategies. Persistent bleeding should always be investigated for pregnancy and/or uterine pathology—including transvaginal ultrasound exam and endometrial biopsy—in women with PCOS. PCOS women can have difficulty conceiving. Those who become pregnant are at risk for gestational diabetes (which should be evaluated and managed appropriately) and the microvascular complications of diabetes. Assessment of a woman with PCOS for infertility involves evaluating for preconceptional issues that may affect response to therapy or lead to adverse pregnancy outcomes and evaluating the couple for other common infertility issues that may affect the choice of therapy, such as a semen analysis. Women with PCOS have multiple factors that may lead to an elevated risk of pregnancy, including a high prevalence of IGT—a clear risk factor for gestational diabetes—and MetS with hypertension, which increases the risk for pre-eclampsia and placental abruption. Women should be screened and treated for hypertension and diabetes prior to attempting conception. Women should be counseled about weight loss prior to attempting conception, although there are limited clinical trial data demonstrating a benefit to this recommendation. Treatment for women with PCOS and anovulatory infertility should begin with an oral agent such as clomiphene citrate or letrozole, an aromatase inhibitor. Abbreviations: AMH = anti-Müllerian hormone BMI = body mass index BP = blood pressure CIMT = carotid intima media thickness CV = cardiovascular GnRH = gonadotropin-releasing hormone GWAS = genomewide association study HDL = high-density lipoprotein HOMA-IR = homeostasis model assessment of insulin resistance IGT = impaired glucose tolerance LDL = low-density lipoprotein LH = luteinizing hormone MetS = metabolic syndrome MI = myocardial infarction NIH = National Institutes of Health OCP = oral contraceptive OGTT = oral glucose tolerance test PCOM = polycystic ovary morphology PCOS = polycystic ovary syndrome RR = relative risk SSPG = steady-state plasma glucose T = testosterone T2DM = type 2 diabetes mellitus TG = triglyceride VTE = venous thromboembolic WHR = waist to hip ratio