Brewer M, et.al (2010) conducted a study for Polycystic ovary syndrome (PCOS). They state that is a complex disorder, involving primarily ovarian hyperandrogenism in females and linked with insulin resistance in the majority of cases. Clinical features are widely variable and include a combination of menstrual irregularities, acne, hirsutism, and alopecia. The pathophysiology of PCOS still remains unknown and likely includes a combination of genetic factors, insulin resistance, and environmental factors. A thorough diagnostic work up is required in suspected cases and several management modalities have been suggested. Since various long term complications and comorbidities are associated with PCOS, early diagnosis and therapeutic intervention is warranted in these cases.
Bremer AA. (2010) studied that in Department of Pediatrics, Division of Endocrinology, Vanderbilt University School of Medicine, he suggesting that the syndrome is influenced by fetal programming and/or early postnatal events. However, given that the full clinical spectrum of PCOS does not typically appear until puberty, a "two-hit" hypothesis has been proposed: (1) a girl develops hyperandrogenism via one or more of many different potential mechanisms; (2) the preexisting hyperandrogenism subsequently disturbs the hypothalamic-pituitary-ovarian axis, resulting in ovulatory dysfunction and sustained hyperandrogenism. No consensus guidelines exist regarding the diagnosis and management of PCOS in the pediatric population; however, because the syndrome is a diagnosis of exclusion, the clinical evaluation of girls suspected of having PCOS is aimed at excluding other causes of androgen excess and menstrual dysfunction. For the syndrome's management, emphasis is placed on lifestyle and symptom-directed treatment.
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Moran LJ,et.al. (2010 Mar;6) conducted a study related to obesity and weight gain worsen the features of PCOS, while weight loss improves the features of PCOS. If the young women mainted her weight who do not suffer from PCOS. Weight management strategies in younger women with or without PCOS should encompass both the prevention of excess weight gain and achieving and maintaining a reduced weight through multidisciplinary lifestyle management, comprising dietary, exercise and behavioral therapy, as well as attention to psychosocial stress and practical and physiological barriers to weight management. Further research is warranted in the examination of specific barriers to weight management in women with PCOS, as well as in the determination of optimal components of lifestyle weight management interventions in young women in order to facilitate long-term compliance.
Shayya R, Chang RJ. Polycystic ovary syndrome (PCOS) is mainly affected by endocrine among reproductive-aged women, and it typically presents during adolescence. The clinical manifestations of PCOS in adolescent girls altered reproductive physiology. Recognising adolescents at risk for PCOS and taking the appropriate steps to reduce circulating androgen levels is critical in reducing the clinical symptomatology of this disorder, and the development of adulthood infertility, diabetes, and metabolic syndrome in patients with PCOS.
Minerva Pediatr. 2010 Oct Polycystic ovary syndrome (PCOS) is a complex disorder, involving primarily ovarian hyperandrogenism in females and linked with insulin resistance in the majority of cases. Clinical features are widely variable and include a combination of menstrual irregularities, acne, hirsutism, and alopecia. Although it typically presents around puberty, several risk factors during childhood may help raise a high index of suspicion for the development of PCOS in adolescents. The pathophysiology of PCOS still remains unknown and likely includes a combination of genetic factors, insulin resistance, and environmental factors. A thorough diagnostic work up is required in suspected cases and several management modalities have been suggested. Since various long term complications and comorbidities are associated with PCOS, early diagnosis and therapeutic intervention is warranted in these cases.
2.Review related to risk factors.
Rosenfield RL. The University of Chicago Pritzker School of Medicine, Department of Pediatrics,( 2007) conducted a study on Polycystic ovary syndrome (PCOS) it appears to arise to contributions factors are both heritable and nonheritable. Polygenic influences appear to account for about 70% of the variance in pathogenesis. In view of this evidence for congenital contributions to the syndrome, childhood manifestations may be expected. The objective has been to review the evidence that risk factors for PCOS can be recognized in childhood.. Congenital virilizing disorders; above average or low birth weight for gestational age; premature adrenarche, particularly exaggerated adrenarche; atypical sexual precocity; or intractable obesity with acanthosis nigricans, metabolic syndrome, and pseudo-Cushing syndrome or pseudo-acromegaly in early childhood have been identified as independent prepubertal risk factors for the development of PCOS. During adolescence, PCOS may masquerade as physiological adolescent anovulation. Asymptomatic adolescents with a polycystic ovary occasionally (8%) have subclinical PCOS but often (42%) have a subclinical PCOS type of ovarian dysfunction, the prognosis for which is unclear. Identifying children at risk for PCOS offers the prospect of eventually preventing some of the long-term complications associated with this syndrome once our understanding of the basis of the disorder improves.
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Trimèche S, Thuan Dit Dieudonne JF, Jeandel C, Paris F, Simoni-Brum I, Orio F, Sultan C. Polycystic ovary syndrome (PCOS) is a common cause of hyperandrogenism in adolescent girls. In its complete post menarchal expression, the syndrome is characterized by the association of typical clinical, biological, and ultrasonographic findings. Many factors have contributed to our knowledge of different clinical forms of PCOS in adolescent girls. They are helpful for clarifying misleading situations in a period of life when diagnosis of PCOS implies a treatment for many years and may interfere with gynecological outcome. During the last 3 years, we had the opportunity to manage in our unit 45 adolescent girls with ovarian hyperandrogenism: 32 of them had PCOS and the other 13 functional ovarian hyperandrogenism defined by clinical and biological hyperandrogenism without ultrasonographic abnormality. In this review, we report, from our personal experience as well as from recent literature data, the different clinical expressions of PCOS in the pubertal period: the classical post menarchal form, the exceptional pre menarchal form, the post precocious pubarche and the post precocious puberty forms, the familial expression as well as the dominant metabolic expression.
Glueck CJ, Goldenberg N, Wang P. (2009 Sep) conduct a study on adolescent pcos treated withmetformin diet for 1year and assed the effectiveness 20 adolescents age < or = 17 (16 +/- 1 yr) with polycystic ovary syndrome (PCOS), disease (CHD) risk factors.Median weight fell from 85.5 to 78.4 kg (p = 0.004), waist circumference from 91 to 84 cm (p = 0.017), triglyceride from 108 to 71 mg/dl (p = 0.008), insulin from 20.5 to 15 microU/ml (p = 0.018), HOMA-IR from 2.0 to 1.5 (p = 0.026), and testosterone from 45.5 to 31.5 ng/dl (p = 0.03). The percentage of cycles with normal menses rose from a pre-treatment median of 8% to 100%, p < 0.0001.In adolescents (< or = age 17 yr) with PCOS, metform in-diet safely ameliorates CHD risk factors and endocrinopathy while facilitating resumption of regular menses.
Shayya R, Chang RJ. Recommended that Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among reproductive-aged women, and it typically presents during adolescence. The objective of this review is to describe the clinical manifestations of PCOS in adolescent girls and the underlying basis for the altered reproductive physiology. Recognising adolescents at risk for PCOS and taking the appropriate steps to reduce circulating androgen levels is critical in reducing the clinical symptomatology of this disorder, and the development of adulthood infertility, diabetes, and metabolic syndrome in patients with PCOS.
Kassi E, Diamanti-Kandarakis E. A total of 325 adolescent girls with normal menstruation, 18 obese (OB-CON) and 307 non-obese (NOB-CON), were enrolled as controls from multiple middle schools in Shanghai, China. A total of 167 adolescent girls with PCOS, 90 obese (OB-PCOS) and 77 non-obese (NOB-PCOS), were also recruited. All cases were evaluated for their clinical manifestations, reproductive endocrine and metabolic parameters. Hyperandrogenism was determined by serum testosterone (T), free androgen index (FAI) and dehydroepiandrosterone sulfate (DHEA-S). Insulin sensitivity was measured by fasting insulin (FINS) and assessment of insulin resistance (HOMA-IR). They coclude that : (1) Menarche was significantly earlier in adolescent PCOS than in controls. The incidence of obesity was significantly higher in adolescent PCOS than that in control group. (2) T, FAI and DHEA-S were significantly higher in adolescent PCOS group than those in control group. FAI was higher in OB-PCOS group than in NOB-PCOS group. LH and LH/FSH were higher in PCOS groups than those in controls. LH and LH/FSH were also much higher in NOB-PCOS group than those in OB-PCOS group. (3) HOMA-IR and FINS were significantly higher in PCOS group than those in control group. Incidence of acanthosis nigricans, FINS, HOMA-IR and triglyceride were significantly higher in OB-PCOS group than those in NOB-PCOS group. (4) 95.21% PCOS girls presented with an ultrasonic morphological evidence of polycystic ovarian.The essential features of adolescent PCOS are an earlier onset of menarche, a persistent menstrual disorder over 2 years after menarche, a higher incidence of obesity, marked hyperandrogenism and insulin resistance and disorderly gonadotropine secretion in comparison with control subjects. Hyperandrogenism and insulin resistance are much more severe in obese adolescent PCOS.
Wang Y, Mao WW, Chen YJ, Li MZ, Qiao J, Wang LN. He says that the family history of diabetes mellitus has the most effect on the clinical phenotype in women with PCOS. The family history of other diseases such as menstrual disorder, premature balding and hypertension play less significant roles. A family history of positive coronary heart disease does not affect the clinical phenotype of such patients.A survey of the polycystic ovary syndrome in the Greek island of Lesbos: hormonal and metabolic profile.
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Halperin IJ,ET.AL Department of Medicine, Women's College Hospital, University of Toronto, Canada Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of young women. First-line treatment is often the oral contraceptive pill (OC), but evidence suggests that OC may worsen metabolic outcomes in this population. We undertook this meta-analysis of observational studies and cohorts from within randomized controlled studies to investigate the association between OC use and dysglycemia, dyslipidemia and insulin resistance (IR) in women with PCOS. OC use was significantly associated with an increase in high-density lipoprotein cholesterol (HDL-C) (P = 0.004) and triglycerides (P = 0.004). Significant heterogeneity was found in glucose, cholesterol, HDL-C, low-density lipoprotein cholesterol triglycerides, fasting glucose to insulin ratios and homeostatic model assessments-IR. Study characteristics such as mean BMI, mean age and duration of study could explain some of the heterogeneity. Use of OC was not associated with clinically significant adverse metabolic consequences. Because of limitations of the underlying studies, further research including rigorously designed randomized trials would more definitively confirm our findings.
Review related to screening
Deng Y, Wang Y, Shen Y. (2010) The proposed system consists of two major functional blocks: preprocessing phase and follicle identification based on object growing. Based on the judgment of subject matter experts, the proposed diagnostic system achieved 89.4% recognition rate (RR) and 7.45% misidentification rate (MR) while the RR and MR of the level set method, the BVF method and the FSVM classifier are around 65.3% and 2.11%, 76.1% and 4.53%, and 84.0% and 16.3%, respectively. The proposed diagnostic system also achieved better performance than those reported in recently published literature. The paper proposed an automated diagnostic system for the PCOS using ultrasound images, which consists of two major functional blocks: preprocessing phase and follicle identification based on object growing. Experimental results showed that the proposed system is very effective in follicle identification for PCOS diagnosis.
.Caglar GS, Oztas E, Karadag D, Pabuccu R, Eren AA.(2010) This study was planned to screen polycystic ovary syndrome (PCOS) women for albuminuria and to evaluate the association between urinary albumin excretion (UAE) and metabolic disturbances of PCOS. In addition, this is the first study in the literature evaluating the association between UAE and carotid intima-media thickness (CIMT) in PCOS cases. The study population consisted of 65 PCOS women. The study was prospectively designed and performed in a university hospital. The diagnosis of PCOS was made according to the Rotterdam criteria: exclusion criteria were hyperprolactinemia, thyroid dysfunction, adrenal dysfunction, diabetes mellitus, hypertension, and pregnancy. Blood samples were collected in the follicular phase of a menstrual cycle and serum samples were analyzed for fasting glucose, insulin, and hormone and lipid profiles. Twenty-four hour urine specimens were collected for the detection of UAE. CIMT was estimated by visual assessment of the distance between the lumen-intima and intima-adventitia interfaces. UAE, expressed as uACR>6.93Î¼g/mg, seems to be an associated sign of metabolic problems which might help in discriminating PCOS at risk of future CVD. Further studies are needed before routine use of albuminuria in PCOS cases for the detection of CVD risk.
Pembe AB, Abeid MS.(2009) The aim of this study was to determine prevalence of polycystic ovaries (PCO) and associated clinical and biochemical features among women with infertility attending gynaecological outpatient department (GOPD) at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. All women with infertility attending the GOPD from 11th September 2006 to 15th February 2007 were recruited to the study. Information on socio-demographic, obstetric and menstrual characteristics was collected. Anthropometric measurement, clinical examination of acne and hirsutism, vaginal ultrasonography for PCO and biochemical analysis of luteinizing hormone (LH), follicle stimulating hormone (FSH) and testosterone were performed. All 102 women who attended the GOPD during the study period due to infertility were recruited. Two women were excluded after diagnosis of pregnancy made by hormonal assay and ultrasonography thus remaining with 100 women for analysis. Oligomenorrhoea and acne were significantly higher in a group of women with PCO than among women with normal ovaries. The mean hirsutism score though was not significant, was higher in women with PCO than in women with normal ovaries (5.1 +/- 2.7 vs. 4 +/- 2.4, P < 0.057). Using the Rotterdam criteria 32 (32%) women were diagnosed to have polycystic ovary syndrome (PCOS). Among these women 25 (78.1%) had PCO, 24 (75%) had signs of oligoanovulation, and 18 (56.3%) had hirsutism. Among 68 women with no PCOS, 7 (10.3%) had polycystic ovaries, 15 (22.1%) had signs of oligoanovulation and 6 (8.8%) had hirsutism. In conclusion, polycystic ovaries are common among women with infertility, however are not necessarily associated with polycystic ovary syndrome.
Review related to treatment
Center for Reproductive Medicine, Shandong Provincial Hospital, Shandong University, China. To analyze the clinical and metabolic characteristics of large-scale Chinese women with polycystic ovary syndrome (PCOS). Retrospective study. Hospital-based IVF center. Patients with PCOS.In the present study, one thousand and forty PCOS patients were selected from women who visited the Reproductive Medicine Center at Shandong Provincial Hospital Shandong University between January 2002 and December 2006. All the patients had been performed a 75 g OGTT. Clinical characteristics, serum hormonal levels, glucose levels, insulin levels and lipid profiles were reviewed. An oral glucose tolerance test and insulin release test were performed for each woman. After overnight fasting, blood samples were collected to determine fasting blood glucose, blood glucose and insulin (30 min, 60 min, 120 min, 180 min) after digesting 75 g glucose, luteotrophic hormone (LH), follicle-stimulating hormone (FSH), testosterone (T), prolactin (PRL), estradiol (E2), and blood lipid levels. Height, weight, waistline, hip circumference, F-G grade for hirsutism, gonadal hormone results, blood lipid level, blood glucose tolerance, each-moment insulin level, and family history were determined. (i) The presence of oligomenorrhea was 62.6% while amenorrhea was 19.71%. Menstrual disorder of all the adult patients could be traced back to their adolescent menarche. There were 450 obesity cases of which 259 patients were central obesity. The incidence of acanthosis nigricans was 15.19%, 65.19% with obesity. (ii) Cholesterol (4.8 +/- 0.98 vs 4.61 +/- 0.86) and LDL (3.80 +/- 6.92 vs 2.88 +/- 1.01) were both significantly higher in the obesity patients than the non obesity patients. (iii) 173 patients were diagnosed as diabetes mellitus (DM), 179 IGT, 27 IFG and 9 (IFG and IGT). Those women with plasma glucose values abnormality of 0, 30 min, 60 min, 120 min, 180 min were 19 cases 0.98% (19/173), 74 cases 42.77% (74/173), 110 cases 63.58% (110/173), 42 cases 24.28% (42/173) and 12 cases 6.94% (12/173) respectively. Ten (10/173) patients would have been undetected if fasting plasma glucose levels were not evaluated, while omission of 30 min, 60 min, 120 min, or 180 min plasma glucose levels would have resulted in 16 cases (16/173), 50 cases (50/173), 28 cases (28/173) and 1 case (1/173) being missed respectively. If we took three times blood samples to evaluate plasma glucose levels, 39 cases (39/173) (0 min + 30 min +60 min), 102 cases (0 min + 30 min + 120 min), 21 cases (0 min + 30 min + 180 min), 34 cases (0 min + 60 min + 120 min), 45 cases (0 min + 60 min + 180 min), 123 cases (0 min + 120 min + 180 min) would be missed. Compared AUC of plasma glucose and insulin in 5 times with 3 times (0 min + 30 min + 60 min), the differences were statistically significant. Body mass index (BMI) was positively correlated with HOMA-IR (r = 0.29987 (P<0.01) as well as WHR (r = 0.12441, P<0.0001). (i) The prevalence rate of obesity was higher in PCOS. The state of obesity had a positive relation with insulin resistance. (ii) The prevalence rate of lipid profiles abnormality in obesity group was higher than in non-obesity. (iii) OGTT was the essential examination for all the PCOS patients
Department of Gynecology, Affiliated Obstetrics and Gynecology Hospital, Fudan University, Shanghai China. To investigate the clinical presentation, hormonal profile and metabolic abnormalities in subgroups of women with PCOS and explore a reasonable classification for PCOS.A cross-sectional study of 192 women with PCOS (14 - 38 years of age) was performed. The patients were divided into 3 groups of A, B and C according to the revised 2003 consensus on diagnostic criteria and also divided into 2 groups according to body mass index (BMI): (1) Clinical phenotypes: the presence of obesity was 36.4% (70/192), among which 80.0% (56/70) were central obesity. Higher rates of acanthosis nigricans were observed in OB-PCOS group (35.7%, 25/70) compared with NOB-PCOS group (7.4%, 9/122; P < 0.01). Waist to hip ratio (WHR) was lower in group C than those in groups A and B (P < 0.05). (2) Endocrinology: FAI level was higher in OB-PCOS group than in NOB-PCOS group (P < 0.01), whereas LH/FSH ratio was lower in OB-PCOS group compared with NOB-PCOS group (P < 0.01). FAI level was higher in groups A and B than in group C (P < 0.01). SHBG, LH/FSH ratio did not differ between groups A, B, and C. (3) Metabolism: the prevalence of IR was 43.2% (83/192). A higher prevalence was observed in group OB-PCOS (82.8%, 58/70) compared with group NOB-PCOS (20.5%, 25/122; P < 0.01). FINS, HOMA-IR, glucose area under the curve (GAUC), IAUC and TG were higher in group OB-PCOS than in group NOB-PCOS (P < 0.01), whereas HOMA-IR, lipid profile did not differ between groups A, B, and C. The classification according to the revised 2003 consensus on diagnosis reflects the basic characteristics of PCOS; while the classification based on obesity shows the severity of hyperandrogenism and degree of IR, and thus has substantial significance for evaluation of metabolic complications.
Genazzani AD,et.al. conducted a study related to Metformin treatment for PCOS.they said that metformine is a old drug, but it is optimal for the control of glycemia in Type 2 diabetes. It was reported, 15 years ago, that insulin resistance was abnormally high in most polycystic ovary syndrome (PCOS) patients. which is the most common cause of menstrual irregularity, inesthetisms and infertility. Metformin induces higher glucose uptake, thus inducing a lower synthesis/secretion of insulin. Such an effect permits the possible restoration of the normal biological functions that are severely affected by the compensatory hyperinsulinemia reactive to the increased peripheral insulin resistance. These are the basis of the many positive effects of this drug, such as the restoration of menstrual cyclicity, ovulatory cycles and fertility, because abnormal insulin levels affect the hypothalamus-pituitary-ovarian function, as well as the use of glucose in peripheral tissues. Metformin improves the impairments typically observed in hyperinsulinemic PCOS patients, reducing the possible evolution towards metabolic syndrome and Type 2 diabetes; and when pregnancy occurs, it consistently reduces the risk of gestational diabetes, eclampsia and hypertension. PCOS seems to be the perfect physiopathological condition that might have higher benefits from metformin administration, obviously after Type 2 diabetes. This review focuses on the many aspects of PCOS and on the possible issues of this disease for which metformin might be a putative optimal treatment.
Katsiki N, Hatzitolios AI. The aim of the current review was to update the knowledge regarding the role of metformin and thiazolidinediones in PCOS treatment, focusing on recently published studies. Several clinical trials examined metformin effectiveness on lipids, atherosclerosis and inflammatory markers, hormone levels, menstrual irregularities, ovulation induction, fertility, hirsutism, obesity parameters and quality of life in PCOS women. Metformin treatment was shown to improve these features, although conflicting results were also reported. Only one study investigated pioglitazone effect on PCOS, reporting an improved IVF outcome in clomiphene citrate-resistant PCOS patients. Finally, both metformin and pioglitazone, as a part of a low-dose polytherapy, exerted beneficial effects on lipids, androgen levels, hirsutism and markers of atherosclerosis in nonobese PCOS women. Further research, including larger randomized controlled trials and meta-analyses, is needed to clarify the role of metformin and thiazolidinediones in the treatment of clinical and biochemical PCOS characteristics
Liang F, Koya D. Insulin resistance (IR) is closely associated with obesity, type 2 diabetes mellitus (T2DM), hypertension, polycystic ovary syndrome (PCOS), non-alcohol fatty liver diseases (NAFLD) and metabolic syndrome and is also a risk factor for serious diseases such as cardiovascular diseases. Pharmacological treatments available for IR are limited by drug adverse effects. Because acupuncture has been practiced for thousands of years in China, it has been increasingly used worldwide for IR-related diseases. This review analyses 234 English publications listed on the PubMed database between 1979 and 2009 on the effectiveness of acupuncture as a treatment for IR. These publications provide clinical evidence, although limited, in support of the effectiveness of acupuncture in IR. At this stage, well-designed, evidence-based clinical randomized controlled trial studies are therefore needed to confirm the effects of acupuncture on IR. Numerous experimental studies have demonstrated that acupuncture can correct various metabolic disorders such as hyperglycemia, overweight, hyperphagia, hyperlipidemia, inflammation, altered activity of the sympathetic nervous system and insulin signal defect, all of which contribute to the development of IR. In addition, acupuncture has the potential to improve insulin sensitivity. The evidence has revealed the mechanisms responsible for the beneficial effects of acupuncture, though further investigations are warranted.
Thomson RL, Buckley JD, Brinkworth GD. conducted evaluating the benefits of exercise training and specific exercise regimes in women with PCOS. From the limited studies there appears to be a beneficial effect of exercise either alone or in combination with energy restriction has shown to improve fitness, cardiovascular, hormonal, reproductive and psychological outcomes. While the addition of regular exercise to energy restriction appears to only have additional benefits for improving body composition, these greater improvements are likely to have long-term implications. While lifestyle modification including regular exercise appears to be an effective strategy for the management of overweight PCOS women, methodological limitations in the studies limit the generalizability of the findings. Future research with rigorous study designs is needed to determine specific exercise guidelines that will provide the greatest benefit for these women.
Fertil Steril. 2010 May 6. To compare different oral ovulation induction agents in treating infertile women with polycystic ovary syndrome (PCOS). Decision-analytic model comparing three treatment strategies using probability estimates derived from literature review and sensitivity analyses performed on the baseline assumptions. Outpatient reproductive medicine and gynecology practices. Infertile women with PCOS. intervention(s): Metformin, clomiphene citrate, or metformin with clomiphene citrate. MAIN OUTCOME MEASURE(S): Live birth. RESULT(S): Within the baseline assumptions, combination therapy with metformin and clomiphene citrate was the preferred therapy for achieving live birth in women with PCOS. Sensitivity analysis revealed the model to be robust over a wide range of probabilities. CONCLUSION(S): Combination therapy with metformin and clomiphene citrate should be considered as first-line treatment for
infertile women with PCOS.
Lim CE, Wong WS. This paper aims to provide a literature review on evaluating the efficacy of acupuncture therapy in the treatment of polycystic ovarian syndrome (PCOS) by reviewing clinical trials; randomised and non-randomised and observational studies on PCOS. The paper will also determine the possible mechanism of acupuncture treatment in PCOS, limitations of recruited studies and suggest further improvements in future studies.
Four studies were recruited. Several studies showed that acupuncture
significantly increases beta-endorphin levels for periods up to 24 h and may have regulatory effect on FSH, LH and androgen. beta-endorphin increased levels secondary to acupuncture affects the hyperthalamic-pituitary-adrenal (HPA) axis through promoting the release of ACTH through stimulation of its precursor pro-opiomelanocortin synthesis Acupuncture is a safe and
effective treatment to PCOS as the adverse effects of pharmacologic interventions are not expected by women with PCOS. Acupuncture therapy may have a role in PCOS by: increasing of blood flow to the ovaries, reducing of ovarian volume and the number of ovarian cysts, controlling hyperglycaemia through increasing insulin sensitivity and decreasing blood glucose and insulin levels, reducing cortisol levels and assisting in weight loss and anorexia. However, well-designed, randomised controlled trials are needed to elucidate the true effect of acupuncture on PCOS.