The relationship between lifestyle and prevalence ofpolycystic ovary syndrome

Polycystic ovary syndrome, which is caused by an imbalance in female sex hormones, leads tothe formation of cysts in the antral follicles of the ovary. Here, a cyst is a fluid-filled saccontaining an egg that must normally be drained for possible fertilization. The transformationof the ovum into a cyst, which is called a "functional cyst", prevents ovulation and also leadsto a disturbance in the menstrual cycle and "amenorrhea" occurs. When multiple cysts form inovarian follicles due to hormonal imbalance, it is known as PCOS. Due to water-retained cysts,some of which can be as large as ۱۰ mm in diameter, the ovary increases in size by up to ۱۰cm. Absence of ovulation and menstrual cycle prevents fertilization and as a result pregnancybecomes difficult. Even if implantation occurs, the risk of miscarriage, stillbirth, and small-forgestational-age fetus increases. Polycystic ovary syndrome can cause pregnancy-relatedcomplications such as gestational diabetes, pregnancy-induced high blood pressure.Normally, ovarian theca cells support the growing follicle and help produce mature eggs, butin PCOS patients, these cells overreact to the stimulatory effects of insulin, thus causingovarian hypertezosis by multiplying. become Insulin resistance enhances androgenic potentialin theca cells and exacerbates PCOS. Also, high sensitivity of theca cells to gonadal steroidgonadotropin stimulation contributes to androgenism in PCOS.Impaired release of pulsatile gonadotropin-releasing hormone (GnRH) from the hypothalamusis the cause of PCOS. GnRH causes the pituitary gland to release the hormones (FSH) and(LH). In polycystic ovary syndrome, since these hormones are low, the egg either does notform or is not released from the follicle. Therefore, the cycle is disrupted and amenorrheaoccurs, which can be of two types, primary or secondary amenorrhea. While primaryamenorrhea is the inability to menstruate due to chromosomal or anatomical issues, secondaryamenorrhea, also called hypothalamic amenorrhea, is characterized by the absence of menstrualcycles for ۳ or more consecutive months. High levels of prolactin, a peptide hormone, blockGnRH. Since the human body is a complex system and metabolites are functionally related, adisruption in one can affect the others. Decreased levels of a number of hormones (prolactin,anti-Müllerian hormone (AMH), cortisol, and androgens), neurotransmitters (dopamine),peptides, lipids, proteins, and glucose are associated with PCOS manifestations.Hyperprolactinemia causes hypogonadotropic hypogonadism characterized by amenorrhea,galactorrhea (abnormal milk production from the breasts), and osteoporosis. Normally, afterchildbirth, prolactin stimulates milk production by the alveolar cells of the breast. Prolactinomaof the pituitary gland is one of the causes of high prolactin levels .The proper functioning ofthe mechanisms responsible for the maturation of the ovarian follicle and ovulation dependson the proper physiological activity of three organs: the hypothalamus, the pituitary gland, and the ovaries. Hormonal regulation mechanisms in the hypothalamus-pituitary-ovary system are carried out through negative feedback axes: long, short and ultra-short feedback. In the suprachiasmatic nucleus of the hypothalamus, there are neurons that synthesize gonadotropin-releasing hormone (GnRH), which is released in the median eminence into the pituitary portal circulation. (GnRH) release is regulated by a network of interconnected neurons. Gonadoliprin is an example of a hormone that is secreted in a pulsating rhythm, and the frequency of this rhythm determines the type of gonadotropin released. The low frequency of gonadoliberin pulses lead to the release of follicle stimulating hormone (FSH), while the high frequency leads to the release of luteinizing hormone (LH) from the anterior lobe of the pituitary gland. It is responsible for the luteinization of the corpus luteum, that is, the conversion of granulosa cells into tekalutein cells that produce progesterone. In turn, FSH stimulates ovarian follicle maturation and estrogen secretion in the granulosa cells of ovarian follicles. It also increases the activity of aromatase, the enzyme responsible for converting androgens (testosterone and androstenedione) into estrogen. When the concentration of luteinizing hormone increases relative to FSH, androgen overproduction occurs, which is more common in women with PCOS. Insulin directly and indirectly affects the pathogenesis of PCOS. Acts synergistically with luteinizing hormone, increases production of androgens (theca cells) and decreases hepatic synthesis of major testosterone binding protein (SHBG), leading to circulating unbound testosterone and Activated. Excess body fat contributes to PCOS in many ways. Adipose tissue cells (adipocytes) produce peptide hormones such as resistin and leptin as well as some inflammatory cytokines (IL-beta, TNF-alpha.)Leptin activity affects the function of the hypothalamus-pituitary gland-ovary axis by changing the secretion of GnRH, LH and FSH. Leptin is a signal for the hypothalamus to release LH, which also triggers pituitary GnRH secretion. This can lead to excessive androgen synthesis. By secreting pro-inflammatory factors such as the mentioned cytokines, adipose tissue helps to cause inflammation in PCOS and increase the amount of free radicals caused by hyperglycemia. Excess adipose tissue and androgens contribute to the formation of chronic inflammation in PCOS. Visible symptoms of hyperandrogenism include: weight gain, abdominal and subcutaneous fat, hirsutism (facial and body hair), male pattern alopecia (hair loss), clitoromegaly (enlargement of the clitoris), loud voice, oily skin, acne, etc. Apart from these morphological features, metabolic changes also occur. Insulin resistance is one of the main symptoms of PCOS, which leads to hyperinsulinemia and can eventually lead to diabetes. High levels of insulin cause fat deposits around the abdomen or central obesity, and most women with PCOS have a body mass index (BMI) of ۳۰ or higher. Other than that, high blood pressure, cardiovascular problems, dyslipidemia, etc. are among the diseases associated with PCOS. Healthy blood pressure for women is ۱۲۰ over ۸۰ or less. PCOS patients are at high risk of premature cardiovascular disease. PCOS patients often exhibit sugar cravings, urinary frequency, delayed recovery, fatigue, blurred vision, tingling, mood swings, anxiety, and depression, which are also associated with diabetes. Patients often feel pelvic pain, fever, nausea, vomiting, urinary conditions, constipation, etc. Large cysts pressing on the bladder or rectum are responsible for abnormal urination and bowel movement. Sleep apnea (a sleep disorder in which breathing stops and starts repeatedly) is another symptom of PCOS caused by changing sex steroid levels. PCOS can put a woman at risk for uterine cancer because high levels of estradiol and a lack of progesterone due to improper ovarian function increase the risk of endometrial hyperplasia. An endocervix with a lack of mucus and a smooth vagina is one of the characteristics of PCOS that can be seen in a pelvic exam. Due to the hormonal imbalance in polycystic ovary syndrome, light brown or black spots appear on the skin, which creates a condition called acanthosis nigricans, and the skin of the neck, armpits, thighs, and breasts are more exposed to these skin pigments. Also, skin tags appear in those areas. In fact, dark pigmentation is a skin marker for insulin resistance. However, PCOS symptoms can be considered a spectrum, as its manifestations vary between races and individuals. Hirsutism is mild or absent in PCOS women of South Asian and Scandinavian origin, because the androgen sensitivity of the pilo-sebaceous glands is different, but PCOS patients of Middle Eastern and Mediterranean origin are more affected by hirsutism. Polycystic ovary syndrome will lead to potential complications such as infertility, uterine cancer, which makes this disease one of the cases that must be prevented and treated.

Keywords:

Lifestyle , nutrition , physical activity , polycystic ovary syndrome