Polycystic Ovary Syndrome And You: The complete reference guide to help you understand and overcome PCOS

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POLYCYSTIC OVARIAN SYNDROME AND YOU The complete reference to help you understand and overcome PCOS

Elsie Ijorogu Reed

© Copyright 2021 - All rights reserved. The content contained within this book may not be reproduced, duplicated or transmitted without direct written permission from the author or the publisher. Under no circumstances will any blame or legal responsibility be held against the publisher, or author, for any damages, reparation, or monetary loss due to the information contained within this book, either directly or indirectly. Legal Notice: This book is copyright protected. It is only for personal use. You cannot amend, distribute, sell, use, quote or paraphrase any part, or the content within this book, without the author or publisher's consent. Disclaimer Notice: This book was created to provide information about natural medicines, cures, and remedies used in the past. This information is made available with the knowledge that the publisher, editor and authors do not offer any legal or otherwise medical advice. In the case you are ill, you should always consult with your caring physician or another medical specialist. This book does not claim to contain and indeed does not contain all the information available on the subject of natural remedies. While the authors, editor and publisher have gone to great lengths to provide the most useful and accurate collection of healing plants and remedies, there may still exist typographical and content errors. Therefore, this book should not be used as a medical guide. The authors, editor and publisher, shall incur no liability or be held responsible to any person or entity regarding any loss of life or injury, alleged or otherwise, that happened directly or indirectly due to using the information

contained in this book. It is your responsibility, and if you want to use a potion, tincture, decoction or anything else from this book, you should consult with your physician first. Some of the remedies and cures found within do not comply with FDA guidelines. The book's information has not been reviewed, tested or approved by any official testing body or government agency. The authors and editor of this book make no guarantees of any kind, expressed or implied, regarding the final results obtained by applying the information found in this book. Using and consuming any of the products described will be done at your own risk. The authors, editor and publisher, hold no responsibility for the misuse or misidentification of a plant using this book's contents or any consequences to your health or that of others that may result. Some names and identifying details have been changed to protect the privacy of the authors and other individuals. Please note the information contained within this document is for educational and entertainment purposes only. All effort has been executed to present accurate, update, reliable, complete information. No warranties of any kind are declared or implied. Readers acknowledge that the author is not engaged in rendering legal, financial, medical or professional advice. The content within this book has been derived from various sources. Please consult a licensed professional before attempting any techniques outlined in this book. By reading this document, the reader agrees that under no circumstances is the author responsible for any losses, direct or indirect, that are incurred due to the use of the information contained within this document, including, but not limited to, errors, omissions, or inaccuracies.

Table of Contents Story Time Chapter 1. POLYCYSTIC OVARIAN SYNDROME CHAPTER 2. HISTORY OF PCOS CHAPTER 3. PRESENTATION AND TYPES OF PCOS CHAPTER 4. PCOS PATHOGENESIS CHAPTER 5. PCOS AND THE FEMALE MIND CHAPTER 6. PCOS DIAGNOSIS CHAPTER 7. PCOS HERBAL TREATMENT CHAPTER 8. PCOS MEDICAL TREATMENT CHAPTER 9. PCOS SURGERY CHAPTER 10. PARTING WORDS References

ACKNOWLEDGMENT I dedicate this book to my daughter Gabrielle and friends, who have been a constant source of motivation, inspiration, and constructive criticism for me. Above all, this book is dedicated to every woman out there afflicted with Polycystic Ovarian Syndrome at any point in her life, whether past or present. You are not alone in your struggle. You never were, and you never will be. This book is a testament to your will to survive, persevere and grow.

Story Time Before we formally begin our dive into the complex endocrine entity Polycystic Ovarian Syndrome, I'd like to share a story with you. This little story is about a friend of mine whose actual name shall not be revealed to maintain her privacy and dignity. Let's call her Katherine. Katherine and I had been friends in high school. She was a popular student, great at studies, winner of many debating accolades in intra and inter-school contests; she was a very enthusiastic soccer player who always insisted on being the attacking midfielder to be always close to the action. She was pretty, intelligent, funny and seemed to have it all. Katherine and I weren't exactly besties. We would occasionally be on opposite ends when it came to opinions, but what I liked about her was that she respected differing opinions, a quality rarely found in today's generations, to be honest. I remember her not because of high school but because of the circumstances surrounding how we met many years after graduating. I bumped into her in a mall about a year back, and it took me a second to recognize her. The once free-spirited outgoing bird I knew from school was now a very down and introvert-ish lady in a long scarf covering her head, which she hated to do back in school. I will be lying if I say it did not surprise me. We sat down for coffee, and I asked her how she was doing. It had been quite some time, after all. Understandably she was reluctant to tell me the whole deal and instead focused more on fixing her scarf and checking her phone. I did not press any further, and before bidding my goodbye, I just said that we should get together again sometime and that if she needed any help, she had my number.

She immediately started crying right there and then. No, she was not crying but bawling. And I had no idea why. I sat back down and asked what's wrong. Katherine looked at me with teary eyes and took off her headscarf and face mask. That was when I saw. Katherine had a few hairs punctuating her jawline, interrupted in place with small scars which I could only assume were shaving scars. She was noticeably heavier than I remembered, but I did not immediately notice it due to her loose clothing. Her face also had multiple pimples, and small dotted scars that I could only assume could be acne. I asked her to tell me what happened to her. Katherine explained how after high school, she was getting ready to move to another city for college. That's when she started growing hair in weird places, and she started gaining weight. As if that was not enough, she developed irregular periods. Sometimes they would be less than two days total; other times, her cycle would cross even 35 days. Sometimes she would not get her period at all. Katherine and her husband, let's call him Jack, married about two years ago. He was a very kind and handsome man, and he had no problem marrying Katherine despite what she called her hideous looks. Since their marriage, they both had been trying to conceive, but Katherine was not getting pregnant. This frustrated them both and even led to a few heated fights here and there. She was a broken mess, a total opposite of the Katherine I knew. After ten months of repeatedly trying to get pregnant and failing, the couple visited an endocrinologist. This doctor listened to her whole story, and then he asked her a few questions as well. At the end of the interview, he advised an ultrasound of her pelvis. The ultrasound came back a couple of days before our fateful meeting at the mall, and the doctor explained it to her. She

has polycystic ovaries that were the cause of all her ongoing troubles, the hair, the weight, the acne, the difficulty conceiving, everything. Katherine was devastated. She couldn't help thinking that what if she could never be a mother. However, the good doctor kindly explained to her the various treatment options, medication, surgeries, and everything. All that did was scare her even more. I hadn't noticed that I also had tears in my eyes when she finished her story. I had experience with herbal medicine over the years, and I could not see her like this, so I suggested a few remedies I had learned to help her with her condition. She was doubtful; I don't blame her. But on my persistence, she tried anyway. Fast forward to a couple of days ago, I met her again. Only this time, her skin glowing just as bright as it did in school, her weight managed, and in her arms was the most beautiful baby girl I had ever seen, baby Sara. Katherine and Jack were a proud set of parents now.

CHAPTER 1 POLYCYSTIC OVARIAN SYNDROME

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efore formally beginning our dive into Polycystic Ovarian Syndrome, I'd like to come clean about something. Initially, when I first planned out the manuscript for this book, I did not intend to share my friend's story. At first, the idea was to make this an objective as a possible book for information about a condition I was very passionate about, albeit more due to circumstance than by actual conscious decision to pursue it. But since that day, the objective was modified. I want to clearly state that my friend's storybook and the details within it are not meant to scare or discourage anyone at all and will never be used in this way. The purpose is to tell those of my readers who happen to have this condition that you are not alone. Your story matters and this condition is not a death sentence. I will reiterate this affirmation multiple times throughout the book. With that, let's begin. Polycystic Ovarian Syndrome or PCOS is a common hormonal disorder among females of reproductive age. Anatomically as the name implies, Polycystic Ovarian Syndrome is the constellation of manifesting signs and symptoms of the presence of multiple fluid-filled cysts in the ovaries (the prime female organ responsible for producing half of the DNA you and I have inherited from our mothers, i.e., the egg). Although studies had been raging on ever since its first proper description back in 1935, there still is no

single definitive cause identified for the disorder as of yet. Multiple factors are thought to play a role in the start and progression of Polycystic Ovarian Syndrome, with genetic differences in origin while others are environmental. Let's take a look at some statistics, shall we, to understand the problem's magnitude. The numbers I'm about to quote are not absolute as experts differ on the criteria to define and label any combination of symptoms as Polycystic Ovarian Syndrome. For example, the World Health Organization (WHO) estimates that as of 2010, Polycystic Ovarian Syndrome afflicts 116 million women around the globe. That makes up 3.4% of the global female population at the time. Studies were done using the Rotterdam diagnostic criteria (more on that later), which estimated that overall, 18% of women would experience Polycystic Ovarian Syndrome in their reproductive age. Among them, 70% usually go undiagnosed. A broader estimate by experts puts the risk of Polycystic Ovarian Syndrome at between 2 and 20% in women of childbearing age. Many other studies exist that categorize and quantify the incidences and prevalence of Polycystic Ovarian Syndrome. However, it must be kept in mind that from a research standpoint, we have still only scratched the surface of this condition, and we keep learning new and fascinating things every day about it. The numbers stated above may have changed by now. They may have increased or decreased, they may have skewed the graph to the left or right and may have even disappeared entirely in some world regions. Our knowledge on Polycystic Ovarian Syndrome is evolving, and experts are conducting new and innovative trials on it every day to find a lasting cure for this condition. Among other symptoms, Polycystic Ovarian Syndrome represents a welldocumented source of anxiety and depression as well among women of reproductive age. I say that because, as with every human being we encounter, people have a certain tenacity to focus more on the extremes of

complications associated with any disease. It's a kind of human survival mechanism we had evolved with over time that had served us well when we lived by the philosophy of 'kill or be killed' way back when our distant ancestors were hunter-gatherers on a younger Earth also populated by fearsome beasts bent on hunting us down. In terms of our neurological makeup, we have a built-in circuit to be pessimistic for lack of better words. And the average woman's view on Polycystic Ovarian Syndrome is no exception. This is primarily because, among other things, PCOS is one of the causes of infertility, and this alone is a massive cause of anxiety and frustration. This extends even further to the whole couple as well. We will take a deeper look into the how and why in the coming chapters. This e-book will look at Polycystic Ovarian Syndrome from its inception and work our way towards the present day. As with medical disorders in general, some medical terminologies are used throughout the book, but because the book aims to target even the most average of joes out there, I will try my best to simplify every term outside the scope of normal language and comprehension.

CHAPTER 2 HISTORY OF PCOS

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olycystic Ovarian Syndrome is often thought to be an ancient disorder, and for a good reason. The earliest references to it, including even those that do not explicitly state the obvious, date back to ancient Egyptian papyri more than 30,000 years ago. Extensive references to a hormonal condition affecting female fertility have also been found in Greek and Hebrew literature throughout history, up to the medieval and Renaissance periods. Some historians even suggest that due to the genetics-based predisposition of childbearing age females, Polycystic Ovarian Syndrome may have very well been around even before our distant ancestors developed sufficiently differing features to become a separate race. That's right; Polycystic Ovarian Syndrome may have predated the emergence of our racial diversity more than 50,000 years ago. Some translated descriptions of possible PCOS presentations include but are not limited to the following. Hippocrates (460 BC-377 BC) notes that "But those women whose menstruation is less than three days or is meager, are robust, with a healthy complexion and a masculine appearance; yet they are not concerned about bearing children nor do they become pregnant." Soranus of Ephesus (c. 98-138 AD) noted that "sometimes it is also natural not to menstruate at all... It is natural too in persons whose bodies are of a

masculine type... we observe that the majority of those not menstruating are rather robust, like mannish and sterile women." A physician named Moises Maimonides (1135-1204 AD) noted that "...there are women whose skin is dry and hard, and whose nature resembles the nature of a man. However, if any woman's nature tends to be transformed to the nature of a man, this does not arise from medications, but is caused by heavy menstrual activity." Renaissance surgeon and obstetrician Ambroise Pare (1510-1590 AD) observed that "Many women, when their flowers or tears be stopped, degenerate after a manner into a certain manly nature, whence they are called Viragines, that is to say, stout or manly women; therefore, their voice is loud and bigger, like unto a mans, and they become bearded." In 1721 in Italy, a man named Vallisneri described a married, infertile woman with shiny ovaries with a white surface and the size of ovaries as "pigeon eggs." Then in 1844, Chereau and Rokitansky further localized that pathology to cysts within the ovaries as fibrous and sclerotic lesions. However, the first proper description of this condition was published in 1935 in a paper by Irwing F. Stein and Michael L. Levinthal. They described a group of 7 women with the combinations of menstruation disturbances, hirsutism and enlarged ovaries with the presence of many small follicles. Hence this disease came to be known then as the "Stein-Levinthal Syndrome." Then came the 1990s. The first formal diagnostic criteria for PCOS were developed at a National Institutes of Health (NIH) sponsored conference on PCOS, called the NIH Criteria, which essentially labelled any unexplained case hyper-androgenic loss of ovulation as PCOS. However, with time, modifications became necessary as medical technology evolved to include

better, more accurate and less invasive investigation techniques. In 2004, the Rotterdam criteria were introduced, which included the symptomatic presentation of PCOS and included the ultrasound-based measures of ovarian imaging. Polycystic Ovarian Syndrome is today recognized as the most common female hormonal disorder in childbearing age.

CHAPTER 3 PRESENTATION AND TYPES OF PCOS

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o clarify any uncertainties, I'd like to begin this chapter by explaining what a 'syndrome' exactly is. A syndrome is, in simple terms, a combination of signs and symptoms in a patient which by itself may look random and unrelated but have an underlying cause that ties them all together. You can think of it as the common source of the different abnormal manifestations we experience. Prevalent examples include Down's Syndrome (genetic syndrome of mental retardation, facial abnormal features and growth anomalies due to an additional 21st chromosome), Fragile X Syndrome (a most common cause of inherited intellectual disability affecting every 1 in 2500 male and 1 in 5000 female babies) and Irritable Bowel Syndrome (a combination of extensive ulceration and inflammation mainly in the large intestines). Polycystic Ovarian Syndrome follows this concept as well. You can get an idea of the apparent randomness of its manifestations from the ones we shall briefly discuss below. Polycystic Ovarian Syndrome has a broad spectrum of presentations, which vary between individual females. Patients may lie anywhere on the chart. They may be completely asymptomatic with a diagnosis only made incidentally on a random ultrasound scan on their pelvic areas, or they may have multiple gynecological, dermatological and metabolic imbalances altogether.

So, you see, a disorder of this type has a very variable set of manifestations. However, there are some signs and symptoms that show a certain amount of overlap. In this book, we will focus more on these commonly shared characteristics. For the sake of simplicity, we will group them according to their primary system. REPRODUCTIVE MANIFESTATIONS Irregular Menstruation Period irregularities are a hallmark feature of symptomatic PCOS. The average menstrual cycle lasts around 28 days; give or take a few. But when this cycle lasts too long or too short, then there is cause to worry. Apart from that, the period may be very scanty (called oligomenorrhea) or very heavy (called Heavy Menstrual Bleeding or HMB) Anovulation This is a condition where the ovarian follicle that is typically released around the middle of the menstrual cycle is not released. The ovary does not send an egg towards the uterus via fallopian tubes for fertilization implantation. Instead, that follicle release is impaired, and that follicle stays inside the ovary, gathering inflammatory cells around it to become a cyst. Infertility This is an extension of the anovulatory manifestation above, whereby the consistent lack of ovulation coupled with multiple failed attempts at conception leads to the diagnosis of infertility. This is a very worrisome problematic diagnosis for the patient and a cause of significant mental health disturbance in anxiety and depression in the patient. ENDOCRINE MANIFESTATIONS Hirsutism

This is the growth of unwanted body hair in places where they would normally not be found on females, such as facial hair. This is a product of the masculinizing effect produced in PCOS due to hyperandrogenism (discussed in detail). Hirsutism is a major cosmetic complaint in PCOS patients. Acne Similar to the cause of hirsutism, hyperandrogenism causes the female to develop persistent acne and oily skin. Again, this is a cosmetic problem for the patient and must be investigated cautiously. Alopecia Alopecia or baldness is another male characteristic found in females suffering from PCOS. The head's male pattern baldness is a major cosmetic complaint due to hormonal imbalances between male and female sex hormones. Diabetes This is a co-morbid presentation because PCOs are also associated with an increased level of resistance of body cells to insulin, leading to persistently high blood glucose levels, which is medically called diabetes mellitus.

Types of PCOS Owing to the current uncertain etiology of PCOS, experts have divided PCOS into four distinct types based on explainable mechanism of action, possible cause and cellular response. These types are: 1. Insulin-resistant PCOS This is the most common type of PCOS. This type of PCOS is caused by smoking, sugar, pollution and trans-fat. In this, high levels of Insulin prevent

ovulation and trigger the ovaries to create Testosterone. Suppose your doctor has told you that you have diabetes on the borderline and your glucose tolerance test was not normal. If you have increased insulin levels and are overweight, you might be having insulin-resistant PCOD. TIP- QUIT SUGAR! Just avoid the sugar; it should be your first step. A small amount of sugar is healthy, but you contribute to insulin resistance by taking it in large quantities. To prevent insulin-resistant PCOS, you can take inositol. A period of almost six to nine months is needed to improve from this PCOS type as it is a slow process. 2. Pill-induced PCOS This type is the second most common PCOS. It gets developed due to birth control pills that suppress ovulation. These effects do not last long for most women, and they resume ovulating after the pill's influence is over. But some women do not resume ovulating for months and years even after the effects of pills are over. During that time, women should consult the doctor. If you experience regular and normal periods before starting with the pills, this might be a sign of Pill-induced PCOS. Or if your LH levels are increased in the blood test, this could be a sign too. 3. Inflammatory PCOS In PCOS, due to inflammation, ovulation is prevented, hormones get imbalanced, and androgens are produced. Inflammation is caused due to stress, toxins of the environment and an inflammatory diet like gluten. If you have symptoms such as headaches, infections or skin allergies, and your blood tests show that you are deficient in vitamin D. In that case, your blood count is not normal with increased thyroid levels, and you might have inflammatory PCOS.

TIP- DON'T STRESS! Stop consuming inflammatory foods like dairy products, sugar or wheat. Start taking supplements of magnesium as it has anti-inflammatory effects. The process of improvement takes about nine months as it is a slow process. 4. Hidden PCOS This is a more straightforward form of PCOS; once the cause is addressed, it takes about three to four months. Causes of Hidden PCOS: Thyroid disease, deficiency of iodine (ovaries need iodine), vegetarian diet (it makes you zinc deficient and the ovaries need zinc) and artificial sweeteners.

CHAPTER 4 PCOS PATHOGENESIS

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ecause Polycystic Ovarian Syndrome has such a wide variety of presentations and patients may have debilitating adverse effects, or they may even go about their lives having completely unnoticed problems at all, it is understandably tough to pinpoint a singular process that causes it all. Therefore, although research into this condition is raging on at the time of writing, there is still a massive amount of uncertainty about how exactly PCOS develops in women and what the root cause of it is, to begin with. But don't feel hopeless just yet. We may not have determined the cause of the condition down to the letter. Still, we have made tremendous progress in identifying some of what experts believe to be the fundamental processes that occur in every symptomatic patient and, therefore, are crucial to developing the disease. These critical endocrine processes are: 1. Hyperandrogenism 2. Luteinizing Hormone (LH) Hypersecretion 3. Hyperinsulinism The interactions of these three processes with each other in Polycystic Ovarian Syndrome are very complicated. We will briefly look into each one of the above as separate entities for simplicity. HYPERANDROGENISM

This is more or less a hallmark feature of PCOS. Present in about 70% of PCOS patients, hyperandrogenism is an excess of androgens or male sex hormones in the female body. The human body has a balanced production and use of both types of sex hormones (male and female) because both are created from the same parent molecule, Cholesterol. The female hormones, i.e., the Estrogens, are responsible for the female reproductive cycle and many female body characteristics such as body shape, tone of voice, hair and fat distribution etc. Estrogens also confer an advantage to women. They protect them from heart disease (that is why after menopause, the risk of heart disease in men and women becomes almost equal compared to much lower risk in women before menopause). The androgens include the infamous Testosterone and its precursor compounds. These are responsible for manly features such as facial hair, deeper voice, more muscle mass etc. An increased level of androgens in the female body is responsible for some of the masculine features of Polycystic Ovarian Syndrome patients, such as hirsutism, deepening of the voice, and male body structure, as we have seen in the previous chapter. How hyperandrogenism develops is a complex and still unclear pathway, but promising theories have suggested that the ovaries' structural damage impairs their ability to synthesize estrogens. This, in turn, causes a shift in the sex hormone production pathway towards androgens. This is the simple version. The longer, more complex version involves things like Sex-hormonebinding-globulins and Cytochrome P450C17 mediated enhancement of androgen synthesis within the ovaries themselves etc., that I won't bore you with. However, it must be kept in mind that other conditions can cause

hyperandrogenism, such as adrenal or ovarian tumors, which must be ruled out before a PCOS diagnosis can be made. LH HYPERSECRETION Luteinizing hormone and its partner, the Follicle Stimulating Hormone or FSH, are another set of crucial hormones utilized by the male and female bodies. The pituitary gland secretes them in the brain and regulates the production of sex hormones. It regulates the sexual characteristics of both male and female bodies. Both these hormones must balance to promote optimal reproductive function such as menstruation and facilitate pregnancy. In the previous section, we saw that due to the structural abnormalities in the ovary, it shifts from its usual role of producing estrogens to producing androgens. This imbalance between estrogens and androgens also affects LH and FSH regulation from the pituitary because the body's hormonal system is usually a tightly monitored and regulated system with multiple feedback systems in place. The estrogen-androgen imbalance's feedback ends up causing an LH-FSH imbalance owing to their feedback with each other. And this results in an abnormally high LH level alongside a diminished level of FSH. FSH is responsible for promoting the ovary into producing egg follicles, which are vital in the reproductive cycle. A lower level of FSH, therefore, causes an impairment in the production of ovarian follicles. Additionally, the higher-than-normal LH levels also promote androgens' production, which further upset the balance between sex hormones. This coupling effect is what drives the menstrual irregularities, and the most dreaded complaint PCOS sufferers have… difficulty getting pregnant. HYPERINSULINISM You may be wondering what Insulin has to do with all this since it is

primarily a hormone controlling blood sugar levels, and here's the catch. Insulin has other functions as well. Insulin regulates the blood sugar levels to prevent them from getting too high and has a role in regulating how fat is stored in the body. A compound called Insulin-like-growth-factor-1 (IGF-1) is also a key mediator in body metabolism, energy production and overall growth. We saw above that having PCOS has an association with obesity and diabetes. Here is how. Obese women, due to their larger fat content, are prone to developing more steroid hormones and gradually reducing the sensitivity of body cells to Insulin. We also discussed above how the body's hormonal system is a tightknit of feedbacks. The same principle applies here too. Because of increased insulin resistance in the body due to obesity, the patient develops diabetes and develops a higher-than-normal insulin level in the body because of the feedback mechanism. This hyperinsulinism is an attempt by the body to counteract the insulin resistance, but instead, it also ends up stimulating another insulin-sensitive organ, the ovaries. Ovaries under direct stimulation from Insulin contribute to hyperandrogenism by amplifying their androgen production. Furthermore, IGF-1 levels are also raised, and they stimulate the production of Testosterone from its precursor compounds, tying into the PCOS puzzle neatly.

CHAPTER 5 PCOS AND THE FEMALE MIND

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his is a special chapter that I intentionally included right here because if you've read up till now, you probably have spent a decent amount of time reading and reading about facts and facts about Polycystic Ovarian Syndrome. In this chapter, I'd like to take a break from the disease and focus a bit on the person, so to speak. I started this book with a story about my friend Katherine and how she overcame immense physical, mental and emotional ordeal to become the proud mother she is today despite her long battle with Polycystic Ovarian Syndrome. I'd like to revisit that story but from a different perspective. Instead of going through the narrative again, I'd like you all to join me and take a deeper look into the mental state of a woman suffering from Polycystic Ovarian Syndrome. You may have noticed that I did not detail the effects of Polycystic Ovarian Syndrome on a woman's mental health in the chapter on PCOS presentation. I did that on purpose, and I would like to dive a little deeper into that specific symptom complex in this one. This is my way of, for lack of better words, de-tracking you from getting too involved with the fact that we forget that this condition affects real human beings with real lives, real dreams and hopes and ambitions. I did not want you to lose sight of the forest while looking at the trees.

As with any affliction we humans face, our mental health is affected just as much as our physical and emotional capacities. One particularly common comorbid condition seen with Polycystic Ovarian Syndrome is that of clinical depression and anxiety disorders. We'll briefly take a look into these. We saw Katherine's suffering and affliction at the beginning of the book. Now please do something for me. Imagine yourself in her place. Think about how it feels. Think about the challenges you would have to face. Think about the crippling self-doubt and anxiety and the late nights of wondering and making up worst-case scenarios in your head, the overthinking and the worrying. It's devastating, correct? Polycystic Ovarian Syndrome is, in actuality, much more than just a physical condition. It's a mental affliction as well. Not only does it restrict the normal functions of the body, but it also takes a hit at one of the most crucial components of a woman's life, i.e., her ability to be a mother. I understand if this concept might be a bit offensive to your modern sensibilities, especially if you believe that motherhood is not a prerequisite to being a real woman. It isn't. I firmly believe that a woman is not any less of a woman if she cannot be a mother, but I also believe that motherhood is not a notion of being dismissed right away either. Some of you may not agree with me on this, but I believe that motherhood is an extraordinary gift and many women know and understand the value of that gift. So, when that gift is hanging in the balance, when the chances of holding a baby in your arms and calling it yours look bleak, I want you to imagine the toll it must take on your mind and every woman's mind fighting the battle against Polycystic Ovarian Syndrome. You see, it's much more than just a disease; it's also like an attack on one of our most dearly held individual and

societal values. The anxiety and depression that a woman must feel are crippling even to imagine. Now extend this to that woman's partner. A man may have a different set of reproductive machinery, but that does not mean Polycystic Ovarian Syndrome's ramifications cannot afflict him. For the males reading this book, you can liken Polycystic Ovarian Syndrome to be equivalent to having Erectile dysfunction or male infertility or impotence. I believe you can also imagine the mental toll these conditions can have on men suffering from them. The loss of self-esteem, the decreased confidence, depressive moods and mood swings. Everything. Now that we have painted a fairly accurate picture of what it must be like to walk in the shoes of people suffering from Polycystic Ovarian Syndrome, I want you to join me in the next step of this exercise. Empathy. I want you to empathize with those you meet suffering from this condition or any condition for that matter. I want you to tell them that you understand. That you are here to help if they require any; that this is not a death sentence. They need to hear this from you. And I cannot overstate the value of a word of hope and encouragement, what it can do to shattered self-esteem and a soul-deep in the pits of depressive self-loathing. This book is an encyclopedia on Polycystic Ovarian Syndrome. My message to everyone out there suffering from any form of long-term condition is that you are not alone. You are not any less than a beautiful human being, and that I and every one of us is here for you. We have made it this far with how Polycystic Ovarian Syndrome looks like and what a problem it is, and now from this point onwards, we will shift our focus to the next most important question. What can we do about it?

CHAPTER 6 PCOS DIAGNOSIS

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olycystic Ovarian Syndrome is a complex entity with various equally difficult manifestations that are not unique to the disease itself. Consequently, no single symptom can be relied upon sufficiently to diagnose the condition in a clinic or outpatient setting. Every symptom of Polycystic Ovarian Syndrome can and usually has multiple differential diagnoses to support it, making it a diagnosis of exclusion. Hence, the first and foremost step to diagnosing Polycystic Ovarian Syndrome is a detailed and thorough history of the patient. Suppose you or someone you know has any combinations of the symptoms described in previous chapters. In that case, it is the best course of action to consult your doctor or endocrinologist for a possible workup of Polycystic Ovarian Syndrome. It is equally vital in the case to have any, and all differential diagnoses ruled out so that you or your loved ones are not burdened by Polycystic Ovarian Syndrome in your minds when, the condition is something much more benign and treatable. Some differential diagnoses to keep in mind with regards to different symptoms suggestive of Polycystic Ovarian Syndrome include: Hypothyroidism The menstrual irregularities, skin changes and tonality of voice can also be explained as under-functioning thyroid glands. On a blood test for

thyroid hormones, the Thyroid Stimulating Hormone or TSH would return as higher than normal, and the levels of thyroid hormones in the blood would provide below. Supplemental thyroid hormone would correct all of the above and allow you to return to normal life. Exogenous androgen exposure As discussed before, with Polycystic Ovarian Syndrome, the deal is all about a hormonal imbalance in the body. However, you may have noted that up till now, all we have discussed is the imbalance happening inside the body. It is also important to remember that a hormonal imbalance can be triggered by taking hormone supplements as part of a prescription or illegal intake. In both these cases, if someone takes supplemental male sex hormones such as Testosterone and whatnot, chances are they might end up inducing a Polycystic Ovarian Syndrome, a state within their body, without necessarily having cysts in their ovaries in the first place. This will be ruled out when your physician takes a detailed history to account for this possibility. Cushing Syndrome Another syndrome of hormone excess is Cushing Syndrome. Here the culprit organ is the adrenal glands located above the kidneys. They produce an excess of a group of hormones called corticosteroids, including the androgen hormones, hence simulating Polycystic Ovarian Syndrome like symptoms related to hyperandrogenism. Idiopathic Hirsutism This is simply the occurrence of excessive body hair in a female without an exact identifiable cause. Treatment involves mainly cosmetic care and shaving or waxing excess hair regularly. Hypothalamic-Pituitary-Axis abnormality

The HPA is responsible for a majority of the hormonal control of the body's different systems. You can think of it as the chief controller of hormonal systems and were it to be disrupted in any way by disease, trauma or otherwise; it could mimic the symptoms and signs of Polycystic Ovarian Syndrome, among other conditions. Treatment generally involves either correction of the cause, if possible or if not possible, supplemental hormones make up for any losses and regular follow-up for monitoring. DIAGNOSING PCOS The definition of Polycystic Ovarian Syndrome has evolved much over the years, and so have the criteria needed to make a confident diagnosis of it. Although in many cases, a working diagnosis can be confidently made following a detailed history and examination of the patient without needing any special ultrasonography, organizations have used different criteria to diagnose Polycystic Ovarian Syndrome. The Rotterdam criteria of 2003 are advised by endocrinologists today to diagnose the condition, with it requiring at least two out of the three listed features to be met for an accurate diagnosis to be made. The features under question are: 1. Features of Hyperandrogenism 2. Oligomenorrhea (decreased menstrual periods) 3. Evidence of polycystic ovaries on ultrasonography The Androgen Excess Society criteria of 2009 also used these three features but recommend that because hyperandrogenism is so common among Polycystic Ovarian Syndrome patients, it should only be diagnosed if hyperandrogenism is confirmed to be present alongside any of the remaining two features. Hyperandrogenism can be diagnosed clinically by the presence of excessive acne, androgenic alopecia, or hirsutism (terminal hair in a male-

pattern distribution); or chemically, by elevated serum levels of total, bioavailable, or free Testosterone. As regards polycystic ovaries on ultrasound, a polycystic ovary is defined as an ovary containing 12 or more follicles (or 25 or more follicles using new ultrasound technology) measuring anywhere between 2 to 9 mm in diameter or an ovary that has a total volume of greater than 10 mL on ultrasonography. Both ovaries do not need to have confirmed cysts within them to make a diagnosis, as even a single ovary meeting either or both of these definitions is sufficient for diagnosis.

CHAPTER 7 PCOS HERBAL TREATMENT

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specialize in herbal treatments and remedies for various diseases. My clients suffering from PCOS have majorly complained of one thing that they cannot live without, the ability to get pregnant. I don't blame them. For most women, pregnancy and the prospects of motherhood and having children is one of life's greatest pleasures, and to have that one crucial aspect of their lives hang in the balance is something not many women would want. Therefore, I offer my services as a specialist in alternative or herbal medicine to my clients suffering from Polycystic Ovarian Syndrome, hoping that the gift of motherhood is not taken away from them forever. I am proud to say that my clients have not only gotten symptom resolution using my treatments, but many of them are proud mothers of beautiful little bundles of joy. They are partly why I wrote this book in the first place so that I can share my knowledge and advice with as many people as I can to help them lead better, healthier lives full of joy and peace. This chapter deals with the remedies I have recommended to my clients for their PCOS symptoms, including infertility. Medicinal plants and herbal supplements help with hormone regulation, insulin resistance, and inflammation associated with PCOS. But while my sincerest attempt is to help as many people as possible, I also must be objective about the caveats. Herbal supplements aren't entirely

regulated by the U.S. Food and Drug Administration (FDA). Therefore, I strongly advise that you contact your doctor or even myself before taking any supplement as each remedy works on different patients. The incorrectly chosen remedy or supplement can interfere with other prescribed PCOS treatments and medications. Some herbal remedies and supplements that are in my recommendations list include but are not limited to: Inositol Inositol is a form of vitamin B complex that can help improve insulin resistance by increasing cellular sensitivity and insulin response. It has also been found to help with fertility in some cases of PCOS in a few studies. Chromium Chromium supplements are known to improve your body mass index, which can help with PCOS weight-related problems. Chromium also helps in the metabolism of glucose, allowing for better and improved insulin sensitivity. Zinc Zinc is a trace element that can boost fertility and your immune system. Low levels of zinc have been associated with male and female infertility, and zinc is routinely offered as a supplement to boost reproductive function. Excessive or unwanted hair growth and alopecia may be improved with zinc supplements. You can also eat red meat, beans, tree nuts, and seafood to get more zinc in your diet. Combined vitamin D and calcium Vitamin D is a hormone that's vital to your musculoskeletal and endocrine system. Vitamin D deficiency is relatively common in women with PCOS. Vitamin D and calcium may improve irregular periods, menstrual pain, allow

for greater bone and muscle strength as well as helping you ovulate. Turmeric The active ingredient in turmeric is called Curcumin. Although research is inconclusive, some have shown turmeric to be a promising tool for decreasing insulin resistance alongside its role as an anti-inflammatory agent and an antioxidant to combat the effect of chronic stress. Cinnamon Cinnamon comes from the bark of cinnamon trees. Cinnamon extract has been shown to have a positive effect on insulin resistance through an as-ofyet uncertain mechanism. Similarly, Cinnamon also has shown some effectiveness to regulate menstruation for women with PCOS. Evening primrose oil Evening primrose oil has been used to help with menstrual pain and the woes of irregular menstruation. It is also theorized to improve body cholesterol levels and improve the body's response to oxidative stress, linked to PCOS. Cod liver oil Cod liver oil is a natural source of healthy polyunsaturated fats, vitamins D and A, and high amounts of omega-3 fatty acids. These acids can help improve menstrual regularity and help eliminate excessive fat to optimize your BMI and improve insulin resistance at the tissue level. Berberine Berberine is a herb referenced in ancient Chinese medicine to help with insulin resistance at the cellular level by modulating the number of glucose transporters in the cell membrane, as theorized in some studies. If you have PCOS, berberine may boost your metabolism and balance your body's endocrine responses to various stressors in a more optimized fashion.

Adaptogen herbs We have discussed that when your body can't regulate Insulin, it can build up in your body and cause higher levels of male sex hormones called androgens due to the direct effect of Insulin on the ovaries. Adaptogen herbs aid your body in balancing these hormones. Some adaptogen herbs also claim to ease other symptoms of PCOS, like irregular periods through unknown mechanisms. Again, I must advise that you use caution and talk with your doctor before taking any herbal supplement, as the FDA hasn't evaluated their claims. Maca root The maca plant's root is a traditional herb and has been used to boost fertility and libido for hundreds of years. Research suggests that Maca root may help balance hormones and lower cortisol levels. Additionally, it is also postulated to help with the mood depressing effect of PCOS on its sufferers. Ashwagandha Ashwagandha is also called "Indian ginseng." It is often used for treating pain syndromes such as fibromyalgia due to its effect on pain receptors and hormonal pain response systems. It is theorized to show a similar effect in PCOS and can help balance cortisol levels, improving stress and symptoms of PCOS. Holy basil Holy basil also called 'Tulsi,' takes care of chemical and metabolic stress. It's referred to as "queen of herbs." Holy basil can help reduce your blood glucose levels within a normal range, prevent weight gain, and lower your cortisol levels to help ease metabolic stress on the body. Licorice root

The licorice plant root contains a compound by the name of Glycyrrhizin, which has several unique properties. Licorice root has been theorized to be an effective anti-inflammatory agent. It helps metabolize sugar and balance hormones, especially stress hormones, aiding them in the fight against oxidative stress on the body. Tribulus Terrestris Tribulus Terrestris has been shown to help stimulate ovulation and support healthy menstruation in PCOS patients and other ovarian failure syndromes. Interestingly, some claim that it may also decrease the number of ovarian cysts, allowing for an easier and gradual recovery period back to normal life. Chasteberry Chasteberry has been in use for hundreds of years to help with reproductive conditions such as erectile dysfunction, amenorrhea, loss of libido, heavy menstruation, and some forms of subfertility. It may improve some symptoms of PMS, though its effect on fertility requires more research. Herbal medicine offers a different take to the usual approach doctors and clinicians have towards diseases. Most of them try to fix the problem using a combination of medication and surgery. However, I wrote this chapter first in the treatments section to show that medication and surgery are not the only two cards in the game. You can achieve a healthy return to fertility and normal even without medication and surgery simply by trusting the age-old art of alternative medicinal healing.

CHAPTER 8 PCOS MEDICAL TREATMENT

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longside herbal remedies, allopathic medicine offers multiple options for medically treating Polycystic Ovarian Syndrome based on the patient's desires, especially regarding future fertility. The regimens and subsequent options explored differ if the patient wants to continue conceiving or if she has completed her family and does not wish to get pregnant again. Multiple options exist to tackle the pathogenic factors associated with the development of Polycystic Ovarian Syndrome, and not all of these are drugs, as we will discuss below. We have seen the three crucial processes required to develop Polycystic Ovarian Syndrome. The allopathic medical treatments aim to either restore the hormonal balances or increase insulin sensitivity, thereby accelerating the recovery process or achieving a higher chance of a successful pregnancy. We will briefly look into the different recommended routes of recovery as promoted by gynecologists, endocrinologists and fertility experts. LIFESTYLE MODIFICATION The simplest non-invasive methods to aid recovery and promote fertility are making certain adjustments to your lifestyle to reduce your risk factors for disease progression and attenuate the process itself by stripping it of its compounding factors. These include:

Weight Control This is hands down the first recommendation your doctor will give you when starting PCOS treatment plans. Why? Because it can tackle about half of the symptoms you experience and is much easier to do with minimal side effects. Experts at the American College of Obstetricians and Gynecologists (ACOG) estimate that just a 10% reduction in body weight can re-sensitize the body cells to Insulin, and this will improve the symptoms related to hyperinsulinism and insulin resistance such as type 2 diabetes, acne, promote regular menstrual cycles and even the excess hair growth. Not only that, but according to a study at Penn State University, it was found that PCOS patients who lost about 7% of their body weight before beginning fertility treatments were twice as likely to conceive a baby using said fertility treatments than those who relied on fertility treatments alone and did not lose weight. Experts also state that up to 75% of PCOS patients experience much more regular periods, better control over blood glucose levels, and even an improvement in androgens and estrogen levels in the blood simply by controlling their weight. Yes, it really is that beneficial. Modified Diet As we have seen, PCOS is strongly associated with insulin resistance and diabetes. The diet modification principles that your doctor would usually recommend to a purely diabetic patient would also apply to you. Cutting out processed sugars and junk food and replacing them with fresh fruits and vegetables alongside whole grain cereals may reduce the burden on your pancreas and help with hyperinsulinism. However, the research in this domain is inconclusive as of yet, with some modifications showing benefits to some women and not to others. There is no single best diet plan at the time of writing that

would benefit every Polycystic Ovarian Syndrome patient, but research continues. Therefore, it is highly recommended to consult your dietician regarding your daily food intake and proper meal plan. Exercise A healthy body is a healthy mind… and healthier ovaries. Incorporating exercise into your day instead of leading a relatively sedentary lifestyle is a proven source of improvement in many medical conditions, and Polycystic Ovarian Syndrome is no different. According to the Centre for Disease Control (CDC), regular aerobic exercise, even as simple as going for a brisk walk for a minimum of 30 minutes, five days a week, is proven to reduce your risk of cardiovascular disease and improve your immune system. Furthermore, exercising muscles utilize glucose without needing insulin, leading to less reliance on the pancreas and hence, reduce the need for increased insulin secretion. Exercise can also help with weight control, and you gain the plethora of medical benefits we just discussed. Stress Relief I understand that being with Polycystic Ovarian Syndrome or having a loved one in this ordeal is difficult to get through and even think about stress relief methods. However, trust me when I say that every patient with Polycystic Ovarian Syndrome needs it dearly. Relaxing your mind in any way can help with the condition. How? The mind is the control center for your entire body and chronic stress about anything, from work to relationships to health, is detrimental to recovery. Chronic stress causes long-term stress hormone release. This is another common cause for persistently high blood glucose and increased manufacturing of steroid hormones from the adrenal glands. Chronic stress also promotes inadvertent weight gain. All features of PCOS that

we want to minimize. Psychologists recommend a daily session of mindful meditation or even simple light stretching, yoga, reading a book, going for a walk or listening to some music. Whatever you can do to unwind a little and distract your brain from the problem can help you recover from Polycystic Ovarian Syndrome. MEDICATIONS For many patients, lifestyle modifications often relieve their condition by more than 50%. In some cases, patients do not even require additional help in the form of medication to get back to their normal lives. Patients begin to get pregnant again and successfully grow their families. But even then, there are some patients who require medication support alongside lifestyle adjustments to solidify their recovery and get them back into the world. The choice of medication will depend on your specific history, risk factors for side effects and your particular expectations of the outcome. Some of the commonly prescribed medications for Polycystic Ovarian Syndrome include but are not limited to: Clomiphene Citrate This is a particular drug used chiefly to improve the chances of getting pregnant. This is used in fertility clinics to treat many infertility causes, and it has its role in Polycystic Ovarian Syndrome and promising fertility aid. Clomiphene is essentially an inducer of ovulation and, therefore, increases pregnancy chances by simulating an ovary's normal ovulation process. Research has shown that a 6-month course of clomiphene treatment allowed for successful pregnancies in up to 40% of patients with Polycystic Ovarian Syndrome. If clomiphene does not work for any particular case, then a trial of supplemental gonadotropin hormones is given.

Combined Oral Contraceptive Pills (COCP) I know it looks counter-intuitive to use a birth control pill to improve the chances of getting pregnant. However, do not be misled by the name. COCPs containing estrogen and progestins help balance out your hormonal levels of sex hormones. This is what helps to improve fertility and counter irregularities in menstruation. Furthermore, COCPs can counter the male sex hormones already present in the blood to reduce the masculinizing effects of androgens such as excessive hair, acne, and voice tonality. Combined Oral Contraceptive Pills can also be given just before starting fertility treatment to promote a better working ground for the treatment by essentially neutralizing androgens' effects. However, it is essential to note that while COCPs have an important role in balancing out your hormonal system, they are stillbirth control pills and therefore do not increase ovulation chances. They only help to level the playing field for conception to take place. Insulin Sensitizers You probably know a few drugs in this category. They are primarily used as a treatment for diabetes mellitus. However, their use can be extended to any condition with insulin resistance and hyperinsulinism in its pathogenesis, such as Polycystic Ovarian Syndrome. FDAapproved medications for use in Polycystic Ovarian Syndrome include Metformin and Pioglitazone. Again, reducing insulin resistance and promoting insulin sensitivity using these drugs has the benefit of not only controlling PCOS-associated diabetes but also, as we discussed, reducing the direct stimulation effect high Insulin has on the androgen production machinery in the ovaries thereby reducing androgen levels as well. Win-win, right? Drugs for Hirsutism and Acne

While acne can be dealt with by almost all the categories of drugs mentioned above, hirsutism is a cosmetic problem that is not easily solved by drugs. Instead, experts recommend regular shaving and waxing of any excess hair alongside your routine PCOS treatment so that their chances of re-eruption also decrease over time but don't keep you in a pickle until they do regress.

CHAPTER 9 PCOS SURGERY

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o far, we have discussed the different treatment options for Polycystic Ovarian Syndrome, ranging from simple lifestyle modification strategies to medications to herbal remedies. However, in some cases, surgical intervention may be indicated, especially if the patient in question prioritizes the return of fertility over everything else. While all the treatment options discussed so far have been tested in some shape and form and have their advantages and disadvantages, not all of them will guarantee symptom resolution and fertility return. And make no mistake, the surgical intervention also does not carry a hundred percent guarantee that the patient will achieve conception on the very next try. That being said, surgical options exist for Polycystic Ovarian Syndrome primarily to offer another level of possibilities for treating PCOS-induced infertility and symptom resolution when herbal, medical and lifestyle strategies have in any way failed to fulfill their purpose. This is not as common as most women successfully achieve pregnancy status using non-surgical methods. So, this chapter will not dive that deeply into the nitty-gritty details of surgical procedures as chances are you or your loved one probably will not need them. But it is still a good idea to know what options are available so that if you or your loved ones wish to go this route, then you all would be duly informed.

Some of the surgical procedures offered for Polycystic Ovarian Syndrome include but are not limited to: Cyst Aspiration This is a simple operation whereby the fluid-filled fibrous cysts are essentially emptied of their contents to allow the ovary to repurpose or dispose of them and return to work. Several methods exist for this purpose ranging from aspiration via a simple long syringe needle under ultrasonographic guidance so that the cysts can be accurately located and targeted. Other methods include using a particular instrument called a laparoscope to perform minimally invasive 'keyhole' surgery and manipulate the ovarian cyst contents to either eradicate the cyst or drain it of its contents. This can also be done in an open setting whereby the pelvic cavity can be accessed via an incision in the skin, and the ovarian cysts can be drained manually.Cyst aspiration can confer several benefits ranging from attenuation of the hormonal feedback imbalances caused by cyst contents and allow the ovary to basically do a reboot of sorts and start properly manufacturing ovarian follicles again. Laparoscopic Ovarian Drilling This procedure is another minimally invasive surgical attempt at making small pockets in the ovaries by targeting the cysts themselves for destruction. The drilling technique allows for all the inflammatory sclerotic cyst and its contents to be obliterated. It allows the ovary to do a reboot of sorts again back into follicle production mode. Ovarian drilling has been shown to have moderate efficacy in patients resistant to the ovulation inducer drug we discussed in the previous chapter, Clomiphene. Ovarian drilling does not, however, have any effect on the fat profile of the patient or their level of insulin resistance. A study has

shown that in patients with clomiphene-resistant PCOS, ovarian drilling has allowed half of them to get pregnant and continue on with their lives successfully. In many centers worldwide, this procedure has been perfected and done even on an outpatient basis. Bariatric Surgery This is not strictly a procedure for Polycystic Ovarian Syndrome. However, recent studies suggest that patients with PCOS, especially those with morbid levels of obesity, can benefit greatly from weight loss surgery, not just for their Polycystic Ovarian Syndrome but also for their overall metabolic profile. A BMI higher than 35 confers a great risk for cardiovascular disease, diabetes and in women, Polycystic Ovarian Syndrome. So bariatric surgery can be availed as an option to reduce the patient's weight massively and thereby surgically reducing their insulin resistance and androgen production capabilities due to the anatomical loss of fat or the impaired capacity to store more fat, such as after a Sleeve Gastrectomy operation (a type of bariatric surgery where the stomach is essentially reduced in volume by half, restricting the patient's capacity for food intake and hence, facilitating weight loss instead of weight gain).

CHAPTER 10 PARTING WORDS

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elcome to the end of this short e-book. So far, we have walked together to understand what Polycystic Ovarian Syndrome is and how it has affected the lives of millions of women across the globe. We have seen what it looks like and how it develops. We have taken a brief look at various treatment options for it, and hopefully, you have arrived at the end armed with the knowledge to empathize and guide others regarding this condition. PCOS has come to be the most common endocrine origin syndrome in women of childbearing age, with seemingly random manifestations tied down to three crucial processes present in about every Three out of four cases. Not only does it represent a significant hit to a patient's self-esteem and confidence about her reproductive capability, but it also shows that such people direly need our support and support of their community at large to pull through this ordeal. Below you shall find a few PCOS support groups and their website links so that you too can join and spread awareness about PCOS and help those suffering from it. Thank you.

PCOS SUPPORT GROUPS

1. Verity https://www.verity-pcos.org.uk/ 2. PCOS Challenge https://www.pcoschallenge.org/pcos-support 3. PCOS Awareness Association https://www.pcosaa.org/

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