Brianna Lunsford

Dr. Cassel

ENG 101-13

2 November 2018

Annotated Bibliography

My research will evaluate Polycystic Ovarian Syndrome (PCOS) in women. This is a

hormonal disorder that causes enlarged ovaries to form small cysts on the outer edges. I am

looking to answer how PCOS affects the body and mind of women and how it can be managed.

Chaudhari, Aditi, et al. “Anxiety, Depression, and Quality of Life in Women with Polycystic

Ovarian Syndrome.” Indian Journal of Psychological Medicine, vol. 40, no. 3, May

2018, pp. 239–246. EBSCOhost, doi:10.4103/IJPSYM.IJPSYMpass:[_]561_17.

PCOS affects a woman’s identity, mental health and quality of life, but these aspects

haven’t received the proper attention in India. This study aims to examine the “prevalence” of

anxiety and depression in women with PCOS, determine if symptoms are associated with

psychiatric morbidity (mental illness), and to determine the impact it has on the quality of life. 70

women with PCOS were clinically evaluated to see if they suffered from pre-existing mental

illness. The quality of life was assessed in this study using the Word Health Organization. A

binary logistic regression was performed to study the association between anxiety/depression and

the symptoms caused by the disease.

PCOS is a very common disorder that affects the endocrine system among females 18-45.

Abnormal menstruation, excessive hair growth or loss, infertility, weight gain, obesity, acne and
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the inability to ovulate are the most common physical symptoms. Psychologically, women with

PCOS tend to suffer more from anxiety and/or depression than the general population. It was

found through international research that this disorder has an effect on one’s quality of life. It is

understood that if researcher’s can target the symptoms that cause the most impact, then they can

better manage the disorder. There is currently an Indian study that focuses on anxiety/depression

in women with PCOS. The study places and emphasis on the medical symptoms of a patient and

the quality of life.

The overall psychiatric morbidity of women in the study by the Bhabha Atomic Research

Centre Hospital was 50% (anxiety-38.6% and depression- 25.7%). A study performed in India

used the same methods and found a psychiatric morbidity rate of 52.7% (anxiety- 39% and

depression- 25%). In Iran, 35.7% of them suffered from anxiety and 18.9% from depression. A

standardized review on anxiety and depression in PCOS concluded that women with this disease

experience elevated anxiety and depression. The previous studies confirm this claim. The reasons

for more anxiety/depression in women with PCOS are abstruse. Emotional distress could have a

psychological causes as well as physical. Women explained how they felted robbed of their

essence of being feminine, so many people consider PCOS to be the “Thief of womanhood.”

Many researchers have theorized a biological significance between the symptoms of PCOS and

anxiety/depression.

Symptoms of hair loss and infertility were associated with anxiety. Acne was an

associated cause of depression. Women with psychiatric morbidity had lower scores on

“domains” of the quality of life, physical/psychological health, and social/personal relationships.

The authors’ purpose was to evaluate the mental state of women with PCOS, so they

could conduct a medical research and a study. Their intended audience is all women who suffer

from PCOS. This article was published in India in June of 2018. The date is relevant because it

shows that the information is relevant, but where it was published is more important. It was said

that the mental health of women with this disorder weren’t receiving adequate attention in India,

so the study was trying to give the women the attention they deserved.

The three authors of this piece were Aditi Chaudhari, Kaustubh Mazumdar, and Pooja

Mehta. They are credible because they are affiliated with the Department of Psychiatry at

Bhabha Atomic Research Centre Hospital and the medical division at BARC Hospital. It is

proven that the information is adequate because it was approved by Dr.Amrita Misri- Head of

Obstetrics and Gynecology. This is a reliable source due to the fact that it is an academic journal

that was written and approved by credible professionals.

I will use the information in my paper because I am investigating how PCOS affects the

body and mind and how it can be managed. This article is a study showing anxiety and

depression rates of women with this disorder and how they have lower quality of life. The study

will help better understand the mental affects of the disorder and how the quality of life is

damaged.

Havelock, Jon. “Polycystic Ovary Syndrome.” BCMJ, BC Medical Journal, May 2018,

www.bcmj.org/articles/polycystic-ovary-syndrome.

PCOS is a metabolic and reproductive disorder that is still not fully understood my

doctors. The characteristics of this disorder were first detailed in 1935 by Irving Stein and

Michael Leventhal. The two gynecologists described a case of 7 women with enlarged ovaries
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and symptoms of hyperandrogenism, amenorrhea and sterility. As a result, the disorder was

known as Stein-Leventhal Syndrome for over 50 years. In 1990, the first definition of PCOS was

developed, but the lack of consensus showed the uncertainty about the Pathophysiology of the

disorder.

The process of elimination is used when it comes to diagnosing PCOS because there are

many other disorders that have similar symptoms. It is recommended that doctors rule out

thyroid dysfunction, hyperprolactinemia, adrenal hyperplasia and androgen-producing tumors

before making a final diagnosis. The use of ultrasound to confirm polycystic ovaries is rarely

required because it adds little clinical value. However, ultrasounds help when investigating

infertility, pelvic pain and mass. It is suggested to use an endovaginal probe when possible

because it provides a more clear picture and helps determine how many follicles are present and

how big they are.

Treatments may be needed to address anovulation, obesity, and hirsutism. Patients should

also be monitored for endometrial cancer and type 2 diabetes. Anovulation can lead to severe

health consequences like endometrial cancer and hyperplasia, but most commonly infertility.

Ovulation induction is the simplest, cheapest and least invasive fertile therapy. Obesity is found

in 50-80% of women with PCOS. It was found that high BMI has a significant effect on fertility,

so a trial was conducted. A group of randomly selected obese women with PCOS were assigned

to lifestyle intervention (diet and exercise) or no intervention for 6 months. The study found that

the women in the lifestyle intervention group had a great improvement in live birth rates. Now,

diet and exercise are at the top of the list for anovulatory therapy in obese women with this

disorder.
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Hirsutism is found in almost all women who have PCOS. This is a result from elevated

testosterone running freely through the body, and it creates terminal hair. As a temporary

solution, one can remove unwanted hairs by electrolysis or depilation. The OCP (oral

contraceptive pill) is the top choice for hirsutism therapy because of its effect on androgen

production. If the OCP treatment doesn’t work, anti-androgen therapies may be beneficial.

Women with PCOS have higher chances of developing endometrial cancer. It was

difficult to associate endometrial cancer with PCOS at first because of the similar symptoms.

Obesity, infertility, diabetes, excess estrogen and irregular menstrual cycles are independent risk

factors for both disorders. OCP’s have been found to reduce chances of endometrial cancer by

50% and can last up to 20 years. The problem is, some women with PCOS can’t tolerate OCP

therapy, so they need cyclic progesterone therapy.

Polycystic Ovary Syndrome remains a prevalent reproductive and metabolic disorder

with conflicting manners. Therapy remains focused on managing symptoms

(infertility/anovulation, obesity, and hirsutism) and reducing long-term health risks (endometrial

cancer and type 2 diabetes).

The writer’s purpose in writing this article is to show symptom management and long-

term complications of PCOS. The audience is all women suffering from the disorder and/or any

medical professional looking for evidence to support any findings. This piece was published in

May of 2018, which proves the information is up to date and appropriate for use.

The writer is Jon Havelock and he is credible because he is an MD and FRCSC. I know

the information provided is accurate because it provides evidence from clinical articles and was

peer reviewed and approved by other medical professionals. I know the source is reliable
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because the references are shown and it is a part of the British Columbia Medical Journal. The

source also states that they provide medical education from evidence-based medicine and has a

page that establishes its credibility.

I will use this source in my paper to show credibility. The information provided by this

paper shows medical evidence and research that I can use to validate my reasons.

Mayo Clinic Staff. “Polycystic Ovary Syndrome (PCOS).” Mayo Clinic, Mayo Clinic, 2017,

https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439

Accessed 29 October 2018.

Polycystic Ovarian Syndrome is a hormonal disorder that can cause the ovaries to

develop follicles and be unable to release eggs monthly. Early diagnosis and treatment can

reduce the severity of further complications.

Symptoms vary and can occur at any time during the reproductive age. The most

common symptoms are irregular periods, excess androgen, and polycystic ovaries. It is suggested

to visit a doctor if one experiences any of the above symptoms. The cause of PCOS is still

unknown, but doctors have found possible factors that contribute to this disorder. These factors

include: excess insulin, low-grade inflammation, and heredity/genetics.

The general complications of PCOS consists of type 2 diabetes, sleep apnea, obesity,

abnormal uterine bleeding and psychological disorders like anxiety, depression and eating

disorders. If someone becomes pregnant with this disorder (infertility is common), they can

experience many complications like gestational diabetes, high blood pressure, miscarriage or

premature birth. The most severe complications include: Non-Alcoholic steatohepatitis (sever

liver inflammation caused by fat accumulation), metabolic syndrome and endometrial cancer.
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The purpose of this article is to provide information about PCOS to women who suffer

from the disorder. The context of this article doesn’t affect the information provided other than

the fact that it was last updated in 2017. This shows that the information is relevant and up to

date.

The staff at Mayo Clinic wrote this article and they are credible because they are a non-

profit organization that provides an unbiased experience, innovation and research, new

technology and experienced doctors. Dr. Chang, M.D, Dr. Chattha, M.B.B.S, and Dr. Vella,

M.D. all have a focus on PCOS and helped take part in the writing of this piece. I know the

article had adequate information because they provide medical evidence and the Mayo Clinic is a

well-known and trusted hospital. This is a reliable source because it was approved by HONcode,

a standard for trustworthy health information, in April of 2017.

This article describes the signs, symptoms, causes and complications of PCOS. I will use

this information to show how the complications can affect a woman’s body and quality of life. It

will also be helpful in defining the order and better understanding it.

“PCOS & Pregnancy.” Attain Fertility, Attain Fertility, 2018, attainfertility.com/understanding-

fertility/trying-to-conceive/causes-of-infertility/pcos/pcos-pregnancy/. Accessed 29

October 2018

Polycystic Ovarian Syndrome is the leading cause of infertility among women of

childbearing age, and is a very complicated disorder. It is recommended to see a doctor if you

experience any of the following symptoms: Irregular or no periods, inability to get pregnant or

frequent miscarriages, excess androgen, pelvic pain, ovarian cysts, acne, hair loss, dandruff,

hirsutism, obesity, insulin resistance and/or high blood pressure.

It is hard for women with PCOS to get pregnant because they do not produce the correct

hormones for normal ovulation. The cysts with PCOS have excessive amounts of androgen in

them, which blocks ovulation. This causes no mature egg to be released, so progesterone is not

made. The progesterone hormone is needed to conceive.

There are some fertility treatments for women with PCOS. Fertility drugs, Metformin,

IVF (In Vitro Fertilization), Ovarian Drilling (Minimally-invasive surgery), and lifestyle changes

are all suggested when trying to gain fertility. Getting pregnant with PCOS has certain risks,

such as: miscarriage, high blood pressure, gestational diabetes or premature birth. Though these

are severe, it is possible to have a healthy pregnancy with PCOS. Talking with a doctor can help

someone with PCOS find appropriate treatment if they intend to start a family soon.

The purpose of this article is to provide fertility facts and support to women with PCOS.

The context of the article does not hold much value, but it does let me know that it is appropriate

to use. The article was last updated in 2018, so it is relevant enough for use.

The author of this article is the Attain Fertility Foundation. They have over 130 locations

nationwide, so I know they are credible. The information is adequate because they used well-

known and trusted sources in their work. Most of the information came from the American

Society for Reproductive Medicine and provides factual information. This source is reliable due

to the dedicated and experienced professionals behind the creation of the site and the foundation.

I will use this information in my paper to provide evidence on how PCOS can affect the

mind and body. Being unable to conceive can cause many women to experience depression,

which affects ones mental state. Infertility also places a large affect on the body because the

women are unable to produce hormones, which causes harm to the body.
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“Polycystic Ovary Syndrome (PCOS).” Hormone.org, Hormone Health Network, Sept. 2018,

www.hormone.org/diseases-and-conditions/womens-health/polycystic-ovary-syndrome. /

Polycystic Ovary Syndrome is a hormone disorder defined by a group of signs and

symptoms such as excess androgen, problems with ovulation and ultrasound findings. Excess

androgen causes elevated testosterone levels in blood and clinical signs of acne, excess facial

hair or hair loss. Irregular or absent menstrual cycles and infertility are effects of ovulation

issues. Ultrasounds find enlarged ovaries and with many small follicles thus the term

“polycystic.” This disorder affects 7-10% of women in childbearing age and is the most common

hormonal disorder that causes infertility.

Teens experience different signs and symptoms than others with PCOS. Irregular

menstruation is common when girls first start their period, so it is harder to diagnose. The signs

of ovulation problems in teens include: irregular periods for over two years after starting a

period, no cycle for more than three months or never having a period after puberty. Heavy or

frequent periods are also a sign of this disorder among teens.

The cause of this disorder is still unknown, but androgen excess is seen in 60-80% of all

girls with PCOS. Insulin resistance may worsen androgen excess, and so can brain

communication abnormalities. PCOS is perceived to be inherited and environmental risk factors

such as low birth rate, excess adult weight and unhealthy lifestyles are important. These factors

may interact with genes to cause PCOS according to medical researchers.

This disorder has no cure, but can be managed. Symptoms are treatable with medications

and changes in ones diet and exercise. Hormonal imbalances can be treated with birth control
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pills, androgen blocking medications or medicine to help the body respond better to insulin.

Fertility drugs can help improve ovulation to increase ones chances of having a baby.

The writer’s purpose of this article is to raise awareness about PCOS and to further

patient education on hormone related issues. The intended audience is women affected by the

disease and to patients with hormonal disorders. This piece was released in September of 2018,

so the information is relevant and viable.

The Endocrine Society wrote this article and it is credible because the editors are all

medical professionals. These professionals are Dr. Azziz (MD, MPH), Dr. Solorzano (MD), and

Dr. Ehrmann (MD). The information is adequate because it is a medical cite and used other

reliable sources like the PCOS challenge and Mayo Clinic. This is a reliable source due to the

fact that it is sponsored and published by the Hormone Health network.

This article will be helpful in my research because it discusses the signs, symptoms,

potential causes and treatments of the disorder. I will use the information found to further my

explanation of physical symptoms and how to better manage the disorder.

Popescu. “Controversies in Polycystic Ovarian Syndrome.” GINECOeu, Medical Services, 20

Jan. 2017, gineco.eu/system/revista/37/42-45.pdf.

Polycystic Ovarian Syndrome is a frequent disorder, and was first described in 1935 by

Stein and Leventhal. Even now, over 80 years later, there is still controversy surrounding the

syndrome. It is said that all the conflict about the subject is due to the complexity of the disorder.

Many medical professionals and researchers have argued over the diagnosis and etiology

regarding PCOS.
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It has been clear since 1990 that the diagnosis of PCOS is inadequate. This is due to the

fact that the criteria are based on the opinions of specialists alone, rather than data collected from

clinical trials. In 2003, consensus established the Rotterdam criteria which required patients to

meet 2 out of the 3 symptoms, (chronic anovulation, hyperandrogenism and/or polycystic

ovaries), to be diagnosed. Gynecologists today use this method to diagnose, but Endocrinologists

claim they need to use a new set of criteria. They decided to go with the 2006 AES in which they

believe is more appropriate to use. This required patients to experience 2 out of the 3 following

symptoms: hirsutism or hyperandronemia, anovulation and/or polycystic ovaries. As of right

now, PCOS is diagnosed using the Rotterdam criteria and is based on the total number of

follicles found on the ovaries or an increased volume of the ovaries.

The etiology of the disease is still unknown, and holds much controversy. Intrauterine

theory imposes that exposure to androgens during the neonatal stage of life alters the fetal

ovaries. Other studies claim that various components during adolescents and puberty should take

the blame for the disorder. For example, insulin growth factor 1 is believed to influence ovarian

steroid genesis. The levels of steroid genesis in the ovaries increase during infancy after periods

of excess protein exposure. Others believe that PCOS occurs during puberty due to abnormal

brain development or an increase in adrenal production. (Add more to summary).

The author’s purpose is to present the evolution of the perspective of the subject and

controversies surrounding it. The intended audience is any medical professional looking for

clinical trial evidence and other view point and/or those suffering from the disorder. The location

of the journal has no affect on the information being provided but when it was, does. This piece

was released in 2017, so I know the information being provided is relevant and recent enough to

use.
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The writer is Popescu and he is credible because he is a clinical researcher. I know the

information is adequate because it is supported by the Romanian Society of Ultrasonography in

Obstetrics & Gynecology, Human Pappilomavirus and Urogynecology and the East European

Society for Endometriosis and Infertility. I know this source is reliable because it is published by

medical services and cites all their sources. The website also uses evidence from clinical trials

and gains information from medical professionals.

I will use this information in my research paper to show different viewpoints of the issue.

There is a lot of controversy surrounding the topic of PCOS and this article captures it. This will

allow me to acknowledge all views of the topic and help to understand all sides.

Figure 1: What is PCOS?