{"id":2291,"date":"2020-05-21T09:00:29","date_gmt":"2020-05-21T09:00:29","guid":{"rendered":"https:\/\/www.danielleal.pt\/?p=2291"},"modified":"2020-05-21T09:11:10","modified_gmt":"2020-05-21T09:11:10","slug":"polycystic-ovary-syndrome-what-is-it-part2","status":"publish","type":"post","link":"https:\/\/danielleal.pt\/en\/polycystic-ovary-syndrome-what-is-it-part2\/","title":{"rendered":"Polycystic Ovary Syndrome &#8211; How to treat? &#8211; Part II"},"content":{"rendered":"<p class=\"p1\"><span class=\"s1\">In the<\/span><span class=\"s2\"> <a href=\"https:\/\/www.danielleal.pt\/en\/polycystic-ovary-syndrome-what-is-it-part1\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"s3\">last article<\/span><\/a><\/span><span class=\"s1\">, we explored the several factors that contribute to the excess of male hormones and irregular menstrual cycles, which characterize the Polycystic Ovary Syndrome (PCOS). This article will focus on the available therapeutic options, both from a conventional and more natural approach.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">As explained earlier,<b> there are four main categories of PCOS, and each has different triggering factors, although there may be some interposition. <\/b>It makes sense that the therapeutic approach is also directed at the underlying imbalance. However, from a conventional standpoint, there is no therapeutic individualization, and most PCOS cases are treated the same way.<\/span><\/p>\n<p class=\"p3\"><span class=\"s1\" style=\"color: #35b5a3;\">What is the conventional treatment of PCOS?<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Generally, PCOS treatment is directed at the symptoms resulting from excess androgens, and comprises the following categories of drugs:<\/span><\/p>\n<ul>\n<li class=\"p1\"><span class=\"s1\"><b>Oral contraceptives <\/b>&#8211; these drugs are used to \u201cregulate\u201d the period. Oral contraceptives block communication between the pituitary and ovaries and promote monthly bleeding (if the woman stops taking it monthly), which does not correspond to an actual menstrual cycle, however. That is, <b>the pill can restore monthly bleeding and prevent excessive proliferation of the endometrium (lining of the uterus), but it does not correct the underlying problem. It may even worsen it since it is associated with a decrease in insulin sensitivity <\/b>(<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4900190\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"s4\">1<\/span><\/a>). Some pills also have an anti-androgenic effect and help control acne and hirsutism, typical of PCOS.<\/span><\/li>\n<\/ul>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\"><b>Progestins or micronized progesterone<\/b> &#8211; in women with no periods, who do not take the pill, these drugs are used, cyclically, to induce uterine hemorrhage and prevent excessive development of the endometrium, which increases the risk of cancer in the future.<\/span><\/li>\n<\/ul>\n<ul>\n<li class=\"p1\"><span class=\"s1\"><b>Anti-androgens <\/b>&#8211; drugs specifically designed to block male sex hormone receptors (spironolactone, for example) and thus lessen their effects, such as acne, hirsutism, and alopecia.<\/span><\/li>\n<\/ul>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\"><b>Metformin<\/b> &#8211; a drug used to treat diabetes due to its insulin-sensitizing effect. This is a way to decrease insulin resistance, which is one of the factors promoting PCOS.<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\" style=\"color: #35b5a3;\">What else can be done to treat PCOS?<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">The focus of treatment should be the reversal of the underlying imbalance, so that <b>women can restore their regular ovulatory cycles and thus produce their own hormones (specifically progesterone) naturally<\/b>, which has many positive effects. We will then analyze the therapeutic options for the different types of PCOS, always starting with diet and lifestyle.<\/span><\/p>\n<p class=\"p3\"><span class=\"s1\" style=\"color: #35b5a3;\">1. Insulin resistant PCOS<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">The goal here is to increase insulin sensitivity, which allows the body to keep stable blood glucose levels. The most useful tools to achieve this state are:<\/span><\/p>\n<ul>\n<li class=\"p1\"><span class=\"s1\"><b>Diet low in sugar and refined carbohydrates<\/b> &#8211; Carbohydrates shouldn\u2019t be avoided completely but must come from unprocessed sources (e.g., potatoes, sweet potatoes, etc.). <b>If the patient is overweight, then weight loss is a great indicator of improving insulin sensitivity. <\/b><\/span><\/li>\n<\/ul>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\"><b>Diet low in sugar and refined carbohydrates<\/b> &#8211; Carbohydrates shouldn\u2019t be avoided completely but must come from unprocessed sources (e.g., potatoes, sweet potatoes, etc.). <b>If the patient is overweight, then weight loss is a great indicator of improving insulin sensitivity.<\/b><\/span><\/li>\n<\/ul>\n<ul>\n<li class=\"p1\"><span class=\"s1\"><b>Decrease the diet\u2019s inflammatory load <\/b>&#8211; processed, fried foods, saturated fat and gluten should be avoided. A dairy-free period can be beneficial, too.<\/span><\/li>\n<\/ul>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\"><b>Exercise<\/b> &#8211; both strength training and aerobic exercise are beneficial, as they increase the muscle\u2019s glucose uptake.<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><img loading=\"lazy\" class=\"size-full wp-image-2345 aligncenter\" src=\"https:\/\/www.danielleal.pt\/wp-content\/uploads\/2020\/05\/danielleal-sindrome-exercise-fig1.jpg\" alt=\"\" width=\"750\" height=\"441\" \/><\/p>\n<h4 class=\"p1\" style=\"text-align: center;\"><span style=\"color: #5e5e5e;\"><span class=\"s1\">Fig. 1 <\/span><span class=\"s1\">&#8211; Exercise is an essential tool for reversing insulin resistance.<\/span><\/span><\/h4>\n<p>&nbsp;<\/p>\n<p class=\"p1\"><span class=\"s1\">Some nutrients and botanical agents are also useful in promoting insulin sensitivity and restoring menstrual cycles, such as the following:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\"><b>Magnesium<\/b> &#8211; a mineral that functions as a cofactor in numerous enzymatic reactions in the body (<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0899900717300229?via=ihub\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"s2\">2<\/span><\/a>).<\/span><\/li>\n<\/ul>\n<ul>\n<li class=\"p1\"><span class=\"s1\"><b>Alpha-lipoic acid <\/b>&#8211; a substance present in food but also produced in our body, which has an important antioxidant action and is also involved in the production of cellular energy. It helps to improve insulin sensitivity and the healthy development of follicles in the ovary (<a href=\"https:\/\/www.tandfonline.com\/doi\/abs\/10.1080\/09513590.2017.1313972?journalCode=igye20\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"s2\">3<\/span><\/a>).<\/span><\/li>\n<\/ul>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\"><b>Myo-Inositol<\/b> &#8211; intracellular messenger that promotes insulin signaling and supports ovulation (<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/30270194\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"s2\">4<\/span><\/a>).<\/span><\/li>\n<\/ul>\n<ul>\n<li class=\"p1\"><span class=\"s1\"><b>Vitamin D<\/b> &#8211; the popular hormone we get from sun exposure. Its supplementation decreases insulin resistance and androgen levels in women with PCOS (<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7086222\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"s2\">5<\/span><\/a>).<\/span><\/li>\n<\/ul>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\"><b>Berberine<\/b> &#8211; phytonutrient present in many plants, which had an effect comparable to metformin in several studies (<a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1111\/cen.12294\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"s2\">6<\/span><\/a>).<\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">Insulin resistance has many harmful consequences in the body, such as the increase in cardiovascular disease, so its treatment is very important.<\/span><\/p>\n<p class=\"p3\"><span style=\"color: #35b5a3;\"><span class=\"s3\">2<\/span><span class=\"s1\">. Post contraceptive pill PCOS<\/span><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">This is a <b>transient problem resulting from the interference of the pill in the communication between the pituitary and the ovaries, which tends to subside with time.<\/b> It is essential to ensure an adequate supply of nutrients at this stage, through a balanced diet. If there is evidence of insulin resistance, sugar and refined carbohydrates should be limited, as we saw above.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">The following supplements can help to accelerate the normalization of the ovulatory cycle:<\/span><\/p>\n<ul>\n<li class=\"p1\"><span class=\"s1\"><b>Zinc<\/b> &#8211; the pill tends to cause deficiencies in this mineral. Zinc plays an important role in supporting ovulation and decreases androgen production in women with PCOS (<a href=\"https:\/\/link.springer.com\/article\/10.1007\/s12011-015-0480-7\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"s2\">7<\/span><\/a>).<\/span><\/li>\n<\/ul>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\"><b>Peony and licorice extract<\/b> &#8211; combination used in Chinese herbal medicine, which helps balancing pituitary hormones and decreasing androgen production (<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5599989\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"s2\">8<\/span><\/a>).<\/span><\/li>\n<\/ul>\n<p class=\"p3\"><span style=\"color: #35b5a3;\"><span class=\"s3\">3. <\/span><span class=\"s1\">PCOS due to inflammation<\/span><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">In these patients, it is essential to discover the focus of inflammation and try to control it. <b>The digestive tract is often a source of silent inflammation, and potential changes in the intestinal flora and food intolerances must be ruled out.<\/b><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">When it comes to supplements, the minerals zinc and magnesium can help reduce inflammation. Other nutrients to consider are:<\/span><\/p>\n<ul>\n<li class=\"p1\"><span class=\"s1\"><b>N-Acetylcysteine<\/b> \u200b\u200b- has an anti-inflammatory effect and assists in the clearance of environmental toxins, through glutathione. In PCOS studies, it had a greater effect than placebo in restoring ovulation (<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4306416\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"s2\">9<\/span><\/a>).<\/span><\/li>\n<\/ul>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\"><b>Melatonin<\/b> &#8211; a hormone produced by the pineal gland that plays a central role in the regulation of circadian rhythm. It also has an antioxidant and protective effect on ovarian follicles, helping to regulate ovulation in women with PCOS (<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=28558523\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"s2\">10<\/span><\/a>).<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><img loading=\"lazy\" class=\"size-full wp-image-2331\" src=\"https:\/\/www.danielleal.pt\/wp-content\/uploads\/2020\/05\/danielleal-sindrome-ovario-poliquistico-flora-intestinal-fig2.png\" alt=\"danielleal-sindrome-ovario-poliquistico-flora-intestinal\" width=\"750\" height=\"359\" \/><\/p>\n<h4 class=\"p1\" style=\"text-align: center;\"><span class=\"s1\" style=\"color: #5e5e5e;\">Fig.2 &#8211; Imbalances in the intestinal flora can cause systemic inflammation.<\/span><\/h4>\n<p>&nbsp;<\/p>\n<p class=\"p1\"><span style=\"color: #35b5a3;\"><span class=\"s1\">4. <\/span><span class=\"s2\">Adrenal<\/span> <span class=\"s2\">PCOS<\/span><\/span><\/p>\n<p class=\"p3\"><span class=\"s2\">This category includes patients with an exaggerated response from the adrenal glands to pituitary stimulation through adrenocorticotropic hormone (ACTH),<span class=\"Apple-converted-space\">\u00a0 <\/span>concerning androgen production<\/span><span class=\"s2\">, pituitary stimulus through adrenocorticotropic hormone (ACTH).<\/span><\/p>\n<p class=\"p3\"><span class=\"s2\">Simply put, <b>stressful situations, in the broadest sense of the word and not just limited to psychological stress, promote the release of ACTH by the pituitary gland. <\/b>Therefore, measures that can help to decrease the \u201calertness in the brain\u201d and consequent ACTH stimulation, should be followed, with a special focus on lifestyle:<\/span><\/p>\n<ul class=\"ul1\">\n<li><span class=\"s2\"><b>perceived stress control strategies<\/b> &#8211; sources of stress are often not preventable, but some practices help to control their effects. For example, meditation practices can help to lower ACTH levels (<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7177919\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"s4\">11<\/span><\/a>). Anything that removes the brain from the hypervigilant state can be beneficial.<\/span><\/li>\n<\/ul>\n<ul>\n<li><span class=\"s2\"><b>prioritize sleep <\/b>&#8211; lack of sleep affects physiology in many ways. The body interprets the lack of sleep as a potential danger signal and activates its \u201csurvival\u201d methods. One of these methods is, precisely, the increase in ACTH (<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6075556\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"s4\">12<\/span><\/a>).<\/span><\/li>\n<\/ul>\n<ul class=\"ul1\">\n<li><span class=\"s2\"><b>a balanced diet and exercise<\/b> (without excess) &#8211; the other pillars of a healthy lifestyle also promote adequate ACTH levels However, when it comes to exercise, very intense practices should be avoided, as these can lead to an increased stress response.<\/span><\/li>\n<\/ul>\n<ul>\n<li><span class=\"s2\"><b>supplements that increase the inhibitory activity of the neurotransmitter GABA in the brain <\/b>may also be beneficial if there is a significant component of stress and anxiety. This includes <b>vitamin B6, magnesium, taurine and L-theanine<\/b>, among others.<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s2\">We covered several therapeutic options, from which it is wise to choose only a few. <b>The priority should be to understand each patient&#8217;s imbalance, which results in excess male hormones, and to try to balance metabolic processes.<\/b> In parallel, symptomatic treatments should be used to reduce the effects of excess androgens.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s2\">References:<\/span><\/p>\n<ol class=\"ol1\">\n<li class=\"li1\"><span class=\"s1\">Adeniji AA, Essah PA, Nestler JE, Cheang KI.<\/span><span class=\"s2\"> <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4900190\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"s6\">Metabolic Effects of a Commonly Used Combined Hormonal Oral Contraceptive in Women With and Without Polycystic Ovary Syndrome.<\/span><\/a><\/span><span class=\"s1\"> <i>J Womens Health (Larchmt)<\/i>. 2016;25(6):638\u2013645.<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Morais JBS, Severo JS, de Alencar GRR, et al.<\/span><span class=\"s2\"> <a href=\"https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0899900717300229?via=ihub\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"s6\">Effect of magnesium supplementation on insulin resistance in humans: A systematic review. <\/span><\/a><\/span><span class=\"s1\">Nutrition. 2017;38:54-60.<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">De Cicco S, Immediata V, Romualdi D, et al. <a href=\"https:\/\/www.tandfonline.com\/doi\/abs\/10.1080\/09513590.2017.1313972?journalCode=igye20\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"s7\">Myoinositol combined with alpha-lipoic acid may improve the clinical and endocrine features of polycystic ovary syndrome through an insulin-independent action.<\/span><\/a> Gynecol Endocrinol. 2017;33(9):698-701.<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Lagan\u00e0 AS, Garzon S, Casarin J, Franchi M, Ghezzi F. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/30270194\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"s7\">Inositol in Polycystic Ovary Syndrome: Restoring Fertility through a Pathophysiology-Based Approach. Trends Endocrinol Metab. 2018;29(11):768-780<\/span><\/a>. <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Miao C-Y, Fang X-J, Chen Y, Zhang Q. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7086222\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"s7\">Effect of vitamin D supplementation on polycystic ovary syndrome: A meta-analysis.<\/span><\/a> Exp Ther Med. 2020;19(4):2641-2649. <\/span><\/li>\n<li class=\"li3\"><span class=\"s2\">An Y, Sun Z, Zhang Y, Liu B, Guan Y, Lu M.<\/span><span class=\"s8\"> <a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1111\/cen.12294\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"s6\">The use of berberine for women with polycystic ovary syndrome undergoing IVF treatment. <\/span><\/a><\/span><span class=\"s2\">Clin Endocrinol (Oxf). 2014;80(3):425-431. doi:10.1111\/cen.12294<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Jamilian, M., Foroozanfard, F., Bahmani, F. et al. <a href=\"https:\/\/link.springer.com\/article\/10.1007\/s12011-015-0480-7\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"s7\">Effects of Zinc Supplementation on Endocrine Outcomes in Women with Polycystic Ovary Syndrome: a Randomized, Double-Blind, Placebo-Controlled Trial.<\/span><\/a> Biol Trace Elem Res 170, 271\u2013278 (2016).<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Arentz S, Smith CA, Abbott J, Fahey P, Cheema BS, Bensoussan A.<\/span><span class=\"s2\"> <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5599989\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"s6\">Combined Lifestyle and Herbal Medicine in Overweight Women with Polycystic Ovary Syndrome (PCOS): A Randomized Controlled Trial.<\/span><\/a><\/span><span class=\"s1\"> Phytother Res. 2017;31(9):1330\u20131340.<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Thakker D, Raval A, Patel I, Walia R. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4306416\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"s7\">N-acetylcysteine for polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled clinical trials.<\/span><\/a> Obstet Gynecol Int. 2015;2015:817849.<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Tagliaferri V, Romualdi D, Scarinci E, et al.<\/span><span class=\"s2\"> <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=28558523\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"s6\">Melatonin Treatment May Be Able to Restore Menstrual Cyclicity in Women With PCOS: A Pilot Study.<\/span><\/a><\/span><span class=\"s1\"> Reprod Sci. 2018;25(2):269-275.<\/span><\/li>\n<li class=\"li4\"><span class=\"s1\">Sanada K, Montero-Marin J, Barcel\u00f3-Soler A, et al. <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7177919\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"s6\">Effects of Mindfulness-Based Interventions on Biomarkers and Low-Grade Inflammation in Patients with Psychiatric Disorders: A Meta-Analytic Review.<\/span><\/a><span class=\"s1\">\u00a0Int J Mol Sci. 2020;21(7):2484.<\/span><\/li>\n<li class=\"li4\"><span class=\"s1\">Guyon A, Morselli LL, Balbo ML, et al. <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6075556\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"s6\">Effects of Insufficient Sleep on Pituitary-Adrenocortical Response to CRH Stimulation in Healthy Men.<\/span><\/a><span class=\"s1\">\u00a0Sleep. 2017;40(6)<\/span><\/li>\n<li class=\"li3\"><span class=\"s2\">Briden, L.\u00a0<\/span><a href=\"https:\/\/www.larabriden.com\/period-repair-manual\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"s4\">The Period Repair Manual 2nd Edition.<\/span><\/a><span class=\"s2\"> CreateSpace Independent Publishing Platform, 2017.<\/span><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>In the last article, we explored the several factors that contribute to the excess of male hormones and irregular menstrual cycles, which characterize the Polycystic Ovary Syndrome (PCOS). This article will focus on the available therapeutic options, both from a conventional and more natural approach. As explained earlier, there are four main categories of PCOS,&#8230;<\/p>\n","protected":false},"author":6,"featured_media":2284,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false},"categories":[65,47,66],"tags":[],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Polycystic Ovary Syndrome - How to treat? - Part II - Dr. Daniel Leal<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/danielleal.pt\/en\/polycystic-ovary-syndrome-what-is-it-part2\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Polycystic Ovary Syndrome - How to treat? - Part II - Dr. Daniel Leal\" \/>\n<meta property=\"og:description\" content=\"In the last article, we explored the several factors that contribute to the excess of male hormones and irregular menstrual cycles, which characterize the Polycystic Ovary Syndrome (PCOS). 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