4 PCOS Types & How to Identify & Treat Them

Are you anxious or depressed?

Do you feel uncomfortable with your body?

Unhappy with the abnormal hair on your face and the stubborn belly fat?

All these are not your fault.

If you were diagnosed with polycystic ovary syndrome (PCOS), all these problems you are suffering from can be nothing but the PCOS symptoms.

And I understand it has never been easy to deal with hormonal problems.

So, in order to make everything easier, it is important to understand PCOS meaning, symptoms and treatment options.

Research shows that PCOS is considered to be one of the most common endocrine problems among women. [1]

Which means you are not alone!

However, many women in London are still unable to find the right gynaecologist, medical doctor or health practitioner who would help them take the shortest way to recovery.

Even for practitioners, it is challenging to set the plan suitable for each woman individually.

Simply because polycystic ovary syndrome occurs in many different forms, from the mildest to the most severe.

For some women, PCOS causes menstrual irregularities, weight gain and even unexplained tiredness.

While some other women manifest with full form PCOS in which there are multiple cysts on the ovaries resulting in lack of ovulation, and thus, impaired fertility.

I know what you are thinking… PCOS symptoms are unpredictable!

Even the diagnosis is tricky…

Sometimes, you can be diagnosed with PCOS while there are no cysts on your ovaries!

Which makes it more overwhelming…

But, no worries!

With the right amount of expert knowledge, and the right professional help, you will go through this and reach your health goals in no time.

By the way,

Did you know that in the last 12 years I with my medical team created some of the most successful Customised PCOS programmes in the UK?

To begin with, let’s go through the different types of PCOS?

It is important to know which type you belong to so that you can work on your health in the right way.

There are 4 types of PCOS that determine the symptoms you may develop.

Understanding these PCOS types and symptoms not only does help you understand more about your condition, but also allows you to help your professional find the perfect plan for you.

For example, reporting the right PCOS types and symptoms linked to each woman’s condition allows me and my medical team to create the most straightforward and effective and accurate nutritional approach.

In fact, reporting the right symptoms in the right details can help you make your PCOS treatment laser sharp customised for your very individual case.

In fact, PCOS treatment often fails is because all cases are handled as if they were identical.

But the truth is:

You are unique and therefore you need a unique programme.

What is PCOS: Understand Your Signs and Symptoms

PCOS is a condition that causes a hormonal imbalance whereby women’s bodies are dominated by male hormones known as androgens.

But what are the signs and symptoms?

There is a misconception in London that a woman with PCOS must be overweight and must have a harsh male-like voice.

But this is not true…

Have you ever been told that you can’t have PCOS because you are thin or because your ovaries don’t have cysts?

Again, not true!!!

Sometimes PCOS is directly linked to being overweight while the rest of the possible symptoms are overlooked and neglected.

PCOS comes in many different forms and can present with just a couple of symptoms such as tiredness and acne.

This is why it is important to have a laboratory check-up to establish an accurate diagnosis.

For instance, research shows that luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio which is normally between 1 and 2.

In PCOS, research shows that the LH – FSH ratio may be elevated or reversed, which explains the absence of ovulation. [2]

Research shows that testosterone can also be another hormone used in diagnosis.

Although it is a male hormone, it is normal for women to have a testosterone value of 15 to 70 ng/dL. [3]

And by the way,

Did you know that in 70-80% of PCOS cases, testosterone is also elevated and can be a key point in making PCOS diagnosis?

Now that you know more about PCOS meaning and few methods pinpointing to more accurate diagnosis, let’s make a PCOS symptoms checklist of the most common signs and symptoms that can occur in the 4 types of PCOS:

• Irregular menstrual cycles
• Excess facial hair
• Acne
• Mood swings
• Difficulty getting pregnant
• Weight gain, especially in the abdominal area also called as stubborn fat or belly fat
• Hair loss

Also, unusual symptoms of PCOS may occur, such as:

• Anxiety
• Fatigue
• High blood pressure
• Depression
• Insomnia
• Dark patches of skin (Acanthosis nigricans)
• Brain fog

By now, you might have recognised your symptoms, but you still do not know the cause!

The 4 types of PCOS all have clear underlying causes that trigger the syndrome.

And by the way some of these symptoms interplay therefore they are not just 4 types of PCOS but in order to make this simple for you I will focus only on the main four.

Types of PCOS: Which Type of PCOS Do I Have?

First of all, PCOS is not considered a disease, but a disorder in which several factors are involved.

The 4 types of PCOS are as follows:

1. Insulin Resistance PCOS
2. Adrenal PCOS
3. Post Pill PCOS
4. Inflammatory PCOS

Let’s go through each of them so that you can guess which type do you have.

1. Insulin Resistance PCOS

You might think, the more insulin, the better I can transport carbohydrates, right?

But this is not the case…

Firstly, insulin is a hormone whose main function is to transport glucose into the cells, thus preventing high blood glucose in your blood. [4]

Research shows that insulin resistance is a metabolic disorder in which different tissues in the body do not respond to insulin. [5]

In other words, the insulin knocks on the door and is not opened, preventing it from delivering the glucose.

Your pancreas, which normally produces insulin, has to produce more in an attempt to reduce blood sugar and avoid the serious complication of high glucose in the blood. [6]

You end up with high glucose and high insulin levels.

What you do not know is: insulin also acts on the ovaries and adrenal glands causing an increase in androgens, the male hormones.

This is why the more insulin you have in your blood, the more androgen your body secrets leading to insulin resistance PCOS.

For this reason, it is very important to have the right nutritional plan for PCOS that includes low sugar foods while you can also replace processed carbs with wholegrain carbohydrates.

Women with PCOS must know very well the root cause of their problem in order to act on it and get the best PCOS training programme for women in London.

BOOK YOUR FREE CONSULTATION NOW !

Can you distinguish Insulin Resistant PCOS?

Insulin affects the hormones that regulate ovarian function by stimulating testosterone production.

This is why it is common for women with diabetes in London to have problems with their menstrual cycle.

An optimal pre-screening will allow you to recognise your symptoms so that you can have an effective solution.

But, you can always get a hint whether this is your PCOS type by knowing the most common insulin resistance PCOS symptoms:

• Hirsutism (excessive growth of dark hair in face, chest, back)
• Oligomenorrhoea (you don’t have your period for 35 days or more)
• Acne
• Increased abdominal fat
• Chronic anovulation
• Infertility

Treatment for Insulin Resistant PCOS

One of the main goal of treatment is to improve insulin resistance.

This is achieved by the following:

• Better Food Choices

Believe it or not, improving the foods you consume can help you improve your symptoms.

Each food has a glycaemic index which indicates how high your blood sugar goes after consuming food.

The higher the glycaemic index, the more glucose there will be circulating in your blood.

This will cause stimulation of insulin, which is already not being used efficiently during PCOS insulin resistance.

Does this mean food choices can improve your symptoms?

Yes!

With choosing right foods that are rich in nutrients and customised for you, success is guaranteed.

• Being Active

Just similar to diet, exercise can work miracles when it comes to improving your symptoms

By getting active, you can get rid of the excess fat, especially around your belly.

But why the belly?

Research shows that the abdomen is where the greatest risk of insulin resistance is concentrated because it is where the visceral fat is located. [7]

In addition, if you use a smartly customised exercise plan for your goal, you can improve your cells’ sensitivity to insulin and cause the cells to take up 40% more glucose. [8]

Believe it or not, when you start exercising, you feel energetic within the first few weeks of training, thanks to:

– Increased blood circulation
– Increased oxygenation of the muscles
– You lose the first pounds from fluid retention
– Losing the first pounds of body fat
– You will feel more relaxed thanks to the endorphins produced during exercise
– Increased confidence and how you see your body
– Reduced anxiety and even depression feelings.

That’s right! a very effective but specifically designed to be simple so you can follow it –– and supervised throughout –– change in your nutrition and exercise plan can help you achieve optimal health without causing yourself further harm!

And, you may ask,

How can exercise or diet cause you more harm than you’re already suffering right now?

That is possible without proper supervision.

For example, you have recognised all these symptoms of PCOS in yourself but no one is talking about that excruciating sciatica pain, shoulder, ankle or knee pain that has been with you for some years,

Nor have I mentioned your limited mobility due to a lower back pain or lower back injury like a herniated disc.

Do you suffer from any of these ailments and feel that they are an impediment to changing your lifestyle?

The answer is absolutely relieving.

At Personal Training Master in London, you can reserve throughout the most qualified PCOS personal trainer who will take your slightest bodily discomfort into account to take your body to the next level.

Are you ready to change your life, physical abilities and transform your PCOS health?

Learn more about your personal case.

Get A Free Consultation Now !

2. Adrenal PCOS

It is important to differentiate between the 4 types of PCOS because they are not all treated in the same way.

Especially when the cause is extra ovarian (outside the ovary), as is the case with Adrenal PCOS.

When I work with a woman in London suffering from PCOS, I don’t expect her to have the ‘usual’ profile: overweight, with acne and a bit of facial hair.

Although unexpected for many professionals, a woman with PCOS may be at her ideal weight and gaining muscle mass with ease.

But she may be dealing with an out-of-control menstrual cycle and all-consuming stress from not recognising her symptoms.

All of this stress, coupled with workloads and family responsibilities, directly affects the adrenal glands.

What is Adrenal PCOS

Polycystic Ovarian Syndrome of adrenal origin is a type of PCOS that originates outside the ovaries, specifically in the adrenal glands.

This means that multiple cysts don’t have to be present on your ovaries.

And also, this is why the diagnosis of PCOS is so complex and must be evaluated by a professional.

At least 2 of the following Adrenal PCOS symptoms must be present:

1. Menstrual irregularities: Amenorrhoea, (no periods for at least 3 months), or oligomenorrhoea, (8 or less periods during the year).
2. Physical characteristics of hyperandrogenism: coarse facial hair, coarse hair on breasts and chin, acne, dry skin, hair loss.
3. Laboratory tests that prove hyperandrogenism.
4. Presence of polycystic ovaries confirmed by pelvic ultrasound.

Insulin is not involved in this type of PCOS.

Although adequate nutrition may improve many of your symptoms, it is not the mainstay of treatment.

Specialised assessment is required to determine which supplements and medications are appropriate to modulate adrenocorticotropic hormone (ACTH).

One of the purposes of treatment is to help you decrease the secretion of ACTH, which acts to promote the production of cortisol when stress occurs.

Elevated ACTH activity is one of the cause of PCOS Adrenal Fatigue.

This is precisely what we want to avoid.

In addition, ACTH has a melanocytic effect, which means that it acts on the cells that pigment the skin.

Therefore, hyperpigmentation of the skin can be part of the adrenal PCOS symptoms, which can also cause:

• Hair loss
• Dizziness
• Low blood pressure
• Tiredness

What happens if you have Adrenal PCOS?

Stress is capable of devastating your body according to multiple studies, leading you to suffer from different chronic diseases. [9]

When you are under continuous stress, your sympathetic nervous system is activated and adrenaline is released.

Adrenaline increases cortisol in the adrenal gland and affects it negatively.

This is very common nowadays, especially after going through a pandemic.

Now the workload and the hours in the office feel like a heavier burden than before.

Did you know that…

According to reports from the government’s Health and Safety Executive, in the UK, 51% of absences from work were due to stress-related illnesses? [10]

When London men and women where surveyed, both reported how stressful it was to work in the capital and how this made it worse for those dealing with upsets, anxiety and depression. [11]

In addition, women face a reality where they commonly feel pressured about how they should look physically.

This is a major stress trigger according to 36% of women in the UK. [12]

The whole overwhelming picture becomes a bombardment of hormones in your body.

Even if you have already been diagnosed with PCOS, the amount of information out there is daunting.

Because there are different types of PCOS, the management of its symptoms is very diverse.

Treatment for Adrenal PCOS

Women with Adrenal PCOS are typically thin, active, very demanding on themselves.

Some may engage in too much physical activity for two reasons:

1. Believing that it is the right treatment for PCOS (unaware that it is adrenal in origin) and;
2. Trying to mask the symptoms of their stress and anxiety

But, this excessive physical activity can make your condition worse.

Research show that strenuous exercise raises cortisol, directly affecting the adrenal glands. [13]

In addition,

There is not often a problem of insulin resistance, (it is not ruled out that it may occur at some point due to poor nutrition) so diet is not the first response either.

A comprehensive specialised and customised consultation is essential to establish the type of PCOS and to create a programme that fits you like a glove.

So, Can Lab Tests Differentiate Between Types Of PCOS?

Lab tests make it possible to clearly differentiate between the types of PCOS.

For instance, research shows that in the case of adrenal PCOS, LH is significantly higher than FSH. [14]

Differential diagnosis based on lab tests is possible, but it must be interpreted by a high-level healthcare team.

Once a precise diagnosis is made, adrenal PCOS can be treated effectively by:

• Creating an exercise plan that is tailored to the type of training, time and intensity.
• Recognise your external and internal causes of stress (during your comprehensive consultation) and teach you how to work on them.
• Eating foods rich in Omega 3, magnesium and Vitamin D to treat adjacent symptoms, if any (this should always be customised).
• In case of infertility, special management with medication will be required to restore ovulation.

3. Post-Pill PCOS

Have you been taking the contraceptive pill for many years?

If your answer is yes, you must be wondering: will I ever be fertile again?

I understand that this is a common concern.

Birth control methods such as the pill, the patch or the implant work in the same way: by preventing ovulation.

This eliminates the risk of pregnancy (or reduces it by a very high percentage).

This effect is achieved with synthetic hormones that not only prevent pregnancy, but also regulate the menstrual cycle.

But what happens when you stop giving your body these synthetic hormones?

Androgens tend to rise after you stop taking the birth control pill.

This is usually short term.

Your body will need to regain its natural balance to produce natural hormones again.

What is Post-Pill PCOS

Post Pill PCOS is a consequence of taking contraceptives for a long time.

This occurs mainly when taking the combined pill, i.e., oestrogen + anti-androgen progestin.

Believe it or not,

Although the contraceptive pill is a part of PCOS treatment. [15]

In some cases, it can be the cause of PCOS.

But this does not mean that it is ruled out as a treatment to regulate the menstrual cycle.

You should be aware that all methods of contraception containing hormones can cause this effect.

What If You Have Post Pill PCOS?

What happens in this case is a false alarm, as there is no ovarian or adrenal disruption (unless previously diagnosed).

Post Pill PCOS can resolve within a couple of months or after several years. This depends on many individual factors and not on a specific pill.

What Are The Symptom Of Post-Pill PCOS?

Post Pill PCOS symptoms are:

• Absence of menstruation for 3 or more months.
• Difficulty conceiving
• Some skin signs such as acne
• Some women may have facial hair growth and thickening.

Treatment for post pill PCOS

The key to resolving post pill PCOS is: stay calm!

Remember, it’s temporary and your body needs time to recover.

Just like you need to wait for your PC to come back on after it reboots.

That’s exactly what happens, your menstrual cycle restarts.

The pill only offered a simulation with synthetic hormones.

This simulation allowed you to have regular periods that are nothing more than deprivative bleeding.

In other words, every month you see bleeding that is the result of the absence of the hormone that stimulates the ovaries.

That’s why it happens right after you stop taking the last pill of each cycle.

You have to trust the process.

And to get through the wait, help your body recover naturally with a laser sharp customised nutritious diet rich in micronutrients.

Minerals, vitamins and antioxidants are essential for the functioning of all body systems.

A long term professional PCOS nutritionist in London can answer any questions you may have about starting your recovery.

Get A Free Consultation Now !

4. Inflammatory PCOS

Inflammation is like a silent enemy.

It gradually sets in and leaves very subtle signs.

It can be a constantly inflamed gut or joint pain.

You may also have lack of energy or concentration.

Getting to the source of inflammation is sometimes difficult, as it systemically affects the body.

Research show that cytokines released during inflammation can act on the ovaries causing an increase in androgens [16] which we have already established that it is responsible for the typical symptoms of PCOS including:

• Hirsutism or increased body hair
• Hair loss
• Hyperpigmentation of the skin

This is in addition to symptoms of chronic inflammation [17] that are also present in PCOS: joint inflammation, fatigue, headache, intestinal inflammation.

What is Inflammatory PCOS

First and foremost, let’s agree that inflammation is a completely normal process.

It starts as the immune system’s response to possible threats.

This means that inflammation protects you from getting sick.

But, have you ever had a friend over because you have a couple of hours to chit-chat?

Then you notice that he or she is getting too comfortable and won’t leave.

The situation can get uncomfortable because you probably need to get back to work or rest.

That’s what this type of PCOS is like!

The problem arises when the inflammation is lasting for a long period of time and won’t let go.

But, where did this inflammation come from in the first place?

Inflammation can be triggered by some actions you do repeatedly, such as:

• Eating too much processed food
• Exposure to chemicals in the home or work area
• Sedentary lifestyle
• Excessive alcohol or cigarette consumption
• Stress
• Lack of exercises
• Lack of customised nutrition

Research shows that when all of these conditions are present, inflammatory mediators, known as cytokines, act directly on the ovaries. [18]

Constant stimulation of the ovaries favours increased androgen production.

This makes inflammatory PCOS one of the most frequent types.

Because it is very common to live with stress and poor nutrition.

What Happens If You Have Inflammatory PCOS?

Have you been experiencing irregular periods for the past few months?

Do you think it is abnormal and you are starting to worry?

It’s time to take action.

Read some of the checklist below to find out if you have inflammatory PCOS symptoms:

• Sensitive skin with tendency to dryness or previously diagnosed conditions such as eczema or psoriasis,
• Recurrent headache,
• Inflammation of the digestive system manifesting with chronic constipation interspersed with diarrhoea,
• Pain in the joints without apparent cause (i.e., not related to physical activity),
• Fatigue for no apparent reason (i.e., not related to physical activity),
• Concentration problems and foggy brain

All these are signs of an inflammatory process that needs to be addressed and treated.

This is especially important when inflammation in a body system is already affecting your reproductive system.

Treatment for Inflammatory PCOS

Treatment of inflammatory PCOS consists of finding and treating the underlying cause of inflammation. [19]

If you don’t do this, you could be treating insulin resistance on the one hand and trying to restore ovulation on the other.

But, if you don’t remove the cause, the problem will remain.

You can’t allow inflammation to set in for too long, it’s not healthy.

I can name many actions you can take to start healing today:

• Safely increase your physical activity,
• Eat more green vegetables in salads and smoothies,
• Reduce consumption of red meat as it is directly related to inflammation [20] [21]
• Practice meditation daily,
• Practice de-stress and deep breathing daily,
• Throw out all foods in your pantry that have more than 3 ingredients on the nutrition label.

I mean, these actions will definitely help you, but a laser sharp customised plan will help you totally transform, so you will leave all this behind.

You may already be practicing some healthy habits…

But what if there is a specific habit that is triggering your symptoms?

It’s best not to act randomly when it comes to PCOS.

Schedule a consultation here so you can get a step-by-step programme that tells you what actions to take now !

Why Comprehensive Assessment and Laser-Sharp Customisation?

I could flood you with scientific data on the latest updates in the treatment of PCOS.

But, there is something I don’t know and it is something I must admit.

I don’t know anything about you yet.

To offer you the 100% customised plan I need to know your case in depth.

I mean, I can tell you about the wonders of kiwifruit to improve constipation [22], but what if you don’t like or are sensitive or allergic to kiwifruit?

Kiwifruit will definitely not be the choice for you.

A laser sharp PCOS programme is intended to be not only effective but also enjoyable.

The essential idea of it all is to restore your happiness before health.

A superficial consultation will achieve nothing but waste your time, resources and perpetuate your discomfort.

That is the last thing I want.

Best of all, you will be supervised and guided to win by long term PCOS trained medical staff, a long-term nutritionist and an elite personal trainer.

This team is your team and it helps you succeed!!

After an extensive comprehensive assessment where we will look deep into every detail, you will be able to receive the most effective customised PCOS solution for your particular case (fits you like a glove) that will not only improve your hormonal profile, but will be able to:

• Improve your physical composition,
• Keep you satiated,
• Reduce cravings
• Consume the right amount of fibre,
• Achieve a radiant and hydrated skin,
• Eliminate inflammation,
• Transform your body confidence.
• Increase your physical endurance,
• Decrease stress,
• Transform your mental health.

Every journey start with the first step.

Why not start today?

London has the right professional who will put together every detail of your case like never before.
BOOK A FREE CONSULTATION NOW !

Myths about Polycystic Ovary Syndrome (PCOS)

The fact that there is so much unawareness surrounding PCOS allows many myths to be created.

There is one particular thought among women that has two opposing sides:

1. If I have PCOS I will never be able to get pregnant.
2. I don’t want to have children so I don’t need to treat my PCOS.

As for the first thought, I have good news for you…

PCOS can be reversed by medical treatment and –– more importantly –– lifestyle modification.

Also, it is believed that in PCOS not all cycles are anovulatory [23].

Therefore, the chances of getting pregnant may be low at first, but not impossible.

As you treat your PCOS according to the type of PCOS you have, your hormonal profile will improve.

Not to mention all the scientific advances that exist to promote assisted reproduction.

You just need the right professionals to be on your side and guide you along the way.

On the other hand, even if you don’t want to have babies, you can’t ignore your diagnosis.

Unfortunately, PCOS has been associated with an increased risk of various diseases [24] such as:

• Type 2 diabetes
• Endometrial cancer
• High blood pressure
• Obesity

This is why it is important for women in London with PCOS to see the best PCOS professional who can help them improve their health in all aspects, including their nutrition, activity, stress and weight.

As you may know, being overweight is also a factor that raises many questions:

If you are overweight, will your ovaries be affected and you will develop PCOS?

Well, research shows that there will certainly be an increased risk, because obesity causes inflammation. [25]

But, you can stop the consequences on time.

Likewise, losing weight will not eliminate the problem.

But it can help you improve your symptoms and achieve your health goals.

This laser sharp customised approach using training and personalised PCOS nutrition for your PCOS type helps you transform your body and symptoms.

In addition, medical treatment and the correct natural supplementation we will create for your case will allow you to have regular cycles.

All these interventions and more in combination as personalised package ensures that your hormonal profile will improve and you will see the symptoms that are bothering you today disappear.

Who is Jazz Alessi

Jazz Alessi is well known for his long-term experience in elite training in London, supported by his expertise in evidence-based nutrition that prioritises the special needs of women with PCOS.

Jazz doesn’t miss a beat; through a series of comprehensive assessment, he gets the data required to create with his medical team your successful laser sharp programme for total women’s health transformation.

His focus on highly effective, medically supervised nutrition, exercise and correct supplementation allows him to have the right tools to create customised PCOS programmes that ensure total physical transformation.

This makes him London’s number one expert in working with specific training to improve polycystic ovarian syndrome.

Q and A

References

1. Polycystic Ovary Syndrome (PCOS). Cleveland Clinic / Health Library / Disease & Conditions https://my.clevelandclinic.org/health/diseases/8316-polycystic-ovary-syndrome-pcos

2. Follicle Stimulating Hormone (LH: FSH) Ratio in Polycystic Ovary Syndrome (PCOS) – Obese vs. Non- Obese Women Med Arch. 2020 Aug https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520057/

3. Total Testosterone. University of Rochester Medical Center Rochester
https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=testosterone_total

4. Role of Insulin in Health and Disease: An Update. Int J Mol Sci. 2021 Jun Md Saidur Rahman, Khandkar Shaharina Hossain, Sharnali Das, Sushmita Kundu, Elikanah Olusayo Adegoke, Md. Ataur Rahman, Md. Abdul Hannan, Md Jamal Uddin, and Myung-Geol Pang https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232639/#:~:text=The%20major%20purpose%20of%20insulin,%2C%20muscle%2C%20and%20adipose%20tissue

5. Insulin Resistance & Prediabetes. National Institutes of Health Health Information Diabetes Diabetes Overview What is Diabetes? Insulin Resistance & Prediabetes https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance#:~:text=the%20normal%20range.-,What%20is%20insulin%20resistance%3F,help%20glucose%20enter%20your%20cells

6. Diabetes – long-term effects. Better Health Channel Reviewed on: 23-03-2021
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/diabetes-long-term-effects

7. Visceral Fat (Active Fat). January 15, 2019 Reviewed June 10, 2022 Diabetes.co.uk
‘https://www.diabetes.co.uk/body/visceralfat.html#:~:text=Carrying%20a%20high%20amount%20of,to%20increase%20resistance%20to%20insulin

8. Effect of Physical activity on Insulin Resistance, Inflammation and Oxidative Stress in Diabetes Mellitus Vighnesh Vetrivel Venkatasamy1, Sandeep Pericherla2, Sachin Manthuruthil3, Shikha Mishra4, Ram Hanno 5 © Copyright 2007-2023, Journal of Clinical and Diagnostic Research, India https://www.jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&volume=7&issue=8&page=1764&issn=0973-709x&id=3306

9. Stress: Are we coping? Report Mental Health Foundation
https://www.mentalhealth.org.uk/explore-mental-health/publications/stress-are-we-coping-report

10. Work-related stress, anxiety or depression statistics in Great Britain, 2022
https://www.hse.gov.uk/statistics/causdis/stress.pdf

11. New research reveals the most stressful London borough to work in. November 5, 2018 Open Access Government
‘https://www.openaccessgovernment.org/new-research-reveals-the-most-stressful-london-borough-to-work-in/54055/

12. Stress: statistics. Results of the Mental Health Foundation’s 2018 study Mental Health Foundation https://www.mentalhealth.org.uk/explore-mental-health/mental-health-statistics/stress-statistics

13. Exercise and circulating cortisol levels: the intensity threshold effect. E E Hill, E Zack, C Battaglini, M Viru, A Viru, A C Hackney. J Endocrinol Invest. 2008 Jul; 31 https://pubmed.ncbi.nlm.nih.gov/18787373/#:~:text=Collectively%2C%20the%20cortisol%20findings%20support,HPA%20axis%20stimulus%20(ACTH).

14. REVIEW ARTICLE: THE POLYCYSTIC OVARY SYNDROME
S. S. C. YEN First published: February 1980 https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2265.1980.tb02132.x

15. Polycystic Ovary Syndrome, Combined Oral Contraceptives, and the Risk of Dysglycemia: A Population-Based Cohort Study With a Nested Pharmacoepidemiological Case-Control Study. Diabetes Care. 2021 Dec; 44(12): 2758–2766.
Published online 2021 Oct 15 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520057/

16. [Cytokines and their role in reproductive system] Fiziol Zh (1994). 2007 https://pubmed.ncbi.nlm.nih.gov/17725048/

17. The Role of Chronic Inflammation in Polycystic Ovarian Syndrome—A Systematic Review and Meta-Analysis. Int J Mol Sci. 2021 Mar. Shaimaa Aboeldalyl, Cathryn James, Emaduldin Seyam, Emad Moussa Ibrahim, Hossam El-Din Shawki, and Saad Amer https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7962967/

18. Association of metabolic and inflammatory markers with polycystic ovarian syndrome (PCOS): an update Subeka Abraham Gnanadass, Yogamaya Divakar Prabhu & Abilash Valsala Gopalakrishnan. Archives of Gynecology and Obstetrics Published: 13 January 2021 https://link.springer.com/article/10.1007/s00404-020-05951-2

19. The role of cytokines in polycystic ovarian syndrome. Krystle Ebejer, Jean Calleja-Agius Pages 536-540 | Received 03 Dec 2012, Accepted 12 Dec 2012, Published online: 01 Feb 2013
https://www.tandfonline.com/doi/abs/10.3109/09513590.2012.760195

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24. Polycystic Ovary Syndrome (PCOS) The Johns Hopkins Hospital, and Johns Hopkins Health System
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