Stein-Leventhal Syndrome (SLS) is the major health problem that affects about 12–21% of women of fertility age. It causes important distress to women and so many costs for healthcare accounting. In fact, SLS is mainly causes of female infertility. The symptom of SLS is the changing definitions and a range of symptoms have made the path to diagnosis for many women difficult up to 70% of women with SLS in the community remain undiagnosed. The National Institutes of Health (NIH) assumed that 50% of women with SLS will become diabetic or pre-diabetic by age 40. There was a different available studies shown that the women with SLS to be at higher risk for suicide as well as endometrial cancer, ovarian cancer and breast cancer. SLS affects the quality of life and psychological disorders like worsen anxiety and depression either due to the features of SLS or due to the diagnosis of chronic symptoms.
Keywords: Sign and symptoms; Management and lifestyle; Complications
SLS is the most common hormonal disorder among women between the ages of 18 and 44. It is one of the leading causes of infertility. It is often associated with psychological impairments including depression and other mood disorders and metabolic derangements . There are a number of definitions of SLS, the Rotterdam consensus is the most widely accepted across Europe, Asia and Australia was the definition used for the guideline. Polycystic means “many cysts,” and SLS regularly causes clusters of small, pearl-sized cysts in the ovaries [2,3]. The cysts are fluid-filled and immature eggs. SLS is also known as “Poly Cystic Ovary Syndrome (PCOS)”. Women with SLS produce a small amount of male hormones known as androgens, which give to some of the symptoms of the condition [2-4] (Figure 1).
It includes irregular or absent of menstrual cycle, it may be heavy periods, unwanted hair growth on a face, gain weight, acne or skin rashes, pelvic pain, pregnancy problem, patches of thick, darker, velvety skin. Associated with potential complications includes type-II diabetes, obesity, obstructive sleep apnea [1,4,5] heart disease , behavior disorders and acanthosis nigricans, Hashimoto diseases, endometrial cancer and breast cancer . Also, a large number of people diagnosed with rheumatoid arthritis (RA), multiple sclerosis and lupus combined . Cysts may be detectable by ultrasound (US). Other conditions that produce similar symptoms involved adrenal hyperplasia, hyperprolactinemia and hypothyroidism [3-7]. 5-10% of women of childbearing age are affected and with <50% of women diagnosed. SLS is only responsible for 70% of infertility issues in women who have difficulty ovulating. Post-menopausal women can also suffer from SLS. Some studies have shown that approximately 40% of patients with diabetes between the ages of 20-50 have SLS. In addition, some studies have found that if a mother has SLS, there is a 50% chance that her daughter will have this syndrome. According to the “U.S. Department of Health and Human Services”, between 1/10 and 1/20 women of childbearing age suffers from SLS. The condition currently affects up to 5 million women in the same country [5-8] (Figure 2).
The management of SLS can include: Lifestyle
modifications: Increasing physical activity levels or yoga or gym
and eating a healthy diet . Weight reduction: Research has
shown that even five to 10% weight loss can provide significant
health benefits [7-9].
Hormonal medication: To block hormones like testosterone
(for example, spironolactone).
Infertility medications: Clomiphene citrate (sold as Clomid)
or metformin may be taken orally to bring about ovulation. For
infertility, “clomiphene” is first-line treatment. For metabolic
disturbances and for improving menstrual regularities problem,
Metformin is of limited or no benefit for managing abnormally
facial hair growth is known as hirsutism, acne, or infertility.
Overall, thiazolidinediones have not favourable risk-benefit
Novel therapy [12-14]: Pineol & inositol are recently
in trials for the management option. The various reason for
taking inositol based powder and other medications. Decreased
insulin resistance, reduced testosterone, less unwanted hair
growth, clearer skin, enhanced chances of ovulation, higher egg
quality, lower chance of gestational diabetes (GD), healthier
liver, anorexia and food cravings, more stable mood, help for
symptoms of menopause, less inflammation and panic, improved
nerve function, fat degradation and cost effective.
SLS continues to be a major global health problem that
represents the challenges to our health care systems. It shows a
too much need for more public education and health awareness
on SLS in the country. In comparison with other complications
remains one of the least understood and the most confusing
medical conditions by health care public and also for the
other population and least funded endocrine disorder. Even
World Health Organization (WHO), ACOG (American Congress
of Obstetricians and Gynecologists) and National Institutes
of Health (NIH) also mentioned in its report that in most of
the countries where; SLS is a major public health concern.
According to the scale of the public health problem, there must
be a comprehensive approach to prevention and management
of SLS is urgently required for the major fertility problem in
women’s. There are various programs like surveillance and
education must be delivered at the community and rural level
through the primary health care (PHC) system so as to increase
public awareness about the problem and lengthen the survival of
affected individuals and also, prevent the general from becoming
affected. The most important challenge is thus to improve the
projection for implementation of research for the patients with
SLS in developing countries. This study may benefit government
to find a new vision and mission in control of SLS. So, our aim
to investigate the understanding and to study the changes
of the hormonal profile in SLS adolescents. Also, the lifestyle
management program on clinical symptoms of the adolescent