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Balkrishna A, Rana M, Mishra S, Srivastava D, Bhardwaj R, Singh S, Rajput SK, Arya V. Incredible Combination of Lifestyle Modification and Herbal Remedies for Polycystic Ovarian Syndrome Management. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2023; 2023:3705508. [PMID: 37383339 PMCID: PMC10299884 DOI: 10.1155/2023/3705508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/30/2023]
Abstract
A relatively frequent endocrine-metabolic illness called polycystic ovarian syndrome (PCOS) is characterized by polycystic ovaries, persistent anovulation, and hyperandrogenism, which cause symptoms such as irregular menstruation, infertility, and hirsutism. PCOS is linked to obesity, insulin resistance, and increased amounts of androgens, or male hormones. The sedentary lifestyle, dietary fluctuations, inactivity, and stress are other contributing variables. According to estimates from India in 2021, around 22.5% of women, or one in five Indian women, suffer from PCOS. Evidence-based medical care for PCOS places a strong focus on a multidisciplinary approach, as standard pharmacological treatment frequently targets a single symptom, may be contraindicated, has adverse effects, and is ineffective in certain circumstances. However, long-term treatments have drawbacks and are likely to be ineffective, making complementary and alternative therapies a worthwhile choice. Yoga science is a thorough treatment plan for a healthy body and mind that may eradicate PCOS's primary causes, stress and obesity. Some common herbal remedies, including Foeniculum vulgare, Tinospora cordifolia, Asparagus racemosus, Ocimum tenuiflorum, Areca catechu, and Lepidium meyenii, have been highly regarded sources that have the benefits of lowering PCOS as well as having hypoglycemic and antiobesity effects. In light of existing literature, women with PCOS experienced symptomatic relief, improvement in hormonal balance, and the quality of life by utilizing yoga practices as well as herbal remedies. In conclusion, combining lifestyle modifications with herbal remedies can be used in the management of PCOS as a holistic approach. Therefore, this review opens a new window for researchers all across the world to validate such findings.
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Affiliation(s)
| | - Maneesha Rana
- Patanjali Herbal Research Department, Patanjali Herbal Research Institute, Haridwar 249405, Uttarakhand, India
| | - Shalini Mishra
- Patanjali Herbal Research Department, Patanjali Herbal Research Institute, Haridwar 249405, Uttarakhand, India
| | - Deepika Srivastava
- Patanjali Herbal Research Department, Patanjali Herbal Research Institute, Haridwar 249405, Uttarakhand, India
| | - Rohit Bhardwaj
- Department of Pharmaceutical Sciences, Gurukula Kangri (Deemed to be University), Haridwar, Uttarakhand 249404, India
| | - Shalini Singh
- Department of Pharmaceutical Sciences, Gurukula Kangri (Deemed to be University), Haridwar, Uttarakhand 249404, India
| | - Satyendra Kumar Rajput
- Department of Pharmaceutical Sciences, Gurukula Kangri (Deemed to be University), Haridwar, Uttarakhand 249404, India
| | - Vedpriya Arya
- Patanjali Herbal Research Department, Patanjali Herbal Research Institute, Haridwar 249405, Uttarakhand, India
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Alhassan S, Elmugadam A, Elfadil GA, Abubaker N, Elfaki EM, Hamza A, Abdalhabib EK, Karar T. Diagnostic Performance of Anti-Müllerian Hormone, Luteinizing Hormone to Follicle-Stimulating Hormone Ratio, Testosterone, and Prolactin to Predict Polycystic Ovary Syndrome Among Sudanese Women. Int J Womens Health 2023; 15:837-843. [PMID: 37275514 PMCID: PMC10237195 DOI: 10.2147/ijwh.s403347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 05/05/2023] [Indexed: 06/07/2023] Open
Abstract
Background Polycystic ovary syndrome (PCOS) is one of the most important contributing factors to infertility. The diagnosis of PCOS is not an easy procedure, as the signs and symptoms are heterogeneous and of undefined etiology. There are only a few published studies that address the diagnostic performance of anti-Müllerian hormone in diagnosis of PCOS in sub-Saharan Africa including Sudan. Objective This study aims to assess anti-Müllerian hormone (AMH), luteinizing to follicle-stimulating hormone ratio (LH: FSH), total testosterone (TT), and prolactin (PRL) levels among PCOS. In addition, we determine if AMH can be used as a predictor of PCOS among Sudanese women. Methods There were 600 women enrolled in this observational cross-sectional study, 300 of whom had PCOS, and 300 of whom healthy women; PCOS was diagnosed using the Rotterdam criteria. On days 2-4 of the menstrual cycle, serum LH, FSH, AMH, TT, and PRL levels were measured for all participants. Diagnostic performance of these parameters for PCOS was determined by receiver operating characteristic (ROC) curve. Results Significantly higher means among PCOS regarding their BMI, AMH; LH: FSH ratio; TT; PRL, whereas significantly inverse in FSH compared with normal ovulatory women. On ROC analysis, AMH had the largest operating characteristic curve at cut-off >3.95 ng/mL; AUC = 0.999 with Youden's index 0.99%, followed by LH: FSH ratio at cut-off 0.749; AUC=0.932; Youden's index 0.813%, TT cut-off 0.82 mIU/L, AUC=0.852 with Youden's index 0.58, while PRL showed the lowest AUC=0.627 with cut-off 15.3 ng/mL, Youden's index was 0.18%, P. value<0.001. Conclusions Sudanese women with PCOS had higher serum AMH level, LH:FSH ratio, and TT level. Moreover, AMH level has better discriminative power and good diagnostic potency for the diagnosis of PCOS among Sudanese.
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Affiliation(s)
- Samia Alhassan
- Department of Clinical Chemistry, College of Medical Laboratory Science, Sudan University of Science and Technology, Khartoum, Sudan
| | - Abdelgadir Elmugadam
- Department of Clinical Chemistry, College of Medical Laboratory Science, Sudan University of Science and Technology, Khartoum, Sudan
| | - Ghada A Elfadil
- Department of Clinical Chemistry, College of Medical Laboratory Science, Sudan University of Science and Technology, Khartoum, Sudan
| | - Nuha Abubaker
- Department of Clinical Chemistry, College of Medical Laboratory Science, Sudan University of Science and Technology, Khartoum, Sudan
| | - Elyasa M Elfaki
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Al-Qurayyat, Saudi Arabia
| | - Alneil Hamza
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Al-Qurayyat, Saudi Arabia
| | - Ezeldine K Abdalhabib
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Al-Qurayyat, Saudi Arabia
| | - Tarig Karar
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
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Effects of a Dulaglutide plus Calorie-Restricted Diet versus a Calorie-Restricted Diet on Visceral Fat and Metabolic Profiles in Women with Polycystic Ovary Syndrome: A Randomized Controlled Trial. Nutrients 2023; 15:nu15030556. [PMID: 36771262 PMCID: PMC9920202 DOI: 10.3390/nu15030556] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/09/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
The effects of dulaglutide and a calorie-restricted diet (CRD) on visceral adipose tissue (VAT) and metabolic profiles in polycystic ovary syndrome (PCOS) have not been extensively investigated. In this study, we investigated whether dulaglutide combined with CRD could further reduce VAT and promote clinical benefits as compared with a CRD regimen alone in overweight or obese PCOS-affected women. Between May 2021 and May 2022, this single-center, randomized, controlled, open-label clinical trial was conducted. Overall, 243 participants with PCOS were screened, of which 68 overweight or obese individuals were randomly randomized to undergo dulaglutide combined with CRD treatment (n = 35) or CRD treatment alone (n = 33). The duration of intervention was set as the time taken to achieve a 7% weight loss goal from baseline body weight, which was restricted to 6 months. The primary endpoint was the difference in the change in VAT area reduction between the groups. The secondary endpoints contained changes in menstrual frequency, metabolic profiles, hormonal parameters, liver fat, and body composition. As compared with the CRD group, the dulaglutide + CRD group had a considerably shorter median time to achieve 7% weight loss. There was no significant between-group difference in area change of VAT reduction (-0.97 cm2, 95% confidence interval from -14.36 to 12.42, p = 0.884). As compared with CRD alone, dulaglutide + CRD had significant advantages in reducing glycated hemoglobin A1c and postprandial plasma glucose levels. The results of the analyses showed different changes in menstruation frequency, additional metabolic profiles, hormonal markers, liver fat, and body composition between the two groups did not differ significantly. Nausea, vomiting, constipation, and loss of appetite were the main adverse events of dulaglutide. These results emphasize the value of dietary intervention as the first line of treatment for PCOS-affected women, while glucagon-like peptide 1 receptor agonist therapy provides an efficient and typically well tolerated adjuvant therapy to aid in reaching weight targets based on dietary therapy in the population of overweight/obese PCOS-affected women.
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Zeng LH, Rana S, Hussain L, Asif M, Mehmood MH, Imran I, Younas A, Mahdy A, Al-Joufi FA, Abed SN. Polycystic Ovary Syndrome: A Disorder of Reproductive Age, Its Pathogenesis, and a Discussion on the Emerging Role of Herbal Remedies. Front Pharmacol 2022; 13:874914. [PMID: 35924049 PMCID: PMC9340349 DOI: 10.3389/fphar.2022.874914] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a very common, complex, and heterogeneous endocrine disorder of women that involves a combination of environmental and genetic factors. PCOS affects women of growing age particularly at the early to late reproductive stage (15-35 years). Currently, PCOS affects 1 in every 10 women worldwide. It is characterized majorly by a raised level of androgens such as testosterone and a large number of ovarian cysts (more than 10) that cause anovulation, infertility, and irregular menstrual cycle. PCOS is also related to other endocrine and metabolic abnormalities, such as obesity, hirsutism, acne, diabetes, insulin resistance, and glucose impairment. PCOS can be treated with allopathic, ayurvedic, and natural or herbal medications along with lifestyle modifications. Herbal medicines remained in demand for numerous reasons such as high cost and side effects associated with the use of allopathic medicine and our traditional norms, which have helped humans to use more herbal products for their health benefits. Estrogenic and nonestrogenic phytochemicals present in various plant species such as Glycyrrhiza glabra L. [Fabaceae], Aloe vera (L.) Burm. f. [Asphodelaceae], Silybum marianum (L.). Gaertn. [Asteraceae], Serenoa repens (W.Bartram) Small [Arecaceae], Actaea racemosa L. [Ranunculaceae], and Angelica sinensis (Oliv.) Diels [Apiaceae] are effective and harmless. Herbal medicines are found to be cost-effective, efficacious, and a highly esteemed source of management/treatment for PCOS than allopathic medicines. In this literature review, diagnosis, signs, and symptoms of PCOS; causes of hormonal imbalance; and risk factors associated with PCOS and their management are discussed briefly, and the focus was to find out the role of herbal remedies in PCOS management.
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Affiliation(s)
- Ling-Hui Zeng
- Department of Pharmacology, Zhejiang University City College, Hangzhou, China
| | - Saba Rana
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Faisalabad, Pakistan
| | - Liaqat Hussain
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Faisalabad, Pakistan
| | - Muhammad Asif
- Department of Pharmacology, Faculty of Pharmacy, Islamia University Bahawalpur, Bahawalpur, Pakistan
| | - Malik Hassan Mehmood
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Faisalabad, Pakistan
| | - Imran Imran
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Anam Younas
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Faisalabad, Pakistan
| | - Amina Mahdy
- Medical Pharmacology Department, International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Fakhria A. Al-Joufi
- Department of Pharmacology, College of Pharmacy, Jouf University, Aljouf, Saudi Arabia
| | - Shaymaa Najm Abed
- Nursing Department, College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia
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Pandit U, Singh M, Ranjan R, Gupta V. The Effect of Exercise Training on Body Composition, Insulin Resistance and High Sensitivity C-reactive Protein (Hs-CRP) in Women With Polycystic Ovary Syndrome: A Pilot Study From North India. Cureus 2022; 14:e23994. [PMID: 35547420 PMCID: PMC9085451 DOI: 10.7759/cureus.23994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2022] [Indexed: 11/05/2022] Open
Abstract
Background Polycystic ovary syndrome (PCOS) is defined as clinical or biochemical hyperandrogenism, oligo/amenorrhea, and polycystic ovaries with or without increased ovarian volume. The goal of this study was to assess the effect of a 20-week home-based aerobic exercise programme on body composition, insulin resistance, and hs-CRP levels in women with PCOS. Methods This 12-month prospective study included 60 female patients diagnosed with PCOS, aged 20 to 40 years. The participants were divided into 2 groups, one for the experiment and the other for the control. For each participant, the 12-hour fasting blood samples were taken on two occasions i.e., 24 hours before the first session and 48 hours after the last session to measure the fasting glucose, fasting insulin, and hs-CRP. The Statistical Package for Social Sciences (SPSS) was used to conduct the analysis, and an association was considered significant when the p-value was less than 0.05. Results In the present study, there was a dropout rate of 16.7% (5/30) in the study group and 23.3% (7/30) in the control group. The baseline characteristics were comparable (p>0.05) between the study group and the control group during the enrolment. The BMI (kg/m2) among the study group before the exercise programme was 22.8±1.8 and it was significantly reduced to 21.1±1.9 after the exercise programme (p<0.05). The HOMA-IR and hs-CRP (mg/L) levels among the study group before the exercise programme were 3.2±1.5 and 6.7±2.7 respectively, and these were significantly reduced to 1.9±1.6 and 4.2±1.3 respectively after the exercise programme (p<0.05). In contrast, paired T-test analysis showed no such significant difference (p<0.05) for all variables (Weight, BMI, Waist, Hip, fasting glucose, Fasting insulin, and hs-CRP) among the control group during the study period. Conclusion In a group of female PCOS patients, a 20-week home-based aerobic exercise programme reduced weight, BMI, HOMA-IR, and hs-CRP. Although more research on the effects of aerobic exercises in PCOS is needed, these findings support aerobic exercise's effectiveness in reducing inflammation and enhancing insulin sensitivity in these patients.
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Ashraf S, Aslam R, Bashir I, Majeed I, Jamshaid M. Environmental determinants and PCOS symptoms severity: a cross-sectional study. Health Care Women Int 2021; 43:98-113. [PMID: 34432612 DOI: 10.1080/07399332.2021.1959590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Polycystic Ovary Syndrome is a complicated female disorder worldwide. Researchers conducted a quantitative study to examine multiple environmental determinants contributing to its symptoms severity. Data of 150 PCOS diagnosed women (16 to 45 years) was gathered from private clinics and hospitals of Lahore, Pakistan. Chi-square, spearman's correlation, and linear regression tests were run. Chicken, fast food and spicy food intake were found to be the significant predictors of PCOS severity (F (1, 148) = 6.903, p = 0.01), (F (1, 148) = 11.400, p = 0.001), and (F (1, 148) = 4.525, p = 0.035) respectively. We also found significant relationships of sedentary lifestyle (p = .034) & BMI (p = 0.025) with PCOS symptoms severity. However, relationship of socioeconomic status (SES) was non-significant with the disease severity. These determinants will direct healthcare professionals in proper management and counseling of PCOS women thus improving their life quality.
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Affiliation(s)
- Seemab Ashraf
- Faculty of Pharmacy, University of Central Punjab, Lahore, Pakistan
| | - Rabia Aslam
- Faculty of Pharmacy, University of Central Punjab, Lahore, Pakistan
| | - Irfan Bashir
- Faculty of Pharmacy, University of Central Punjab, Lahore, Pakistan
| | - Imtiaz Majeed
- Faculty of Pharmacy, University of Central Punjab, Lahore, Pakistan
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Doudenkova V. Médicalisation et autonomie des femmes affectées par le syndrome des ovaires polykystiques. CANADIAN JOURNAL OF BIOETHICS 2021. [DOI: 10.7202/1077630ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Le syndrome des ovaires polykystiques (SOPK) est un trouble endocrinien répandu qui affecte environ 10% des femmes en âge de procréer. Bien qu’il soit principalement connu pour ses effets sur la fertilité, le SOPK est considéré comme un facteur de risque pouvant mener au diabète de type 2. Il est également associé à des conditions comme les cancers hormono-dépendants, les troubles psychiatriques ou encore les maladies cardio-vasculaires. La volonté de prévenir les conditions associées pourrait pousser à une plus grande médicalisation des femmes atteintes par le SOPK, notamment par d’éventuels dépistages. Cet article examine les facteurs potentiels pouvant contribuer à la médicalisation de ces femmes et la manière dont leur autonomie pourrait être affectée par ce phénomène. Entre autres, l’article met en évidence comment la médicalisation façonne des représentations collectives et individuelles par rapport aux notions de santé, de maladie et de traitement. Dans une perspective relationnelle de l’autonomie, il attire l’attention sur l’importance de reconnaitre comment la médicalisation influence ces représentations et l’impact potentiel que cela pourrait avoir sur les femmes. Encourager la démédicalisation du SOPK par une approche visant à soutenir la santé pousse à interroger ces représentations et fait partie des pistes de solution permettant de favoriser l’autonomie des femmes affectées par le SOPK. Il devient alors possible non seulement de contrôler la maladie, mais aussi de soutenir la santé, voire de faire les deux selon la situation individuelle.
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Affiliation(s)
- Victoria Doudenkova
- Programmes de sciences biomédicales, Faculté de médecine, Université de Montréal, Montréal, Canada
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Ramanjaneya M, Jerobin J, Bettahi I, Bensila M, Aye M, Siveen KS, Sathyapalan T, Skarulis M, Abou-Samra AB, Atkin SL. Lipids and insulin regulate mitochondrial-derived peptide (MOTS-c) in PCOS and healthy subjects. Clin Endocrinol (Oxf) 2019; 91:278-287. [PMID: 31066084 DOI: 10.1111/cen.14007] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/02/2019] [Accepted: 05/05/2019] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Polycystic ovarian syndrome (PCOS) is a heterogeneous endocrine disorder associated with mitochondrial dysfunction and insulin resistance (IR). MOTS-c, a mitochondrial peptide, promotes insulin sensitivity (IS) through activating AKT and AMPK-dependent pathways. The current study was designed to examine the response of MOTS-c to lipids (intralipid) followed by insulin in PCOS and healthy subjects. METHODS All subjects underwent 5-hour intralipid/saline infusion with a hyperinsulinemic-euglycaemic clamp in the final 2 hours. Plasma samples were collected to measure circulating MOTS-c using a commercial ELISA kit. Subsequently, this was repeated following an eight-week exercise intervention. RESULTS Intralipid significantly increased plasma MOTS-c both in controls and PCOS subjects, whilst the insulin infusion blunted the intralipid-induced response seen for both lipids and MOT-c. Intralipid elevated plasma MOTS-c to 232 ± 124% of basal in control (P < 0.01) and to 349 ± 206% of basal in PCOS (P < 0.001) subjects. Administration of insulin suppressed intralipid-induced MOTS-c from 232 ± 124% to 165 ± 97% (NS) in control and from 349 ± 206% to 183 ± 177% (P < 0.05) in PCOS subjects, respectively. Following exercise, intralipid elevated plasma MOTS-c to 305 ± 153% of basal in control (P < 0.01) and to 215 ± 103% of basal in PCOS (P < 0.01) subjects; insulin suppressed intralipid-induced MOTS-c only in controls. CONCLUSIONS In conclusion, this is the first study to show increased lipid enhanced circulating MOTS-c whilst insulin attenuated the MOTS-c response in human. Further, eight weeks of moderate exercise training did not show any changes in circulating MOTS-c levels in healthy controls and in women with PCOS.
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Affiliation(s)
- Manjunath Ramanjaneya
- Qatar Metabolic Institute, Interim Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Jayakumar Jerobin
- Qatar Metabolic Institute, Interim Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Ilham Bettahi
- Qatar Metabolic Institute, Interim Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Milin Bensila
- Qatar Metabolic Institute, Interim Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Myint Aye
- Department of Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, Hull, UK
| | | | - Thozhukat Sathyapalan
- Department of Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, Hull, UK
| | - Monica Skarulis
- Qatar Metabolic Institute, Interim Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Abdul-Badi Abou-Samra
- Qatar Metabolic Institute, Interim Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
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Ding W, Zhang FL, Liu XC, Hu LL, Dai SJ, Li G, Kong HJ, Guo YH. Impact of Female Obesity on Cumulative Live Birth Rates in the First Complete Ovarian Stimulation Cycle. Front Endocrinol (Lausanne) 2019; 10:516. [PMID: 31428050 PMCID: PMC6687867 DOI: 10.3389/fendo.2019.00516] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 07/15/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Female overweight/obesity has been reported to be associated with compromised pregnancy outcomes in fresh embryo transfer cycles. It is unclear whether the cumulative live birth rate (CLBR) is adversely affected after all viable embryos are transferred from the first ovarian stimulation cycle. Objectives: To investigate whether the CLBR was compromised in obese women. Method: A total of 9,772 young women underwent their first IVF/ICSI cycles from January 2012 to October 2017. Pregnancy outcomes were compared according to female BMI. Results: Among 1,671 women with polycystic ovary syndrome (PCOS), those with a BMI ≥ 28 kg/m2 had a lower cumulative clinical pregnancy rate (CCPR) and CLBR during the first complete ovarian stimulation cycle. Additionally, the pregnancy loss rate was increased in this group, although the difference was not significant. Among the 8,101 women without PCOS, the CCPR and CLBR of obese patients was also significantly decreased, and this group also showed increased pregnancy loss rates. Moreover, overweight women also had a decreased CLBR. Conclusions: Female obesity adversely affected the CLBR after utilizing the viable embryos from first oocytes retrieval.
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Affiliation(s)
- Wen Ding
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fu-li Zhang
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiao-cong Liu
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lin-li Hu
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shan-jun Dai
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Gang Li
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hui-juan Kong
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yi-hong Guo
- Reproductive Medicine Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Yi-hong Guo
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Cornejo-Pareja I, Clemente-Postigo M, Tinahones FJ. Metabolic and Endocrine Consequences of Bariatric Surgery. Front Endocrinol (Lausanne) 2019; 10:626. [PMID: 31608009 PMCID: PMC6761298 DOI: 10.3389/fendo.2019.00626] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 08/29/2019] [Indexed: 12/17/2022] Open
Abstract
Obesity is one of the most serious worldwide epidemics of the twenty-first century according to the World Health Organization. Frequently associated with a number of comorbidities, obesity threatens and compromises individual health and quality of life. Bariatric surgery (BS) has been demonstrated to be an effective treatment to achieve not only sustained weight loss but also significant metabolic improvement that goes beyond mere weight loss. The beneficial effects of BS on metabolic traits are so widely recognized that some authors have proposed BS as metabolic surgery that could be prescribed even for moderate obesity. However, most of the BS procedures imply malabsorption and/or gastric acid reduction which lead to nutrient deficiency and, consequently, further complications could be developed in the long term. In fact, BS not only affects metabolic homeostasis but also has pronounced effects on endocrine systems other than those exclusively involved in metabolic function. The somatotropic, corticotropic, and gonadal axes as well as bone health have also been shown to be affected by the various BS procedures. Accordingly, further consequences and complications of BS in the long term in systems other than metabolic system need to be addressed in large cohorts, taking into account each bariatric procedure before making generalized recommendations for BS. In this review, current data regarding these issues are summarized, paying special attention to the somatotropic, corticotropic, gonadal axes, and bone post-operative health.
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Affiliation(s)
- Isabel Cornejo-Pareja
- Unidad de Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga—IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
- Centro de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Málaga, Spain
| | - Mercedes Clemente-Postigo
- Unidad de Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga—IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
- Centro de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Málaga, Spain
- *Correspondence: Mercedes Clemente-Postigo
| | - Francisco J. Tinahones
- Unidad de Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga—IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
- Centro de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Málaga, Spain
- Francisco J. Tinahones
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Tola H, Abbas M, Alhassan EA, Shrif NE, Rida M. Assessment of the Role of the Anti-Mullerian Hormone, Luteinizing Hormone/Follicle Stimulating Hormone Ratio in the Diagnosis of Polycystic Ovary Syndrome in Sudanese Women. Open Access Maced J Med Sci 2018; 6:1244-1247. [PMID: 30087729 PMCID: PMC6062285 DOI: 10.3889/oamjms.2018.260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/22/2018] [Accepted: 05/25/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The diagnosis of polycystic ovary syndrome (PCOS) is not an easy procedure, as the signs and symptoms are heterogeneous and of undefined aetiology. AIM This study is aimed to evaluate serum anti-Mullerian hormone (AMH) level and luteinizing hormone (LH)/folic stimulating hormone (FSH) ratio in women with PCOS in Sudan and to assess the diagnostic efficiency for the diagnosis of PCOS. METHODS In a case-control study, Serum AMH, LH, FSH was measured in the early follicular phase from Sudanese patients (N = 230) with PCOS and100 controls. The LH/FSH ratio was calculated, and its diagnostic power was evaluated by receiver operating characteristic curves. RESULTS The means of serum AMH, serum LH level and LH/FSH ratio of the test, were significantly increased in the test group compared to the control group (P-value < 0.000). The AMH sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were found to be 83%, 99%, 99%, and 72% respectively. Serum AMH was considered adequate measures for the diagnosis of PCOS; its level showed an area under the ROC curve of 0.98 (95% confidence, P-value < 0.000). The best compromise between 98% specificity and 90% sensitivity was obtained with a cut-off value of 3.3 ng/mL for PCOS diagnosis. There was no correlation between age, body mass index (BMI) and AMH level in the test group. CONCLUSIONS The Serum AMH level and LH/FSH ratio were higher in patients than in control. However AMH level has better discriminative power and good diagnostic potency for the diagnosis of the PCOS among Sudanese women.
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Affiliation(s)
- Hafza Tola
- Faculty of Medical Laboratory Sciences, Alzaim Alazhari University, Sudan
| | - Mohammed Abbas
- Medical Laboratory Sciences Program, Allied Health Department, College of Health Sciences, University of Bahrain, Kingdom of Bahrain
| | | | - Nassr Eldin Shrif
- Faculty of Medical Laboratory Sciences, Alzaim Alazhari University, Sudan
| | - Mohammed Rida
- Dr. Elsir Abu Alhassan Fertility Center, Khartoum, Sudan
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Merlo E, Silva IV, Cardoso RC, Graceli JB. The obesogen tributyltin induces features of polycystic ovary syndrome (PCOS): a review. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2018; 21:181-206. [PMID: 30015594 DOI: 10.1080/10937404.2018.1496214] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a heterogeneous syndrome characterized by abnormal reproductive cycles, irregular ovulation, and hyperandrogenism. This complex disorder has its origins both within and outside the hypothalamic-pituitary-ovarian axis. Cardio-metabolic factors, such as obesity and insulin resistance, contribute to the manifestation of the PCOS phenotype. Polycystic ovary syndrome is one of the most common endocrine disorders among women of reproductive age. Growing evidence suggested an association between reproductive and metabolic features of PCOS and exposure to endocrine-disrupting chemicals (EDC), such as bisphenol A. Further, the environmental obesogen tributyltin (TBT) was shown to induce reproductive, metabolic and cardiovascular abnormalities resembling those found in women and animal models of PCOS. However, the causal link between TBT exposure and PCOS development remains unclear. The objective of this review was to summarize the most recent research findings on the potential association between TBT exposure and development of PCOS-like features in animal models and humans.
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Affiliation(s)
- Eduardo Merlo
- a Department of Morphology , Federal University of Espirito Santo , Vitoria, Brazil
| | - Ian V Silva
- a Department of Morphology , Federal University of Espirito Santo , Vitoria, Brazil
| | - Rodolfo C Cardoso
- b Department of Animal Science , Texas A&M University , College Station, TX, USA
| | - Jones B Graceli
- a Department of Morphology , Federal University of Espirito Santo , Vitoria, Brazil
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13
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Escobar-Morreale HF, Santacruz E, Luque-Ramírez M, Botella Carretero JI. Prevalence of 'obesity-associated gonadal dysfunction' in severely obese men and women and its resolution after bariatric surgery: a systematic review and meta-analysis. Hum Reprod Update 2017; 23:390-408. [PMID: 28486593 DOI: 10.1093/humupd/dmx012] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/21/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Sexual dimorphism manifests noticeably in obesity-associated gonadal dysfunction. In women, obesity is associated with androgen excess disorders, mostly the polycystic ovary syndrome (PCOS), whereas androgen deficiency is frequently present in obese men in what has been termed as male obesity-associated secondary hypogonadism (MOSH). Obesity-associated gonadal dysfunction, consisting of PCOS in women and MOSH in men, is a frequent finding in patients with severe obesity and it may be ameliorated or even resolve with marked weight loss, especially after bariatric surgery. OBJECTIVE AND RATIONALE We aimed to obtain an estimation of the prevalence of obesity-associated gonadal dysfunction among women and men presenting with severe obesity and to evaluate the response to bariatric surgery in terms of resolution and/or improvement of this condition and changes in circulating sex hormone concentrations. SEARCH METHODS We searched PubMed and EMBASE for articles published up to June 2016. After deleting duplicates, the abstract of 757 articles were analyzed. We subsequently excluded 712 articles leaving 45 studies for full-text assessment of eligibility. Of these, 16 articles were excluded. Hence, 29 studies were included in the quantitative synthesis and in the different meta-analyses. Quality of the studies was assessed using the Quality index for prevalence studies and the Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group available from the National Heart, Lung and Blood Institute. For meta-analyses including more than 10 studies, we used funnel and Doi plots to estimate publication bias. OUTCOMES In severely obese patients submitted to bariatric surgery, obesity-associated gonadal dysfunction was very prevalent: PCOS was present in 36% (95CI 22-50) of women and MOSH was present in 64% (95CI 50-77) of men. After bariatric surgery, resolution of PCOS was found in 96% (95CI 89-100) of affected women and resolution of MOSH occurred in 87% (95CI 76-95) of affected men. Sex hormone-binding globulin concentrations increased after bariatric surgery in women (22 pmol/l, 95CI 2-47) and in men (22 pmol/l, 95CI 19-26) and serum estradiol concentrations decreased in women (-104 pmol/l, 95CI -171 to -39) and to a lesser extent in men (-22 pmol/l, 95CI -38 to -7). On the contrary, sex-specific changes were observed in serum androgen concentrations: for example, total testosterone concentration increased in men (8.1 nmol/l, 95CI 6-11) but decreased in women (-0.7 nmol/l, 95CI -0.9 to -0.5). The latter was accompanied by resolution of hirsutism in 53% (95CI 29-76), and of menstrual dysfunction in 96% (95CI 88-100), of women showing these symptoms before surgery. WIDER IMPLICATIONS Obesity-associated gonadal dysfunction is among the most prevalent comorbidities in patients with severe obesity and should be ruled out routinely during their initial diagnostic workup. Considering the excellent response regarding both PCOS and MOSH, bariatric surgery should be offered to severely obese patients presenting with obesity-associated gonadal dysfunction.
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Affiliation(s)
- Hector F Escobar-Morreale
- Department of Endocrinology and Metabolism, Hospital Universitario Ramón y Cajal & Universidad de Alcalá, E-28034 Madrid, Spain.,Diabetes, Obesity and Human Reproduction Group, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) & Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
| | - Elisa Santacruz
- Department of Endocrinology and Metabolism, Hospital Universitario Ramón y Cajal & Universidad de Alcalá, E-28034 Madrid, Spain.,Diabetes, Obesity and Human Reproduction Group, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) & Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
| | - Manuel Luque-Ramírez
- Department of Endocrinology and Metabolism, Hospital Universitario Ramón y Cajal & Universidad de Alcalá, E-28034 Madrid, Spain.,Diabetes, Obesity and Human Reproduction Group, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) & Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
| | - José I Botella Carretero
- Department of Endocrinology and Metabolism, Hospital Universitario Ramón y Cajal & Universidad de Alcalá, E-28034 Madrid, Spain.,Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain
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14
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Mariona FG. Perspectives in obesity and pregnancy. WOMEN'S HEALTH (LONDON, ENGLAND) 2016; 12:523-532. [PMID: 29334009 PMCID: PMC5373261 DOI: 10.1177/1745505716686101] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/17/2016] [Accepted: 12/02/2016] [Indexed: 02/06/2023]
Abstract
Obesity is currently recognized as a health epidemic worldwide. Its prevalence has doubled in the last three decades. Obesity is a complex clinical picture associated with physical, physiologic, hormonal, genetic, cultural, socioeconomic and environmental factors. The rate of obesity is also increasing in the pregnant women population. Maternal obesity is associated with less than optimal obstetrical, fetal and neonatal outcomes. It is also associated with significant adverse long-term effects on both obese parturients and the infants born from obese women. A number of guidelines have been published to educate health care workers and the general population in an attempt to develop effective interventions on a large scale to prevent obesity. These guidelines are multiple, confusing and inconsistent. There are no standard recommendations regarding gestational weight gaining goals, nutrients and additional elements necessary for certain obese women who have been treated with bariatric surgical procedures, screening for metabolic diseases such as diabetes, additional preventive health care services indicated for obese women in the pregnancy planning stages, during prenatal care, in the immediate post-partum period and as a long-term approach for health preservation. In 2013, the American Medical Association supported by several US national medical specialty organizations published Resolution 420 (A-13) recognizing obesity as a disease state with multiple pathophysiological aspects requiring a range of interventions to improve its prevention and treatment. The goal of this decision was to encourage a broader spectrum of health care benefits insurance coverage for the prevention and treatment of obesity. There are a number of myths and misconceptions associated with obesity. These perspectives present our views and clinical experience with a partial review of recent bibliography addressing the associations between obese reproductive age women and their risks during pregnancy.
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Affiliation(s)
- Federico G. Mariona
- Division of Maternal-Fetal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
- Michigan Perinatal Associates, Dearborn, MI, USA
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15
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Ismail KMK, Issa BG, Jones P, Hanna FW, Indusekhar R. Hypoglycaemic agents for pregnant women with polycystic ovarian syndrome. Hippokratia 2016. [DOI: 10.1002/14651858.cd009828.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Khaled MK Ismail
- University of Birmingham; School of Clinical and Experimental Medicine, College of Medical and Dental Sciences; 3rd Floor, Birmingham Women's Foundation Trust Edgbaston Birmingham UK B15 2TG
| | - Basil G Issa
- South Manchester University Hospital Trust; Department of Endocrinology and Diabetes; Wythenshawe Hospital Southmoor Road Manchester UK M23 9LT
| | - Peter Jones
- Keele University; School of Computing & Mathematics; Keele Stafforshire UK ST5 5BG
| | - Fahmy W Hanna
- University Hospital of North Staffordshire; Department of Diabetes and Endocrinology; Stoke-on-Trent UK ST4 6QG
| | - Radha Indusekhar
- University Hospital of North Staffordshire, City General Hospital; Department of Obstetrics and Gynaecology, Women and Children's Division; Stoke-on-Trent Staffordshire UK
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16
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Singh AK, Singh R. Can anti-Mullerian hormone replace ultrasonographic evaluation in polycystic ovary syndrome? A review of current progress. Indian J Endocrinol Metab 2015; 19:731-743. [PMID: 26693422 PMCID: PMC4673800 DOI: 10.4103/2230-8210.167548] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Several studies over the past decade have now consistently indicated that the serum anti-Mullerian hormone (AMH) levels are at least 2-3-fold higher in the patients with polycystic ovary syndrome (PCOS), which also corresponds to the increased number of AMH producing preantral and small antral follicles. Moreover, AMH levels have been found to be associated in direct proportion to the follicle numbers per ovary or antral follicular count, assessed by the transvaginal ultrasound (TVS). Furthermore, AMH correlates directly with the rising serum testosterone and luteinizing hormone levels in PCOS. Hence, serum AMH in women with oligo-anovulation and/or hyperandrogenemia could indicate the presence of underlying PCOS, when reliable TVS is not feasible, or not acceptable, either due to the virginal status or psycho-social issue. In addition, the imaging quality of abdominal ultrasound is often impaired by obesity, which typically occurs in PCOS women. Indeed, PCOS occurs most commonly in young females who cannot be subjected to invasive TVS for various reasons; therefore, a desirable alternative to TVS is urgently required to diagnose the most prevalent endocrine abnormality of young women. This review will analyze the currently available evidence regarding the role of AMH in the diagnosis of PCOS.
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Affiliation(s)
- Awadhesh Kumar Singh
- Department of Endocrinology, GD Hospital and Diabetes Institute, Kolkata, West Bengal, India
- Department of Endocrinology, Sun Valley Diabetes Hospital, Guwahati, Assam, India
| | - Ritu Singh
- Department of Gynecology, GD Hospital and Diabetes Institute, Kolkata, West Bengal, India
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17
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Hecht Baldauff N, Arslanian S. Optimal management of polycystic ovary syndrome in adolescence. Arch Dis Child 2015; 100:1076-83. [PMID: 26101431 DOI: 10.1136/archdischild-2014-306471] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 06/02/2015] [Indexed: 11/03/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a heterogeneous disorder of reproduction and metabolism, which emerges at puberty, and is characterised by a wide spectrum of signs and symptoms of hyperandrogenism, anovulation, hyperinsulinaemia and associated comorbidities. Unlike adult PCOS, there are no agreed-upon diagnostic criteria for adolescent PCOS, but hyperandrogenaemia remains the sine qua non for its diagnosis. Many adolescent girls with PCOS are overweight/obese, and have a heightened risk for comorbidities such as dysglycaemia, dyslipidaemia, fatty liver disease, sleep apnoea and cardiovascular disease. Therefore, early and accurate diagnosis is essential for implementation of appropriate treatment and management. Available treatments include lifestyle modifications, hormonal contraceptives and insulin sensitisers. However, there are limited data on the best treatment modalities in adolescents. The objective of this review is to describe the clinical manifestations of PCOS in adolescents and the appropriate diagnostic work-up. The optimal treatment modalities based on a review of the available adult and adolescent literature will be discussed.
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Affiliation(s)
- Natalie Hecht Baldauff
- Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Silva Arslanian
- Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA Division of Weight Management and Wellness, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
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18
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Marzouk T, Nabil H, Senna M. Impact of a Lifestyle Modification Program on Menstrual Irregularity among Overweight or Obese Women with Polycystic Ovarian Syndrome. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2015; 21:161-170. [PMID: 37684821 DOI: 10.4069/kjwhn.2015.21.3.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 09/10/2023] Open
Abstract
PURPOSE This study aimed to evaluate the impact of a lifestyle modification program on menstrual irregularity among overweight and obese women with polycystic ovarian syndrome. METHODS A quasi experimental research design was used to conduct this study on 82 women with polycystic ovarian syndrome at the Gynecology and Obesity clinics of Mansoura University Hospital, Egypt. Two groups were included; the study group received a lifestyle modification program for 48 weeks, while the control group was not subjected to this program. Data collection was done for the following variables, a structured interview questionnaire was used to assess the women's general characteristics, menstrual patterns, and 24-hour dietary recall and the researcher took anthropometric measurements and assessed hirsutism by the Ferriman-Gallwey scale. RESULTS After one year of lifestyle modification, the number of menstrual cycles significantly increased from 2.7+/-1.6 to 6.9+/-1.5 (t=12.26, p<.001) in the study group compared to insignificant minor changes among the control group (t=0.69, p=.488). Additionally, 58.5% were menstruating regularly compared to none in the control group (chi2=33.93, p<.001). CONCLUSION Participating in a lifestyle modification program was effective in reducing menstrual cycle's irregularity among overweight and obese women with PCOS. Thus, it is recommended to motivate the nurses in counseling the PCOS women on lifestyle modifications.
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Affiliation(s)
- Tyseer Marzouk
- Woman's Health and Midwifery Nursing Department, Faculty of Nursing, Mansoura University, Egypt
| | - Hanan Nabil
- Woman's Health and Midwifery Nursing Department, Faculty of Nursing, Mansoura University, Egypt
| | - Mohammed Senna
- Woman's Health and Midwifery Nursing Department, Faculty of Nursing, Mansoura University, Egypt
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Nasrat H, Patra SK, Goswami B, Jain A, Raghunandan C. Study of Association of Leptin and Insulin Resistance Markers in Patients of PCOS. Indian J Clin Biochem 2015; 31:104-7. [PMID: 26855496 DOI: 10.1007/s12291-015-0499-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 04/12/2015] [Indexed: 10/23/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrinological disorder among women of the reproductive age group with long term sequelae which include diabetes mellitus, hypertension and CAD. The present study was conducted to evaluate the association of leptin-an adipokine playing an important role in carbohydrate metabolism and markers of insulin resistance among women with PCOS. Sixty diagnosed cases of PCOS as per Rotterdam criteria were enrolled in this study after informed written consent. Insulin resistance was estimated using the homeostatic model assessment-insulin resistance (HOMA-IR). HOMA-IR was calculated as the product of the fasting plasma insulin value (mU/ml) and the fasting plasma glucose value (mg/dl), divided by 405 and HOMA β was calculated as 360 × [insulin]/([glucose] - 63) % (glucose in mg/dl). Estimation of serum leptin levels was done by ELISA using leptin ELISA kit from (DRG). A positive correlation of serum leptin levels was observed with markers of insulin resistance. Multiple regression analysis with HOMA-IR as dependent variable demonstrated a statistically significant contribution of fasting insulin levels. This study highlights the role of leptin in alterations in carbohydrate metabolism in patients with PCOS.
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Affiliation(s)
- Huma Nasrat
- Department of Biochemistry, Lady Hardinge Medical College, New Delhi, India
| | - Surajeet K Patra
- Department of Biochemistry, Lady Hardinge Medical College, New Delhi, India
| | - Binita Goswami
- Department of Biochemistry, Lady Hardinge Medical College, New Delhi, India
| | - Anju Jain
- Department of Biochemistry, Lady Hardinge Medical College, New Delhi, India
| | - Chitra Raghunandan
- Department of Obstetrics & Gynecology, Lady Hardinge Medical College, New Delhi, India
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Sedighi S, Amir Ali Akbari S, Afrakhteh M, Esteki T, Alavi Majd H, Mahmoodi Z. Comparison of lifestyle in women with polycystic ovary syndrome and healthy women. Glob J Health Sci 2014; 7:228-34. [PMID: 25560358 PMCID: PMC4796416 DOI: 10.5539/gjhs.v7n1p228] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/27/2014] [Accepted: 07/21/2014] [Indexed: 01/20/2023] Open
Abstract
Given the high prevalence of polycystic ovary syndrome (PCOS), and that a lifestyle is recognized effective in development of many diseases, this study aimed to compare lifestyle of women with PCOS and healthy women. Nor are there sufficient studies on the difference between lifestyle of these people with that of healthy people. Furthermore, studies show that changes in lifestyle improve this disease. This descriptive-comparative study was conducted on 65 women with PCOS and 65 healthy women of 18 to 45 years old who presented to hospitals affiliated to Shahid Beheshti University of Medical Sciences in 2013. The subjects were selected using multi stage random sampling method. The data were collected using questionnaires for diet, International Physical Activity Questionnaire, and unhealthy behaviors and were analyzed in SPSS v. 17, using descriptive statistics, Man-Whitney, independent t, Chi-square and logistic regression tests. The results showed there was a significant relationship between PCOS and inappropriate diet (p=0.009), low physical activity (p=0.009), but no relationship was observed between PCOS and unhealthy behaviors. Given the results obtained, training and awareness raising is necessary for women and girls especially about appropriate diet and regular physical activity.
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Affiliation(s)
| | - Sedigheh Amir Ali Akbari
- Department of Midwifery, Nursing and Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Derman EW, Patel DN, Nossel CJ, Schwellnus MP. Healthy lifestyle interventions in general practice. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2008.10873732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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22
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Estrada E, Eneli I, Hampl S, Mietus-Snyder M, Mirza N, Rhodes E, Sweeney B, Tinajero-Deck L, Woolford SJ, Pont SJ. Children's Hospital Association consensus statements for comorbidities of childhood obesity. Child Obes 2014; 10:304-17. [PMID: 25019404 PMCID: PMC4120655 DOI: 10.1089/chi.2013.0120] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Childhood obesity and overweight affect approximately 30% of US children. Many of these children have obesity-related comorbidities, such as hypertension, dyslipidemia, fatty liver disease, diabetes, polycystic ovary syndrome (PCOS), sleep apnea, psychosocial problems, and others. These children need routine screening and, in many cases, treatment for these conditions. However, because primary care pediatric providers (PCPs) often are underequipped to deal with these comorbidities, they frequently refer these patients to subspecialists. However, as a result of the US pediatric subspecialist shortage and considering that 12.5 million children are obese, access to care by subspecialists is limited. The aim of this article is to provide accessible, user-friendly clinical consensus statements to facilitate the screening, interpretation of results, and early treatment for some of the most common childhood obesity comorbidities. METHODS Members of the Children's Hospital Association (formerly NACHRI) FOCUS on a Fitter Future II (FFFII), a collaboration of 25 US pediatric obesity centers, used a combination of the best available evidence and collective clinical experience to develop consensus statements for pediatric obesity-related comorbidities. FFFII also surveyed the participating pediatric obesity centers regarding their current practices. RESULTS The work group developed consensus statements for use in the evaluation and treatment of lipids, liver enzymes, and blood pressure abnormalities and PCOS in the child with overweight and obesity. The results of the FFFII survey illustrated the variability in the approach for initial evaluation and treatment as well as pattern of referrals to subspecialists among programs. CONCLUSIONS The consensus statements presented in this article can be a useful tool for PCPs in the management and overall care of children with overweight and obesity.
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Affiliation(s)
- Elizabeth Estrada
- Division of Endocrinology, Connecticut Children's Medical Center, University of Connecticut, Hartford, CT
| | - Ihuoma Eneli
- Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | - Sarah Hampl
- Weight Management, Children's Mercy Hospital, University of Missouri–Kansas City, Kansas City, MO
| | - Michele Mietus-Snyder
- Department of Pediatrics, Children's National Medical Center, George Washington University School of Medicine, Washington, DC
| | - Nazrat Mirza
- Department of Pediatrics, Children's National Medical Center, George Washington University School of Medicine, Washington, DC
| | - Erinn Rhodes
- Division of Endocrinology, Boston Children's Hospital, Boston, MA
| | - Brooke Sweeney
- Department of Pediatrics, Kosair Children's Hospital, University of Louisville, Louisville, KY
| | | | - Susan J. Woolford
- Department of Pediatrics, C.S. Mott Children's Hospital and Von Voigtlander Women's Hospital, University of Michigan, Ann Arbor, MI
| | - Stephen J. Pont
- Dell Children's Medical Center, University of Texas Southwestern, Austin, TX
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Massicotte MH, Langlois F, Baillargeon JP. Current procedures for managing polycystic ovary syndrome. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.09.74] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Eilertsen TB, Vanky E, Carlsen SM. Anti-Mullerian hormone in the diagnosis of polycystic ovary syndrome: can morphologic description be replaced? Hum Reprod 2012; 27:2494-502. [DOI: 10.1093/humrep/des213] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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25
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Ismail KMK, Issa BG, Jones P, Hanna FW, Indusekhar R. Hypoglycaemic agents for pregnant women with polycystic ovarian syndrome. Cochrane Database Syst Rev 2012. [DOI: 10.1002/14651858.cd009828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Atis A, Aydin Y, Ciftci F, Sakız D, Arslan A, Toklu AS, Donmez M, Goker N. Hyberbaric oxygen increases atresia in normal & steroid induced PCO rat ovaries. Reprod Biol Endocrinol 2012; 10:11. [PMID: 22309835 PMCID: PMC3395821 DOI: 10.1186/1477-7827-10-11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 02/06/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In this study, we investigated the effect of hyperbaric oxygen therapy (HBOT) on the morphology of estradiol valerate (EV) induced polycystic ovary (PCO) to find a new treatment modality for improvement of PCO. METHODS The rats were divided into four groups. Group1, control; group 2, PCO group; group 3, PCO with HBOT group and group 4, normal ovary with HBOT. PCO was induced by a single intramuscular injection of 4 mg EV in adult cycling rats. Other rats with normal ovaries had oil injection as placebo. HBOT was applied to third and fourth groups for six weeks. Histopathologic evaluation of ovaries of all groups were performed & compared. RESULTS Six weeks of HBOT was resulted in increase in follicular atresia, decrease in the number of primary, secondary, tertiary follicles and decrease in the number of fresh corpus luteum in normal rat ovary. HBOT on polycystic rat ovary, resulted in significant increase in atretic follicles which were already present. CONCLUSIONS HBOT of six weeks itself, changed ovarian morphology in favor of atresia both in PCO group and control group. This result of aggravated follicular atresia after HBOT on EV induced PCO may be due to long-term exposure in our protocol which with this state seems to be inapplicable in the improvement of PCO morphology.
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Affiliation(s)
- Alev Atis
- Sisli Etfal Training & Research Hospital Obstetrics & Gynecology, Istanbul, Turkey
| | - Yavuz Aydin
- Istanbul University Medicosocial Unit Department of Obstetrics & Gynecology, Istanbul, Turkey
| | - Filiz Ciftci
- Sisli Etfal Training & Research Hospital Obstetrics & Gynecology, Istanbul, Turkey
| | - Damlanur Sakız
- Sisli Etfal Training & Research Hospital Department of Pathology, Istanbul, Turkey
| | - Abdullah Arslan
- Istanbul University Faculty of Medicine, Department of Underwater and Hyperbaric Medicine, Istanbul, Turkey
| | - Akın S Toklu
- Istanbul University Faculty of Medicine, Department of Underwater and Hyperbaric Medicine, Istanbul, Turkey
| | - Melahat Donmez
- Sisli Etfal Training & Research Hospital Obstetrics & Gynecology, Istanbul, Turkey
| | - Nimet Goker
- Sisli Etfal Training & Research Hospital Obstetrics & Gynecology, Istanbul, Turkey
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Jamal M, Gunay Y, Capper A, Eid A, Heitshusen D, Samuel I. Roux-en-Y gastric bypass ameliorates polycystic ovary syndrome and dramatically improves conception rates: a 9-year analysis. Surg Obes Relat Dis 2011; 8:440-4. [PMID: 22169760 DOI: 10.1016/j.soard.2011.09.022] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 09/13/2011] [Accepted: 09/19/2011] [Indexed: 12/23/2022]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a common cause of infertility, especially in the morbidly obese. We evaluated the long-term effects of Roux-en-Y gastric bypass on PCOS and infertility. METHODS A total of 566 morbidly obese women underwent Roux-en-Y gastric bypass from 2000 to 2009. A total of 31 patients (5.5%) had a history of PCOS. Of the 31 patients, 6 were postmenopausal and 5 lost to follow-up and were excluded. Telephone interviews were conducted with the 20 eligible patients. RESULTS The mean age and body mass index was 32 ± 5.8 years (range 22-42) and 52.8 ± 9.08 kg/m(2) (range 37-76) before surgery. All 20 patients had ≥ 2 of 3 diagnostic criteria for PCOS, including clinical or biochemical evidence of hyperandrogenism, anovulation, or polycystic ovaries. Of these, 85% had oligomenorrhea, 70% had hirsutism, and 45% had type 2 diabetes mellitus with medication. Before surgery, 8 patients conceived with or without hormonal treatment, 2 did not desire pregnancy, and 10 did not conceive. The mean follow-up was 46.7 months. After surgical weight loss, menstruation was corrected in 82%, hirsutism had resolved in 29%, and 77.8% of those with diabetes had complete remission. Of the 10 patients who did not conceive before surgery, 4 no longer desired pregnancy, and the remaining 6 patients had become pregnant within 3 years of surgery-5 without any hormonal treatment and 1 with in utero insemination. CONCLUSION Surgical weight loss after Roux-en-Y gastric bypass achieves excellent amelioration of PCOS manifestations and the postoperative conception rate in infertile PCOS subjects desiring pregnancy was 100%.
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Affiliation(s)
- Mohammad Jamal
- Department of Surgery, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA
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Ornstein RM, Copperman NM, Jacobson MS. Effect of weight loss on menstrual function in adolescents with polycystic ovary syndrome. J Pediatr Adolesc Gynecol 2011; 24:161-5. [PMID: 21419674 DOI: 10.1016/j.jpag.2011.01.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 01/11/2011] [Accepted: 01/17/2011] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE To compare the effects of a hypocaloric low-fat diet with those of a very low carbohydrate diet on body mass index (BMI), waist circumference (WC), and menstrual function in overweight adolescent females with polycystic ovary syndrome (PCOS). DESIGN Randomized pilot trial of two diets in a prospective, 12-week study. SETTING A hospital-based, academic adolescent medicine division. PARTICIPANTS 24 females, age 12-22 years (mean 15.8 ± 2.2), with PCOS and a BMI above the 85(th) percentile for age (mean 35.7 ± 6.0 kg/m(2)). INTERVENTIONS Nutrition counseling was given biweekly, and dietary compliance, menstrual history, and weight were recorded. WC was measured at the beginning and end of the study. MAIN OUTCOME MEASURES Changes in weight, BMI, WC, and improvement in menstrual function over the course of the study period. RESULTS 16 participants completed the study. 12 completers menstruated during the study period, 8 with regularity. The number of periods over 3 months increased from 0.6 ± 0.6 pre-treatment to 1.6 ± 1.3 post-treatment (P = 0.003). Overall, weight loss averaged 6.5% (P < 0.0001) and the WC decreased by an average of 5.7 ± 7.7 cm (P = 0.01). Those who lost weight were 3.4 times more likely to have improved menstrual function (P = 0.001). There were no statistically significant differences between the two groups. CONCLUSIONS Weight loss is feasible in adolescents with PCOS and results in significant improvements in BMI, WC, and menstrual function. Weight management may be preferable as first-line treatment in adolescents, because it targets both the menstrual dysfunction and risk factors for long-term morbidity associated with PCOS.
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Affiliation(s)
- Rollyn M Ornstein
- Division of Adolescent Medicine and Eating Disorders, Penn State Hershey Children's Hospital, Hershey, Pennsylvania, USA.
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Jones GL, Palep-Singh M, Ledger WL, Balen AH, Jenkinson C, Campbell MJ, Lashen H. Do South Asian women with PCOS have poorer health-related quality of life than Caucasian women with PCOS? A comparative cross-sectional study. Health Qual Life Outcomes 2010; 8:149. [PMID: 21171983 PMCID: PMC3024276 DOI: 10.1186/1477-7525-8-149] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 12/20/2010] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is the most common chronic endocrine disorder affecting women of reproductive age. This study aimed to compare the HRQoL of South Asian and white Caucasian women with PCOS, given that it is particularly common among women of South Asian origin and they have been shown to have more severe symptoms. METHODS The Polycystic Ovary Syndrome Questionnaire (PCOSQ) and the Short Form-36 (SF-36) were administered in a cross-sectional survey to 42 South Asian and 129 Caucasian women diagnosed with PCOS recruited from the gynaecology outpatient clinics of two university teaching hospitals in Sheffield and Leeds. Additional clinical data was abstracted from medical notes. Normative data, collected as part of the Oxford Health and Lifestyles II survey, was obtained to compare SF-36 results with ethnically matched women from the general UK population. Using the SF-36, normative HRQoL scores for women of South Asian origin were lower than for Caucasian women. Given this lower baseline we tested whether the same relationship holds true among those with PCOS. RESULTS Although HRQoL scores for women with PCOS were lower than normative data for both groups, South Asian women with PCOS did not have poorer HRQoL than their Caucasian counterparts. For both the SF-36 and PCOSQ, mean scores were broadly the same for both Asian and Caucasian women. For both groups, the worst two HRQoL domains as measured on the PCOSQ were 'infertility' and 'weight', with respective scores of 35.3 and 42.3 for Asian women with PCOS compared to 38.6 and 35.4 for Caucasian women with PCOS. The highest scoring domain for South Asian women with PCOS was 'menstrual problems' (55.3), indicating best health, and was the only statistically significant difference from Caucasian women (p = 0.01). On the SF-36, the lowest scoring domain was 'Energy & Vitality' for Caucasian women with PCOS, but this was significantly higher for Asian women with PCOS (p = 0.01). The best health status for both groups was 'physical functioning', although this was significantly lower for South Asian women with PCOS (p = 0.005). Interestingly, only two domains differed significantly from the normative data for the Asian women with PCOS, while seven domains were significantly different for the Caucasian women with PCOS compared to their normative counterparts. CONCLUSIONS The HRQoL differences that exist between South Asian and Caucasian women in the general population do not appear to be replicated amongst women with PCOS. PCOS reduces HRQoL to broadly similar levels, regardless of ethnicity and differences in the normative baseline HRQoL of these groups.
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Affiliation(s)
- Georgina L Jones
- Senior Lecturer, Health Services Research Section, ScHARR, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Manisha Palep-Singh
- Consultant Gynaecologist & Subspecialist in Reproductive Medicine & Surgery, Saint Mary's University Teaching Hospital & CMMC NHS Trust, Manchester, M13 0JH, UK
| | - William L Ledger
- Professor, Academic Unit of Reproductive & Developmental Medicine, Jessop Wing Hospital, Tree Root Walk, Sheffield, S10 2TJ, UK
| | - Adam H Balen
- Professor, United Leeds Teaching Hospitals, Clarendon Wing, Leeds General Infirmary, LS2 9NS, UK
| | - Crispin Jenkinson
- Professor, Department of Public Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Michael J Campbell
- Professor, Medical Statistics Unit, ScHARR, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Hany Lashen
- Senior Lecturer, Academic Unit of Reproductive & Developmental Medicine, Jessop Wing Hospital, Tree Root Walk, Sheffield, S10 2TJ, UK
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Deligeoroglou E, Athanasopoulos N, Tsimaris P, Dimopoulos KD, Vrachnis N, Creatsas G. Evaluation and management of adolescent amenorrhea. Ann N Y Acad Sci 2010; 1205:23-32. [DOI: 10.1111/j.1749-6632.2010.05669.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Oliveira A, Sampaio B, Teixeira A, Castro-Correia C, Fontoura M, Luís Medina J. Polycystic ovary syndrome: challenges in adolescence. ACTA ACUST UNITED AC 2010; 57:328-36. [PMID: 20708160 DOI: 10.1016/j.endonu.2010.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 04/05/2010] [Accepted: 04/12/2010] [Indexed: 12/12/2022]
Abstract
Polycystic ovary syndrome (PCOS) is one of the most common endocrine diseases in women of reproductive age. PCOS typically develops during adolescence and is a heterogeneous syndrome classically characterized by features of anovulation combined with signs of androgen excess (hirsutism, acne). Increasing obesity in adolescents probably exacerbates signs of PCOS, contributing to its earlier recognition. Recognizing the features of this syndrome can be very challenging in adolescence. Although adolescents' concerns are often cosmetic, if left untreated these girls are at risk for diabetes, metabolic syndrome, and infertility as they mature. Efforts should be made to diagnose and treat PCOS to minimize the development of symptoms and prevent the onset of cardiovascular and metabolic disturbances.
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Affiliation(s)
- Ana Oliveira
- Endocrinology Department, Hospital de São João-EPE, Porto, Portugal.
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Women's perceptions of polycystic ovary syndrome following participation in a clinical research study: implications for knowledge, feelings, and daily health practices. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010; 32:453-459. [PMID: 20500954 DOI: 10.1016/s1701-2163(16)34499-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Polycystic ovary syndrome (PCOS) is a complex endocrine disorder that affects 6% to 10% of reproductive aged women. It is a poorly understood and often undiagnosed condition that has implications for the health of affected women. We assessed changes in knowledge, feelings, and daily health practices related to PCOS in clinical research study participants. METHODS Sixty-eight women who had received counselling and education about PCOS while participating in a clinical research study were invited to complete an online survey that assessed levels of concern, knowledge, healthy dieting, active living, and health care satisfaction before and after the study. Differences and associations between scores were analyzed by paired t tests and Pearson correlation. RESULTS Forty-three women (63%) completed the survey. After taking part in a clinical research study, participants believed they had increased knowledge of (P < 0.001) and concern about (P = 0.029) the etiology and health consequences of PCOS, better lifestyle practices (P < 0.001), and improved health care satisfaction (P = 0.045). Enhanced knowledge of PCOS was positively associated with changes in concern (P = 0.045), healthy dietary habits (P = 0.04), activity levels (P = 0.003), and health care satisfaction (P < 0.001). After the study, women felt empowered to participate in the management of their condition and communicate with their primary care providers. CONCLUSION Women with PCOS felt that they had more knowledge and motivation to implement preventive health strategies after participating in a clinical research study. Education about how PCOS affects their immediate and long-term health enabled women with PCOS to feel physical and psychological benefits and to engage more with their health care providers.
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Bekx MT, Connor EC, Allen DB. Characteristics of adolescents presenting to a multidisciplinary clinic for polycystic ovarian syndrome. J Pediatr Adolesc Gynecol 2010; 23:7-10. [PMID: 19648034 DOI: 10.1016/j.jpag.2009.04.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Revised: 04/06/2009] [Accepted: 04/08/2009] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To characterize patients referred to the adolescent polycystic ovarian syndrome (PCOS) clinic at the American Family Children's Hospital, University of Wisconsin, Madison, Wisconsin. DESIGN Chart review of patients seen in the first 33 months for details of initial presentation, age, body mass index (BMI), menstrual pattern, clinical and laboratory features of androgen excess, insulin resistance, and dyslipidemia. SETTING Multidisciplinary clinic for adolescents with PCOS at the American Family Children's Hospital, Madison, Wisconsin. PARTICIPANTS Adolescent girls with PCOS. RESULTS Seventy patients (84% Caucasian) presented with an average age at referral of 16.2 years (range 11-22 y). Eighty four percent had a BMI > the 85(th) percentile and 70% had a BMI > 95(th) percentile. Menstrual pattern was quite varied, with some patients having primary amenorrhea, and over 50% experiencing hirsutism. There were 3 cases of type 2 diabetes, and over half of the patients had elevated fasting insulin levels and low HDL levels. CONCLUSION Polycystic ovarian syndrome is a complex and heterogeneous disorder that requires multidisciplinary expertise. Knowing the unique features of the adolescent with PCOS and metabolic risks should permit earlier intervention with intensive counseling and medical therapy to address current health concerns and prevent future co-morbidities.
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Affiliation(s)
- M Tracy Bekx
- Department of Pediatric Endocrinology, American Family Children's Hospital, Madison, Wisconsin, USA.
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Percy CA, Gibbs T, Potter L, Boardman S. Nurse-led peer support group: experiences of women with polycystic ovary syndrome. J Adv Nurs 2009; 65:2046-55. [DOI: 10.1111/j.1365-2648.2009.05061.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shi D, Dyck MK, Uwiera RRE, Russell JC, Proctor SD, Vine DF. A unique rodent model of cardiometabolic risk associated with the metabolic syndrome and polycystic ovary syndrome. Endocrinology 2009; 150:4425-36. [PMID: 19470707 DOI: 10.1210/en.2008-1612] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism, oligo-/anovulation, and polycystic ovarian morphology and is a complex endocrine disorder that also presents with features of the metabolic syndrome, including obesity, insulin resistance, and dyslipidemia. These latter symptoms form cardiometabolic risk factors predisposing individuals to the development of type 2 diabetes and cardiovascular disease (CVD). To date, animal models to study PCOS in the context of the metabolic syndrome and CVD risk have been lacking. The aim of this study was to investigate the JCR:LA-cp rodent as an animal model of PCOS associated with the metabolic syndrome. Metabolic indices were measured at 6 and 12 wk, and reproductive parameters including ovarian morphology and estrous cyclicity were assessed at 12 wk or adulthood. At 6 wk of age, the cp/cp genotype of the JCR:LA-cp strain developed visceral obesity, insulin resistance, and dyslipidemia (hypertriglyceridemia and hypercholesterolemia) compared with control animals. Serum testosterone concentrations were not significantly different between groups at 6 wk of age. However, at 12 wk, the cp/cp genotype had higher serum testosterone concentrations, compared with control animals, and presented with oligoovulation, a decreased number of corpora lutea, and an increased number of total follicles, in particular atretic and cystic follicles. The cardiometabolic risk factors in the cp/cp animals were exacerbated at 12 wk including obesity, insulin resistance, and dyslipidemia. The results of this study demonstrate that the JCR:LA-cp rodent may be a useful PCOS-like model to study early mechanisms involved in the etiology of cardiometabolic risk factors in the context of both PCOS and the metabolic syndrome.
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Affiliation(s)
- Danni Shi
- Alberta Institute for Human Nutrition, University of Alberta, Edmonton, Alberta, Canada
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111/121 diplotype of Calpain-10 is associated with the risk of polycystic ovary syndrome in Korean women. Fertil Steril 2009; 92:830-3. [DOI: 10.1016/j.fertnstert.2008.06.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2008] [Revised: 06/10/2008] [Accepted: 06/11/2008] [Indexed: 11/24/2022]
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Jones GL, Balen AH, Ledger WL. Health-related quality of life in PCOS and related infertility: How can we assess this? HUM FERTIL 2009; 11:173-85. [DOI: 10.1080/14647270802078179] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Farshchi H, Rane A, Love A, Kennedy RL. Diet and nutrition in polycystic ovary syndrome (PCOS): Pointers for nutritional management. J OBSTET GYNAECOL 2009; 27:762-73. [DOI: 10.1080/01443610701667338] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Affiliation(s)
- Elise DeVore Berlan
- Nationwide Children's Hospital, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, USA.
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Mannerås L, Cajander S, Lönn M, Stener-Victorin E. Acupuncture and exercise restore adipose tissue expression of sympathetic markers and improve ovarian morphology in rats with dihydrotestosterone-induced PCOS. Am J Physiol Regul Integr Comp Physiol 2009; 296:R1124-31. [PMID: 19158405 DOI: 10.1152/ajpregu.90947.2008] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Altered activity of the sympathetic nervous system, which innervates adipose and ovarian tissue, may play a role in polycystic ovary syndrome (PCOS). We hypothesize that electro-acupuncture (EA) and physical exercise reduce sympathetic activity by stimulating ergoreceptors and somatic afferent pathways in muscles. Here we investigated the effects of low-frequency EA and physical exercise on mRNA expression of sympathetic markers in adipose tissue and on ovarian morphology in female rats that received dihydrotestosterone (DHT) continuously, starting before puberty, to induce PCOS. At age 11 wk, rats with DHT-induced PCOS were randomly divided into three groups: PCOS, PCOS plus EA, and PCOS plus exercise. The latter two groups received 2-Hz EA (evoking muscle twitches) three times/week or had free access to a running wheel for 4-5 wk. In mesenteric adipose tissue, expression of beta(3)-adrenergic receptor (ADRB3), nerve growth factor (NGF), and neuropeptide Y (NPY) mRNA was higher in untreated PCOS rats than in controls. Low-frequency EA and exercise downregulated mRNA expression of NGF and NPY, and EA also downregulated expression of ADRB3, compared with untreated rats with DHT-induced PCOS. EA and exercise improved ovarian morphology, as reflected in a higher proportion of healthy antral follicles and a thinner theca interna cell layer than in untreated PCOS rats. These findings support the theory that increased sympathetic activity contributes to the development and maintenance of PCOS and that the effects of EA and exercise may be mediated by modulation of sympathetic outflow to the adipose tissue and ovaries.
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Affiliation(s)
- Louise Mannerås
- Department of Physiology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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Use of insulin-sensitizing agents in the treatment of polycystic ovary syndrome. Fertil Steril 2008; 90:S69-73. [PMID: 19007650 DOI: 10.1016/j.fertnstert.2008.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 08/05/2008] [Indexed: 11/22/2022]
Abstract
The role of insulin sensitizing agents is discussed at length in this Committee Opinion.
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Hoeger K, Davidson K, Kochman L, Cherry T, Kopin L, Guzick DS. The impact of metformin, oral contraceptives, and lifestyle modification on polycystic ovary syndrome in obese adolescent women in two randomized, placebo-controlled clinical trials. J Clin Endocrinol Metab 2008; 93:4299-306. [PMID: 18728175 PMCID: PMC2582568 DOI: 10.1210/jc.2008-0461] [Citation(s) in RCA: 164] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
CONTEXT Polycystic ovary syndrome (PCOS) presents in adolescence, and obesity is a common finding. The benefits and risks of alternate approaches to the management of PCOS in obese adolescent women are not clear. OBJECTIVE We investigated the effects of metformin, oral contraceptives (OCs), and/or lifestyle modification in obese adolescent women with PCOS. DESIGN Two small, randomized, placebo-controlled clinical trials were performed. PATIENTS AND PARTICIPANTS A total of 79 obese adolescent women with PCOS participated. INTERVENTIONS In the single treatment trial, subjects were randomized to metformin, placebo, a lifestyle modification program, or OC. In the combined treatment trial, all subjects received lifestyle modification and OC and were randomized to metformin or placebo. MAIN OUTCOME MEASURES Serum concentrations of androgens and lipids were measured. RESULTS Lifestyle modification alone resulted in a 59% reduction in free androgen index with a 122% increase in SHBG. OC resulted in a significant decrease in total testosterone (44%) and free androgen index (86%) but also resulted in an increase in C-reactive protein (39.7%) and cholesterol (14%). The combination of lifestyle modification, OC, and metformin resulted in a 55% decrease in total testosterone, as compared to 33% with combined treatment and placebo, a 4% reduction in waist circumference, and a significant increase in HDL (46%). CONCLUSIONS In these preliminary trials, both lifestyle modification and OCs significantly reduce androgens and increase SHBG in obese adolescents with PCOS. Metformin, in combination with lifestyle modification and OC, reduces central adiposity, reduces total testosterone, and increases HDL, but does not enhance overall weight reduction.
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Affiliation(s)
- Kathleen Hoeger
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 668, Rochester, New York 14642, USA.
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Rofey DL, Szigethy EM, Noll RB, Dahl RE, Lobst E, Arslanian SA. Cognitive-behavioral therapy for physical and emotional disturbances in adolescents with polycystic ovary syndrome: a pilot study. J Pediatr Psychol 2008; 34:156-63. [PMID: 18556675 DOI: 10.1093/jpepsy/jsn057] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility and effectiveness of an enhanced cognitive-behavioral therapy (CBT), Primary and Secondary Control Enhancement Training (PASCET-PI-2), for physical (obesity) and emotional (depression) disturbances in adolescents with polycystic ovary syndrome (PCOS). METHOD In an open trial, 12 adolescents with PCOS, obesity, and depression underwent eight weekly sessions and three family-based sessions of CBT enhanced by lifestyle goals (nutrition and exercise), physical illness narrative (meaning of having PCOS), and family psychoeducation (family functioning). RESULTS Weight showed a significant decrease across the eight sessions from an average of 104 kg (SD = 26) to an average of 93 kg (SD = 18), t(11) = 6.6, p <.05. Depressive symptoms on the Children's Depression Inventory significantly decreased from a mean of 17 (SD = 3) to a mean of 9.6 (SD = 2), t(11) = 16.8, p <.01. CONCLUSION A manual-based CBT approach to treat depression in adolescents with PCOS and obesity appears to be promising.
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Polycystic ovary syndrome in adolescents. J Pediatr Adolesc Gynecol 2008; 21:119-28. [PMID: 18549963 DOI: 10.1016/j.jpag.2007.07.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Revised: 07/17/2007] [Accepted: 07/17/2007] [Indexed: 11/23/2022]
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Bibliography. Current world literature. Obesity and nutrition. Curr Opin Endocrinol Diabetes Obes 2007; 14:421-6. [PMID: 17940474 DOI: 10.1097/med.0b013e3282f0ca40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW To provide an overview of our current understanding of polycystic ovary syndrome, its epidemiology and natural history, and potential therapeutic options. RECENT FINDINGS Polycystic ovary syndrome is estimated to affect 5-10% of premenopausal women. While once thought to affect primarily adult women, polycystic ovary syndrome is frequently diagnosed during adolescence and may be increasing in prevalence secondary to the recent trend of increasing obesity among teenagers. Adolescents and young women often present with hirsutism, irregular menses, and obesity. There is increasing evidence that these women are also at increased risk later in life for cardiovascular and metabolic disease. Early treatment may prevent disease progression. Treatment options have focused on improving clinical symptoms of androgen excess and anovulation. Newer therapies, such as insulin-sensitizing agents, are beneficial in correcting the underlying metabolic disorder and, therefore, theoretically may have a more significant impact on reducing associated long-term morbidity. SUMMARY An increasing number of adolescents are presenting with signs of polycystic ovary syndrome. While once thought to primarily affect appearance and fertility, it has become clear that women with this syndrome may also potentially face long-term health sequelae. Efforts should be made to diagnose and treat these women in adolescence to minimize the development of symptoms, and prevent the onset of cardiovascular and metabolic problems.
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Affiliation(s)
- Areej Hassan
- Division of Adolescent, Young Adult Medicine, Children's Hospital Boston, Boston, MA 02115, USA.
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Abstract
Polycystic ovary syndrome (PCOS) affects 5-10% of reproductive-aged women and is one of the most common endocrine disorders in women. The disorder is commonly characterized by elevated levels of androgen and insulin. Women with PCOS may present with a range of signs and symptoms, and face increased risks of reproductive, metabolic, cardiovascular, psychologic, and neoplastic sequelae, particularly if the condition is left unrecognized or untreated. The clinical definition of PCOS has changed in recent years and includes as one of its cardinal criteria the dermatologic manifestations of hyperandrogenism, chiefly hirsutism, acne vulgaris, and androgenetic alopecia. Acanthosis nigricans, a cutaneous sign of hyperinsulinemia, may also be present. These dermatologic features may provide early clinical clues to recognition of PCOS, and treatment of these cutaneous conditions may improve the patient's quality of life and psychologic well-being. The effects of androgen on pilosebaceous units in the skin can vary by anatomic location, producing pathophysiologic effects on hair growth and differentiation, sebaceous gland size and activity, and follicular keratinization. Treatment modalities may include hormonal therapy intended to modulate androgen production and action as well as non-hormonal therapies directed toward specific dermatologic conditions.
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Affiliation(s)
- Amy T Lee
- School of Medicine, University of California, San Francisco, California 94143-0316, USA
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