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Wei M, An G, Fan L, Chen X, Li C, Chen J, Ma Q, Yang D, Wang J. Characteristics of menstrual cycle disorder and saliva metabolomics of young women in a high-temperature environment. Front Physiol 2023; 13:994990. [PMID: 36714308 PMCID: PMC9880290 DOI: 10.3389/fphys.2022.994990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/30/2022] [Indexed: 01/14/2023] Open
Abstract
Objective: Menstrual disorders induced by high-temperature environments, can seriously damage women's reproductive health and workability. The regulation mechanism underlying it is not yet to be elucidated. Saliva is an information-rich biological fluid that can reflect systemic diseases. Here, we investigated the characteristics of menstrual cycle disorders and saliva metabolomics to provide a deeper insight of the regulation mechanism of young women in high-temperature environments. Methods: Women from high and normal temperature areas of China were selected and divided into two groups-high-temperature (H group) and control (C group). A questionnaire survey was conducted in summer (July) to investigate the incidence rate of menstrual disorders, characteristics of the disorders, and factors influencing the risk of these disorders in different regions. Metabolomics was applied to analyze the characteristics of the salivary metabolites and neurotransmitters in the two groups of women with menstrual disorders. Results: The incidence rate of menstrual disorders was significantly higher in the H group than that in the C group (p < 0.05). High-temperature environment, stress, and sleep quality were identified as critical factors associated with menstrual disorders. Non-targeted saliva metabolomics identified 64 significantly different metabolites between two groups, which mainly enriched in metabolic pathways such as carbohydrate metabolism, membrane transport, digestive system, and nucleotide metabolism (p < 0.05). N-acetylneuraminic acid, MYO, and tyramine may be candidate markers for early diagnosis of menstrual disorders in high temperature environments. Metabolites may be involving in the acute-phase response during an inflammatory process, to affecting the reproductive system by influencing the HPA axis loop. Regulations about oocyte membrane production and the luteal functions would be exerted in menstrual disorders. Targeted metabolomics of neurotransmitters revealed increased expression of histamine (HA) and glutamine and decreased expression of 5-hydroxyindole acetic acid (5-HIAA) (p < 0.05). Conclusion: Menstrual disorder characteristics induced by high temperature environments were specific. Anxiety, sleep quality and temperature feeling were the key factors to the menstrual disorder. endocrine regulation mechanism and inflammatory reactions might contribute to the development of menstrual disorders through influencing the formation of the follicular cell membrane.
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Affiliation(s)
- MengFan Wei
- Department of Operational Medicine, Tianjin Institute of Environmental and Operational Medicine, Tianjin, China,Zhongguancun Hospital, Chinese Academy of Sciences, Beijing, China
| | - GaiHong An
- Department of Operational Medicine, Tianjin Institute of Environmental and Operational Medicine, Tianjin, China
| | - LiJun Fan
- Department of Operational Medicine, Tianjin Institute of Environmental and Operational Medicine, Tianjin, China
| | - XueWei Chen
- Department of Operational Medicine, Tianjin Institute of Environmental and Operational Medicine, Tianjin, China
| | - Chao Li
- Department of Operational Medicine, Tianjin Institute of Environmental and Operational Medicine, Tianjin, China
| | - JiaJun Chen
- Department of Operational Medicine, Tianjin Institute of Environmental and Operational Medicine, Tianjin, China
| | - Qiang Ma
- Department of Operational Medicine, Tianjin Institute of Environmental and Operational Medicine, Tianjin, China,*Correspondence: Qiang Ma, ; DanFeng Yang, ; Jing Wang,
| | - DanFeng Yang
- Department of Operational Medicine, Tianjin Institute of Environmental and Operational Medicine, Tianjin, China,*Correspondence: Qiang Ma, ; DanFeng Yang, ; Jing Wang,
| | - Jing Wang
- Department of Operational Medicine, Tianjin Institute of Environmental and Operational Medicine, Tianjin, China,*Correspondence: Qiang Ma, ; DanFeng Yang, ; Jing Wang,
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Hudnut-Beumler J, Kaar JL, Taylor A, Kelsey MM, Nadeau KJ, Zeitler P, Snell-Bergeon J, Pyle L, Cree-Green M. Development of type 2 diabetes in adolescent girls with polycystic ovary syndrome and obesity. Pediatr Diabetes 2021; 22:699-706. [PMID: 33870630 PMCID: PMC8808365 DOI: 10.1111/pedi.13206] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Adult women with polycystic ovary syndrome (PCOS) and obesity have an 8-fold increased risk of developing type 2 diabetes (T2D). Our goal was to determine the incidence and risk factors for T2D in adolescents with PCOS and obesity. RESEARCH DESIGN AND METHODS Retrospective chart review of girls aged 11-21 years with confirmed PCOS (oligomenorrhea and hyperandrogenism) diagnosis between July 2013 and Aug 2018 and at least one follow-up visit and BMI >85%ile. T2D incidence, defined with an HbA1c ≥6.5%, was calculated. A nested case-control study with 1:3 matching by race, ethnicity, and BMI was performed to determine predictors of T2D diagnosis. RESULTS Four hundred ninety-three patients with PCOS (age 15.6 ± 1.9 years, BMI 36.2 ± 6.3 kg/m2 ) were identified with a follow-up of 1018 person-years. Twenty-three developed T2D (incidence 22.6/1000 person-years) with diagnosis a median of 1.8 years (2 months-5.5 years) after PCOS diagnosis. T2D risk was higher in girls with a prediabetes HbA1c (5.7%-6.4%) (HR 14.6 [4.8-44.5]) and among Hispanic girls with an elevated HbA1c and alanine aminotransferase (HR 19.0 [3.7-97.2]) at the time of PCOS diagnosis. In the 1:3 matched cohort, T2D risk was 18.7 times higher (OR 18.66 [2.27-153.24]) for every 0.1% increase in HbA1c at the time of PCOS diagnoses. CONCLUSIONS Girls with PCOS and obesity have an 18-fold increase in T2D incidence compared to published rates in non-PCOS youth. Hispanic girls with elevated HbA1c and ALT are at particular risk. Due to the morbidity associated with youth onset T2D, these findings argue for better screening and prevention approaches in this population.
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Affiliation(s)
- Julia Hudnut-Beumler
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jill L Kaar
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Anya Taylor
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Megan M Kelsey
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kristen J Nadeau
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Philip Zeitler
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Janet Snell-Bergeon
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Laura Pyle
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Melanie Cree-Green
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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3
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Ramezani Tehrani F, Behboudi-Gandevani S, Bidhendi Yarandi R, Saei Ghare Naz M, Carmina E. Prevalence of acne vulgaris among women with polycystic ovary syndrome: a systemic review and meta-analysis. Gynecol Endocrinol 2021; 37:392-405. [PMID: 33355023 DOI: 10.1080/09513590.2020.1859474] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The aim of this meta-analysis was to evaluate the prevalence of acne among women with PCOS worldwide, and in subgroups of patients with different age, geographical-region, and PCOS definition-criteria, compared to healthy non-PCOS counterparts. METHODS A comprehensive literature search was performed in PubMed (including Medline), Web of Science, and Scopus databases for retrieving articles in English investigating the prevalence of PCOS. 'Meta-prop' method was applied to estimate pooled prevalence of acne in both groups. Meta-regression was conducted to find the association between acne in women with and without PCOS. RESULTS We used 60 studies, included data of 240,213 women with PCOS and 1,902,022 healthy-controls for the meta-analysis. The overall pooled prevalence of acne among women with and without PCOS, was 43% (95% CI: 41-45%) and 21% (95% CI: 19-22%), respectively, which was 1.6-fold significantly higher than among healthy-controls. The pooled prevalence of acne in adults, and in adolescents PCOS patients were 42 and 59%, respectively, which were significantly higher than non-PCOS counterparts. The pooled estimated prevalence of acne in adult PCOS women was 76% using the NIH definition and 36% by Rotterdam-criteria; both were significantly higher than non-PCOS counterparts, respectively. In subgroups of adults, who used Rotterdam-definition, the highest prevalence of acne in PCOS patients was reported in East Asia and was 3.5-fold higher than non-PCOS counterparts. CONCLUSIONS Despite the presence of heterogeneity and publication bias among available literature, it may be concluded that acne is one of the common dermatological manifestations in PCOS. In addition, results highlight geographical differences among PCOS patients.
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Affiliation(s)
- Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Razieh Bidhendi Yarandi
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Saei Ghare Naz
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Enrico Carmina
- Department of Health Promotion, Mother and Child Care and General and Specialist Medicine, University of Palermo Medical School, Palermo, Italy
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Al Khalifah RA, Florez ID, Zoratti MJ, Dennis B, Thabane L, Bassilious E. Efficacy of Treatments for Polycystic Ovarian Syndrome Management in Adolescents. J Endocr Soc 2020; 5:bvaa155. [PMID: 33324861 PMCID: PMC7724745 DOI: 10.1210/jendso/bvaa155] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Indexed: 02/07/2023] Open
Abstract
Limited evidence on treatment options for polycystic ovarian syndrome (PCOS) has led to considerable variation in health care practices. We aimed to compare the effects of metformin and/or oral contraceptive pills (OCP) in combination with pioglitazone, spironolactone, flutamide, and lifestyle interventions among adolescents aged 11 to 19 years with PCOS. Literature searches were performed in Medline, Embase, and the Cochrane Central Register of Controlled Trials from database inception through December 2018, with no language restriction. Two reviewers screened titles and abstracts, assessed full text eligibility, and extracted information from eligible trials. Evidence was synthesized through network meta-analyses (NMA) using a Bayesian random-effects approach. We identified 37 randomized controlled trials, in which 2400 patients were randomized. NMA showed no statistically important difference among all interventions to improve menstrual regulation or body mass index. Moderate-quality evidence showed hirsutism scores were reduced by multiple interventions that included single and combination medications namely; lifestyle intervention, metformin, OCP, spironolactone, pioglitazone, metformin-OCP, metformin-spironolactone, and metformin-flutamide against placebo. Moderate-quality evidence showed OCP results in more dysglycemia compared to metformin (odds ratio, 2.98; 95% credible interval, 1.02-8.96), no intervention resulted in dysglycemia reduction. In conclusion, metformin and OCP as monotherapy or in combination with other interventions compared with placebo can reduce hirsutism scores, but none of these medications lead to effective menstrual cycle regulation or weight reduction. However, the use of OCP leads to worse cardiometabolic risk factors. Further research into new treatment options is urgently needed. PROSPERO registration number CRD42015016148.
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Affiliation(s)
- Reem A Al Khalifah
- Department of Pediatrics, Division of Pediatric Endocrinology and Metabolism, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ivan D Florez
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, Universidad de Antioquia, Medellín, Colombia
| | - Michael J Zoratti
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Brittany Dennis
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics and Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Ereny Bassilious
- Department of Pediatrics, Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada
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5
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Wiweko B, Handayani LK, Harzif AK, Pratama G, Muharam R, Hestiantoro A, Sumapraja K. Correlation of anti-Müllerian hormone levels with metabolic syndrome events in polycystic ovary syndrome: A cross-sectional study. Int J Reprod Biomed 2020; 18:187-192. [PMID: 32309767 PMCID: PMC7142316 DOI: 10.18502/ijrm.v18i3.6716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 08/14/2019] [Accepted: 10/03/2019] [Indexed: 11/24/2022] Open
Abstract
Background Various endocrine disorders have been reported in women of reproductive age, 10% of which is affected by polycystic ovary syndrome (PCOS). Objective This study aimed to evaluate the correlation of anti-Müllerian hormone (AMH) levels with the metabolic syndrome in patients with PCOS. Materials and Methods This cross-sectional study employed a consecutive sampling method using medical records from January 2013 to December 2017 at Dr. Cipto Mangunkusumo General Hospital polyclinic and Yasmin in vitro fertilization Clinic (Kencana), Jakarta, Indonesia. The primary outcome of the study was the AMH levels as independent variable correlated with metabolic syndrome. The secondary outcome was also the AMH levels correlated with each PCOS phenotype. The tertiary outcome was each PCOS phenotype as independent variable correlated with metabolic syndrome. Results Women with phenotype 1 of PCOS had a median AMH level of 13.92 (range: 3.88-34.06) ng/ml. 21% patients had metabolic syndrome, with a median AMH level 7.65 (3.77-20.20) ng/ml, higher than the women without metabolic syndrome (p = 0.38). The most frequent phenotype in women with PCOS was phenotype 4, oligo- or anovulation and polycystic ovary morphology (OA/PCOM) in 41.3%. The most frequent phenotype in women with metabolic syndrome was phenotype 1, OA + PCOM + hyperandrogenism in 56.5%. Conclusion All PCOS phenotypes exhibited significant correlations with the AMH level. Phenotype 1 (OA + PCOM + hyperandrogenism) was associated with the highest AMH level and was significantly associated with metabolic syndrome.
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Affiliation(s)
- Budi Wiweko
- Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia, Jakarta, 10430, Indonesia.,Yasmin IVF Clinic, Dr. Cipto Mangunkusumo General Hospital, Jakarta, 10430, Indonesia.,Human Reproductive, Infertility and Family Planning Research Center, Indonesia Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Lieke Koes Handayani
- Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Achmad Kemal Harzif
- Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia, Jakarta, 10430, Indonesia.,Yasmin IVF Clinic, Dr. Cipto Mangunkusumo General Hospital, Jakarta, 10430, Indonesia.,Human Reproductive, Infertility and Family Planning Research Center, Indonesia Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Gita Pratama
- Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia, Jakarta, 10430, Indonesia.,Yasmin IVF Clinic, Dr. Cipto Mangunkusumo General Hospital, Jakarta, 10430, Indonesia.,Human Reproductive, Infertility and Family Planning Research Center, Indonesia Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Raden Muharam
- Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia, Jakarta, 10430, Indonesia.,Yasmin IVF Clinic, Dr. Cipto Mangunkusumo General Hospital, Jakarta, 10430, Indonesia.,Human Reproductive, Infertility and Family Planning Research Center, Indonesia Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Andon Hestiantoro
- Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia, Jakarta, 10430, Indonesia.,Yasmin IVF Clinic, Dr. Cipto Mangunkusumo General Hospital, Jakarta, 10430, Indonesia.,Human Reproductive, Infertility and Family Planning Research Center, Indonesia Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Kanadi Sumapraja
- Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia, Jakarta, 10430, Indonesia.,Yasmin IVF Clinic, Dr. Cipto Mangunkusumo General Hospital, Jakarta, 10430, Indonesia.,Human Reproductive, Infertility and Family Planning Research Center, Indonesia Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
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Tang R, Ding X, Zhu J. Kisspeptin and Polycystic Ovary Syndrome. Front Endocrinol (Lausanne) 2019; 10:298. [PMID: 31156550 PMCID: PMC6530435 DOI: 10.3389/fendo.2019.00298] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/25/2019] [Indexed: 11/22/2022] Open
Abstract
Although the pathogenesis of Polycystic Ovary Syndrome (PCOS) is still unclear, the disturbance of hypothalamic-pituitary-gonadal (HPG) axis is suspected to be the main culprit in the development of PCOS. Kisspeptin, a hypothalamic peptide encoded by the KISS1 gene, is widely reported as a key factor in the regulation of luteinizing hormone (LH)/ follicular-stimulating hormone (FSH) secretion, which may be potentially involved with the development of PCOS. Objective: The objective of this study is to summarize the existing knowledge in the literature in terms of the circulating kisspeptin concentration in PCOS women, kisspeptin and metabolic profiles in PCOS women and kisspeptin expression in PCOS animal models. Method: A systematic literature search was conducted using "Pubmed," "Embase," "Web of Science" for all English language articles published up to July 2018 with the terms "PCOS," "Stein-Leventhal Syndrome," "Polycystic ovary syndrome," "metastins" and "kisspeptin". Conclusion: Overall, kisspeptin levels are higher in the PCOS population, which supports the hypothesis that an over-active KISS1 system leads to enhanced HPG-axis activity, thereby causing irregular menstrual cycles and excessive androgen release in PCOS women.
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Affiliation(s)
- Rong Tang
- Department of Pediatrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Xiaohong Ding
- The First Clinical Medical School, Wenzhou Medical University, Wenzhou, China
| | - Jianghu Zhu
- Department of Pediatrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
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7
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Kakoly NS, Khomami MB, Joham AE, Cooray SD, Misso ML, Norman RJ, Harrison CL, Ranasinha S, Teede HJ, Moran LJ. Ethnicity, obesity and the prevalence of impaired glucose tolerance and type 2 diabetes in PCOS: a systematic review and meta-regression. Hum Reprod Update 2019; 24:455-467. [PMID: 29590375 DOI: 10.1093/humupd/dmy007] [Citation(s) in RCA: 203] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 03/12/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Our prior meta-analyses demonstrated an increased prevalence of impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM) with polycystic ovary syndrome (PCOS), but with substantial clinical heterogeneity. OBJECTIVE AND RATIONALE We aimed to update our previous review to quantify the prevalence of IGT and T2DM in PCOS with only quality studies (good and fair quality). We also aimed to examine the contribution of parameters including ethnicity, obesity and method of diagnosing T2DM in explaining the observed heterogeneity in IGT and T2DM prevalence in PCOS. SEARCH METHODS We conducted a literature search (MEDLINE, CINAHL, EMBASE, clinical trial registries and hand-searching) up to June 2016 to identify studies reporting the prevalence of dysglycemia (IGT and T2DM) in women with and without PCOS. We included studies where women with PCOS (defined according to original National Institute of Health) were compared to women without PCOS for the end-points of the prevalence of IGT or T2DM. We excluded case reports, case series, editorials, and narrative reviews. Studies where PCOS was diagnosed by self-report, or where IGT or T2DM were measured by fasting glucose, only were excluded. We assessed the methodological quality of the included studies using a priori criteria based on the Newcastle-Ottawa Scaling (NOS) for non-randomized studies. Data are presented as odds ratio (OR) (95% CI) with random-effects meta-analysis by Mantel-Haenszel methods. We assessed the contribution of demographic and clinical factors to heterogeneity using subgroup and meta-regression analysis. OUTCOMES We reviewed 4530 studies and included 40 eligible studies in the final analysis. On meta-analysis of quality studies, women with PCOS had an increased prevalence of IGT (OR = 3.26, 95% CI: 2.17-4.90) and T2DM (OR = 2.87, 95% CI: 1.44-5.72), which differed by ethnicity (for IGT, Asia: 5-fold, the Americas: 4-fold and Europe: 3-fold), was higher with obesity, and doubled among studies using self-report or administrative data for diagnosing diabetes. The ethnicity-related difference retained its significance for Asia and Europe in BMI-matched subgroups. Clear contributors to heterogeneity did not emerge in meta-regression. WIDER IMPLICATIONS Our findings underscore the importance of PCOS as a cause of dysglycemia with a higher prevalence of IGT and T2DM. They support the relevance of ethnicity and obesity and emphasize the need for accurate diagnostic methods for diabetes. PROSPERO REGISTRATION NUMBER CRD42017056524.
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Affiliation(s)
- N S Kakoly
- The Department of Epidemiology and Preventive Medicine, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - M B Khomami
- The Department of Epidemiology and Preventive Medicine, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - A E Joham
- The Department of Epidemiology and Preventive Medicine, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, Australia
| | - S D Cooray
- The Department of Epidemiology and Preventive Medicine, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - M L Misso
- The Department of Epidemiology and Preventive Medicine, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - R J Norman
- The Robinson Research Institute, Discipline of Obstetrics and Gynaecology, University of Adelaide and Fertility, Adelaide SA, Australia
| | - C L Harrison
- The Department of Epidemiology and Preventive Medicine, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - S Ranasinha
- The Department of Epidemiology and Preventive Medicine, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - H J Teede
- The Department of Epidemiology and Preventive Medicine, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, Australia.,Monash Partners Academic Health Sciences Centre, PO Box 315, Prahran, Melbourne, Victoria, Australia
| | - L J Moran
- The Department of Epidemiology and Preventive Medicine, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,The Robinson Research Institute, Discipline of Obstetrics and Gynaecology, University of Adelaide and Fertility, Adelaide SA, Australia
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Wiweko B, Indra I, Susanto C, Natadisastra M, Hestiantoro A. The correlation between serum AMH and HOMA-IR among PCOS phenotypes. BMC Res Notes 2018; 11:114. [PMID: 29426356 PMCID: PMC5807763 DOI: 10.1186/s13104-018-3207-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 01/25/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Polycystic ovarian syndrome (PCOS) is known to be one of the most prevalent endocrine disorders affecting reproductive age women. One of the endocrine disorder is hyperinsulinemia, which corresponds with the severity of PCOS. However, the pathogenesis of PCOS is not fully understood, but one theory of anti-mullerian hormone (AMH) has been proposed as one of the factor related to the degree of severity of PCOS. However, there are no clear correlation between levels of AMH with the incidence of insulin resistance in PCOS patients especially in Indonesia. METHODS This is a cross-sectional study involving reproductive age women aged 18-35 years. Subjects were recruited consecutively at Dr. Cipto Mangunkusumo General Hospital between 2011 until 2014. PCOS women diagnosed using 2003 Rotterdam criteria were categorized into four different PCOS phenotypes. Subsequently, serum level of AMH and HOMA-IR was measured and evaluated with correlation tests performed using SPSS 11.0 RESULTS: A total of 125 PCOS patients were included in a study conducted within a 3-year period. Phenotype 1 (anovulation, hyperandrogenism, and polycystic ovaries) shows the highest levels of AMH and HOMA-IR, which decreases in accordance to severity level (p < 0.005). The positive correlation between AMH and HOMA-IR persisted even after adjusting for BMI in multivariate analysis. CONCLUSIONS There was a positive correlation between serum AMH and HOMA IR levels. Serum AMH and HOMA IR levels were significantly different across the four PCOS phenotypes; with the highest values were present with phenotype 1.
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Affiliation(s)
- Budi Wiweko
- Division of Reproductive Endocrinology and Infertility, Department of Obstetric and Gynecology Faculty of Medicine, Universitas Indonesia; Dr, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Indra Indra
- Division of Reproductive Endocrinology and Infertility, Department of Obstetric and Gynecology Faculty of Medicine, Universitas Indonesia; Dr, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Cynthia Susanto
- Division of Reproductive Endocrinology and Infertility, Department of Obstetric and Gynecology Faculty of Medicine, Universitas Indonesia; Dr, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Muharam Natadisastra
- Division of Reproductive Endocrinology and Infertility, Department of Obstetric and Gynecology Faculty of Medicine, Universitas Indonesia; Dr, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Andon Hestiantoro
- Division of Reproductive Endocrinology and Infertility, Department of Obstetric and Gynecology Faculty of Medicine, Universitas Indonesia; Dr, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
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9
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Feng JG, Guo Y, Ma LA, Xing J, Sun RF, Zhu W. Prevalence of dermatologic manifestations and metabolic biomarkers in women with polycystic ovary syndrome in north China. J Cosmet Dermatol 2017; 17:511-517. [PMID: 28940857 DOI: 10.1111/jocd.12387] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Cutaneous features of hyperandrogenism in polycystic ovary syndrome (PCOS) include acne, hirsutism, seborrhea, androgenic alopecia (AGA), and acanthosis nigricans (AN). However, the relationships have not been well known broadly in terms of clinical hyperandrogenism and biochemical markers. OBJECTIVES The aim of this study was to investigate biochemical and metabolic parameters in relation to cutaneous characters women in with and without PCOS. METHODS This was a cross-sectional retrospective study including 186 women with PCOS and 113 age-matched without PCOS women. Acne grade, hirsutism, seborrhea, AGA, and AN were recorded. Hormonal and metabolic parameters were measured. RESULTS The most common finding was acne, and AN was the least dermatological manifestations between PCOS and non-PCOS groups. The severity location and type of acne did not differ in PCOS women compared to non-PCOS women. Significant differences were found with respect to free androgen index (FAI) (P = .036), sex hormone-binding globulin (SHBG) (P = .023), and body mass index (BMI) (P = .001) between PCOS with acne and PCOS without acne groups. Overall, age (P = .005) was significantly decreased, while BMI (P = .004) was significantly higher in PCOS with hirsutism. The mean serum total testosterone (TT), dehydroepiandrosterone sulfate, and FAI were significantly elevated, but SHBG was decreased between PCOS with and without hirsutism groups. There were significantly different BMI (P = .018) and triglyceride (P = .024) except other hormonal parameter of without AGA group. CONCLUSION This study indicated a strong correlation between hirsutism and metabolic abnormalities. Hirsutism is the most common cutaneous finding in PCOS women. Acne and AGA are associated with other manifestations of clinical hyperandrogenism, but not obvious markers of biochemical hyperandrogenemia and metabolic dysfunction.
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Affiliation(s)
- Jin-Ge Feng
- Department of Dermatology, Fu Xing Hospital of Capital Medical University, Beijing, China
| | - Yan Guo
- Department of Obstetrics and Gynecology, Fu Xing Hospital of Capital Medical University, Beijing, China
| | - Li-Ang Ma
- Department of Physical Examination, Primary and Middle School Health Care Institute of Xuan wu District, Beijing, China
| | - Jin Xing
- Department of Ultrasonography, Fu Xing Hospital of Capital Medical University, Beijing, China
| | - Rui-Feng Sun
- Department of Dermatology, Xuan Wu Hospital Capital Medical University, Beijing, China
| | - Wei Zhu
- Department of Dermatology, Xuan Wu Hospital Capital Medical University, Beijing, China
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10
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Li L, Feng Q, Ye M, He Y, Yao A, Shi K. Metabolic effect of obesity on polycystic ovary syndrome in adolescents: a meta-analysis. J OBSTET GYNAECOL 2017; 37:1036-1047. [DOI: 10.1080/01443615.2017.1318840] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Li Li
- Department of Gynecology and Obstetrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Qiong Feng
- Department of Gynecology and Obstetrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ming Ye
- Department of Gynecology and Obstetrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yaojuan He
- Department of Gynecology and Obstetrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Aling Yao
- Department of Biostatistics, Southern Medical University, Guangzhou, China
| | - Kun Shi
- Department of Gynecology and Obstetrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
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11
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Al Khalifah RA, Florez ID, Dennis B, Thabane L, Bassilious E. Metformin or Oral Contraceptives for Adolescents With Polycystic Ovarian Syndrome: A Meta-analysis. Pediatrics 2016; 137:peds.2015-4089. [PMID: 27244814 DOI: 10.1542/peds.2015-4089] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Polycystic ovarian syndrome (PCOS) is a common disease. There is limited evidence to support various treatment choices. This leads to variable treatment practices. OBJECTIVES To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the use of metformin versus oral contraceptive pills (OCPs) for the treatment of PCOS in adolescents aged 11 to 19 years. DATA SOURCES We performed literature searches through Ovid Medline, Ovid Embase, Cochrane Central Register of Controlled Trials, and gray literature resources, up to January 29, 2015. STUDY SELECTION AND DATA EXTRACTION Two reviewers screened titles and abstracts of identified citations, assessed full text eligibility, and extracted information from eligible trials. RESULTS Four RCTs met the inclusion and exclusion criteria. The reviewed evidence came from 170 patients. Overall, OCP treatment resulted in modest improvement in menstrual cycle frequency (weighted mean difference [WMD] = 0.27, P < .01, 95% confidence interval [CI] -0.33 to -0.21) and mild reduction of acne scores (WMD = 0.3, P = .02, 95% CI 0.05 to 0.55). While metformin resulted in greater BMI reduction (WMD = -4.02, P < .01, 95% CI -5.23 to -2.81) it was associated with decreased dysglycemia prevalence (risk ratio: 0.41, P = .02, 95% CI 0.19 to 0.86) and improved total cholesterol and low-density lipoprotein levels. Metformin and OCPs were similar in terms of impact on hirsutism. CONCLUSIONS AND LIMITATIONS Current evidence is derived from very low to low quality evidence. Therefore, treatment choice should be guided by patient values and preferences while balancing potential side effects. Future high quality RCTs are needed to address several questions for the treatment of adolescents with PCOS.
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Affiliation(s)
- Reem A Al Khalifah
- Division of Endocrinology and Metabolism, Department of Pediatrics, Departments of Clinical Epidemiology and Biostatistics, Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia;
| | - Ivan D Florez
- Departments of Clinical Epidemiology and Biostatistics, Department of Pediatrics, Universidad de Antioquia, Colombia; and
| | - Brittany Dennis
- Departments of Clinical Epidemiology and Biostatistics, St. George's University of London, Cranmer Terrace, London, United Kingdom
| | - Lehana Thabane
- Departments of Clinical Epidemiology and Biostatistics, Pediatrics and Anesthesia, McMaster University, Hamilton, Canada
| | - Ereny Bassilious
- Division of Endocrinology and Metabolism, Department of Pediatrics
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12
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Layegh P, Mousavi Z, Farrokh Tehrani D, Parizadeh SMR, Khajedaluee M. Insulin resistance and endocrine-metabolic abnormalities in polycystic ovarian syndrome: Comparison between obese and non-obese PCOS patients. Int J Reprod Biomed 2016. [DOI: 10.29252/ijrm.14.4.263] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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13
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Al Khalifah RA, Flórez ID, Dennis B, Neupane B, Thabane L, Bassilious E. The effectiveness and safety of treatments used for polycystic ovarian syndrome management in adolescents: a systematic review and network meta-analysis protocol. Syst Rev 2015; 4:125. [PMID: 26420636 PMCID: PMC4589072 DOI: 10.1186/s13643-015-0105-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 08/25/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Polycystic ovarian syndrome (PCOS) is a common reproductive endocrine disease that is seen among adolescent women. Currently, there is limited evidence to support treatment options leading to considerable variation in practice among healthcare specialists. The objective of this study is to review and synthesize all the available evidence on treatment options for PCOS among adolescent women. METHODS/DESIGN We will conduct a systematic review of all randomized controlled trials evaluating the use of metformin, oral contraceptive pills as monotherapy, or as combination with pioglitazone, spironolactone, flutamide, and lifestyle interventions in the treatment of PCOS in adolescent women ages 11 to 19 years. The primary outcome measures are menstrual regulation and change hirsutism scores. The secondary outcome measures include acne scores, prevalence of dysglycaemia, BMI, lipid profile, total testosterone level, and adverse events. We will perform literature searches through Ovid Medline, Ovid Embase, and Cochrane Central Register of Controlled Trials (CENTRAL), and gray literature resources. Two reviewers will independently screen titles and abstracts of identified citations, review the full texts of potentially eligible trials, extract information from eligible trials, and assess the risk of bias and quality of the evidence independently. Results of this review will be summarized narratively and quantitatively as appropriate. We will perform a multiple treatment comparison using network meta-analysis to estimate the pooled direct and indirect effects for all PCOS interventions on outcomes if adequate data is available. DISCUSSION PCOS treatment poses a clinical challenge to the patients and physicians. This is the first systematic review and network meta-analysis for PCOS treatment in adolescents. We expect that our results will help improve patient care, unify the treatment approaches among specialists, and encourage research for other therapeutic options. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015016148.
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Affiliation(s)
- Reem A Al Khalifah
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Juravinski Site, G Wing, 2nd Floor, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada. .,Department of Pediatrics, Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada. .,Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia.
| | - Iván D Flórez
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Juravinski Site, G Wing, 2nd Floor, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada. .,Department of Pediatrics, University of Antioquia, Medellín, Colombia.
| | - Brittany Dennis
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Juravinski Site, G Wing, 2nd Floor, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada.
| | - Binod Neupane
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Juravinski Site, G Wing, 2nd Floor, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada.
| | - Lehana Thabane
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Juravinski Site, G Wing, 2nd Floor, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada. .,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada. .,Department of Pediatrics and Anesthesia, McMaster University, Hamilton, Canada.
| | - Ereny Bassilious
- Department of Pediatrics, Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada.
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Statistical Genomic Approach Identifies Association between FSHR Polymorphisms and Polycystic Ovary Morphology in Women with Polycystic Ovary Syndrome. BIOMED RESEARCH INTERNATIONAL 2015; 2015:483726. [PMID: 26273622 PMCID: PMC4529894 DOI: 10.1155/2015/483726] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/13/2015] [Indexed: 11/17/2022]
Abstract
Background. Single-nucleotide polymorphisms (SNPs) in the follicle stimulating hormone receptor (FSHR) gene are associated with PCOS. However, their relationship to the polycystic ovary (PCO) morphology remains unknown. This study aimed to investigate whether PCOS related SNPs in the FSHR gene are associated with PCO in women with PCOS. Methods. Patients were grouped into PCO (n = 384) and non-PCO (n = 63) groups. Genomic genotypes were profiled using Affymetrix human genome SNP chip 6. Two polymorphisms (rs2268361 and rs2349415) of FSHR were analyzed using a statistical approach. Results. Significant differences were found in the allele distributions of the GG genotype of rs2268361 between the PCO and non-PCO groups (27.6% GG, 53.4% GA, and 19.0% AA versus 33.3% GG, 36.5% GA, and 30.2% AA), while no significant differences were found in the allele distributions of the GG genotype of rs2349415. When rs2268361 was considered, there were statistically significant differences of serum follicle stimulating hormone, estradiol, and sex hormone binding globulin between genotypes in the PCO group. In case of the rs2349415 SNP, only serum sex hormone binding globulin was statistically different between genotypes in the PCO group. Conclusions. Functional variants in FSHR gene may contribute to PCO susceptibility in women with PCOS.
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15
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Turan V, Mutlu EK, Solmaz U, Ekin A, Tosun O, Tosun G, Mat E, Gezer C, Malkoc M. Benefits of short-term structured exercise in non-overweight women with polycystic ovary syndrome: a prospective randomized controlled study. J Phys Ther Sci 2015; 27:2293-7. [PMID: 26311969 PMCID: PMC4540866 DOI: 10.1589/jpts.27.2293] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/16/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The short-term effects of structured exercise on the anthropometric,
cardiovascular, and metabolic parameters of non-overweight women diagnosed with polycystic
ovary syndrome were evaluated. [Subjects and Methods] Thirty women with a diagnosis of
polycystic ovary syndrome were prospectively randomized to either a control group (n=16)
or a training group (n=14) for a period of 8 weeks. Anthropometric, cardiovascular, and
metabolic parameters and hormone levels were measured and compared before and after the
intervention. [Results] Waist and hip measurements (anthropometric parameters); diastolic
blood pressure; respiratory rate (cardiovascular parameters); levels of low-density
lipoprotein cholesterol, total cholesterol, fasting glucose, and fasting insulin; and the
homeostasis model assessment of insulin resistance index (metabolic parameters) were
significantly lower in the training group after 8 weeks of exercise compared to the
baseline values. After exercise, the training group had significantly higher oxygen
consumption and high-density lipoprotein levels and significantly shorter menstrual cycle
intervals. The corresponding values for controls did not significantly differ between the
start and end of the 8-week experiment. [Conclusion] Short-term regular exercise programs
can lead to improvements in anthropometric, cardiovascular, and metabolic parameters of
non-overweight women with polycystic ovary syndrome.
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Affiliation(s)
- Volkan Turan
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Turkey
| | - Ebru Kaya Mutlu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University, Turkey
| | - Ulas Solmaz
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Turkey
| | - Atalay Ekin
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Turkey
| | - Ozge Tosun
- Department of Physiotherapy, Dokuz Eylul University, Turkey
| | - Gokhan Tosun
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Turkey
| | - Emre Mat
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Turkey
| | - Cenk Gezer
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Turkey
| | - Mehtap Malkoc
- Department of Physiotherapy, Dokuz Eylul University, Turkey
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16
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Esmaeilzadeh S, Delavar MA, Amiri M, Khafri S, Pasha NG. Polycystic ovary syndrome in Iranian adolescents. Int J Adolesc Med Health 2015; 26:559-65. [PMID: 24447981 DOI: 10.1515/ijamh-2013-0335] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 11/24/2013] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Polycystic ovary syndrome (PCOS) is linked with metabolic syndrome, which includes obesity, insulin resistance, dyslipidemia, and endocrine function in patients with PCOS. The aim of this study was to determine the prevalence of adolescent PCOS and characteristics associated with PCOS in adolescents in Babol, Iran. MATERIALS AND METHODS A cross-sectional study was conducted on 1549 girl high school students aged 16-20 years who were living in Iran. After overnight fasting, blood samples were collected to determine hormones and lipid levels in PCOS patients between the first and fifth days of their menstrual period or withdrawal bleeding. RESULTS The overall prevalence of adolescent PCOS was 129 (8.3%) (95% CI; 4.0, 12.0). Irregular menstruation was observed in 24.1% of adolescents. A total of 68% of PCOS adolescents had insulin resistance. Compared with non-PCOS adolescents, the OR of adolescent PCOS for family history of hirsutism was 1.53 (95% CI, 1.06-2.20; p=0.024), family history of irregular menstrual cycle was 2.27 (95% CI, 1.56-3.30; p<0.001), menarche age <13 years was 1.95 (95% CI, 1.36-2.81; p<0.001), hirsutism was 1.14 (CI 95%, 1.10-1.17; p<0.001), acne was 5.10 (CI 95%, 3.52-7.40; p<0.001), and wrist circumference was 1.28 (CI 95%, 1.07-1.54; p=0.007). CONCLUSION The presenting findings showed the high prevalence of PCOS among Iranian adolescents. Emphasis should be placed on clinical screening in adolescents with high-risk factors, including irregular menstrual, menarche <13 years, hirsutism, acne, high wrist circumference, and paternal obesity to help reduce the risk of developing metabolic disturbance and to find ways to improve long-term health.
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17
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Ramezani Tehrani F, Rashidi H, Bahri Khomami M, Tohidi M, Azizi F. The prevalence of metabolic disorders in various phenotypes of polycystic ovary syndrome: a community based study in Southwest of Iran. Reprod Biol Endocrinol 2014; 12:89. [PMID: 25224635 PMCID: PMC4180586 DOI: 10.1186/1477-7827-12-89] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 08/26/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a common endocrinopathy, associated with metabolic abnormalities. Metabolic features of various phenotypes of this syndrome are still debatable. The aim of present study hence was to evaluate the metabolic and hormonal features of PCOS phenotypes in comparison to a group of healthy control. METHODS A total of 646 reproductive-aged women were randomly selected using the stratified, multistage probability cluster sampling method. The subjects were divided into five phenotypes: A (oligo/anovulation + hyperandrogenism + polycystic ovaries), B (oligo/anovulation + hyperandrogenism), C (hyperandrogenism + polycystic ovaries) and D (oligo/anovulation + polycystic ovaries). Hormonal and metabolic profiles and the prevalence of metabolic syndrome among these groups were compared using ANCOVA adjusted for age and body mass index. RESULTS Among women with PCOS (n = 85), those of groups A and C had higher serum levels of insulin and homeostatic model assessment for insulin resistance (HOMA-IR), compared to PCOS women of group D. Serum concentrations of cholesterol, low density lipoprotein, triglycerides and glucose in group A were higher than in other phenotypes, whereas the metabolic syndrome was more prevalent among group B. CONCLUSIONS Women who had all three components of the syndrome showed the highest level of metabolic disturbances indicating that metabolic screening of the severest phenotype of PCOS may be necessary.
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Affiliation(s)
- Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Homeira Rashidi
- Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahnaz Bahri Khomami
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Tohidi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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18
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Ibáñez L, Ong KK, López-Bermejo A, Dunger DB, de Zegher F. Hyperinsulinaemic androgen excess in adolescent girls. Nat Rev Endocrinol 2014; 10:499-508. [PMID: 24776733 DOI: 10.1038/nrendo.2014.58] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hyperinsulinaemic androgen excess is the most common cause of hirsutism, acne and menstrual irregularity in adolescent girls. Here, we propose that the disorder frequently originates from an absolute or relative excess of lipids in adipose tissue, and from associated changes in insulin sensitivity, gonadotropin secretion and ovarian androgen release. Girls from populations with genotypes attuned to nutritionally harsh conditions seem to be particularly vulnerable to the development of hyperinsulinaemic androgen excess in today's obesogenic environment. We propose that hirsutism, hyperandrogenaemia and menstrual irregularity (≥2 years after menarche) is used as a diagnostic triad for the disorder. No pharmacological therapy has been approved for girls with androgen excess; however, lifestyle intervention is essential to reduce adiposity. In girls without obesity who are not sexually active, insulin sensitization has more broadly normalizing effects than estradiol-progestogen combinations. The early recognition of girls at risk of developing hyperinsulinaemic androgen excess might enable prevention in childhood.
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Affiliation(s)
- Lourdes Ibáñez
- Endocrinology Unit, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Ken K Ong
- MRC Epidemiology Unit, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Abel López-Bermejo
- Paediatric Endocrinology, Dr Josep Trueta Hospital and Girona Institute for Biomedical Research, Avenue de França s/n, 17007 Girona, Spain
| | - David B Dunger
- Department of Paediatrics, Box 116, Level 8, Addenbrooke's Hospital Hills Road, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Francis de Zegher
- Paediatric Endocrinology, University Hospital Gasthuisberg, University of Leuven, Herestraat 49, 3000 Leuven, Belgium
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Chung JPW, Yiu AKW, Chung TKH, Chan SSC. A randomized crossover study of medroxyprogesterone acetate and Diane-35 in adolescent girls with polycystic ovarian syndrome. J Pediatr Adolesc Gynecol 2014; 27:166-71. [PMID: 24656700 DOI: 10.1016/j.jpag.2013.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 09/18/2013] [Accepted: 09/18/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the effects of 4-month treatment of medroxyprogesterone acetate (MPA) and Diane-35 on the clinical and biochemical features of hyperandrogenism and quality of life of adolescent girls with polycystic ovarian syndrome (PCOS). DESIGN A prospective, randomized, cross-over study. SETTING An accredited pediatric and adolescent gynecology clinic of a university-affiliated tertiary hospital. PARTICIPANTS 76 adolescents girls aged 14 to 19 years old with PCOS were recruited from July 2007 to July 2010. INTERVENTIONS Girls were randomized into 2 groups. Group 1 received oral MPA for 4 months, followed by a washout period of 4 months, and then Diane-35 for another 4 months. Group 2 received the same combination but in the reverse order. MAIN OUTCOME MEASURES Clinical and biochemical features of hyperandrogenism and quality of life were assessed. RESULTS There was no significant difference between the 2 groups at baseline. No significant difference was found in the clinical and biochemical parameters of hyperandrogenism before and after treatment with MPA. Significant reduction of the acne score, LH/FSH ratio, and testosterone level was seen after taking Diane-35. Hirsutism was also improved but it did not reach statistical significant. When comparing post-MPA and post-Diane-35, the post-Diane-35 group had significantly improved acne score and LH/FSH ratio. No significant difference was found on quality of life between both groups after treatment. CONCLUSION Diane-35 may be a more suitable treatment option in adolescent girls diagnosed with PCOS when compared to MPA.
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Affiliation(s)
- Jacqueline P W Chung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong.
| | - Alice K W Yiu
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong
| | - Tony K H Chung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong
| | - Symphorosa S C Chan
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong
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20
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Agapova SE, Cameo T, Sopher AB, Oberfield SE. Diagnosis and challenges of polycystic ovary syndrome in adolescence. Semin Reprod Med 2014; 32:194-201. [PMID: 24715514 DOI: 10.1055/s-0034-1371091] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Although the diagnostic criteria for polycystic ovary syndrome (PCOS) have become less stringent over the years, determination of the minimum diagnostic features in adolescents is still an area of controversy. Of particular concern is that many of the features considered to be diagnostic for PCOS may evolve over time and change during the first few years after menarche. Nonetheless, attempts to define young women who may be at risk for development of PCOS is pertinent since associated morbidity such as obesity, insulin resistance, and dyslipidemia may benefit from early intervention. The relative utility of diagnostic tools such as persistence of anovulatory cycles, hyperandrogenemia, hyperandrogenism (hirsutism, acne, or alopecia), or ovarian findings on ultrasound is not established in adolescents. Some suggest that even using the strictest criteria, the diagnosis of PCOS may not valid in adolescents younger than 18 years. In addition, evidence does not necessarily support that lack of treatment of PCOS in younger adolescents will result in untoward outcomes since features consistent with PCOS often resolve with time. The presented data will help determine if it is possible to establish firm criteria which may be used to reliably diagnose PCOS in adolescents.
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Affiliation(s)
- Sophia E Agapova
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Tamara Cameo
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Aviva B Sopher
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Sharon E Oberfield
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Columbia University Medical Center, New York, New York
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21
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Ságodi L, Lombay B, Vámosi I, Barkai L. [Obesity, hormonal and metabolic abnormalities in adolescent girls with polycystic ovary syndrome]. Orv Hetil 2013; 154:1226-34. [PMID: 23895991 DOI: 10.1556/oh.2013.29669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Polycystic ovary syndrome is associated with metabolic abnormalities, such as dyslipidemia, obesity, glucose intolerance, which are also components of the metabolic syndrome. Central obesity and insulin resistance appear to play an important role in the pathogenesis of polycystic ovary syndrome, perhaps via subsequent steroidogenic dysregulation. AIM The aim of the authors was to assess metabolic and hormonal abnormalities in adolescent girls with polycystic ovary syndrome. METHOD The study included 52 adolescents diagnosed with polycystic ovary syndrome based on the Rotterdam criteria. Anthropometric, hormonal and metabolic parameters were evaluated among all subjects. 20 healthy, age-matched, non-obese, regularly menstruating girls were used as controls. Of the 52 patients, 15 patients were born with low-birth-weight and 37 patients were born with normal birth weight. Oral glucose tolerance test was performed in all patients and controls. The age of patients was 16.8±3.1 years, and the age of controls was 16.95±2.1 years. RESULTS Among patients with polycystic ovary syndrome the prevalence of overweight and obesity was 35% (n = 18), while impaired fasting glucose occurred in one patient, impaired glucose tolerance in 8 patients, insulin resistance in 25 patients and metabolic syndrome in 12 patients. Serum triglyceride levels in patients and controls were 1.4±0.8 and 0.9±0.3 mmol/l, respectively (p<0.05), while fasting blood glucose, total cholesterol, HDL and LDL cholesterol were not different in the two groups. Metabolic abnormalities and obesity were more severe and more frequent in patients with low-birth-weight compared to those born with normal weight. There was a negative correlation between birth weight and body mass index SDS values and a positive correlation between fasting insulin levels and body mass index SDS (r = 0.37) in patients born with low-birth-weight. CONCLUSIONS Abnormal glucose metabolism is frequently present in adolescents with polycystic ovary syndrome. It is possible that early diagnosis of polycystic ovary syndrome in adolescence may prevent some of the long-term complications associated with this syndrome.
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Affiliation(s)
- László Ságodi
- Borsod-Abaúj-Zemplén Megyei Kórház és Egyetemi Oktató Kórház Csecsemő- és Gyermekosztály Miskolc.
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Ságodi L, Kiss-Tóth E, Barkai L. [Role of genetic and environmental factors in the development of polycystic ovary syndrome]. Orv Hetil 2013; 154:650-7. [PMID: 23608312 DOI: 10.1556/oh.2013.29589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Polycystic ovary syndrome is the most common heterogeneous endocrine abnormality in women in the reproductive age. The syndrome remains an enigmatic disorder because the aetiology is still unclear. Familial aggreagation is relatively common among patients with polycystic ovary syndrome suggesting a significant genetic component, although the way of inheritance has not been established firmly. The authors review the relevant medical literature and suggest that genetic and environmental factors play a role in the development of polycystic ovary syndrome. To date, no gene has been identified that causes or contributes substantially to the development of a polycystic ovary syndrome phenotype. Polycystic ovarian syndrome is considered to be an oligogenic disorder in which the interaction of a number of genetic and environmental factors determines the heterogeneous clinical and biochemical phenotype. To summarize current evidence the authors conclude, that when we are able to identify and then modify environmental determinants, then we will be able to safeguard better the health of those patients who are predisposed to disease development due to genotype or previous environmental effects.
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Affiliation(s)
- László Ságodi
- Borsod-Abaúj-Zemplén Megyei Kórház és Egyetemi Oktató Kórház Csecsemő- és Gyermekosztály, Miskolc, Szentpéteri kapu 72-76. 3524. Miskolci Egyetem, Egészségügyi Kar, Preventív Egészségtudományi Tanszék, Miskolc.
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