The long term health consequences of polycystic ovary syndrome

Integrated lipid metabolomics and proteomics analysis reveal the pathogenesis of polycystic ovary syndrome

BACKGROUND

Polycystic ovary syndrome (PCOS) is an endocrinological and metabolic disorder that can lead to female infertility. Lipid metabolomics and proteomics are the new disciplines in systems biology aimed to discover metabolic pathway changes in diseases and diagnosis of biomarkers. This study aims to reveal the features of PCOS to explore its pathogenesis at the protein and metabolic level.

METHODS

We collected follicular fluid samples and granulosa cells of women with PCOS and normal women who underwent in vitro fertilization(IVF) and embryo transfer were recruited. The samples were for the lipidomic study and the proteomic study based on the latest metabolomics and proteomics research platform.

RESULTS

Lipid metabolomic analysis revealed abnormal metabolism of glycerides, glycerophospholipids, and sphingomyelin in the FF of PCOS. Differential lipids were strongly linked with the rate of high-quality embryos. In total, 144 differentially expressed proteins were screened in ovarian granulosa cells in women with PCOS compared to controls. Go functional enrichment analysis showed that differential proteins were associated with blood coagulation and lead to follicular development disorders.

CONCLUSION

The results showed that the differential lipid metabolites and proteins in PCOS were closely related to follicle quality,which can be potential biomarkers for oocyte maturation and ART outcomes.

The Association of Polycystic Ovarian Syndrome Among Reproductive-Aged Women With Consumption of Junk Food in Jeddah, Saudi Arabia

OBJECTIVE

Polycystic ovarian syndrome (PCOS) is a common reproductive and endocrinological disorder that affects a significant percentage of women worldwide. Despite its high prevalence, the possible environmental factors that influence the development of PCOS, especially dietary habits, are still unclear. The aim of this study is to investigate the association between PCOS and junk food consumption among women of childbearing age in Jeddah, Saudi Arabia.

METHODS

A cross-sectional study was conducted from February 2023 to April 2023 in 155 women diagnosed with PCOS according to the Rotterdam criteria. Participants aged 18-47 years and living in Jeddah, Saudi Arabia completed a validated 30-item electronic questionnaire that included sociodemographic information, medical history, PCOS symptoms, and fast food consumption patterns.

RESULTS

The study revealed a high prevalence of obesity and overweight among PCOS patients, which was significantly associated with their diets high in carbohydrates, fats, and refined sugars. In addition, weight loss was difficult for these patients, which could be influenced by hormonal imbalances and dietary factors. In particular, fast food consumption showed a significant association with facial acne in PCOS patients, while some participants also experienced excessive hair growth on the face, abdomen, and back, which may be related to excessive fat intake.

CONCLUSION

This study provides evidence to support an association between junk food consumption and the prevalence of PCOS among women of reproductive age in Jeddah, Saudi Arabia. The findings suggest that dietary patterns may influence the development and treatment of PCOS, highlighting the need for lifestyle interventions as part of treatment strategies. Further studies with larger and more diverse populations, as well as longitudinal studies, are warranted to clarify causal relationships and gain a comprehensive understanding of the impact of dietary factors on the development and progression of PCOS. Identifying the potential effects of diet on PCOS can lead to more effective treatments and improve the overall health and well-being of those affected.

Age related endocrine patterns observed in polycystic ovary syndrome patients vs. ovulatory controls: descriptive data from a university based infertility center

Objective

To compare serum anti-Müllerian hormone (AMH) and other endocrine parameters between patients diagnosed with polycystic ovary syndrome (PCOS) and age-matched ovulatory women.

Materials and methods

AMH, DHEAS, FSH, LH, PRL, TSH and total testosterone (TT) were prospectively measured in oligo-ovulatory PCOS patients (n = 595) and in ovulatory non-PCOS women (n = 157) referred to a tertiary infertility center. Mean BMI was similar across the two study populations and there were no smokers in the sample. Patients in both groups were further classified into three categories by age: < 25 yrs, 25-34 yrs, and ≥ 35 yrs. Selected clinical and demographic characteristics were tabulated for each group.

Results

Serum AMH was significantly higher among PCOS patients compared to non-PCOS controls in the non-stratified sample (7.54 ± 5.8 vs. 2.49 ± 2.0 ng/mL, respectively; p < 0.0001), while serum FSH, DHEAS, TSH and prolactin were similar for both groups (p > 0.05). As expected, mean (total) testosterone levels were notably different between PCOS vs. non-PCOS controls (0.84 ± 0.76 vs. 0.43 ± 0.38 ng/mL, respectively; p < 0.001), and mean AMH level was significantly lower in the oldest age category (> 35 yrs) compared to both younger control groups (p < 0.0001). Both DHEAS and total testosterone decreased with age among PCOS patients, although mean serum DHEAS for women age > 35 yrs was significantly lower than DHEAS measured in younger women with PCOS (p < 0.02). For PCOS patients, AMH remained relatively stable irrespective of age.

Conclusion

Although AMH can serve as a satisfactory marker of ovarian reserve, for PCOS patients the expected decline in AMH associated with reproductive aging appears attenuated despite ovarian senescence. In contrast, mean DHEAS levels were markedly lower among older PCOS women (> 35 yrs) compared to younger PCOS patients.

High sensitivity C-reactive protein and its relationship with impaired glucose regulation in lean patients with polycystic ovary syndrome

The polycystic ovary syndrome (PCOS) is the most common endocrine-metabolic disorder, also associated with the metabolic syndrome. Serum high sensitivity C-reactive protein (hs-CRP), a marker of low-grade chronic inflammation is a potent predictor of cardiovascular events, closely linked to metabolic syndrome features and higher in patients with PCOS. However, hs-CRP in lean patients with PCOS has not been fully evaluated and few data are available. We aimed to investigate the relation between glucose intolerance and hs-CRP levels in lean patients with PCOS, and to evaluate the possible relationship between hs-CRP and PCOS by evaluating PCOS-related metabolic abnormalities in Korean women. We consecutively recruited 115 lean (BMI < 25kg/m(2)) patients diagnosed with PCOS and 103 lean healthy controls. The PCOS group was divided two groups: impaired glucose regulation (IGR) and normal glucose tolerance group (NGT). In lean patients with PCOS, hs-CRP level was higher in the IGR group than in the NGT group (0.60 ± 1.37 versus 0.18 ± 0.46, p(Bonf) = 0.023) and other metabolic risk factors were also higher in the IGR group than in the NGT group. And there were close relationships between hs-CRP level and metabolic risk factor, such as 2 h postprandial insulin level in the lean patients with PCOS.

Relation between C-reactive protein and body mass index in patients with polycystic ovarian syndrome

INTRODUCTION

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women. These patients share common features like obesity with metabolic syndrome. C-reactive protein (CRP) is a low-grade chronic inflammation biomarker that independently predicts high-risk patients for cardiovascular diseases (CVD). Although many studies showed increased plasma CRP levels in patients with PCOS, there is still less evidence that can link obesity and CRP levels in patients with PCOS. The objective of this study was to investigate the relations between body mass index (BMI) and CRP plasma levels in patients with PCOS.

METHOD

Forty patients with PCOS and 30 controls matched by age and BMI were included. Blood sample was obtained from all individuals in early follicular phase of menstrual cycle. CRP, fasting blood sugar (FBS), triglyceride (TG), and total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), blood pressure, waist circumference (WC) and BMI was measured for all subjects.

RESULT

CRP and TG levels were higher in patients with PCOS (p < 0.001 and p = 0.011, respectively). CRP level increased significantly only in patients with PCOS with BMI ≥ 25 kg/m(2) (p = 0.001) but was not significant in patients with PCOS with BMI < 25 kg/m(2) (p = 0.067). In further analysis, BMI and WC affect CRP rising in patients with PCOS (p = 0.001).

CONCLUSION

In patients with PCOS, serum CRP levels were higher than age and BMI-matched controls. Furthermore, BMI was strongly related to CRP only in overweight patients with PCOS.

Lack of association between intercellular adhesion molecule-1 (ICAM-1) polymorphisms and polycystic ovary syndrome

PURPOSE

This study examined the possible association of G241R and K469E single nucleotide polymorphisms (SNPs) of ICAM-1 gene with the occurrence and clinical/biochemical characteristics of polycystic ovary syndrome (PCOS).

METHODS

G241R and K469E SNPs in DNA from peripheral blood leukocytes of 169 PCOS and 259 healthy control women were investigated by real-time PCR combined with melting curve analysis using fluorescence-labeled hybridization probes.

RESULTS

We did not find significant differences in the distributions of G241R and K469E polymorphisms, nor in the haplotype frequencies between PCOS and control women. None of the studied polymorphisms were found to affect insulin resistance indices significantly.

CONCLUSIONS

These preliminary results suggest that the 241 and 469 SNPs of ICAM-1 gene may not be risk factors for PCOS. Further studies with a larger cohort, analyzing other ICAM-1 polymorphisms are necessary to support our observations before any statement can be made about the relationship between PCOS and ICAM-1 polymorphisms.

Insulin resistance and the long-term consequences of polycystic ovary syndrome

In a significant number of women with the polycystic ovary syndrome there is impaired insulin metabolism with hypersecretion of insulin. Insulin resistance is defined as a diminution in the glucose response to a given amount of insulin. Insulin resistance has been implicated in the pathogenesis of many aspects of the syndrome. Hyperinsulinaemia leads to increased production of androgens resulting in anovulatory infertility. Women and particularly obese women with insulin resistance and the polycystic ovary syndrome have an increased risk of developing gestational diabetes and also type 2 diabetes and cardiovascular disease in later life. The women should be counselled about long-term health risks, and obese women with the polycystic ovary syndrome should be periodically screened. Lifestyle modification to reduce weight in obese women and treatment with insulin-sensitising drugs such as metformin in women with glucose intolerance result in the improvement of some metabolic abnormalities and hyperandrogenic disorders with the consequent restoration of normal menstrual and ovulatory function in a significant number of women with polycystic ovaries.

Therapeutic options in the polycystic ovary syndrome

The polycystic ovary syndrome is the most common endocrine disorder affecting women. It is a heterogeneous familial condition of uncertain aetiology. The diagnosis is made by the detection of polycystic ovaries on ultrasound examination and the occurrence of single or multiple clinical features such as menstrual cycle disturbances, obesity, acne, hirsutism, alopecia and biochemical abnormalities such as hypersecretion of luteinising hormone and testosterone. In a significant number of women with this condition there is impaired insulin metabolism. Women with the polycystic ovary syndrome are at an increased risk of developing diabetes and possibly cardiovascular disease in later life. The management should be symptom-orientated. Menstrual cycle regulation may be attained with the combined oral contraceptive pill or cyclical progestogen therapy. In obese women, with the loss of weight, the symptoms and endocrine profile are generally improved. Short-term treatment with metformin may be useful in women with insulin resistance. Hyperandrogenism may be treated with the contraceptive pill containing cyproterone acetate or with short-term low-dose anti-androgen therapy, together with effective contraception. Ovulation may be induced with clomiphene citrate with careful monitoring, failing which low-dose gonadotrophin therapy or laparoscopic ovarian diathermy are effective options.

Effects of oral fat and glucose tolerance test on serum lipid profile, apolipoprotein, and CRP concentration, and insulin resistance in patients with polycystic ovary syndrome

OBJECTIVE

To evaluate serum lipid responses and insulin resistance to a high-fat content meal in patients with polycystic ovary syndrome (PCOS).

DESIGN

Controlled clinical study.

SETTING

Healthy volunteers and patients with PCOS in clincial research.

PATIENT(S)

Twenty women with PCOS (22.7 +/- 4 years, body mass index [BMI]: 23.5 +/- 2.6 kg/m(2)) and 20 age- and BMI-matched control women (22.8 +/- 4, BMI: 23.1 +/- 3.1 kg/m(2)) were included in the study. Waist circumference, BMI, fat mass, fat percent, and fat-free mass were measured.

INTERVENTION(S)

A standard oral glucose tolerance test (75 g of glucose, 2 hours) was performed, and the area under the curve-glucose (AUC(glu)) and homeostasis model assessment of insulin resistance (HOMA-IR) were used for insulin resistance. An oral fat tolerance test (OFTT) with 500 mL standard fat meal (1493 kcal) was performed. With OFTT, both timely (at 0, second, fourth, sixth, and eighth hours) and AUC(triglyceride), AUC(total-cholesterol), AUC(VLDL-cholesterol), AUC(HDL-cholesterol), AUC(LDL-cholesterol), AUC(insulin), AUC(glucose), AUC(hs-CRP), AUC(LP(a)), AUC(ApoA1), and AUC(ApoB) responses were evaluated.

MAIN OUTCOME MEASURE(S)

Plasma lipid, insulin, and C-reactive protein levels.

RESULT(S)

Waist circumference, fat percent, and HOMA-IR values of PCOS patients were higher than those of control subjects. AUC(glu) values were also higher in patients with PCOS. After OFTT, AUC(triglyceride), AUC(total cholesterol), and AUC(VLDL) values were higher in patients with PCOS.

CONCLUSION(S)

Patients with PCOS have insulin resistance and prolonged lipid response to OFTT. These exaggerated responses may cause early atherogenesis in these patients.

Effects of two forms of combined oral contraceptives on carbohydrate metabolism in adolescents with polycystic ovary syndrome

OBJECTIVE

To compare the effects of combined oral contraceptives (OCs) containing cyproterone acetate or desogestrel on insulin sensitivity in adolescents with polycystic ovary syndrome (PCOS).

DESIGN

A prospective randomized clinical trial.

SETTING

Outpatient gynecological clinic of Aretaieion University Hospital.

PATIENT(S)

Thirty-six adolescent girls with hyperandrogenism and six or less menses in the preceding 12 months.

INTERVENTION(S)

Patients were separated in two groups: group A (n = 18) received 0.15 mg of desogestrel plus 0.030 mg of ethinyl E2 daily; and group B (n = 18) received 2 mg of cyproterone acetate plus 0.035 mg of ethinyl E2 daily, for 21 days followed by a 7-day rest, for 12 months.

MAIN OUTCOME MEASURE(S)

Hirsutism score, lipid, androgen, and sex hormone-binding globulin (SHBG) levels were evaluated at baseline. An oral glucose tolerance test (OGTT) was performed and metabolism indices, based on previously studied mathematical formulas, were assessed at baseline and at 12 months.

RESULT(S)

After 12 months of treatment, the homeostasis model assessment index of insulin resistance increased significantly in both groups. The fasting glucose-to-insulin ratio and predicted insulin sensitivity index decreased in group B. The delta of the area under the OGTT curve for insulin and predicted first and second phase insulin secretion indices increased significantly only in group B.

CONCLUSION(S)

We conclude that treatment of adolescent girls with PCOS with the two combined OCs administered, results in unfavorable changes of insulin sensitivity. In addition, cyproterone acetate is associated with an increase of insulin secretion and hyperinsulinemia.

Serum C-reactive protein (CRP) levels and insulin resistance in non-obese women with polycystic ovarian syndrome, and effect of bicalutamide on hirsutism, CRP levels and insulin resistance

BACKGROUND/AIMS

Insulin resistance is associated with serum C-reactive protein (CRP) levels. We aimed to evaluate the effect of bicalutamide on insulin resistance and serum CRP levels in non-obese polycystic ovarian syndrome (PCOS) patients.

METHODS

40 non-obese patients (BMI < or =25 kg/m2) with PCOS and, 40 age- and BMI-matched healthy women were studied. Patients received bicalutamide orally at the dose of 25 mg/day. Serum CRP levels were measured with immunometric assay. Homeostasis model assessment (HOMA-IR) index was used for insulin resistance.

RESULTS

Mean Ferriman-Gallwey score (FGS) (p = 0.001), insulin (p = 0.001), serum glucose (p = 0.001), prolactin (p < 0.003), total (p < 0.04) and free testosterone (p = 0.001) and free androgen index (FAI) levels (p = 0.001) of PCOS subjects were higher than in the control group. Mean HOMA-IR of PCOS patients was higher than in control subjects (2.43 +/- 1.2 and 0.94 +/- 0.37, p = 0.001). CRP levels in subjects with PCOS was also higher than in control subjects (4.27 +/- 1.33 and 0.98 +/- 0.19, p = 0.001). After bicalutamide treatment, FGS, free and total testosterone and FAI decreased (p = 0.001). HOMA-IR, prolactin and CRP levels did not show any statistical difference with bicalutamide treatment.

CONCLUSIONS

PCOS patients had insulin resistance and a high CRP level. Bicalutamide treatment did not influence insulin resistance and CRP level in PCOS, and this ineffectiveness of bicalutamide on CRP levels may be the result of insulin resistance and/or high prolactin levels at this time.

Cyproterone Acetate with Ethinylestradiol as a Risk Factor for Venous Thromboembolism: An Epidemiological Evaluation

OBJECTIVE

To review the incidence of venous thromboembolism (VTE) in association with combined cyproterone acetate and ethinylestradiol (CPA/EE) use, compared to the incidence of VTE in association with conventional oral contraceptive (OC) use, in women aged 14 to 49 years.

METHODS

A review consistent with the guidelines of "best evidence synthesis" was conducted on 6 peer-reviewed, controlled epidemiological studies reporting both outcome numerators and exposure denominators. Relative risks as the estimate of the association between CPA/EE and the clinical outcome of VTE were set aside in favour of absolute incidence rates, rate differences, or attributable risks.

RESULTS

The range of absolute incidence rates of VTE among CPA/EE users varied from 1.2 to 9.9 per 10 000 women-years (WYs). All other marketed conventional OCs were the reference. In 6 studies conducted in 3 European countries, CPA/EE exhibited an attributable risk in women not higher than 0.04% when compared to approved conventional OCs. Except for 1 study exhibiting a small statistically significant benefit, there was no difference between the incidence rates of VTE among CPA/EE users and those among conventional OC users. VTE as an adverse event for CPA/EE was either rare or very rare, according to the criteria set by the World Health Organization/ Council for International Organizations of Medical Sciences. No deaths were reported in the studies reviewed.

CONCLUSIONS

The evidence in the worldwide literature does not demonstrate an excess of health-threatening harm for CPA/EE. A best-evidence synthesis, using sound epidemiological methods, showed clearly that the risks of VTE among CPA/EE users do not exceed the risks of VTE among conventional OC users.

Insulin resistance and lipid profile in women with polycystic appearing ovaries: implications with regard to polycystic ovary syndrome

The aim of this study was to investigate carbohydrate and lipid profiles in women with polycystic appearing ovaries (PCO) on ultrasound examination who did not fulfill the criteria for polycystic ovary syndrome (PCOS). We sonographically evaluated and biochemically diagnosed 35 patients with PCO, 31 women with PCOS and 23 healthy controls. We performed oral glucose tolerance tests (OGTT) and calculated the quantitative insulin sensitivity check index (QUICKI) and the homeostatic model assessment (HOMAIR) scores. Serum fasting insulin levels, 1-h insulin response, HOMAIR and QUICKI scores were significantly higher in the PCO and PCOS groups than in the controls. However, serum fasting glucose levels, fasting insulin levels, HOMAIR and QUICKI scores were similar in women with PCO and PCOS. In women with PCO, high-density lipoprotein (HDL) levels were higher, and very-low-density lipoprotein (VLDL) and triglyceride levels were lower compared with women with PCOS. Furthermore, insulin responses to OGTT, HOMAIR and QUICKI scores and lipid values correlated with serum androgen levels and body mass index (BMI) in PCO patients. In conclusion, women with PCO who do not fulfill the criteria for PCOS have abnormal insulin sensitivity and insulin resistance. The finding of similar insulin abnormalities in women with PCO to those in women with PCOS confirms that women with PCO have similar metabolic characteristics to those with PCOS.

Diagnostic and treatment characteristics of polycystic ovary syndrome: descriptive measurements of patient perception and awareness from 657 confidential self-reports

BACKGROUND: This investigation was undertaken to describe patient perception and awareness of the polycystic ovary syndrome (PCOS), the most common cause of anovulation/oligoovulation among women of reproductive age. METHODS: Fifteen parameters were evaluated by a computer-based research instrument accessed by a large, unscreened population. Incomplete questionnaires were not entered, and responses were electronically tabulated to block duplicate submissions. RESULTS: From 657 participants, the majority (63%) were between 26-34 years old; mean BMI was 30.4 kg/m2. 343 of 657 had at least one pregnancy and 61% of the study group had taken fertility medicine (any type) at least once. Physicians were the most common provider of PCOS information for all study participants, irrespective of age. Patient emotions associated with the diagnosis of PCOS included "frustration" (67%), "anxiety" (16%), "sadness" (10%), and "indifference" (2%). Self-reported patient aptitude regarding PCOS was scored as high or "very aware" in >60% of women. Respondents were also asked: "If your PCOS could be safely and effectively helped by something else besides fertility drugs or birth control pills, would that interest you?" Interest in alternative PCOS treatments was expressed by 99% of the sample (n = 648). CONCLUSIONS: In our study population, most women associated negative emotions with PCOS although the self-reported knowledge level for the disorder was high. While these women regarded their obstetrician-gynecologist as integral to their PCOS education, traditional PCOS therapies based on oral contraceptives or ovulation induction agents were regarded as unsatisfactory by most women.