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Tan K, Coster T, Mousa A, Mar A, Piltonen T, Boyle JA, Teede H, Joham A, Romualdi D, Tay CT. Laser and Light-Based Therapies for Hirsutism Management in Women With Polycystic Ovarian Syndrome: A Systematic Review. JAMA Dermatol 2024; 160:746-757. [PMID: 38630483 DOI: 10.1001/jamadermatol.2024.0623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
Importance Hirsutism represents a significant concern for women with polycystic ovary syndrome (PCOS), with deleterious psychological effects warranting acknowledgment and a clear imperative to provide effective management. To our knowledge, this is the first review to exclusively examine the effectiveness of laser and light-based therapies in addressing hirsutism in women with PCOS. Objective To synthesize the existing literature regarding the effectiveness of laser and light hair reduction therapies, either as stand-alone treatments or in combination with systemic agents, in treating hirsutism for women with PCOS. Evidence Review A systematic literature review was performed using MEDLINE, Embase, EMCARE, and CINAHL according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Articles written in English, reporting on patients who met pre-established inclusion criteria were selected. Objective and subjectively measured outcomes relating to the effect of laser or light-based hair reduction therapies on hirsutism were abstracted. Heterogeneity among included studies precluded a meta-analysis, necessitating a narrative synthesis. Findings Six studies reporting data on 423 individual patients with PCOS who underwent laser or light-based hair reduction therapies were included: 4 randomized clinical trials and 2 cohort studies. Alexandrite laser demonstrated significant improvements in hirsutism severity and psychological outcomes, particularly at high-fluence application. Alexandrite laser was also found to be more effective than intense pulsed light (IPL). The combination of diode laser with either metformin or combined oral contraceptive pill was superior to the application of diode laser alone, just as the addition of metformin to IPL demonstrated superior results to IPL treatment alone. Overall, most interventions were well tolerated. The overall certainty of evidence across all outcomes and comparisons was limited in part due to the observational nature of some studies. Conclusions and Relevance This systematic review highlights the potential of laser and light hair reduction therapies, both as stand-alone treatments and in combination with other pharmacological agents in PCOS. However, this review was limited by low certainty of the evidence, few studies evaluating effectiveness and safety in those with skin of color, and heterogeneity in outcome assessment. Future studies are needed to provide more robust evidence among diverse individuals with PCOS and hirsutism.
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Affiliation(s)
- Katrina Tan
- Monash Health, Department of Dermatology, Melbourne, Australia
| | - Thisara Coster
- Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine Nursing and Health Sciences, Monash University, Australia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine Nursing and Health Sciences, Monash University, Australia
| | - Adrian Mar
- Monash Health, Department of Dermatology, Melbourne, Australia
| | - Terhi Piltonen
- Department of Obstetrics and Gynecology, Research Unit of Clinical Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Jacqueline A Boyle
- Eastern Health Clinical School, Monash University, Melbourne, 3128, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine Nursing and Health Sciences, Monash University, Australia
| | - Anju Joham
- Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine Nursing and Health Sciences, Monash University, Australia
| | - Daniela Romualdi
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Chau Thien Tay
- Monash Centre for Health Research and Implementation (MCHRI), Faculty of Medicine Nursing and Health Sciences, Monash University, Australia
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Sakina S, Behram F, Jadoon SK, Mumtaz S, Akbar A, Ijaz Raja A, Tasneem S. Impact of Laser Therapy on the Quality of Life in Women Living With Polycystic Ovary Syndrome-Associated Hirsutism: An Observational Study. Cureus 2024; 16:e61125. [PMID: 38813070 PMCID: PMC11134484 DOI: 10.7759/cureus.61125] [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] [Accepted: 05/26/2024] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION This study aimed to observe the impact of laser-assisted hair removal (LAHR) on the quality of life in women with polycystic ovary syndrome (PCOS)-associated hirsutism. METHODOLOGY An observational study was conducted on 172 women living with PCOS at a specialized clinic. The Dermatology Life Quality Index (DLQI) and Ferriman-Gallwey (FG) score were employed to assess the quality of life and severity of hirsutism, respectively. Laser therapy was administered using ruby diode or alexandrite lasers. Follow-up on the DLQI and FG score assessment was done at 12-, 18-, and 24-week post-treatment. RESULTS The number of cases that reported stress, anxiety, and depression reduced over time. However, there was no correlation between the patient-reported decrease and DLQI scores. The FG score was significantly related to mental health. The severity of the hirsutism impacted mental health. The regrowth of hair at six months indicated limited long-term efficacy LAHR. CONCLUSION LAHR significantly improves the quality of life in the short term for women living with PCOS. However, the short-term benefit of the therapy indicates a need for research to find new treatment strategies.
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Affiliation(s)
| | - Faiza Behram
- Dermatology, Abbas Institute of Medical Sciences, Muzaffarabad, PAK
| | | | - Sarosh Mumtaz
- Dermatology, Combined Military Hospital, Muzaffarabad, PAK
| | - Amna Akbar
- Emergency and Accident, District Headquarter Hospital, Jhelum Valley, Muzaffarabad, PAK
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Khare VR, Sinha B, Sengupta N, Chatterjee S, Maji D, Majumder A, Guha P, Datta S, Hawelia DK, Bhattacharyya S, Chaudhuri SR, Batin M. Practise Updates: Diagnosis and Management of Idiopathic Hirsutism. Indian J Endocrinol Metab 2024; 28:239-249. [PMID: 39086564 PMCID: PMC11288517 DOI: 10.4103/ijem.ijem_2_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/19/2024] [Accepted: 04/11/2024] [Indexed: 08/02/2024] Open
Abstract
Idiopathic hirsutism (IH) is a common clinical condition with multiple diagnostic and therapeutic uncertainties. There are no clear recommendations for the diagnosis and management of the condition. This practice update was developed to guide the primary care physicians and the specialists in better and more systematic management of IH particularly in the Indian context. Twelve experienced members consisting of eminent endocrinologists, physicians, a dermatologist, a gynaecologist and a psychiatrist were invited by the Integrated Diabetes and Endocrine Academy (IDEA). A literature search was performed using online databases from PubMed, Cochrane Library and Google Scholar. Published articles from peer-reviewed indexed journals, with a preference for meta-analyses and randomized controlled trials, were selected. A meeting took place with all the 12 members individually giving their opinions on predetermined questions of interest. After the initial meeting during IDEACON 2023, two more meetings were held and the practice update was formulated after voting. Practice updates were made on important areas such as the cut-off for modified Ferriman-Gallwey Score for the Indian population, conditions to be excluded before diagnosing IH, when to refer to specialists, investigations in a suspected case of IH and choice of therapies for its management.
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Affiliation(s)
- Vibhu R. Khare
- Department of Endocrinology, Nil Ratan Sircar Medical College and Hospital, Anandapur, India
| | - Binayak Sinha
- Department of Endocrinology, AMRI Hospitals, Anandapur, India
| | - Nilanjan Sengupta
- Department of Endocrinology, Nil Ratan Sircar Medical College and Hospital, Anandapur, India
| | | | - Debasish Maji
- Department of Endocrinology, RK Mission Seva Pratisthan, Anandapur, India
| | - Anirban Majumder
- Department of Endocrinology, KPC Medical College and Hospital, Anandapur, India
| | - Prathama Guha
- Department of Psychiatry, Calcutta National Medical College, Anandapur, India
| | - Sujata Datta
- Department of Gynaecology, Fortis Hospital, Anandapur, India
| | - Dinesh K. Hawelia
- Dermatologist, AMRI Hospital and Belle Vue Clinic, Naihati, West Bengal, India
| | - Supratik Bhattacharyya
- Department of Metabolic Medicine, SKN Diabetes and Endocrine Centre, Naihati, West Bengal, India
| | | | - Masood Batin
- Medicine and Diabetology, Mission of Mercy Hospital, Kolkata, West Bengal, India
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Elliott J, Liu K, Motan T. Directive clinique n° 444 : Hirsutisme : Évaluation et traitement. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:102273. [PMID: 38049279 DOI: 10.1016/j.jogc.2023.102273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
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Elliott J, Liu K, Motan T. Guideline No. 444: Hirsutism: Evaluation and Treatment. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:102272. [PMID: 38049282 DOI: 10.1016/j.jogc.2023.102272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
OBJECTIVE This guideline reviews the etiology, diagnosis, evaluation, and treatment of hirsutism. TARGET POPULATION Women with hirsutism. OPTIONS Three approaches to management include: 1) mechanical hair removal; 2) suppression of androgen production; and 3) androgen receptor blockade. OUTCOMES The main limitations of the management options include the adverse effects, costs, and duration of treatment. BENEFITS, HARMS, AND COSTS Implementation of the recommendations in this guideline may improve the management of hirsutism in women with this condition. Adverse effects and a potential long duration of treatment are the main drawbacks to initiating treatment, as is the possibility of significant financial costs for certain treatments. EVIDENCE A comprehensive literature review was updated to April 2022, following the same methods as for the prior Society of Obstetricians and Gynaecologists of Canada (SOGC) Hirsutism guidelines. Results were restricted to systematic reviews, randomized controlled trials, controlled clinical trials, and observational studies. There were no date limits, but results were limited to English- or French-language materials. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, along with the option of designating a recommendation as a "good practice point." See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE Primary care providers, family medicine physicians, obstetricians and gynaecologists, reproductive endocrinologists and others who manage the care of patients with hirsutism. TWEETABLE ABSTRACT Management of hirsutism involves a 3-pronged approach of mechanical hair removal, suppression of androgen production, and androgen receptor blockade. SUMMARY STATEMENTS RECOMMENDATIONS.
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Hirsutism is associated with increased hospitalization for mental health disorders. Arch Dermatol Res 2022; 315:1277-1286. [DOI: 10.1007/s00403-022-02477-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/15/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022]
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Lefoulon N, Begon E, Perrissin-Fabert M, Grouthier V, Hocke C, Bernard V. [Impact of combined oral contraceptives and spironolactone on hirsutism and quality of life]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:591-599. [PMID: 35697273 DOI: 10.1016/j.gofs.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/03/2022] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Combined oral contraceptives (COC) and spironolactone are the first and second-line treatments of mild hirsutism, since the use of cyproterone acetate was restricted to the treatment of severe hirsutism by the French guidelines for hyperandrogenism published in May 2020. Because spironolactone was until now barely used in France, the aim of this study was to evaluate the indication, efficacy and impact on quality of life of COC and spironolactone treatments on mild hirsutism in non-menopausal women. METHODS This retrospective monocentric study was conducted between June 2020 and October 2021. It included patients with mild hirsutism who received a prescription of COC or/and spironolactone. Modified Ferriman and Gallwey score (FGm) was performed by clinicians and self-rated by patients during the follow-up. Hirsutism-related quality of life was assessed using the Dermatology Life Quality Index (DLQI) and a visual analog scale. RESULTS A total of 44 patients were included, but only 30 patients received the treatment for 6 months. 70% of patients were free of side effects. Clinically we observed a decrease of 26% in the FGm score rated by clinicians and patients after 6 months of treatment (P<0,01). This was not correlated with an improvement in quality of life. CONCLUSIONS The data collected showed the clinical efficacy of both COC and spironolactone in the treatment of mild hirsutism. These two treatments were well-tolerated. However, the quality of life scores did not improve after 6 months. These treatments should be evaluated after a longer period.
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Affiliation(s)
- Nina Lefoulon
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, Bordeaux, France
| | - Emmanuelle Begon
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, Bordeaux, France
| | - Marie Perrissin-Fabert
- Service de gynécologie, CH de Mont de Marsan, avenue Pierre de Coubertin, 40000 Mont de Marsan, France
| | - Virginie Grouthier
- Service d'endocrinologie, diabétologie et nutrition, CHU de Bordeaux, Bordeaux, France
| | - Claude Hocke
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, Bordeaux, France
| | - Valérie Bernard
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, Bordeaux, France.
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Wang TM, Chou CH, Lee YL, Chung CH, Huang YC, Lai XC, Sun CA, Kang CY, Wu GJ, Chien WC. Clinical Characteristics of Hyperandrogenism Include Hirsutism, Polycystic Ovary Syndrome, and Acne: Association with Psychiatric Disease in Women -A Nationwide Population-Based Cohort Study in Taiwan. Int J Womens Health 2022; 14:1173-1189. [PMID: 36059578 PMCID: PMC9432384 DOI: 10.2147/ijwh.s376244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/10/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Previous studies have shown an increased in psychiatric disorders in women with disorders associated with hyperandrogenism, but few nationwide cohorts have studied this phenomenon. Therefore, this study is aimed to examine the association between the clinical manifestations of hyperandrogenism and subsequent psychiatric disorders. Methods Based on the National Health Insurance Research Database, 49,770 enrolled participants were matched for age and index date between January 1, 2000, and December 31, 2015. Hirsutism, polycystic ovary syndrome, and acne are characterized by hyperandrogenism. After adjusting for confounding factors, we used Cox proportional analysis to compare the risk of psychiatric disorders during the 16 years of follow-up. Results Of all the participants, 1319 (13.25%) had psychiatric disorders in the study group, whereas only 3900(9.80%) had psychiatric disorders in the control group. After adjusting for age, and monthly income, the Cox regression analysis showed that the study patients were more likely to develop psychiatric disorders (hazard ratio [HR]: 2.004, 95% confidence interval [CI] = 1.327–2.724, P < 0.001). The results demonstrated that women aged 20–29 years had a more significant risk. Conclusion Women with clinical characteristics of hyperandrogenism have a higher risk of developing psychiatric disorders, especially those aged 20–29 years.
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Affiliation(s)
- Tsan-Min Wang
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
- Taipei Municipal Jianguo High School, Taipei, Taiwan
| | - Cheng-Hao Chou
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
- Taipei Municipal Jianguo High School, Taipei, Taiwan
| | - Yi-Liang Lee
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Department of Obstetrics and Gynecology, Kang Ning Hospital, Taipei, Taiwan, Republic of China
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei, Taiwan
| | - Yao-Ching Huang
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei, Taiwan
| | - Xiao-Cheng Lai
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, Republic of China
- Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, Republic of China
| | - Chieh-Yi Kang
- Chi Mei Medical Center Gynecologic Oncologist Division, Department of Obstetrics & Gynecology, Tainan City, Taiwan, Republic of China
- Correspondence: Gwo-Jang Wu; Chieh-Yi Kang, Email ;
| | - Gwo-Jang Wu
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
- Correspondence: Gwo-Jang Wu; Chieh-Yi Kang, Email ;
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
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Krasniqi A, McClurg DP, Gillespie KJ, Rajpara S. Efficacy of lasers and light sources in long-term hair reduction: a systematic review. J COSMET LASER THER 2022; 24:1-8. [DOI: 10.1080/14764172.2022.2075899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- A. Krasniqi
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - D. P. McClurg
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - K. J. Gillespie
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - S. Rajpara
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- Department of Dermatology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK
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Hsieh WC, Chen CH, Cheng YC, Yu TS, Hsu CY, Ke DS, Lin CM, Hsu CY. The Risk of Herpes Zoster in Women with Polycystic Ovary Syndrome: A Retrospective Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053094. [PMID: 35270787 PMCID: PMC8909925 DOI: 10.3390/ijerph19053094] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/16/2022]
Abstract
Background: The association between polycystic ovary syndrome (PCOS) and the risk of herpes zoster (HZ) remains unclear. This study investigated the risk of HZ in women with PCOS. Methods: This study used data from the Longitudinal Generation Tracking Database (LGTD 2005) which contains the information of 2 million randomly selected from National Health Insurance beneficiaries. Patients who received a diagnosis of PCOS between 2000 and 2017 were included in the PCOS cohort. Patients who were not diagnosed as having PCOS were randomly selected from the LGTD 2005 and included in the control cohort. Patients who were aged <20 years and had a history of HZ before the index date were excluded. Patients who were in both the cohorts were matched at a ratio of 1:1 through propensity score matching based on age, comorbidities, and medication. The primary outcome was the diagnosis of HZ. Results: A total of 20,142 patients were included in each case and control cohorts. The incidence rates of HZ in the PCOS and control cohorts were 3.92 and 3.17 per 1000 person-years, respectively. The PCOS cohort had a significantly higher risk of HZ than did the control cohort (adjusted hazard ratios [aHR] = 1.26). Among the patients aged 30−39 years, those with PCOS had a significantly higher risk of HZ than did those without PCOS (aHR = 1.31). Among the patients without any comorbidities, those with PCOS had a significantly higher risk of HZ (aHR = 1.26) than did those without PCOS. Conclusion: PCOS is associated with the risk of HZ, especially in young women. The risk of HZ should be addressed while treating patients with PCOS. An HZ vaccine is recommended for these patients.
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Affiliation(s)
- Wen-Che Hsieh
- Department of Chinese Medicine, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi 600, Taiwan;
| | - Chia-Hung Chen
- Department of Medical Education, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi 600, Taiwan; (C.-H.C.); (Y.-C.C.)
- Department of Medical Imaging, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi 600, Taiwan
| | - Yung-Chi Cheng
- Department of Medical Education, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi 600, Taiwan; (C.-H.C.); (Y.-C.C.)
- Department of Rehabilitation, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 600, Taiwan
| | - Teng-Shun Yu
- Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan;
- College of Medicine, China Medical University, Taichung 404, Taiwan
| | - Chung Y. Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 404, Taiwan;
| | - Der-Shin Ke
- Department of Neurology, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi 600, Taiwan;
| | - Chih-Ming Lin
- Department of Laboratory Medicine, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi 600, Taiwan
- Correspondence: (C.-M.L.); (C.-Y.H.)
| | - Chao-Yu Hsu
- Department of Medical Education, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi 600, Taiwan; (C.-H.C.); (Y.-C.C.)
- Department of Optometry/Medical Imaging and Radiological Sciences, Central Taiwan University of Science and Technology, Taichung 406, Taiwan
- Center for General Education, National Taichung University of Science and Technology, Taichung 404, Taiwan
- Department of General Education, National Chin-Yi University of Technology, Taichung 411, Taiwan
- Correspondence: (C.-M.L.); (C.-Y.H.)
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Joshi RD, Sawant N, Mayadeo NM. How Common are Depressive-Anxiety States, Body Image Concerns and Low Self-Esteem in Patients of PCOS? J Obstet Gynaecol India 2022; 72:72-77. [PMID: 35125741 PMCID: PMC8804144 DOI: 10.1007/s13224-021-01505-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/22/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age with increased incidence of emotional disturbances and other psychopathology. We undertook this research to study the prevalence and severity of depression and anxiety as well as understand body image disturbances and self-esteem of the women of PCOS. We studied the relationship of depressive symptoms with self-esteem and body image disturbances. METHOD A total of 105 patients diagnosed as PCOS were recruited from gynecology OPD after informed consent and ethics approval. A proforma along with Beck's Depression Inventory, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Body Image Concern Inventory and Rosenberg' s Self-Esteem Scale were administered to patients for further assessment. RESULTS In total, 54 (51.43%) patients of PCOS had depression on BDI, 12( 11.43%) patients had body image disturbances an d 23 (21.90%) patients had a low self-esteem. A total of 21 patients( 20%) had mild and moderate depression while 5% had severe depression. Majority 53 (50.48%) of our patients had mild anxiety whereas severe to extreme anxiety was seen in about 31% of patients. Body image disturbances were seen in only 12(11.43%) patients and low self-esteem was present in 23 patients. No statistically significant correlation of depression was seen with body image or self-esteem. CONCLUSIONS The results of this study indicate that there is a high prevalence of depression and anxiety in patients of PCOS than body image concerns and low self-esteem. Prognosis for patients would improve by liaison between gynecologist and psychiatrist.
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Affiliation(s)
- Rashmi D. Joshi
- Seth Gordhandas Sunderdas Medical College: King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra India
| | - Neena Sawant
- Seth Gordhandas Sunderdas Medical College: King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra India
| | - Niranjan M. Mayadeo
- Seth Gordhandas Sunderdas Medical College: King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra India
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Chin HB, Marsh EE, Hall JE, Baird DD. Prevalence of Hirsutism Among Reproductive-Aged African American Women. J Womens Health (Larchmt) 2021; 30:1580-1587. [PMID: 34520248 DOI: 10.1089/jwh.2021.0125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Hirsutism is the most common clinical symptom of hyperandrogenism, but racial and ethnic-specific thresholds have not been established. Our objective was to characterize hirsutism using self-report of hair growth in a large sample of African American women. Materials and Methods: The Study of Environment, Lifestyle, and Fibroids is a prospective community-based cohort study of African American women (23-34 at recruitment). A total of 1568 participants received the modified Ferriman-Gallwey (mFG) pictorial assessment and were asked if they were ever bothered by excess hair. We estimated the prevalence of hirsutism (mFG score ≥8) and associations of acne, polycystic ovary syndrome (PCOS), and menstrual cycle characteristics with hirsutism. We also explored hirsutism defined by the 95th percentile of scores in our cohort (mFG = 11) and a newly recommended criterion, mFG = 4. Results: We could determine hirsutism status in 1556 women. Thirty-seven percent reported being bothered by excess hair, and 10% met the mFG criterion for hirsutism. History of severe facial acne was positively associated with hirsutism (prevalence ratio: 1.90; 95% confidence interval [CI]: 1.30-2.76), as was physician-diagnosed PCOS (2.22, 95% CI: 1.30-3.81). Women with irregular menstrual cycles were also more likely to report hirsutism (1.78, 95% CI: 1.00-3.18). Results were similar using mFG ≥11 and attenuated using mFG ≥4. Conclusions: Hirsutism prevalence was 10% in this community sample of African American women and was associated with PCOS, severe acne, and irregular menstrual cycles suggesting this represented hirsutism caused by hyperandrogenism. Ethnically diverse, population-based studies assessing the association between mFG score and androgen levels are needed to better understand the hirsutism threshold as a clinical marker of hyperandrogenism.
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Affiliation(s)
- Helen B Chin
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, Virginia, USA.,Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, USA
| | - Erica E Marsh
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Janet E Hall
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, USA
| | - Donna D Baird
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, USA
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13
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Kałużna M, Nomejko A, Słowińska A, Wachowiak-Ochmańska K, Pikosz K, Ziemnicka K, Ruchała M. Lower sexual satisfaction in women with polycystic ovary syndrome and metabolic syndrome. Endocr Connect 2021; 10:1035-1044. [PMID: 34319905 PMCID: PMC8428045 DOI: 10.1530/ec-21-0257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/28/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a multi-symptom disorder linked with a range of metabolic and hormonal disturbances. Psychological and sexual aspects of PCOS also need to be considered. OBJECTIVE OF THE STUDY This study aimed to assess sexual satisfaction (SS) in PCOS patients and eumenorrheic controls (CON). The relationships between SS, depressive symptoms, health-related quality of life (HRQoL), and hormonal and metabolic profiles were evaluated. METHODS In this study, 190 patients with PCOS (mean age 26.34 ± 5.47 years) and 197 age-matched CON (mean age 27.12 ± 4.97 years) were enrolled. All subjects completed Polish version of the Sexual Satisfaction Questionnaire (SSQ), WHO Quality of Life-BREF (WHOQOL-BREF), and the Center for Epidemiologic Studies Depression Scale-Revised (CESD-R) questionnaire. Fasting blood samples were collected to assess hormonal, lipid, and glucose profiles. Anthropometric measures were collected. Metabolic syndrome (MS) was evaluated according to the IDF-AHA/NHLBI criteria. RESULTS Patients with PCOS and MS had lower SS vs non-MS-PCOS. There were no significant differences in the level of SS, presence of depressive symptoms, or HRQoL between PCOS and CON (P > 0.05). Negative correlations were found between the SS level and BMI, waist circumference, and waist-to-height ratio in PCOS women. However, overweight or obese PCOS women did not differ in SS levels vs normal-weight PCOS patients. The social dimension of WHOQOL-BREF was the only significant predictor of SS in PCOS patients. CONCLUSIONS SS in PCOS women appears to be undisturbed. However, MS in PCOS patients could negatively influence SS. The level of SS should be assessed in PCOS women, especially if MS is present.
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Affiliation(s)
- Małgorzata Kałużna
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
- Correspondence should be addressed to M Kałużna:
| | - Agnieszka Nomejko
- Institute of Psychology, Faculty of Pedagogical and Historical Sciences, University of Wrocław, Wrocław, Poland
| | - Aleksandra Słowińska
- Institute of Psychology, Faculty of Pedagogical and Historical Sciences, University of Wrocław, Wrocław, Poland
| | | | - Katarzyna Pikosz
- Department of Pharmacognosy, Poznan University of Medical Sciences, Poznan, Poland
| | - Katarzyna Ziemnicka
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Ruchała
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
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14
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Lin H, Liu M, Zhong D, Ng EHY, Liu J, Li J, Shi Y, Zhang C, Wen X, Mai Z, Ou M, Ma H. The Prevalence and Factors Associated With Anxiety-Like and Depression-Like Behaviors in Women With Polycystic Ovary Syndrome. Front Psychiatry 2021; 12:709674. [PMID: 34744814 PMCID: PMC8563587 DOI: 10.3389/fpsyt.2021.709674] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 09/16/2021] [Indexed: 02/04/2023] Open
Abstract
Increasing evidence shows that polycystic ovary syndrome (PCOS) patients are particularly vulnerable to anxiety/depression-like behaviors. This study sought to determine the prevalence of anxiety/depression-like behaviors among women with PCOS and to identify factors associated with these behaviors. This study was a secondary analysis of three studies performed on Chinese women who were aged 18 to 40 and diagnosed with PCOS according to the modified Rotterdam criteria. We obtained 802 useable responses for the self-rating anxiety scale and 798 responses for the self-rating depression scale. The prevalence of anxiety-like and depression-like behaviors among women with PCOS was 26.1% (209/802) and 52.0% (415/798), respectively. Anxiety-like behaviors were associated with age, body image-related factors (including body mass index and waist-to-hip ratio), and hyperandrogenism-related factors (including free androgen index and hirsutism). Depression-like behaviors were associated with age, body image-related factors, hyperandrogenism-related factors, and metabolic factors (including fasting insulin, fasting plasma glucose, and homeostatic model assessment of insulin resistance). Body image-related factors and hyperandrogenism-related factors were related to both anxiety-like behaviors and depression-like behaviors in both infertile and fertile PCOS patients.
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Affiliation(s)
- Han Lin
- Department of Gynecology of Traditional Chinese Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Mingxing Liu
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dongmei Zhong
- Department of Gynecology of Traditional Chinese Medicine, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ernest Hung Yu Ng
- Department of Obstetrics and Gynecology, the University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, Hong Kong, SAR China
| | - Jianping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Juan Li
- Department of Gynecology of Traditional Chinese Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yu Shi
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chunren Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaohui Wen
- Department of Gynecology of Traditional Chinese Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhefen Mai
- Department of Gynecology of Traditional Chinese Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Miaoxian Ou
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hongxia Ma
- Department of Gynecology of Traditional Chinese Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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15
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Harnod T, Tsai IJ, Wang JH, Lin SZ, Ding DDC. Women with polycystic ovary syndrome associated with increased anxiety risk: A population-based cohort study in Taiwan. J Affect Disord 2020; 273:532-537. [PMID: 32560950 DOI: 10.1016/j.jad.2020.04.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 04/02/2020] [Accepted: 04/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) has been associated with developing mental disorders in Western populations, but this association is poorly studied in Asians. Hence, using insurance claims data, this study evaluated the anxiety risk in women with PCOS. METHODS Using Taiwan's National Health Insurance Research Database, we identified 7026 women aged 15-49 years with newly diagnosed PCOS without anxiety in 1998-2013 as the PCOS cohort. We also randomly selected 28,104 women without PCOS and anxiety as the comparison cohort, which was frequency-matched to cases by age and index year. Determined by incidence and Cox method, the hazard ratio (HR) of anxiety and the 95% confidence interval (CI) for the association with PCOS were estimated after a 16-year follow-up. RESULTS The incidence of anxiety was 19.5% higher in the PCOS cohort than in the comparison cohort (15.3 vs. 12.8 per 1000 person-years), with an adjusted HR of 1.18 (95% CI=1.07-1.30). For women with both PCOS and comorbid depression, it was 32.1 per 1000 person-years, with an adjusted HR of 2.24 (95% CI=1.24-4.06), compared with those without PCOS or depression. Moreover, it was 48.0 per 1000 person-years for women with depression alone (adjusted HR=3.46; 95% CI=2.58-4.64). LIMITATIONS We used a diagnostic code to identify PCOS cases without reference to pathology records. Miscoding might have occurred in the database. CONCLUSIONS PCOS is associated with an increased risk of developing anxiety independently. Comorbid depression could increase the risk further. Our findings provide vital information for Asian women to cope with anxiety.
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Affiliation(s)
- Tomor Harnod
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan
| | - I-Ju Tsai
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Jen-Hung Wang
- Department of Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan
| | - Shinn-Zon Lin
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan
| | - Dr Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan; Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
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16
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Karjula S, Morin-Papunen L, Franks S, Auvinen J, Järvelin MR, Tapanainen JS, Jokelainen J, Miettunen J, Piltonen TT. Population-based Data at Ages 31 and 46 Show Decreased HRQoL and Life Satisfaction in Women with PCOS Symptoms. J Clin Endocrinol Metab 2020; 105:5709653. [PMID: 31970392 PMCID: PMC7150615 DOI: 10.1210/clinem/dgz256] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 04/03/2020] [Indexed: 12/11/2022]
Abstract
CONTEXT Polycystic ovary syndrome (PCOS) is associated with decreased health-related quality of life (HRQoL), but longitudinal data beyond the reproductive years are lacking, and the impact of isolated PCOS symptoms is unclear. OBJECTIVE To study generic HRQoL using the 15D questionnaire, life satisfaction, and self-reported health status in women with PCOS symptoms at ages 31 and 46 years. DESIGN A longitudinal assessment using the Northern Finland Birth Cohort 1966. SETTING General community. PARTICIPANTS The 15D data were available for women reporting isolated oligo-amenorrhea (OA; at age 31 years, 214; and 46 years, 211), isolated hirsutism (H; 31 years, 211; and 46 years, 216), OA + H (PCOS; 31 years, 74; and 46 years, 75), or no PCOS symptoms (controls; 31 years, 1382; and 46 years, 1412). Data for life satisfaction and current health status were available for OA (31 years, 329; and 46 years, 247), H (31 years, 323; and 46 years, 238), PCOS (31 years, 125; and 46 years, 86), control (31 years, 2182; and 46 years, 1613) groups. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) 15D HRQoL, questionnaires on life satisfaction, and self-reported health status. RESULTS HRQoL was lower at ages 31 and 46 in women with PCOS or H than in the controls. PCOS was an independent risk factor for low HRQoL, and the decrease in HRQoL in PCOS was similar to that of women with other chronic conditions, such as asthma, migraine, rheumatoid arthritis, and depression. The risk for low HRQoL in PCOS remained significant after adjusting for body mass index, hyperandrogenism, and socioeconomic status. Mental distress was the strongest contributing factor to HRQoL. PCOS was also associated with a risk for low life satisfaction and a 4-fold risk for reporting a poor health status. CONCLUSIONS Women with PCOS present with low HRQoL, decreased life satisfaction, and a poorer self-reported health status up to their late reproductive years. Assessments and interventions aiming to improve HRQoL in PCOS should be targeted beyond the fertile age.
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Affiliation(s)
- Salla Karjula
- Department of Obstetrics and Gynecology, PEDEGO Research Unit and Medical Research Centre Oulu and PEDEGO Research Unit, Oulu, University Hospital of Oulu, University of Oulu, Oulu, Finland
| | - Laure Morin-Papunen
- Department of Obstetrics and Gynecology, PEDEGO Research Unit and Medical Research Centre Oulu and PEDEGO Research Unit, Oulu, University Hospital of Oulu, University of Oulu, Oulu, Finland
| | - Stephen Franks
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Juha Auvinen
- Center for Life Course Health Research, Faculty of Medicine Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Marjo-Riitta Järvelin
- Department of Epidemiology and Biostatistics, Medical Research Council-PHE (Public Health England) Centre for Environment & Health, School of Public Health, Imperial College London, London, UK; Centre for Life Course Epidemiology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Juha S Tapanainen
- Department of Obstetrics and Gynecology, PEDEGO Research Unit and Medical Research Centre Oulu and PEDEGO Research Unit, Oulu, University Hospital of Oulu, University of Oulu, Oulu, Finland
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Jouko Miettunen
- Center for Life Course Health Research, Faculty of Medicine Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Terhi T Piltonen
- Department of Obstetrics and Gynecology, PEDEGO Research Unit and Medical Research Centre Oulu and PEDEGO Research Unit, Oulu, University Hospital of Oulu, University of Oulu, Oulu, Finland
- Correspondence and Reprint Requests: Terhi Piltonen, Department of Obstetrics and Gynecology, PEDEGO Research Unit and Medical Research Centre Oulu, Oulu University Hospital, University of Oulu, PL 23 90029 OYS, Oulu, Finland. E-mail:
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17
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Scaruffi E, Franzoi IG, Civilotti C, Guglielmucci F, La Marca L, Tomelini M, Veglia F, Granieri A. Body image, personality profiles and alexithymia in patients with polycystic ovary syndrome (PCOS). J Psychosom Obstet Gynaecol 2019; 40:294-303. [PMID: 30398405 DOI: 10.1080/0167482x.2018.1530210] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Aim: Polycystic ovary syndrome (PCOS) is a common endocrine-metabolic disorder. It affects women's physical well-being and leads to great psychological distress. Indeed, women with PCOS show a compromised quality of life as well as impaired emotional well-being. The aim of this study is to assess personality characteristics, body image and alexithymia in women with PCOS. Materials and methods: A total of 59 women with PCOS and 38 healthy controls were administered the Toronto Alexithymia Scale (TAS), the Body Uneasiness Test (BUT) and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Results: The PCOS group showed higher values of alexithymia and a higher body uneasiness. They also showed higher values on many clinical, content and supplementary scales of the MMPI-2. Discussion: It seems that physical appearance and bodily function have a central place in the minds of women with PCOS, as well as in their relationships. However, it is a body they find it hard to feel and with which they mostly feel uncomfortable. Their approach to the outside world seems to be characterized by a certain degree of immaturity, anger, hostility and distrust. Low self-esteem also seems to be connected to a certain tendency toward introversion and withdrawal. This leads to problems in social, professional and intimate relationships.
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Affiliation(s)
| | | | | | | | - Luana La Marca
- Faculty of Human Sciences, UKE - Kore University of Enna, Cittadella Universitaria , Enna , Italy
| | - Michela Tomelini
- Department of Medical Sciences, Division of Endocrinology and Metabolism, University of Turin , Turin , Italy
| | - Fabio Veglia
- Department of Psychology, University of Turin , Turin , Italy
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18
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Kenawi MZ, Akl EM, Sabry JH, Mostafa ST. Evaluation of serum level of omentin-1 in females with hirsutism. J Cosmet Dermatol 2019; 19:535-539. [PMID: 31190433 DOI: 10.1111/jocd.13043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 05/03/2019] [Accepted: 05/20/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hirsutism is a common clinical condition encountered in day-to-day practice. The androgenic causes account for more than 80% of these patients and include polycystic ovary syndrome (PCOS), which affects about 70%-80% of hirsute women. The second most common cause is idiopathic hirsutism. Omentin-1 is an adipokine mainly produced by visceral adipose tissue. AIM The current study aimed at evaluating omentin-1 levels in hirsute females with PCOS and in idiopathic hirsutism. PATIENTS AND METHODS Eighty-five females were included in this study. They were classified into three groups: thirty hirsute patients with PCOS, thirty females with idiopathic hirsutism, and twenty-five healthy control females. The participants were subjected to history taking, physical and dermatological examination. A gynecological history and radiological examination of the ovary also were done. Serum testosterone and omentin-1 were measured by ELISA. RESULTS Serum testosterone was statistically elevated in PCOS than other groups. Serum omentin-1 in females with idiopathic hirsutism was statistically significantly higher than control and PCOS. There was a significant inverse correlation between serum testosterone level and serum omentin-1 level. CONCLUSION Omentin-1 may be involved in the pathogenic process of hirsutism.
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Affiliation(s)
- Mohammed Z Kenawi
- Department of Dermatology, Venereology & Andrology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Essam M Akl
- Department of Dermatology, Venereology & Andrology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Jehan H Sabry
- Department of Clinical Pathology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Sara T Mostafa
- Department of Obstetric & Gynecology, Faculty of Medicine, Benha University, Benha, Egypt
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19
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Psychodermatology: An Association of Primary Psychiatric Disorders With Skin. ACTA ACUST UNITED AC 2019; 48:50-57. [DOI: 10.1016/j.rcp.2017.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/26/2017] [Accepted: 07/10/2017] [Indexed: 02/02/2023]
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20
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Sharma A, Kapoor E, Singh RJ, Chang AY, Erickson D. Diagnostic Thresholds for Androgen-Producing Tumors or Pathologic Hyperandrogenism in Women by Use of Total Testosterone Concentrations Measured by Liquid Chromatography-Tandem Mass Spectrometry. Clin Chem 2018; 64:1636-1645. [DOI: 10.1373/clinchem.2018.290825] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/16/2018] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Previously defined thresholds for total testosterone (TT) concentrations to screen for androgen-producing tumors (APTs) have used RIA, which can be less accurate in women. We aimed to define diagnostic thresholds to screen for APTs or postmenopausal pathologic hyperandrogenism using TT concentrations measured by Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS).
METHODS
We performed a retrospective cohort study on all women with TT ≥3.5 nmol/L and all postmenopausal women presenting with hyperandrogenism between 2004 and 2014 at the Mayo Clinic in Rochester, MN.
RESULTS
Of the 369 women with TT ≥3.5 nmol/L, 89 were included and subdivided into 3 groups based on their clinical diagnosis [21 (24%), APT; 16 (18%), postmenopausal pathologic hyperandrogenism; 52 (58%), polycystic ovary syndrome]. The source of the APT was more frequently ovarian (81%, n = 17) than adrenal (19%, n = 4). The diagnostic threshold using ROC analysis for TT to identify APT in women with severe biochemical hyperandrogenemia was ≥5.1 nmol/L (sensitivity, 90%; specificity, 81%). In a second analysis of a cohort of postmenopausal women only presenting with symptoms or signs of hyperandrogenism, median TT was significantly higher in the postmenopausal pathologic hyperandrogenism group (APT and ovarian hyperthecosis) vs the idiopathic hyperandrogenism group (4.9 vs 0.8 nmol/L; P < 0.01). In postmenopausal women, the diagnostic threshold for pathologic hyperandrogenism was TT ≥2.2 nmol/L (sensitivity, 100%; specificity, 86%).
CONCLUSIONS
The diagnostic threshold for TT concentration as measured by LC-MS/MS to identify APT in women with biochemical severe hyperandrogenemia was TT ≥5.1 nmol/L. In postmenopausal women, the diagnostic threshold for pathologic hyperandrogenism was lower (TT ≥2.2 nmol/L).
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Affiliation(s)
- Anu Sharma
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester MN
| | - Ekta Kapoor
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester MN
| | - Ravinder J Singh
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN
| | - Alice Y Chang
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester MN
| | - Dana Erickson
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester MN
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21
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Ali FM, Johns N, Salek S, Finlay AY. Correlating the Dermatology Life Quality Index with psychiatric measures: A systematic review. Clin Dermatol 2018; 36:691-697. [DOI: 10.1016/j.clindermatol.2018.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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22
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Gherardi A, Roze S, Kuijvenhoven J, Ghatnekar O, Yip Sonderegger YL. Budesonide with multi-matrix technology as second-line treatment for ulcerative colitis: evaluation of long-term cost-effectiveness in the Netherlands. J Med Econ 2018; 21:869-877. [PMID: 29857775 DOI: 10.1080/13696998.2018.1484371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIMS Budesonide with multi-matrix technology (MMX) is an oral corticosteroid, shown to have high topical activity against ulcerative colitis (UC) while maintaining low systemic bioavailability with few adverse events. The aim of this study was to evaluate the cost-effectiveness of budesonide MMX versus commonly used corticosteroids, in the second-line treatment of active mild-to-moderate UC in the Netherlands. MATERIALS AND METHODS An eight-state Markov model with an 8 week cycle length captured remission, four distinct therapy stages, hospitalization, possible colectomy and mortality. Remission probability for budesonide MMX was based on the CORE-II study. Population characteristics were derived from the Dutch Inflammatory Bowel Disease South Limburg cohort (n = 598) and included patients with proctitis (39%), left-sided (42%) and extensive disease (19%). Comparators (topical budesonide foam and enema, oral budesonide and prednisolone) were selected based on current Dutch clinical practice. Treatment effects were evaluated by network meta-analysis using a Bayesian framework. Cost-effectiveness analysis was performed over a 5 year time horizon from a societal perspective, with costs, health-state and adverse event utilities derived from published sources. Outcomes were weighted by disease extent distribution and corresponding comparators. RESULTS Budesonide MMX was associated with comparable quality-adjusted life year (QALY) gain versus foam and oral formulations (+0.01 QALYs) in the total UC population, whilst being cost-saving (EUR 366 per patient). Probabilistic sensitivity analysis evaluated an 86.6% probability of budesonide MMX being dominant (cost-saving with QALY gain) versus these comparators. Exploratory analysis showed similar findings versus prednisolone. LIMITATIONS Differing definitions of trial end-points and remission across trials meant indirect comparison was not ideal. However, in the absence of head-to-head clinical data, these comparisons are reasonable alternatives and currently offer the only comparison of second-line UC treatments. CONCLUSIONS In the present analysis, budesonide MMX was shown to be cost-effective versus comparators in the total UC population, for the second-line treatment of active mild-to-moderate UC in the Netherlands.
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Affiliation(s)
| | | | | | - Ola Ghatnekar
- c Ferring International PharmaScience Center , Copenhagen , Denmark
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23
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Berni TR, Morgan CL, Berni ER, Rees DA. Polycystic Ovary Syndrome Is Associated With Adverse Mental Health and Neurodevelopmental Outcomes. J Clin Endocrinol Metab 2018; 103:2116-2125. [PMID: 29648599 DOI: 10.1210/jc.2017-02667] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 02/09/2018] [Indexed: 02/04/2023]
Abstract
CONTEXT Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism and subfertility, but the effects on mental health and child neurodevelopment are unclear. OBJECTIVES To determine if (1) there is an association between PCOS and psychiatric outcomes and (2) whether rates of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are higher in children of mothers with PCOS. DESIGN Data were extracted from the Clinical Practice Research Datalink. Patients with PCOS were matched to two control sets (1:1) by age, body mass index, and primary care practice. Control set 2 was additionally matched on prior mental health status. Primary outcomes were the incidence of depression, anxiety, and bipolar disorder. Secondary outcomes were the prevalence of ADHD or ASD in the children. RESULTS Eligible patients (16,986) were identified; 16,938 and 16,355 were matched to control sets 1 and 2, respectively. Compared with control set 1, baseline prevalence was 23.1% vs 19.3% for depression, 11.5% vs 9.3% for anxiety, and 3.2% vs 1.5% for bipolar disorder (P < 0.001). The hazard ratio for time to each endpoint was 1.26 (95% confidence interval 1.19 to 1.32), 1.20 (1.11 to 1.29), and 1.21 (1.03 to 1.42) for set 1 and 1.38 (1.30 to 1.45), 1.39 (1.29 to 1.51), and 1.44 (1.21 to 1.71) for set 2. The odds ratios for ASD and ADHD in children were 1.54 (1.12 to 2.11) and 1.64 (1.16 to 2.33) for set 1 and 1.76 (1.27 to 2.46) and 1.34 (0.96 to 1.89) for set 2. CONCLUSIONS PCOS is associated with psychiatric morbidity and increased risk of ADHD and ASD in their children. Screening for mental health disorders should be considered during assessment.
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Affiliation(s)
- Thomas R Berni
- Pharmatelligence, Cardiff Medicentre, Cardiff, United Kingdom
| | - Christopher L Morgan
- Pharmatelligence, Cardiff Medicentre, Cardiff, United Kingdom
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Ellen R Berni
- Pharmatelligence, Cardiff Medicentre, Cardiff, United Kingdom
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff, United Kingdom
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Liu K, Motan T, Claman P. No. 350-Hirsutism: Evaluation and Treatment. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 39:1054-1068. [PMID: 29080721 DOI: 10.1016/j.jogc.2017.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To review the etiology, evaluation, and treatment of hirsutism. EVALUATION A thorough history and physical examination plus selected laboratory evaluations will confirm the diagnosis and direct treatment. TREATMENT Pharmacologic interventions can suppress ovarian or adrenal androgen production and block androgen receptors in the hair follicle. Hair removal methods and lifestyle modifications may improve or hasten the therapeutic response. OUTCOMES At least 6 to 9 months of therapy are required to produce improvement in hirsutism. EVIDENCE The quality of evidence reported in this guideline has been determined using the criteria described by the Canadian Task Force on the Periodic Health Examination. RECOMMENDATIONS Hirsutism can be slowly but dramatically improved with a 3-pronged approach to treatment: mechanical hair removal, suppression of androgen production, and androgen receptor blockade. Lifestyle changes, including weight loss and exercise, will lower serum androgen levels and improve self-esteem in patients with polycystic ovary syndrome. The patient should be educated regarding the associated health problems or long-term medical consequences of hyperandrogenism, particularly in the context of polycystic ovary syndrome, including obesity, irregular menses, anovulation, infertility, pregnancy-induced hypertension, diabetes, hyperlipidemia, hypertension, and heart disease. SUMMARY STATEMENTS RECOMMENDATIONS.
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N o 350-Hirsutisme : évaluation et traitement. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:1069-1084. [DOI: 10.1016/j.jogc.2017.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
PURPOSE OF REVIEW Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive age women and is associated with an increased prevalence of depression and anxiety symptoms. This review presents potential mechanisms for this increased risk and outlines treatment options. RECENT FINDINGS Women with PCOS have increased odds of depressive symptoms (OR 3.78; 95% CI 3.03-4.72) and anxiety symptoms (OR 5.62; 95% CI 3.22-9.80). Obesity, insulin resistance, and elevated androgens may partly contribute to this association. Therefore, in addition to established treatment options, treatment of PCOS-related symptoms with lifestyle modification and/or oral contraceptive pills may be of benefit. Screening for anxiety and depression is recommended in women with PCOS at the time of diagnosis. The exact etiology for the increased risk in PCOS is still unclear. Moreover, there is a paucity of published data on the most effective behavioral, pharmacological, or physiological treatment options specifically in women with PCOS.
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Affiliation(s)
- Laura G Cooney
- Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market Street 8th Floor, Philadelphia, PA, 19146, USA
| | - Anuja Dokras
- Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market Street 8th Floor, Philadelphia, PA, 19146, USA.
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Karjula S, Morin-Papunen L, Auvinen J, Ruokonen A, Puukka K, Franks S, Järvelin MR, Tapanainen JS, Jokelainen J, Miettunen J, Piltonen TT. Psychological Distress Is More Prevalent in Fertile Age and Premenopausal Women With PCOS Symptoms: 15-Year Follow-Up. J Clin Endocrinol Metab 2017; 102:1861-1869. [PMID: 28323926 PMCID: PMC5470769 DOI: 10.1210/jc.2016-3863] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/22/2017] [Indexed: 01/30/2023]
Abstract
Context Polycystic ovary syndrome (PCOS) is associated with increased psychological distress, obesity and hyperandrogenism being suggested as key promoters. Objectives To investigate the prevalence of anxiety/depression and their coexistence in women with PCOS/PCOS-related symptoms at ages 31 and 46. The roles of obesity, hyperandrogenism, and awareness of PCOS on psychological distress were also assessed. Design Population-based follow-up. Setting Northern Finland Birth Cohort 1966 with 15-year follow-up. Participants At age 31, a questionnaire-based screening for oligoamenorrhea (OA) and hirsutism (H): 2188 asymptomatic (controls), 331 OA, 323 H, and 125 OA plus H (PCOS). Follow-up at age 46: 1576 controls, 239 OA, 231 H, and 85 PCOS. Interventions Questionnaire-based screening for anxiety and depression symptoms (Hopkins Symptom Checklist-25) and previously diagnosed/treated depression at ages 31 and 46. Body mass index (BMI), serum testosterone/free androgen index, and awareness of polycystic ovaries/PCOS on psychological distress were also assessed. Main Outcomes Population-based prevalence of anxiety and/or depression in women with PCOS/PCOS-related symptoms at ages 31 and 46. Results Anxiety and/or depression symptoms, their coexistence, and rate of depression were increased at ages 31 and 46 in women with PCOS or isolated H compared with controls. High BMI or hyperandrogenism did not associate with increased anxiety or depression symptoms. The awareness of PCOS was associated with increased anxiety. Conclusions Women with PCOS or isolated H present more often with anxiety and/or depression symptoms and their coexistence compared with controls. High BMI or hyperandrogenism did not provoke psychological distress in PCOS. The awareness of PCOS increased anxiety but did not associate with severe anxiety or depression.
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Affiliation(s)
- Salla Karjula
- Department of Obstetrics and Gynecology, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
- Medical Research Center, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
- PEDEGO Research Unit, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
| | - Laure Morin-Papunen
- Department of Obstetrics and Gynecology, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
- Medical Research Center, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
- PEDEGO Research Unit, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
| | - Juha Auvinen
- Medical Research Center, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
- Center for Life Course Health Research, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
| | - Aimo Ruokonen
- Medical Research Center, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
- NordLab Oulu, Department of Clinical Chemistry, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
| | - Katri Puukka
- Medical Research Center, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
- NordLab Oulu, Department of Clinical Chemistry, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
| | - Stephen Franks
- Institute of Reproductive and Developmental Biology, Imperial College London, London W12 ONN, United Kingdom
| | - Marjo-Riitta Järvelin
- Center for Life Course Epidemiology, Faculty of Medicine, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
- Department of Epidemiology and Biostatistics, Medical Research Council-Public Health England Centre for Environment and Health, School of Public Health, Imperial College London, London W2 1PG, United Kingdom
| | - Juha S. Tapanainen
- Department of Obstetrics and Gynecology, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
- Medical Research Center, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
- PEDEGO Research Unit, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, FI-00014 Helsinki, Finland
| | - Jari Jokelainen
- Faculty of Medicine, University of Oulu, FI-90014 Oulu, Finland
| | - Jouko Miettunen
- Medical Research Center, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
- Center for Life Course Health Research, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
| | - Terhi T. Piltonen
- Department of Obstetrics and Gynecology, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
- Medical Research Center, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
- PEDEGO Research Unit, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
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Bitzer J, Römer T, Lopes da Silva Filho A. The use of cyproterone acetate/ethinyl estradiol in hyperandrogenic skin symptoms - a review. EUR J CONTRACEP REPR 2017; 22:172-182. [PMID: 28447864 DOI: 10.1080/13625187.2017.1317339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Hyperandrogenism affects approximately 10-20% of women of reproductive age. Hyperandrogenic skin symptoms such as hirsutism, acne, seborrhea and alopecia are associated with significant quality of life and psychological impairment. Women with abnormalities in androgen metabolism may have accompanying anovulation and/or polycystic ovary syndrome (PCOS), both of which have reproductive and metabolic implications if left untreated. Cyproterone acetate (CPA), combined with ethinylestradiol (EE), is indicated for the treatment of moderate to severe acne related to androgen-sensitivity (with or without seborrhea) and/or hirsutism, in women of reproductive age. OBJECTIVE To review the data on the efficacy and safety of CPA 2 mg/EE 35 μg for the treatment of hyperandrogenic skin symptoms in women. METHODS A non-systematic narrative review based on a literature search of the PubMed database. RESULTS Seventy-eight studies were identified. The majority of sufficiently powered studies show a high efficacy of CPA 2 mg/EE 35 μg in the treatment of severe acne and hirsutism. Studies show that therapeutic response in women with hirsutism requires a long-term approach and that hyperandrogenic skin symptoms in patients with PCOS are efficiently treated. Additional benefits include cycle control and, in some women, improvement in mood and perception of body image. Safety and tolerability data are summarized by the pharmacovigilance risk assessment committee (PRAC) of the European Medicine's Agency's (EMA). CONCLUSIONS This review provides a comprehensive overview about the efficacy of CPA 2 mg/EE 35 μg in the treatment of hyperandrogenic skin symptoms, thus allowing both health care professionals and women to balance the risks and benefits of treatment based on evidence.
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Affiliation(s)
- J Bitzer
- a University Hospital , Basel , Switzerland
| | - T Römer
- b Department of Obstetrics and Gynecology , Academic Hospital Weyertal, University Cologne , Germany
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Cooney LG, Lee I, Sammel MD, Dokras A. High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod 2017; 32:1075-1091. [DOI: 10.1093/humrep/dex044] [Citation(s) in RCA: 224] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 02/17/2017] [Indexed: 01/16/2023] Open
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Dokras A, Sarwer DB, Allison KC, Milman L, Kris-Etherton PM, Kunselman AR, Stetter CM, Williams NI, Gnatuk CL, Estes SJ, Fleming J, Coutifaris C, Legro RS. Weight Loss and Lowering Androgens Predict Improvements in Health-Related Quality of Life in Women With PCOS. J Clin Endocrinol Metab 2016; 101:2966-74. [PMID: 27253669 PMCID: PMC4971336 DOI: 10.1210/jc.2016-1896] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 05/26/2016] [Indexed: 01/22/2023]
Abstract
CONTEXT Polycystic ovary syndrome (PCOS) is associated with reduced health-related quality of life (HRQOL) and increased prevalence of depressive and anxiety disorders. The impact of PCOS-specific treatments on these co-morbidities is unclear. OBJECTIVE To assess the impact of weight loss and decreasing hyperandrogenism on HRQOL and mood and anxiety disorders in women with PCOS. DESIGN/SETTING/PARTICIPANTS A secondary analysis of a randomized controlled trial (OWL-PCOS) of preconception treatment conducted at two academic centers in women (age, 18-40 years; body mass index, 27-42 kg/m(2)) with PCOS defined by Rotterdam criteria. INTERVENTION Continuous oral contraceptive pill (OCP) or intensive lifestyle intervention or the combination (Combined) for 16 weeks. MAIN OUTCOME MEASURE(S) Changes in HRQOL assessed by PCOSQ and SF-36 and prevalence of depression and anxiety disorder assessed by PRIME-MD PHQ. RESULTS The lowest scores were noted on the general health domain of the SF-36 and the weight and infertility domains on the PCOSQ. All three interventions resulted in significant improvement in the general health score on the SF-36. Both the OCP and Combined groups showed improvements in all domains of the PCOSQ (P < .01) compared to baseline scores. The Combined group had significant improvements in the weight, body hair, and infertility domains compared to a single treatment group (P < .05). In a linear regression model, change in weight correlated with improvements in the weight domain (P < .001) and physical well-being (P < .02), change in T correlated with improvements in the hair domain (P < .001), and change in both weight and T correlated with the infertility (P < .001) and menstrual domains (P < .05). CONCLUSIONS Both weight loss and OCP use result in significant improvements in several physical and mental domains related to quality of life, depressive symptoms, and anxiety disorders, and combined therapies offer further benefits in overweight/obese women with PCOS.
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Affiliation(s)
- Anuja Dokras
- Departments of Obstetrics and Gynecology (A.D., L.M., C.C.) and Psychiatry (D.B.S., K.C.A.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104; Departments of Obstetrics and Gynecology (C.L.G., S.J.E., R.S.L.), and Public Health Sciences (A.R.K., C.M.S., R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033; and Departments of Nutritional Sciences (P.M.K.-E., J.F.) and Kinesiology (N.I.W.), Penn State College of Health and Human Development, University Park, Pennsylvania 16802
| | - David B Sarwer
- Departments of Obstetrics and Gynecology (A.D., L.M., C.C.) and Psychiatry (D.B.S., K.C.A.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104; Departments of Obstetrics and Gynecology (C.L.G., S.J.E., R.S.L.), and Public Health Sciences (A.R.K., C.M.S., R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033; and Departments of Nutritional Sciences (P.M.K.-E., J.F.) and Kinesiology (N.I.W.), Penn State College of Health and Human Development, University Park, Pennsylvania 16802
| | - Kelly C Allison
- Departments of Obstetrics and Gynecology (A.D., L.M., C.C.) and Psychiatry (D.B.S., K.C.A.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104; Departments of Obstetrics and Gynecology (C.L.G., S.J.E., R.S.L.), and Public Health Sciences (A.R.K., C.M.S., R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033; and Departments of Nutritional Sciences (P.M.K.-E., J.F.) and Kinesiology (N.I.W.), Penn State College of Health and Human Development, University Park, Pennsylvania 16802
| | - Lauren Milman
- Departments of Obstetrics and Gynecology (A.D., L.M., C.C.) and Psychiatry (D.B.S., K.C.A.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104; Departments of Obstetrics and Gynecology (C.L.G., S.J.E., R.S.L.), and Public Health Sciences (A.R.K., C.M.S., R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033; and Departments of Nutritional Sciences (P.M.K.-E., J.F.) and Kinesiology (N.I.W.), Penn State College of Health and Human Development, University Park, Pennsylvania 16802
| | - Penny M Kris-Etherton
- Departments of Obstetrics and Gynecology (A.D., L.M., C.C.) and Psychiatry (D.B.S., K.C.A.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104; Departments of Obstetrics and Gynecology (C.L.G., S.J.E., R.S.L.), and Public Health Sciences (A.R.K., C.M.S., R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033; and Departments of Nutritional Sciences (P.M.K.-E., J.F.) and Kinesiology (N.I.W.), Penn State College of Health and Human Development, University Park, Pennsylvania 16802
| | - Allen R Kunselman
- Departments of Obstetrics and Gynecology (A.D., L.M., C.C.) and Psychiatry (D.B.S., K.C.A.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104; Departments of Obstetrics and Gynecology (C.L.G., S.J.E., R.S.L.), and Public Health Sciences (A.R.K., C.M.S., R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033; and Departments of Nutritional Sciences (P.M.K.-E., J.F.) and Kinesiology (N.I.W.), Penn State College of Health and Human Development, University Park, Pennsylvania 16802
| | - Christy M Stetter
- Departments of Obstetrics and Gynecology (A.D., L.M., C.C.) and Psychiatry (D.B.S., K.C.A.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104; Departments of Obstetrics and Gynecology (C.L.G., S.J.E., R.S.L.), and Public Health Sciences (A.R.K., C.M.S., R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033; and Departments of Nutritional Sciences (P.M.K.-E., J.F.) and Kinesiology (N.I.W.), Penn State College of Health and Human Development, University Park, Pennsylvania 16802
| | - Nancy I Williams
- Departments of Obstetrics and Gynecology (A.D., L.M., C.C.) and Psychiatry (D.B.S., K.C.A.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104; Departments of Obstetrics and Gynecology (C.L.G., S.J.E., R.S.L.), and Public Health Sciences (A.R.K., C.M.S., R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033; and Departments of Nutritional Sciences (P.M.K.-E., J.F.) and Kinesiology (N.I.W.), Penn State College of Health and Human Development, University Park, Pennsylvania 16802
| | - Carol L Gnatuk
- Departments of Obstetrics and Gynecology (A.D., L.M., C.C.) and Psychiatry (D.B.S., K.C.A.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104; Departments of Obstetrics and Gynecology (C.L.G., S.J.E., R.S.L.), and Public Health Sciences (A.R.K., C.M.S., R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033; and Departments of Nutritional Sciences (P.M.K.-E., J.F.) and Kinesiology (N.I.W.), Penn State College of Health and Human Development, University Park, Pennsylvania 16802
| | - Stephanie J Estes
- Departments of Obstetrics and Gynecology (A.D., L.M., C.C.) and Psychiatry (D.B.S., K.C.A.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104; Departments of Obstetrics and Gynecology (C.L.G., S.J.E., R.S.L.), and Public Health Sciences (A.R.K., C.M.S., R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033; and Departments of Nutritional Sciences (P.M.K.-E., J.F.) and Kinesiology (N.I.W.), Penn State College of Health and Human Development, University Park, Pennsylvania 16802
| | - Jennifer Fleming
- Departments of Obstetrics and Gynecology (A.D., L.M., C.C.) and Psychiatry (D.B.S., K.C.A.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104; Departments of Obstetrics and Gynecology (C.L.G., S.J.E., R.S.L.), and Public Health Sciences (A.R.K., C.M.S., R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033; and Departments of Nutritional Sciences (P.M.K.-E., J.F.) and Kinesiology (N.I.W.), Penn State College of Health and Human Development, University Park, Pennsylvania 16802
| | - Christos Coutifaris
- Departments of Obstetrics and Gynecology (A.D., L.M., C.C.) and Psychiatry (D.B.S., K.C.A.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104; Departments of Obstetrics and Gynecology (C.L.G., S.J.E., R.S.L.), and Public Health Sciences (A.R.K., C.M.S., R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033; and Departments of Nutritional Sciences (P.M.K.-E., J.F.) and Kinesiology (N.I.W.), Penn State College of Health and Human Development, University Park, Pennsylvania 16802
| | - Richard S Legro
- Departments of Obstetrics and Gynecology (A.D., L.M., C.C.) and Psychiatry (D.B.S., K.C.A.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104; Departments of Obstetrics and Gynecology (C.L.G., S.J.E., R.S.L.), and Public Health Sciences (A.R.K., C.M.S., R.S.L.), Penn State College of Medicine, Hershey, Pennsylvania 17033; and Departments of Nutritional Sciences (P.M.K.-E., J.F.) and Kinesiology (N.I.W.), Penn State College of Health and Human Development, University Park, Pennsylvania 16802
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IRAK L, ÇINAR YAVUZ H, AYÇİÇEK DOĞAN B, METE T, BERKER D, GÜLER S. Depression, anxiety, and their relation with clinical parametersand androgen levels in hirsute women. Turk J Med Sci 2016; 46:245-50. [DOI: 10.3906/sag-1405-72] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 07/12/2015] [Indexed: 11/03/2022] Open
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Modeling Clinical States and Metabolic Rhythms in Bioarcheology. BIOMED RESEARCH INTERNATIONAL 2015; 2015:818724. [PMID: 26346040 PMCID: PMC4544883 DOI: 10.1155/2015/818724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 11/26/2014] [Accepted: 12/11/2014] [Indexed: 12/02/2022]
Abstract
Bioarcheology is cross disciplinary research encompassing the study of human remains. However, life's activities have, up till now, eluded bioarcheological investigation. We hypothesized that growth lines in hair might archive the biologic rhythms, growth rate, and metabolism during life. Computational modeling predicted the physical appearance, derived from hair growth rate, biologic rhythms, and mental state for human remains from the Roman period. The width of repeat growth intervals (RI's) on the hair, shown by confocal microscopy, allowed computation of time series of periodicities of the RI's to model growth rates of the hairs. Our results are based on four hairs from controls yielding 212 data points and the RI's of six cropped hairs from Zweeloo woman's scalp yielding 504 data points. Hair growth was, ten times faster than normal consistent with hypertrichosis. Cantú syndrome consists of hypertrichosis, dyschondrosteosis, short stature, and cardiomegaly. Sympathetic activation and enhanced metabolic state suggesting arousal was also present. Two-photon microscopy visualized preserved portions of autonomic nerve fibers surrounding the hair bulb. Scanning electron microscopy found evidence that a knife was used to cut the hair three to five days before death. Thus computational modeling enabled the elucidation of life's activities 2000 years after death in this individual with Cantu syndrome. This may have implications for archeology and forensic sciences.
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Ekbäck MP, Lindberg M, Benzein E, Årestedt K. Social support: an important factor for quality of life in women with hirsutism. Health Qual Life Outcomes 2014; 12:183. [PMID: 25526751 PMCID: PMC4297415 DOI: 10.1186/s12955-014-0183-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 12/02/2014] [Indexed: 12/03/2022] Open
Abstract
Background Women with hirsutism have reported imparied health and health-related quality of life (HRQoL). Social support is a factor that might increase HRQoL in chronic diseases, but little is known about this association among women with hirsutism. Aim The aim of the study was to describe social support and explore its association with HRQoL among women with hirsutism. A further aim was to compare HRQoL in women with hirsutism with a Swedish normal population. Methods A questionnaire including socio-demographic questions, Short-Form Health Survey (SF-36), the Multidimensional Scale of Perceived Social Support (MSPSS), and a self-estimation of hairiness using the Ferriman-Gallway scale (F-G scale) was answered by 127 women with hirsutism. Results Multiple regression analyses showed significant associations between social support and all health dimensions in the SF-36, also after the model was adjusted for age, hairiness and body mass index. Compared to the normal Swedish population, women with hirsutism reported significantly lower HRQoL in all dimensions of the SF-36 (p < 0.01). Conclusions There is a significant positive association between social support and HRQoL, demonstrating its importance for the ability to adapt to problems associated with hirsutism. As women with hirsutism reported poorer HRQoL compared to the normal population, social support may be a factor to consider in clinical practice.
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Affiliation(s)
- Maria Palmetun Ekbäck
- Department of Dermatology, University Hospital Örebro, 701 85, Örebro, Sweden. .,Faculty of Medicine and Health, Örebro University, SE 70182, Örebro, Sweden. .,Department of Pharmacology and Therapeutics, Örebro County Council, Örebro, Sweden.
| | - Magnus Lindberg
- Department of Dermatology, University Hospital Örebro, 701 85, Örebro, Sweden. .,Faculty of Medicine and Health, Örebro University, SE 70182, Örebro, Sweden.
| | - Eva Benzein
- Faculty of Medicine and Health, Örebro University, SE 70182, Örebro, Sweden. .,Department of Health and Caring Science, Linnaeus University, Kalmar, Sweden.
| | - Kristofer Årestedt
- Department of Health and Caring Science, Linnaeus University, Kalmar, Sweden. .,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. .,Palliative Research Centre, Ersta Sköndal University College and Ersta Hospital, Stockholm, Sweden.
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34
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Abstract
BACKGROUND Hirsutism has a relatively high prevalence among women. Depending upon societal and ethnic norms, it can cause significant psychosocial distress. Importantly, hirsutism may be associated with underlying disorders and co-morbidities. Hirsutism should not simply be looked upon as an issue of cosmesis. Patients require appropriate evaluation so that underlying etiologies and associated sequelae are recognized and managed. Treatment of hirsutism often requires a multidisciplinary approach, and a variety of physical or pharmacologic modalities can be employed. Efficacy of these therapies is varied and depends, among other things, upon patient factors including the underlying etiology, hormonal drive, and local tissue sensitivity to androgens. OBJECTIVE The objective of this paper is to review and summarize current evidence evaluating the efficacy of various treatment modalities for hirsutism in premenopausal women. METHODS Online databases were searched to identify all relevant prior systematic reviews and meta-analyses as well as recently published (2012-present) randomized controlled trials (RCTs) on hirsutism treatment. RESULTS Four recently published RCTs met criteria for inclusion in our review. In addition, one meta-analysis and one systematic review/treatment guideline were identified in the recent literature. Physical modalities and oral contraceptive pills (OCPs) remain first-line treatments. Evidence supports the use of electrolysis for permanent hair removal in localized areas and lasers (particularly alexandrite and diode lasers) for permanent hair reduction. Topical eflornithine can be used as monotherapy for mild hirsutism and as an adjunct therapy with lasers or pharmacotherapy in more severe cases. Combined OCPs as a class are superior to placebo; however, antiandrogenic and low-dose neutral OCPs may be slightly more efficacious in improving hirsutism compared with other types of OCPs. Antiandrogens are indicated for moderate to severe hirsutism, with spironolactone being the first-line antiandrogen and finasteride and cyproterone acetate being second-line antiandrogens. Due to its risk for hepatotoxicity, flutamide is not considered a first-line therapy. If used, the lowest effective dose should be administered with careful monitoring of liver enzymes. Monotherapy with an insulin sensitizer does not significantly improve hirsutism. While insulin sensitizers improve important metabolic and endocrine aberrations in polycystic ovary syndrome, they are not recommended when hirsutism is the sole indication for use. Lifestyle modification counseling is recommended. Gonadotropin-releasing hormone analogs and glucocorticoids are only recommended in specific circumstances. Additional therapies without sufficient supportive evidence of efficacy are ovarian surgery, statins (HMG-CoA reductase inhibitors), and vitamin D supplementation. LIMITATIONS In general, most therapies garner recommendations that are weak (where the estimates of benefits versus risks of therapy are either closely balanced or uncertain) and are based on low- to moderate-quality evidence. CONCLUSIONS Risks and benefits of treatment must be carefully considered and discussed with the patient. Expectations for efficacy should be appropriately set. A minimum of 6 months is required to see benefit from pharmacotherapy and lifelong treatment is often necessary for sustained benefit.
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