Depression and Body Image among Women with Polycystic Ovary Syndrome

Cross-disciplinary working between gynaecologists and mental healthcare professionals: a mixed-methods systematic review protocol

INTRODUCTION

Reproductive hormone transitions (menstrual cycle, post partum and menopause) can trigger mental disorders in a subset of women. Gynaecological diseases, such as endometriosis and polycystic ovary syndrome, can also elevate the risk of mental illness. The link between psychiatrists and obstetricians is already well established in the peripartum period; however, the link between gynaecology and psychiatry is less so. This mixed-methods systematic review aims to synthesise the existing evidence for integrated mental healthcare for gynaecological illnesses or reproductive hormone transitions outside the perinatal period.

METHODS AND ANALYSIS

A systematic search of the MEDLINE, Embase, Scopus, PsycInfo, CINAHL and Web of Science databases will be conducted. All study types will be considered, both quantitative and qualitative. Opinion and expert consensus statements, as well as government and professional body documents, will also be included, but separately analysed and reported. Studies examining the unmet clinical needs and experiences of women experiencing mental disorders related to reproductive hormone transitions (menarche, menstrual, menopause, but not pregnancy or breast feeding) or gynaecological illness will be included. Studies related to the experience or training of professionals caring for them will be included, specifically on the concept of integrated or interdisciplinary work with colleagues outside their specialty. Abstracts of the identified papers will be screened independently by two reviewers. Full texts will be assessed by two reviewers, and data will be extracted using predetermined data extraction tools. Quantitative studies will be synthesised in narrative format. A thematic synthesis of qualitative studies will be conducted and an integrated narrative synthesis will be described.

ETHICS AND DISSEMINATION

Ethical approval is not required for this systematic review, as no primary data will be collected. The results will be disseminated via a peer-reviewed publication in a relevant scientific journal.

PROSPERO REGISTRATION NUMBER

CRD42024523590.

The effect of mindfulness-based art therapy (MBAT) on the body image of women with polycystic ovary syndrome (PCOS): a randomized controlled trial

BACKGROUND

The prevalence of polycystic ovary syndrome (PCOS) has increased in the last decade, resulting in enduring psychological effects, including negative body image. This study explored the effect of mindfulness-based art therapy (MBAT) on body image in women with PCOS.

METHODS

In a randomized, single-blind, controlled trial conducted in Kerman, Iran, women of reproductive age (18-45) who were diagnosed with PCOS and met specific inclusion criteria were randomly allocated to either the MBAT intervention group or a control group placed on a therapy waiting list. The main focus of the study involved evaluating alterations in body image scores as the primary measure. Additionally, the study assessed secondary outcomes, which encompassed various domains of the Multidimensional Body-Self Relations Questionnaire (MBSRQ) before, immediately after, and one month after the intervention. The trial is registered with www.irct.ir (Registration code (25/01/2020): IRCT20170611034452N9).

RESULTS

Between August 2020 and January 2021, 66 participants were randomly assigned to the MBAT or waiting list group, and the study was completed by 60 women. At the end of the intervention, body image (adjusted mean difference from baseline (AMD) of 29.22 [95% CI 19.54, 38.90], P < 0.05) and at the one-month follow-up (AMD of 34.77 [95% CI 24.75, 44.80], P < 0.05) were greater in the MBAT group than in the waiting list group. At certain time points, some MBSRQ domains, including body area satisfaction (BASS) (p < 0.05), appearance evaluation (p < 0.05), fitness orientation (p > 0.05), health orientation (p < 0.05), and self-classified weight (p > 0.05), had higher scores than did the control group. However, only BASS had a conclusive effect size (large). Additionally, appearance orientation (p > 0.05), illness orientation (p > 0.05), health evaluation (p < 0.05), fitness evaluation (p > 0.05), and overweight preoccupation (p < 0.05) had lower scores with variable and inconclusive effect sizes.

CONCLUSIONS

The MBAT has potential as an effective approach for enhancing body image in women with PCOS. However, some MBSRQ domain results were inconclusive, likely due to the small sample size. Therefore, further research with a larger sample size is recommended.

Polycystic ovary syndrome and its multidimensional impacts on women's mental health: A narrative review

Polycystic ovary syndrome (PCOS) is a common endocrine disorder that affects approximately 8% to 13% of women of reproductive age worldwide. It is characterized by a range of symptoms, including hirsutism, acne, and menstrual irregularities, and poses a significant psychological burden, including anxiety and depression. The evolving definition of PCOS, from the 1990 NIH conference to the 2003 Rotterdam conference, highlights its multifaceted nature, encompassing metabolic, reproductive, and psychological aspects. This overview aims to elucidate the complex interplay between PCOS's physiological and psychological dimensions. It focuses on understanding the heightened risk of psychiatric disorders, including depression and anxiety, among women with PCOS and explores the contributing factors, such as obesity, body image issues, and stress. The etiology of PCOS involves a complex mixture of genetic, hormonal, and lifestyle factors that contribute to its pathophysiology and the associated mental health challenges. Stress, in various forms, including metabolic, inflammatory, oxidative, and emotional, is identified as a significant contributor to the pathogenesis of PCOS. Management strategies highlighted include lifestyle modifications, dietary and exercise interventions, and psychological therapies, underscoring the need for comprehensive and integrated care approaches that address the broad spectrum of PCOS effects. A multifaceted treatment approach that goes beyond just the physical symptoms of PCOS to also include its significant psychological effects is emphasized, reinforcing the necessity for a comprehensive, integrated care strategy to manage this complex condition effectively.

The effectiveness of psychological interventions for reducing poor body image in endometriosis, PCOS and other gynaecological conditions: a systematic review and meta-analysis

Gynaecological conditions (e.g., endometriosis, PCOS) result in bodily changes that negatively impact body image. Psychological interventions (e.g., CBT, psychoeducation) have shown promise in reviews with the general population for alleviating body image concerns. This systematic review and meta-analysis aims to provide asynthesis of the impact of psychological interventions for reducing body image concerns for individuals with gynaecological conditions. Electronic databases were searched for relevant psychological intervention studies with body image outcomes. Twenty-one eligible studies were included in the systematic review (ten were included in a random-effects meta-analysis). Studies included participants (N = 1483, M = 71.85, SD = 52.79) with a range of gynaecological conditions, ages (Mage = 35.08, SD = 12.17) and cultural backgrounds. Most included studies reported at least one positive effect with the meta-analysis indicating psychological interventions were moderately superior to control conditions for reducing body image concerns (SMD -.41, 95% CI [-0.20 -0.62]). However, there was a high risk of bias and moderate heterogeneity. Results suggest psychological interventions may hold promise for reducing body image concerns among individuals gynaecological conditions in the short term. Further, preliminary support was found for the use of theory-guided psychological interventions delivered in group settings in particular, with further research needed on optimal intervention length and particular psychotherapeutic approach.

Self-esteem and body image satisfaction in women with PCOS in the Middle East: Cross-sectional social media study

BACKGROUND

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of childbearing age, associated with increased incidence of emotional disorders, anxiety and depression.

OBJECTIVE

The aim was of this study was to investigate whether those women reporting PCOS differed to women without PCOS in measures of psychological well-being including body-image satisfaction and self-esteem across a Middle Eastern population.

MATERIALS AND METHODS

An online survey link of 21 questions was shared and distributed across social media platforms (Instagram and WhatsApp). The main outcome measured was levels of self-esteem and body image satisfaction in association with symptoms experienced by the participants.

RESULTS

12,199 female subjects completed the survey of whom 3,329 respondents (27.3%) self-reported a diagnosis of PCOS. PCOS respondents felt less attractive compared to non-PCOS respondents (73.9% vs 80.5%, p<0.0001). More respondents with PCOS reported avoidance of their reflection in the mirror (61.7% vs 49.8%, p<0.001) and avoidance of social interactions (22.3% vs 32.3%, p<0.0001). More PCOS respondents wanted to lose weight (75.2% vs 68.5%, p<0.001) with increasing weight being associated with being less attractive (p<0.001). Fewer PCOS respondents felt satisfied/confident compared non-PCOS respondents (38.6% vs 50.7%, p<0.001).

CONCLUSION

PCOS respondents reported significantly lower measures of self-esteem and body image satisfaction compared to non-PCOS respondents in this population.

Anxiety, depression, and body image among infertile women with and without polycystic ovary syndrome

STUDY QUESTION

In women undergoing fertility treatment, do those with polycystic ovary syndrome (PCOS) have a higher prevalence of symptoms of anxiety and depression and lower body appreciation than women without PCOS?

SUMMARY ANSWER

Having PCOS was not associated with symptoms of anxiety and depression but was associated with somewhat lower body appreciation.

WHAT IS KNOWN ALREADY

PCOS has been associated with a higher chance to develop mental health problems, like anxiety, and body image concerns. The International Guidelines on PCOS recommend that all women with PCOS should routinely be screened for anxiety and depressive disorders. In most studies in this field, the comparison group included healthy women without fertility problems.

STUDY DESIGN, SIZE, DURATION

We conducted a cross-sectional survey study between May 2021 and July 2023, using an online questionnaire. We informed women about this study at fertility clinics in the Netherlands through posters and leaflets and on the websites of the Dutch patient organizations Freya and Stichting PCOS.

PARTICIPANTS/MATERIALS, SETTING, METHODS

This study included women with infertility, with and without PCOS, who were undergoing fertility treatment. Women completed two assessment tools: the Hospital Anxiety and Depression Scale (HADS) and the Body Appreciation Scale-2 (BAS-2). Primary outcomes were clinically relevant symptoms of anxiety (score ≥ 11) and depression (score ≥ 11), and BAS-2 scores. Secondary outcomes were mean anxiety and depression scores and anxiety and depression scores of 8 and higher. Dichotomous outcomes and continuous outcomes were analysed using logistic and linear regression analyses adjusted for age, BMI, and duration of infertility.

MAIN RESULTS AND THE ROLE OF CHANCE

A total of 1025 women currently undergoing infertility treatment participated, of whom 502 (49.0%) had PCOS and 523 (51.0%) had other infertility diagnoses. We found self-reported clinically relevant symptoms of anxiety in 33.1% of women with PCOS and in 31.0% of women with other infertility diagnoses (adjusted OR: 0.99, 95% CI 0.74-1.31). Clinically relevant symptoms of depression were reported in 15.5% of women with PCOS versus 14.5% of women with other infertility diagnoses (adjusted OR: 1.04, 95% CI 0.71-1.50). Women with PCOS reported slightly less body appreciation (adjusted mean difference: -1.34, 95% CI -2.32 to -0.36).

LIMITATIONS, REASONS FOR CAUTION

Results are based on self-report and may have been affected by sampling bias.

WIDER IMPLICATIONS OF THE FINDINGS

Although guidelines recommend screening women with PCOS, feelings of anxiety and depression can be present in any woman undergoing fertility treatments. We advise fertility clinics to be aware of women's mental health issues and to offer support accordingly, as a part of routine care.

STUDY FUNDING/COMPETING INTEREST(S)

This study did not receive specific funding. All authors report no conflict of interest related to the current research.

TRIAL REGISTRATION NUMBER

This study was pre-registered at OSF: https://osf.io/qbeav.

Bridging the Gap: Integrating Awareness of Polycystic Ovary Syndrome Into Mental Health Practice

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age. Individuals with PCOS report reduced quality of life compared with those without PCOS, with possible contributing factors including infertility, hirsutism, irregular menses, and weight gain. Recent literature also supports increased associations between PCOS and co-occurring psychiatric conditions, particularly depression, anxiety, bipolar disorder, and eating disorders. It is concerning that a higher prevalence of suicidal ideation has been observed in individuals with PCOS. Given the high rates of psychiatric burden among those with PCOS, psychiatric care providers are well suited to be on the front lines of screening for psychiatric symptoms as well as initiating treatment. Current interventions include lifestyle changes (improving exercise and nutrition), pharmacological treatments (e.g., insulin-sensitizing agents, oral contraceptives, and psychotropic drugs), and psychotherapeutic interventions (e.g., cognitive-behavioral therapy and mindfulness-based therapy). This review provides an overview of recent research on the prevalence of comorbid psychiatric conditions, a foundation in PCOS-specific symptom screening and diagnosis, and an overview of treatments for psychiatric symptoms among individuals with PCOS.

Challenges in diagnosis and health care in polycystic ovary syndrome in Canada: a patient view to improve health care

BACKGROUND

Polycystic Ovary Syndrome (PCOS) is the most common endocrine-metabolic disorder affecting health and quality of life of those affected across the lifespan. We currently have limited evidence-based data on the experience of those living with PCOS in the health care system including diagnosis, health concerns and disease management. The aim of this study was to assess the perceptions of health status, health care experience and disease management support in those affected by PCOS in Alberta, Canada.

METHODS

An online questionnaire was completed via REDCap by individuals self-reporting a diagnosis of PCOS. Question categories included demographics, symptoms of PCOS and time to confirm a diagnosis, follow-up care, health concerns, and information resources. Descriptive statistics were used and thematic analyses was applied to open-response questions.

RESULTS

Responses from 194 participants living in Canada (93% in Alberta) were included. The average age was 34 ± 8 years and BMI was 35 ± 9. Menstrual irregularity was identified in 84% of respondents as the first symptom noticed and the primary reason for seeking a medical consultation. A PCOS diagnosis occurred on average 4.3 years following awareness of first symptoms and required consultation with more than one primary care provider for 57% of respondents. Half (53%) of respondents reported not receiving a referral to specialists for follow-up care and 70% were not informed about long-term health morbidity such as diabetes or cardiovascular disease. Most respondents (82%) did their own research about PCOS using on-line sources, academic literature and advice from peer support. The participant themes from open questions for improving health care included more resources and support, increased and reliable information, better education and training for clinicians, timely diagnosis, prompt referrals to specialists, and generally more compassion and empathy to the challenges faced by those managing their disease.

CONCLUSION

Our findings highlight the health concerns and challenges in health care for those with PCOS. In Alberta, Canada we have identified major gaps in health care including a timely diagnosis, follow up care and supports, and multidisciplinary care. This evidence-based data can be used to inform development of pathways to improve the health care experience in those affected by PCOS.

Body image concerns in women with polycystic ovary syndrome: a systematic review and meta-analysis

OBJECTIVE

To assess differences in body image concerns among women with and without polycystic ovary syndrome (PCOS).

DESIGN

This is a systematic review and meta-analysis.

METHODS

Electronic databases (MEDLINE, EMBASE, APA PsychInfo, PUBMED, Web-of-Science Core Collection, and Cochrane Controlled Register of Trials [CENTRAL]) were searched from inception through July 2022. Outcome measures included validated questionnaires reporting on body image concerns. Methodological quality was assessed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system, and included studies were assessed for risk of bias. Meta-analyses were performed using the inverse variance method based on random or fixed effects models (Review Manager, Version 5).

RESULTS

A total of 918 women with PCOS and 865 women without PCOS from 9 studies were included. Meta-analysis of 3 studies using Multidimensional Body-Self Relations Questionnaire Appearance Scale (MBSRQ-AS) showed those with PCOS reported higher dissatisfaction with appearance evaluation and appearance orientation compared to those without PCOS (mean difference [MD] = -0.78, I2 = 0%, P < .00001, and MD = 0.22, I2 = 54%, P = .004, respectively). Meta-analysis of 2 studies showed higher dissatisfaction with overweight preoccupation, lower body area satisfaction, and body weight classification on MBSRQ-AS subscales in those with PCOS compared to those without PCOS (all P < .001). Meta-analysis of 2 studies using the Body Esteem Scale for Adolescents and Adults (BESAA) showed significantly lower scores for the weight subscale in those with PCOS compared to those without PCOS (P = .03).

CONCLUSIONS

Those with PCOS experience more significant body image concerns, emphasising the importance of awareness in the clinical care of PCOS. Considering the limited evidence, further studies are warranted to identify drivers and mitigating factors.

Body Image and Emotional Status in Patients with Acquired Brain Injury

Emotional experiences can lead to a real or distorted self-representation. After brain damage, altered self-perception of one's own body image is frequent. This study evaluates the relationship of mood disorders and lesion sites on body image in a cohort of ABI patients. A total of 46 patients (26 men, 20 women) without severe physical impairments were found eligible for this study. Patients underwent Beck's Depression Inventory and the Hamilton Rating Scale for Anxiety to assess mood disorders, whereas the Body Image Scale and Human Figure Drawing were used to evaluate body dissatisfaction and implicit body image. The Montreal Cognitive Assessment was used to assess patients' cognitive condition. We found a moderate correlation between depression and body image (r = 0.48), as well as between anxiety and body image (r = 0.52), and the regression model also reported the right lesion site as a predictive variable for body image score. In addition, the regression model built by Human Figure Drawing scores showed anxiety, cognitive functioning, and a marital status of single to be significant predictors. The study confirmed that participants with acquired brain injury have deficits in body representation associated with mood disorders, regardless of the side of the lesions. A neuropsychological intervention could be useful for these patients to improve their cognitive performance and learn to manage emotional dysfunction in order to increase their self-perception of body image and improve their quality of life.

A case-control study about markers of stress in normal-/overweight women with polycystic ovary syndrome and in controls

Background

Polycystic ovary syndrome (PCOS) is linked to an elevated risk of psychological disorders, decreased quality of life and emotional distress. Serum cortisol as a potential stress marker has been found to be increased in women with PCOS. The aim of this study was to evaluate both saliva stress markers and subjective psychological distress in women with PCOS.

Methods

In a prospective case-control study, 31 PCOS women and 31 healthy controls were included. Salivary cortisol, and metanephrines were collected in the morning and in the evening. Emotional distress and quality of life were assessed by means of the Perceived Stress Scale (PSS-10) and the Short Form-36 (SF-36). Multivariable generalized linear models were applied to test the influence of various parameters on numerical outcome parameters.

Results

After correction for age and body mass index (BMI), there were no statistically significant differences of salivary biomarkers between PCOS women and healthy controls (p>0.05). PCOS patients revealed significantly higher increased PSS total scores and lower quality of life in all SF-36 modules apart from pain (p< 0.05). The PSS total score was positively correlated to prolactin in PCOS women (r= 0.450; p= 0.011). In overweight/obese PCOS patients, a higher BMI, a higher Ferriman Gallwey score and higher age significantly predicted the PSS total score (p< 0.05).

Conclusion

Stress measured by salivary biomarkers did not differ between PCOS women and healthy controls, whereas stress scores evaluated by questionnaires were significantly greater in women with PCOS. A higher BMI, hirsutism and a higher age seem to be the main modulators of subjective stress in PCOS. Prolactin might serve as a biomarker for chronic stress in PCOS women.

Depression and anxiety in adolescents and young women with polycystic ovary syndrome: a systematic review and meta-analysis

OBJECTIVES

To evaluate the depression and anxiety symptoms, or both in adolescents and young women with polycystic ovary syndrome (PCOS) to those without PCOS.

CONTENTS

A comprehensive electronic search was conducted to identify observational studies on PCOS patients (January 1991-December 2020). The population study included adolescents and young women (14-29 years of age) in two groups of cases (with PCOS) and controls (without PCOS) who were diagnosed with PCOS using the Rotterdam or National Institutes of Health criteria (NIH). Symptoms of depression, anxiety, or both, reported separately, were of interest. Mean (SD) of depression or anxiety symptoms, or both, as measured by a quantitatively validated scale for both the case and control groups. All eligible studies were quality assessed using the Newcastle-Ottawa Scale (NOS) tool. The initial database search resulted in the discovery of 1,582 papers, of which 806 were selected after screening the titles and abstracts and removing duplicates. A total of 49 papers were found to be suitable for full-text reading. This meta-analysis included ten studies comprising 941 adolescent/young women (391 with PCOS and 550 without PCOS). The standard mean difference (SMD) and its corresponding confidence interval (CI) at 95 % were used to compare depression or anxiety symptoms, or both, between two groups.

SUMMARY AND OUTLOOK

The results, which included 192 cases, demonstrated that adolescents/young women with PCOS had significantly more depressive symptoms than those without PCOS (n=360) (SMD 0.72; 95 % CI, 0.09-1.34; Z=2.25, p=0.025; Heterogeneity: I²=89.7 %; p=0.000). Also, the results which included 299 cases demonstrated that adolescents/young women with PCOS had significantly more anxiety symptoms than those without PCOS (n=421) (SMD 0.59; 95 % CI, 0.13-1.05; Z=2.51, p=0.012; Heterogeneity: I²=86.1 %; p=0.000). This meta-analysis demonstrates that adolescent/young women with PCOS have significantly more depression or anxiety symptoms than those without PCOS.

Association Between Mental Health and Reproductive System Disorders in Women: A Systematic Review and Meta-analysis

Importance

Reproductive system and mental health disorders are commonly comorbid in women. Although the causes of this overlap remain elusive, evidence suggests potential shared environmental and genetic factors associated with risk.

Objective

To investigate the comorbidity between psychiatric and reproductive system disorders, both as broad diagnostic categories and among specific pairs of diagnoses.

Data Source

PubMed.

Study Selection

Observational studies published between January 1980 and December 2019 assessing prevalence of psychiatric disorders in women with reproductive system disorders and prevalence of reproductive system disorders in women with psychiatric disorders were included. The study did not include psychiatric and reproductive disorders triggered by life events (eg, trauma, infection, surgery) to address potential confounding.

Data Extraction and Synthesis

A search yielded 1197 records, of which 50 met the inclusion criteria for the qualitative and 31 for the quantitative synthesis in our study. A random-effects model was used for data synthesis and Egger test and I2 to assess study bias and heterogeneity. Data were analyzed from January to December 2022. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline.

Main Outcomes and Measures

Psychiatric and reproductive system disorders.

Results

A total of 1197 records were identified, of which 50 met the inclusion criteria for qualitative and 31 for quantitative synthesis. Diagnosis of a reproductive system disorder was associated with a 2- to 3-fold increased odds of having a psychiatric disorder (lower bound odds ratio [OR], 2.00; 95% CI, 1.41-2.83; upper bound OR; 2.88; 95% CI, 2.21-3.76). The analysis focused on specific diagnoses described in the literature and found that polycystic ovary syndrome was associated with increased odds of depression (population-based studies OR, 1.71; 95% CI, 1.19-2.45; clinical studies OR, 2.58; 95% CI, 1.57-4.23) and anxiety (population-based studies OR, 1.69; 95% CI, 1.36-2.10; clinical studies OR, 2.85; 95% CI, 1.98-4.09). Chronic pelvic pain was also associated with both depression (OR, 3.91; 95% CI, 1.81-8.46) and anxiety (OR, 2.33; 95% CI, 1.33-4.08). Few studies investigated risk of other reproductive system disorders in women with psychiatric disorders, or reverse associations (risk of reproductive system disorder among women with a psychiatric diagnosis).

Conclusions and Relevance

In this systematic review and meta-analysis, a high rate of reported co-occurrence between psychiatric and reproductive disorders overall was observed. However, data for many disorder pairs were limited. The available literature focused overwhelmingly on affective disorders in polycystic ovary syndrome, overlooking a substantial portion of disease overlap. As such, the associations between the majority of mental health outcomes and conditions of the female reproductive system are largely unknown.

Body image, self-compassion, and sexual distress in individuals living with endometriosis

OBJECTIVE

Extensive psychological burden is associated with the experience of living with endometriosis, including negative changes to body image and sexual functioning. Emerging evidence suggests that potential protective factors such as body appreciation and self-compassion may help mitigate these adverse impacts of endometriosis. This study aimed to investigate the association of body image, both positive (body appreciation) and negative (body image disturbance) dimensions, with sexual distress and the potential buffering effect of self-compassion on the body image-sexual distress link.

METHODS

Data were collected via an online cross-sectional survey (N = 471) assessing body image disturbance, body appreciation, self-compassion and sexual distress in individuals with endometriosis. A series of hierarchical linear regression analyses were conducted to explore the relationship between key variables.

RESULTS

>80% of the sample reported clinically significant sexual distress and high levels of body image disturbance. Regression analyses indicated a moderate positive effect of body image disturbance with sexual distress, and a weaker inverse effect of self-compassion with sexual distress. Body appreciation was not associated with sexual distress, and no moderating effects of self-compassion were evident.

CONCLUSION

The high prevalence of sexual distress identified in this sample, along with the finding that body image disturbance was strongly associated with sexual distress, suggest that psychosocial interventions addressing body image may help ameliorate sexual distress in individuals with endometriosis.

Intake of Low Glycaemic Index Foods but Not Probiotics Is Associated with Atherosclerosis Risk in Women with Polycystic Ovary Syndrome

Women with polycystic ovary syndrome (PCOS) are at high cardiometabolic risk. The atherogenic index of plasma (AIP) strongly predicts atherosclerosis. Some studies suggest that probiotic intake may lower AIP. This study analysed the relationship between the frequency of dietary intake of low glycaemic index (prebiotic) and probiotic foods and atherosclerosis risk in women with PCOS.

METHODS

A total of 127 women were divided into two groups: AIP over 0.11 (highAIP) and AIP ≤ 0.11 (lowAIP). The KomPAN® questionnaire was used to measure food frequency intake; pro-healthy, non-healthy, low glycaemic and probiotic dietary indexes were calculated based on daily food consumption. Body composition was measured by air displacement plethysmography (BodPod). AIP was calculated as a logarithm of triglycerides and high-density lipoproteins from plasma.

RESULTS

The highAIP group was 63% less likely to consume low glycaemic index foods three or more times a day than the lowAIP group. The HighAIP group was also 62% less likely to consume buckwheat, oats, whole-grain pasta or coarse-ground grains at least a few times a week. Pro-healthy foods tended to be less frequently consumed by the highAIP group, when adjusted for BMI and age.

CONCLUSION

Women with PCOS at high risk of atherosclerosis consumed less low glycaemic index foods than women with a low risk of atherosclerosis. Intake of high-fibre, low glycaemic index foods could prevent atherosclerosis in women with PCOS; however, the effect of probiotic food intake remains unclear.

Upregulation of TXNIP contributes to granulosa cell dysfunction in polycystic ovary syndrome via activation of the NLRP3 inflammasome

Polycystic ovary syndrome (PCOS) is a complex endocrine disease. Thioredoxin-interacting protein (TXNIP) promotes oxidative stress and triggers inflammation. Herein, we investigated the role and potential mechanism of TXNIP in PCOS. In a mouse model of dehydroepiandrosterone (DHEA)-induced PCOS, we found that TXNIP was upregulated in the ovaries, especially in granulosa cells (GCs). TXNIP was also upregulated in testosterone (T)-treated GCs in vitro. Knockdown of TXNIP by lentivirus-constructed shRNA attenuated T-induced GC injury and oxidative stress, as well as inflammation and the NLRP3 inflammasome. The mechanism by which TXNIP promotes inflammation may involve TXNIP dissociation from the TXNIP-TRX complex and binding to NLRP3 to form the inflammasome. Additionally, we verified that knockdown of TXNIP ameliorated ovarian injury and inflammation in mice with DHEA-induced PCOS in vivo. Collectively, we demonstrated that TXNIP is involved in GC inflammation by promoting NLRP3 inflammasome activation in PCOS.

Lifestyle management in polycystic ovary syndrome - beyond diet and physical activity

Polycystic ovary syndrome (PCOS) is a common condition affecting reproductive-aged women with reproductive, metabolic and psychological consequences. Weight and lifestyle (diet, physical activity and behavioural) management are first-line therapy in international evidence-based guidelines for PCOS. While these recommend following population-level diet and physical activity guidelines, there is ongoing interest and research in the potential benefit of including psychological and sleep interventions, as well as a range of traditional, complimentary and integrative medicine (TCIM) approaches, for optimal management of PCOS. There is limited evidence to recommend a specific diet composition for PCOS with approaches including modifying protein, carbohydrate or fat quality or quantity generally having similar effects on the presentations of PCOS. With regards to physical activity, promising evidence supports the provision of vigorous aerobic exercise, which has been shown to improve body composition, cardiorespiratory fitness and insulin resistance. Psychological and sleep interventions are also important considerations, with women displaying poor emotional wellbeing and higher rates of clinical and subclinical sleep disturbance, potentially limiting their ability to make positive lifestyle change. While optimising sleep and emotional wellbeing may aid symptom management in PCOS, research exploring the efficacy of clinical interventions is lacking. Uptake of TCIM approaches, in particular supplement and herbal medicine use, by women with PCOS is growing. However, there is currently insufficient evidence to support integration into routine clinical practice. Research investigating inositol supplementation have produced the most promising findings, showing improved metabolic profiles and reduced hyperandrogenism. Findings for other supplements, herbal medicines, acupuncture and yoga is so far inconsistent, and to reduce heterogeneity more research in specific PCOS populations, (e.g. defined age and BMI ranges) and consistent approaches to intervention delivery, duration and comparators are needed. While there are a range of lifestyle components in addition to population-recommendations for diet and physical activity of potential benefit in PCOS, robust clinical trials are warranted to expand the relatively limited evidence-base regarding holistic lifestyle management. With consumer interest in holistic healthcare rising, healthcare providers will be required to broaden their knowledge pertaining to how these therapies can be safely and appropriately utilised as adjuncts to conventional medical management.

Depression, anxiety, body image scores, and sexual dysfunction in patients with polycystic ovary syndrome according to phenotypes

Background: Polycystic ovary syndrome (PCOS) has been linked to both mental and metabolic disturbances. The purpose of this research was to investigate psychological features such as anxiety and depression, body image, sexual dysfunction, and associated factors among the PCOS phenotypes and to compare these with healthy controls. Methods: The study involved 167 reproductive-age women with PCOS and 73 healthy controls. Standardized scales assessing depression (the Beck Depression Inventory [BDI]), depression and anxiety (the Hospital Anxiety and Depression Scale [HADS] and the General Health Questionnaire [GHQ]), and body image scale (the Body Cathexis Scale [BCS]) were administered to all participants. Hirsutism scores, serum androgen levels, and metabolic parameters were recorded. Results: Significantly higher BDI, HADS depression, and GHQ scores, and a more negative body image in terms of BCS scores were observed in the women with PCOS than in the healthy controls. BDI scores were significantly higher in phenotypes A, B, and D compared with the healthy controls. No significant difference was observed in BDI and HADS depression scores among the phenotypes. Significant differences were observed only between phenotype A and the control group in terms of HADS depression and GHQ scores. BCS scores were significantly higher in phenotypes A, B, and C than in the healthy controls. No significant difference was determined in Female Sexual Function Index (FSFI) scores between the PCOS phenotypes and the healthy controls. When all participants were divided into three groups based on body mass index (BMI), a statistically significant difference was observed only between the phenotype A lean group (BMI: 18.5-24.9 kg/m²) and the control group in terms of BDI, HADS depression, and BCS scores. Conclusions: BDI, HADS depression scores, and GHQ scores were all higher in patients with PCOS compared with the healthy controls. These features were more pronounced in phenotypes A and B, including hyperandrogenism and oligo-anovulation. Physicians should be aware of the high risk of these disorders in women with PCOS.

Body image and sexual function in women with polycystic ovary syndrome: a case-control study

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CONCLUSION:

Probiotic effects on sexual function in women with polycystic ovary syndrome: a double blinded randomized controlled trial

BACKGROUND

Considering the presence of sexual dysfunction in patients with polycystic ovary syndrome, our aim was to provide scientific evidence studying effect of oral probiotic on sexual function in patients with PCOS treated with letrozole in an Iranian population.

METHODS

This study was a double blind randomized clinical trial. Eligible women were allocated to Lactofem plus letrozole (n = 20) or letrozole (n = 20). Folic acid was prescribed to all participants in two groups during the study. In group A, Lactofem capsule was administered daily for the first month. In the second month, letrozole (2.5 mg daily from the third day of the menstrual cycle for 5 days) plus Lactofem capsule same as previous month were prescribed. In group B, letrozole administered 2.5 days from the third day of the menstrual cycle for 5 days in the second month. All questionnaires were completed by patients after the intervention (two months after the start of treatment). The Female Sexual Function Index (FSFI) and Body Image Concern Inventory (BICI) were used to assess sexual function and body satisfaction, respectively.

RESULTS

There is statistically significant increase in chemical pregnancy rate (10% vs. 0%; p = 0.05) and clinical pregnancy (10% vs. 0%; p = 0.05) in Probiotic plus letrozole group compared to letrozole group after intervention. Based on our results, there was a statistically significant difference in each domain and sum score of sexual function of before and after the intervention between group (P < 0.05). Our findings have been shown, after eight weeks, the probiotic plus letrozole group had a significant improvement in the FSFI domains and sum score compared to letrozole alone group. Moreover, there are a significant improvement in mean (IQR) of body image score in probiotic group [30 (4.99) vs. 40 (4.36); P < 0.01].

CONCLUSION

The results of the current study suggests that eight weeks of administration of probiotic may improve chemical and clinical pregnancy rate, sexual function and body satisfaction in women with PCOS.

Anxiety and Depression in Women with Polycystic Ovary Syndrome

Background and Objectives: Mental health disorders are often the consequence of hormonal disorders such as those accompanying polycystic ovary syndrome (PCOS), where changes in appearance and having to deal with a number of other problems occur due to this illness. The objective of this study was to determine the prevalence and severity of anxiety and depression symptoms, the level of ego-resiliency, and the ways that women with PCOS cope with stress compared to healthy women in order to determine the influence of socio-demographic characteristics in relation to levels of anxiety and depression with ego-resiliency and stress-coping methods. Materials and Methods: The study was conducted in Poland in 2021 and included 230 women with PCOS and 199 healthy controls aged 20-40 years old. The hospital anxiety and depression scale (HADs), ego-resiliency scale, as well as the MINI-COPE inventory were used. Results: The women with PCOS had higher levels of anxiety and depression and poorer ego-resiliency in comparison to the healthy women. The women with PCOS used passive stress-coping strategies significantly more commonly than the healthy women. Living in rural areas, having a lower level of education and being childless increased anxiety levels. Similarly, being over 30, living in a rural area, having a lower level of education, being childless, and being obese increased depression levels in the women with PCOS. A low level of ego-resiliency and passive stress-coping strategies are predictors of high levels of anxiety and depression in women with PCOS. Conclusions: Women with PCOS should be checked for anxiety and depression. They should also be checked to see whether they have the resources to cope with chronic stress in order to optimize therapeutic interventions.

'I'm usually being my own doctor': women's experiences of managing polycystic ovary syndrome in Canada

BACKGROUND

Polycystic ovary syndrome (PCOS) is a complex, chronic condition characterized by anovulation, polycystic ovarian morphology and hyperandrogenism that requires lifelong management. To reduce the risk of comorbidity and to manage symptoms, lifestyle management and pharmaceuticals such as oral contraceptives are the most common forms of treatment and should be tailored to the individual patient. The literature to date has shown PCOS patients to experience widespread dissatisfaction with the amount and quality of information they receive from providers, along with lower levels of trust in physicians. Little is known about the lived experiences of women managing PCOS in Canada, across age groups.

METHODS

In-depth remote interviews explored women's lived experiences managing PCOS and the barriers and facilitators they encountered in their management journeys. Data were analyzed using thematic analysis and interpretive description methodology.

RESULTS

Twenty-five in-depth, telephone interviews conducted with participants (aged 18-63 y) across Canada revealed participants lacking sufficient information and guidance from physicians, especially in primary care. Areas in need of more guidance included lifestyle management and mental health. Lack of empathy and weight bias among physicians were also perceived by participants. Older participants received little guidance on treatment options postmenopause. Loss of trust and withdrawal from seeking medical care were prominent themes, along with greater self-reliance on self-management, including self-educating and self-experimenting with treatments.

CONCLUSIONS

Most women in this study were frustrated with the level of involvement and information provision from their doctors. Key recommendations are identified for the provision of care to younger and older patients with PCOS. Improved education for physicians may be needed to improve the quality of healthcare provision for PCOS.

Efficacy, Feasibility and Acceptability of a Mediterranean Diet Intervention on Hormonal, Metabolic and Anthropometric Measures in Overweight and Obese Women with Polycystic Ovary Syndrome: Study Protocol

Polycystic ovary syndrome (PCOS) is a common endocrine condition in reproductive-aged women associated with metabolic, reproductive and psychological features. Lifestyle modification (diet/physical activity) is considered first-line treatment for PCOS. However, there is limited high-quality evidence to support therapeutic dietary interventions for PCOS beyond general population-based healthy eating guidelines. Adherence to a Mediterranean diet (MedDiet), with or without energy restriction, improves cardiometabolic health in populations including persons with or at high risk of cardiovascular disease and type 2 diabetes. However, there is limited research examining the MedDiet in PCOS. Therefore, this 12 week randomized controlled trial will investigate the efficacy of a MedDiet on cardiometabolic and hormonal parameters and explore its acceptability and feasibility in PCOS. Forty-two overweight and obese women with PCOS (aged 18-45 years) will be randomized to receive dietary advice consistent with Australian Dietary Guidelines or an ad libitum MedDiet intervention. All participants will receive fortnightly counselling to facilitate behaviour change. The primary outcomes will be changes in insulin resistance, glucose, total testosterone and sex hormone-binding globulin. Secondary outcomes include changes in body weight and feasibility and acceptability of the MedDiet intervention. The results of this study will provide further evidence on specific dietary approaches for management of PCOS.

Factors affecting the adoption of health-promoting behaviours in patients with polycystic ovary syndrome: a cross-sectional study

OBJECTIVE

This study aimed to investigate health-promoting lifestyle status and associated risk factors in patients with polycystic ovary syndrome (PCOS).

DESIGN

Cross-sectional study.

SETTING

This study was conducted at a tertiary hospital in Guizhou, China from December 2020 to June 2021.

PARTICIPANTS

A total of 366 participants (18-45 years) diagnosed with PCOS were recruited from the outpatient departments.

MEASURES

Sociodemographic characteristics were collected, and health-promoting behaviours were measured using the Health-Promoting Lifestyle Profile scale. Anxiety status was measured using the Zung's Self-Rating Anxiety Scale, depression status using the Zung's Self-Rating Depression Scale and self-efficacy using the Managing Chronic Disease 6-Item Scale. Multiple stepwise linear regression was conducted to assess the risk factors associated with the health-promoting behaviours of the study participants.

RESULTS

The participants had a poor health-promoting behaviours (88.54±17.44). The highest score in all dimensions was spiritual growth (16.68±4.98), while physical activity (12.71±2.68) was the lowest. Multiple regression analysis revealed that the main factors influencing the development and maintenance of health-promoting behaviours among participants were education (B=10.788, p<0.001), depression (B=-0.377, p<0.001), anxiety (B=-0.333, p<0.001) and self-efficacy (B=0.938, p=0.002). The model showed 74.40% variance shared between the dependent and independent variables (R2=74.40, F=264.633, p<0.001).

CONCLUSION

Health-promoting behaviours are minimal among patients with PCOS, and improving negative emotions and enhancing behavioural awareness and self-efficacy are necessary to increase the adoption of health-promoting behaviours among patients with PCOS.

TRIAL REGISTRATION NUMBER

ChiCTR2000034572.

Confirmatory factor analysis and psychometric properties of the Persian version of the Multidimensional Body-Self Relations Questionnaire-Appearance Scales (MBSRQ-AS) in women with polycystic ovary syndrome

PURPOSE

Body image is a multidimensional and complex psychological construct. Since the Multidimensional Body Self-Relation Questionnaire-Appearance Scale (MBSRQ-AS) is a questionnaire that measures body image as a multidimensional construct. This study aimed to translate and evaluate the psychometric properties of the Persian version of MBSRQ-AS.

METHODS

This methodological study was conducted on 251 women with polycystic ovary syndrome referring to polyclinics of hospitals that were covered by Iran University of Medical Sciences, with age ranging from 18 to 46 years old (M = 27.35; SD = 6.32). The mean body mass index (BMI) was 25.59 kg/m² (SD = 4.9). A forward-backward translation procedure was applied. Then face and content validity was inducted.

RESULTS

Face and content validity of the Persian MBSRQ-AS was established. Confirmatory factor analyses showed good fit indices for the five-factor structure (appearance evaluation, appearance orientation, body areas satisfaction, overweight preoccupation, and self-classified weight). The internal consistency (Cronbach's alpha ranged from 0.71 to 0.85) and test-retest reliability by calculating the intraclass correlation coefficient ranged from 0.75 to 0.91 was adequate.

CONCLUSION

This study confirms the factor structure of the MBSRQ-AS. The Persian version of MBSRQ-AS has acceptable psychometric properties.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

"I felt like she didn't take me seriously": a multi-methods study examining patient satisfaction and experiences with polycystic ovary syndrome (PCOS) in Canada

Background

Polycystic ovary syndrome (PCOS) is a common and complex condition affecting metabolic, reproductive, cardiovascular, and psychological health in women. Previous studies point to widespread dissatisfaction and delays with the diagnosis of PCOS and a lack of information provision by doctors, with few studies on Canadian populations. This multi-methods study explored the perceptions and experiences of PCOS diagnosis in Canada using an online-distributed survey and follow-up, in-depth, semi-structured phone interviews.

Methods

The online questionnaire was completed by 296 women aged 18–60 with a self-reported diagnosis of PCOS. The survey measured time to diagnosis, number of doctors seen, and information provided. Descriptive statistics, Chi-square tests, Fisher’s exact tests, and Spearman’s rank correlations were used to analyze the sample characteristics and correlations between the demographic factors and the outcome measures. Twenty-five follow-up interviews were held over the phone and analyzed using thematic analysis and interpretive description methodology.

Results

Survey respondents were dissatisfied with the information provided about PCOS (66%), lifestyle management (34%), and medical therapy (38%) at the time of diagnosis. Approximately 34% of respondents waited for more than 2 years and 41% saw 3 or more doctors before attaining diagnosis. Many did not receive any information about lifestyle management (42%) or medical therapy (28%). Interview participants encountered doctors who lacked sufficient knowledge on PCOS to diagnose, chronically dismissed concerns, and did not provide necessary medical information about the condition. Women described benefitting from self-advocation to receive the care they needed from doctors, and self-educating about PCOS using materials they could find online. Younger interview participants whose symptoms began in adolescence would often not understand the significance of symptoms until much later in life, contributing to delayed diagnoses.

Conclusions

Greater education on PCOS for physicians, particularly in primary care, is needed to prevent delayed diagnoses and ensure that patients are provided with reliable medical information about their condition. Greater awareness of PCOS may be necessary for the general population to help women identify symptoms, especially for adolescents and their parental figures.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01630-3.

Physical and psychological correlates of self and body compassion in women with polycystic ovary syndrome

This international cross-sectional study examined the level and potential correlates of self and body compassion in women (n = 227) with polycystic ovary syndrome (PCOS). Participants completed an online survey examining quality of life, psychological health, body image and self and body compassion. Low levels of self and body compassion were found, with depression and body image concern identified as negative correlates of self and body compassion. Physical health was identified as a positive correlate of body compassion. The findings identify the important relationship between body image, psychological health and self and body compassion in women with PCOS.

The prevalence of anxiety and depression of different severity in women with polycystic ovary syndrome: a meta-analysis

OBJECTIVE

To assess the prevalence of anxiety and depression symptoms of different severity in women with polycystic ovary syndrome (PCOS) and explore the potential contributors related to these symptoms using a meta-analysis.

MATERIALS AND METHODS

Databases were systemically searched for cross-sectional studies that evaluated the prevalence of anxiety and depression in women with PCOS published up to September 21 2019. Random effects model or fixed-effect model was used to analyze the data in meta-analysis. The pooled odds ratio (OR) and the pooled standardized mean difference (SMD) were performed to estimate the potential factors related to these symptoms.

RESULT

A total of 24 cross-sectional studies were included. All studies assessed depression (2316 women with PCOS). Moreover, 16 studies assessed anxiety (1698 women with PCOS), and 6 studies assessed anxiety with depression (736 women with PCOS). The analysis revealed an increase in pool prevalence of depression (42%, 95%CI: 33-52%) and anxiety (37%, 95%CI: 14-60%) among the participants with PCOS, while the pooled prevalence of depression and concurrent anxiety was 28% (95%CI: 1.7-54.2%). Besides, the pooled prevalence of mild symptoms was higher than other levels (depression: 27.5%, 95%CI: 19-36%; anxiety: 35%, 95%CI: 0.8-70.8%). Obese women with PCOS had higher odds of depression (2.098, 95% CI: 1.411-3.119, I²=0.00%, p > .05).

CONCLUSIONS

Our meta-analysis confirmed that women with PCOS had a high prevalence of anxiety and depression of different severity, with mild symptoms being more common. Moreover, obesity may increase the risk of depression symptoms, while potential contributors and mechanisms affecting these symptoms, such as hirsutism, infertility, insulin resistance (IR), and total testosterone in women with PCOS, need to be further investigated.

Providing lifestyle advice to women with PCOS: an overview of practical issues affecting success

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting up to 13 % of women. Lifestyle interventions are first-line treatments, however attrition in women with PCOS is high. This review summarises current evidence on barriers to lifestyle management in PCOS and suggested strategies for overcoming these challenges, mapped to the Capability, Opportunity, Motivation and Behaviour model.Physical capability for lifestyle changes may be impacted by altered gut hormone regulation and energy expenditure in PCOS. This may contribute to difficulties with weight management. The higher prevalence of eating disorders, disordered eating, fatigue and sleep disturbances are further barriers. Psychological capability may be reduced due psychological symptoms and lack of critical health literacy. Women with PCOS face similar challenges in terms of Opportunity to make lifestyle changes as other women of reproductive age. However, these are complicated by features more common in PCOS including body dissatisfaction. Motivation to adopt healthy lifestyles may be impacted by suboptimal risk perception and intrinsic motivation.To address these barriers, screening for and management of eating disorders, disordered eating, depression, and Obstructive Sleep Apnoea should be undertaken as per international evidence-based guidelines. A weight-neutral approach may be appropriate with disordered eating. Building capability among health professionals to better partner with women with PCOS on their management is essential in addressing health literacy gaps. Behavioural strategies that target risk perception and build intrinsic motivation should be utilised. More research is required to understand optimal self-management strategies, risk perception, energy homeostasis and overcoming attrition in women with PCOS.

Effects of Metformin and Exercise in Polycystic Ovary Syndrome: Systematic Review and Meta-Analysis

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. Metformin is introduced for treatment of women with PCOS, and the beneficial effects of exercise in women with PCOS are found for a range of outcomes. Our aim is to compare the effects of metformin plus exercise with exercise intervention in PCOS on clinical, anthropometric, metabolic, and psychological parameters. MEDLINE, EMBASE, Web of Science and China National Knowledge Infrastructure were searched for studies. Nine studies were considered eligible for inclusion. The meta-analysis reveals that metformin offers additive benefits to exercise, leading to modest improvements in menstrual cycles, hyperandrogenism, and abdominal fat.

Association between Subjective Body Image, Body Mass Index and Psychological Symptoms in Chinese Adolescents: A Nationwide Cross-Sectional Study

Background: Conflicting findings were reported about the associations between subjective body image (SBI), body mass index (BMI) and psychological symptoms in China and other countries in the world. In this study, we aim to explore the associations between SBI, BMI, and psychological symptoms based on a large-scale, national wide survey among Chinese adolescents. Methods: The 2014–2015 China Education Panel Survey (CEPS) database, with 8134 middle school students (4137 boys and 3997 girls), was analyzed to explore the association between SBI, BMI and psychological symptoms. SBI was assessed by one question about the perception of own body shape with options “very thin”, “slightly thin”, “average”, “weak heavy”, and “very heavy”. BMI was calculated by the self-reported body weight and height. Psychological symptoms were evaluated by 10 items involving both aspects of depression and anxiety. Results: The results indicated that both boys and girls who perceived weak or very heavy weight were positively associated with psychological symptoms (p < 0.05). For boys, perceiving very thin body image was also in higher risk of psychological symptoms (p < 0.05), after controlling social-demographic variables and BMI. Comparing with normal weight boys or girls, obese boys (β = −2.22, 95% CI −3.37~−1.07) and overweight girls (β = −1.03, 95% CI −2.01~−0.06) were in lower levels of psychological symptoms after controlling for SBI. Other factors associated with psychological symptoms were family economic status, academic performance, and self-rated health status. Conclusions: A deviation from an “average” SBI was positively associated with psychological symptoms, which should be scanned when evaluating the Chinese adolescents’ mental health. These findings provide epidemiological evidence for the association between SBI and psychological symptoms in non-western social contexts.

An Analysis on the Implementation of the Evidence-based PCOS Lifestyle Guideline: Recommendations from Women with PCOS

Polycystic ovary syndrome (PCOS) is the most common endocrinological disorder affecting women of reproductive age, affecting 8-13% in this group. Women with PCOS are more likely to have excess BMI, which in turn exacerbates the symptoms of PCOS in these women. The latest evidence-based guideline recommends lifestyle management as the first-line treatment for PCOS. However, the implementation of this recommendation through health services faces a significant challenge. As part of the mapping of the implementation plan for lifestyle management in PCOS, citizen panels and semi-structured interviews were conducted to capture the voices of consumers. Women with PCOS expressed the need for multidisciplinary, integrated care as a recurrent theme. Other important considerations included health professionals who listen and are open to learning about PCOS, the empowerment of women to self-manage PCOS and the provision of peer support. Women with PCOS also expressed the key recommendation of focusing on practical skills when providing lifestyle advice. Within that, both individual and group lifestyle sessions were valued for privacy and peer support respectively and delivery by a dietitian is preferred. These recommendations by women with PCOS should be considered when developing the implementation plan for the PCOS lifestyle guideline.

Self-Concept, Depression, and Anxiety Levels of Adolescents with Polycystic Ovary Syndrome

STUDY OBJECTIVE

In this study we explored the level and severity of issues related to self-concept, depression, and anxiety in adolescents with polycystic ovary syndrome (PCOS).

DESIGN

Cross-sectional and case-control study.

SETTING

The research was conducted in the outpatient Pediatric Endocrinology Clinic of Adiyaman University School of Medicine in Turkey.

PARTICIPANTS

The study population comprised 153 patients with PCOS and 161 healthy adolescents.

INTERVENTIONS AND MAIN OUTCOME MEASURES

The Personal Information Form, State-Trait Anxiety Inventory for Children, Children's Depression Inventory, and Piers-Harris Children's Self-Concept Scale were administered to all of the participants who took part in the study.

RESULTS

The Piers-Harris Children's Self-Concept Scale scores were lower in the PCOS group than in the control group (P < .001). In addition, the scores for the Children's Depression Inventory were also significantly higher in the PCOS group (P < .001). The State-Trait Anxiety Inventory for Children scores showed statistically significant higher levels of state anxiety and trait anxiety in the PCOS group (P < .001).

CONCLUSION

Adolescents with PCOS had lower self-concept scores, greater anxiety levels, and increased depressive symptoms than the healthy controls. Future studies are needed to examine the psychiatric problems in adolescents with PCOS.

Polycystic Ovary Syndrome, Affective Symptoms, and Neuroactive Steroids: a Focus on Allopregnanolone

PURPOSE OF REVIEW

To provide an overview of existing studies on alterations in gonadal and neuroactive steroids (NASs) and mood symptoms among women with polycystic ovary syndrome (PCOS).

RECENT FINDINGS

Recent studies have demonstrated a previously underappreciated association between PCOS and comorbid depression and anxiety. However, most studies on affective symptoms among women with PCOS have been cross-sectional, limiting our knowledge about fluctuations in symptoms over the menstrual cycle and reproductive lifespan for women with PCOS, as well as the potential interplay between NAS alterations and mood symptoms. Changes in the NAS allopregnanolone (ALLO) have been implicated in several reproductive-related psychiatric disorders (e.g., premenstrual dysphoric disorder (PMDD) and postpartum depression (PPD)) as well as in normal reproductive functioning, warranting further investigation for its potential role in the psychiatric symptoms observed in women with PCOS. Prospective studies evaluating associations between psychiatric symptoms and NAS are needed to elucidate the biological causes of the increased rates of psychiatric symptoms among women with PCOS and inform clinical treatment. ALLO, with its role in normal reproductive function, menstrual dysregulation among women with PCOS, and reproductive-related psychiatric conditions, makes it a particularly intriguing candidate for future investigation.

Implementation of the polycystic ovary syndrome guidelines: A mixed method study to inform the design and delivery of a lifestyle management program for women with polycystic ovary syndrome

AIM

The 2018 evidence-based polycystic ovary syndrome (PCOS) guidelines recommend lifestyle management as first-line treatment. This study aims to understand the preferred intervention characteristics of a PCOS lifestyle program from the perspectives of women with PCOS to inform the translation of the guidelines into practice.

METHODS

Women with self-reported PCOS residing in Australia took part in semi-structured interviews (n = 20) and an online survey (n = 286). The survey and interview schedule were developed using the template for intervention description and replication checklist.

RESULTS

Women want to take part in a lifestyle program (94.6%) and use government-subsidised sessions to attend (83%). Sessions of 45 to 60 minutes (75%) costing less than AUD$50 are preferred (60%). Topics of most interest related to sustainable daily physical activity (58%), overcoming non-hungry eating (54%), PCOS-specific diets (51%) and how to overcome barriers to behaviour change (45%). A delivery mode that combines online and in-person support is preferred (53%). Women are in need of long-term professional lifestyle support (6-12 months) that provides evidence-based, PCOS-specific, personalised prescription. Multidisciplinary support from a range of PCOS-trained professions is also preferred to address women's physical, psychological and emotional needs.

CONCLUSION

Women with PCOS are willing to take part in lifestyle programs that are low cost, long term, evidence based, PCOS-specific and provide practical strategies for nutrition and physical activity changes. Future online and in-person PCOS programs are strongly recommended to incorporate these findings to improve program engagement and patient satisfaction.

The mental health of women with polycystic ovary syndrome: a systematic review and meta-analysis

Polycystic ovary syndrome (PCOS) has been proposed to be associated with several mental health problems, including anxiety, depression, diminished sexual satisfaction, and lowered health-related quality of life, etc. A systematic review and meta-analysis of published literature was conducted comparing the mental health of women with and without PCOS. Ten English and Chinese databases were searched up to 12/31/2018. Random-effects models were introduced, and subgroup analysis, sensitivity test, and meta-regression were carried out to determine the source for heterogeneity among studies. Forty-six studies, including 30,989 participants (9265 women with PCOS and 25,638 controls), were qualified for review according to the inclusion criteria. Twenty-eight studies reported depression symptoms, 22 studies were on anxiety, 16 studies showed quality of life (QoL) status, 12 studies were about sexual dysfunction, five on emotional distress, four on binge eating, and four on somatization. Women with PCOS reported significantly higher depression (SMD = 0.64; 95% CI 0.50-0.78), anxiety (SMD = 0.63; 95% CI 0.50-0.77), lower QoL (SMD = - 0.55; 95% CI -0.69 to -0.40), and not significant sexual dysfunction (SMD = - 0.24; 95% CI - 0.49 to 0.01). Studies from different countries, adopting various diagnosis criteria, using diverse instruments, as well as in different years, have reported heterogenetic results. Women with PCOS in China reported a larger effect size of depression and anxiety than patients from other countries. The results of this study have indicated that women with PCOS suffer from depression, anxiety, and experience a lower quality of life, whereas their sexual function is not distinct from that of healthy women. Psychological health care interventions for women with PCOS were addressed.

Sexual Function in Women With Polycystic Ovary Syndrome: Design of an Observational Prospective Multicenter Case Control Study

INTRODUCTION

The prevalence of polycystic ovary syndrome (PCOS) is 10-15% in women of reproductive age. Its characteristics are (i) clinical or biochemical hyperandrogenism, (ii) oligomenorrhea or amenorrhea, and (iii) polycystic ovaries on ultrasound. PCOS is associated with lower quality of life, depression, anxiety, diabetes, and cardiovascular disease. Treatment commonly entails oral contraceptive use to lower endogenous androgen levels. Androgen levels and comorbidities may affect sexual function. Previous studies have addressed a limited range of possible contributing factors. We will assess sexual function as well as genital and self-reported sexual arousal in a laboratory setting in women with PCOS compared to an age-matched healthy control group. Modulation by biopsychosocial factors mentioned will be studied.

METHODS

This is a multicenter prospective case control study. The study population includes healthy women with and without PCOS, aged 18-40 years, in a stable heterosexual relationship for at least 6 months. Power is calculated at 67 participants in each group. Anticipating a drop out of 10%, 150 participants will be recruited.

MAIN OUTCOME MEASURES

The main outcomes measured are sexual function using the Female Sexual Function Index, Sexual Desire Inventory, and Female Sexual Distress Scale-Revised; genital sexual arousal measured as vaginal pulse amplitude; and self-reported sexual arousal in response to erotic stimuli in a laboratory setting. The mediators that will be investigated include testosterone, free androgen levels, oral contraceptive use, sensitivity to androgens (using CAG repeat length), body mass index, body image, mental health, and self-esteem.

CONCLUSION

Strengths of this study are the inclusion of a broad range of biopsychosocial outcome measures including DNA analysis, a healthy control group, and standardized assessment of genital and self-reported sexual arousal in a laboratory setting. With the design of this study we aim to provide an insight into which biopsychosocial factors associated with PCOS are related to sexual function, and how sexual function may be affected by treatment. These new insights may help to improve clinical management of PCOS while improving the quality of life. Pastoor H, Both S, Timman R, et al. Sexual Function in Women With Polycystic Ovary Syndrome: Design of an Observational Prospective Multicenter Case Control Study. Sex Med 2020;8:718-729.

The Profiles of Body Image Associate With Changes in Depression Among Participants in Dance Movement Therapy Group

This mixed-methods study analyzed the body image quality of 143 patients with depression. The participants received a 20 × 75 min dance movement therapy (DMT) group treatment, sessions twice a week. Body Image Assessment (BIA) was the data collection tool, with pre-, post-, and 3-mos follow-up assessments. Pre-intervention body image quality characteristics were low energy and activity levels, discomfort, shame and disgust toward the body, tension in social interactions. On the BIA scores, a statistical method of Latent Profile Analysis was utilized to identify participant profiles in the data. The two identified profiles were participant with initial negative body image and participant with initial neutral body image. Depression symptoms were measured with BDI, and symptoms decreased for both participant profiles following the DMT intervention. The neutral profile participants had a significantly lower depression level, better energy level, and more frequently used mindfulness factors of acting aware, non-judgmentality and non-reactivity (measured with FFMQ). Findings suggest a systemic interaction between depression symptoms, body image, attachment style, activity level, and mindfulness skills. In an interactive DMT setting it is possible to address all of these factors simultaneously.

Vitamin D and Polycystic Ovary Syndrome: a Narrative Review

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders of reproductive age women and contributes to metabolic dysfunctions including insulin resistance (IR) and dyslipidemia. Vitamin D is a steroid hormone, which is involved in calcium metabolism and bone structure and has a potential role in the prevention of many illnesses, including cancers, autoimmune disorders, hypertension, diabetes, and obesity. Recently, it has been reported that vitamin D deficiency was a common complication of PCOS and vitamin D status was associated with reproductive ability, metabolic alterations, and mental health of PCOS patients. This review summarizes the advances between vitamin D status and the pathophysiological process of PCOS. Vitamin D level was negatively associated with serum androgen level. Vitamin D treatment could reduce serum androgen and anti-MüllerianHormone (AMH) levels, and decrease endometrial thickness, which resulted in improvement of menstrual cycle and folliculogenesis of PCOS patients. Moreover, vitamin D concentrations were negatively correlated with parameters of IR and body fat mass. Vitamin D supplementation has beneficial effects on IR and lipid metabolism. In addition, a positive of vitamin D on mental health of PCOS patients was proposed. Understanding the relationship between vitamin D status and the symptoms of PCOS patients is of great clinical significance to treat and prevent the progression of PCOS.

"The whole package deal": experiences of overweight/obese women living with polycystic ovary syndrome

BACKGROUND

Polycystic Ovary Syndrome (PCOS) is a common female reproductive disorder with multiple manifestations. There are relatively few qualitative studies exploring the nature of living with PCOS despite its high prevalence. Qualitative research can enhance clinical practice via the provision of patient insights into the experience of living with their condition.

METHODS

We conducted two focus groups and three semi-structured interviews of Australian overweight/obese women with PCOS aged 18-46 years between March and April 2017 who were recruited through social media advertising. Interviews and focus groups were audio recorded and transcribed verbatim. Thematic analysis was applied to the data, using the method of constant comparison.

RESULTS

Ten women contributed data from two focus groups and two semi-structured interviews. Five themes emerged from the data: complexity of the condition with its multiple manifestations, difficulties with delayed diagnosis and lack of information provided after diagnosis, negative experiences on social media and online forums and the need for support, frustration over lack of a "cure"; and the impact of symptoms and concern about long-term sequelae.

CONCLUSIONS

Living with PCOS appears to generate a significant degree of anxiety about the future, dissatisfaction with current treatment models, and loss of feminine identity. Gaps in timely diagnosis, information and support provision need to be addressed. This includes supporting weight management as a fundamental concern for women with PCOS.

Brazilian version of the Multidimensional Body-Self Relations Questionnaire-Appearance Scales (MBSRQ-AS): translation and psychometric properties in adults

OBJECTIVE

The present study investigated the psychometric properties of the Brazilian adaptation of the Multidimensional Body-Self Relations Questionnaire-Appearance Scales, a widely used instrument in body image research.

METHODS

We translated the MBSRQ-AS and determined its psychometric properties among 2 community samples, totaling 387 men and 381 women, and 1 college sample of 104 men and 133 women, aged from 16 to 67 years old (totaling 1005 participants). Near half of the sample (n = 606) was recruited online (SurveyMonkey Database) and the other half was personally recruited from universities, technical schools and libraries.

RESULTS

The translated version was similar to the original, and the items were easily understood. After the exclusion of the negatively worded questions, the Brazilian version had the same factor structure as the original MBSRQ-AS. Internal consistency ranged from .73 to .90 and test-retest reliability indices ranged from .76 to .92. The measure captured sex and weight status differences. Women reported significantly higher levels of investment in appearance, lower levels of satisfaction with specific parts of the body, higher concerns with being overweight, and classified themselves as heavier than men. Overweight and obese men and women reported lower satisfaction with specific parts of their bodies, higher concerns with being overweight, and classified themselves as heavier than their normal weight counterparts. Convergent validity was demonstrated by the significant correlations between the MBSRQ-AS subscales and investment in appearance, internalization of beauty ideals, disordered eating and self-esteem.

CONCLUSIONS

In summary, the Brazilian MBSRQ-AS appears to be a good option for researchers in the country. Furthermore, the study provides substantial parameters for comparison with other adaptations of the instrument around the world.

LEVEL OF EVIDENCE

Level V, descriptive study.

Increased risk of eating disorders in women with polycystic ovary syndrome: a case-control study

Data on eating disorders in women with PCOS is insufficient. The objective of this case study was to examine the hypothesis that women with PCOS exhibit more impaired eating than healthy women. Women diagnosed with PCOS under the 2003 Rotterdam Diagnostic Criteria (n = 40) were compared with a healthy control group (n = 40). The groups also were divided into two as normal body weight and overweight/obese. The Eating Disorders Assessment Questionnaire (EDE-Q) and the Three Factor Eating Questionnaire (TFEQ-R21), were completed by all participants in order to evaluate eating behaviors in addition to eating disorders. Among the overweight/obese group, the average total and subscale scores of the EDE-Q as well as the total and sub-factor scores of the TFEQ-R21 were higher in women with PCOS compared to controls (p < .05). However, this statistically significant result was not shown among the women with normal weight (p > .05). In comparison to the controls, the PCOS women displayed higher values of the tool scores indicating abnormal restraint eating, body shape concern and weight concern subscale scores (p < .05). This result suggests that the evaluation of eating disorders should be added to routine screening and the monitoring of women with PCOS.

Health literacy needs in weight management of women with Polycystic Ovary Syndrome

ISSUE ADDRESSED

Lifestyle modification plays a key role in weight management and chronic disease prevention in polycystic ovary syndrome (PCOS). Women with PCOS experience challenges in adopting and maintaining healthy lifestyle behaviours, which may be related to health literacy. The aims of this study were to explore the health literacy needs of women with PCOS in lifestyle and weight management to inform research and practice.

METHODS

Ten women with PCOS participated in focus groups and semi-structured telephone interviews on lifestyle and weight management in PCOS.

RESULTS

For functional health literacy, women with PCOS are highly motivated for lifestyle and weight management due to the long-term consequences of PCOS. For interactive health literacy, barriers included delayed diagnosis and poor communication. Women with PCOS were resourceful in accessing a wide range of weight management services but some experience barriers such as costs or the feelings of embarrassment associated with accessing relevant services. For critical health literacy, no facilitators and barriers could be identified for the domain of participation in making decisions for health.

CONCLUSIONS

Women with PCOS experience facilitators and barriers in functional and interactive health literacy in lifestyle and weight management. SO WHAT?: Future interventions should seek to further understand and address these gaps in health literacy by increasing weight management skills through behaviour change techniques, improving health professional-patient communication through tools such as question prompt lists, enhancing peer support by increasing distributed health literacy in PCOS support groups and by providing opportunities for co-design of interventions.

Disparate Relationship of Sexual Satisfaction, Self-Esteem, Anxiety, and Depression with Endocrine Profiles of Women With or Without PCOS

Women with polycystic ovary syndrome (PCOS) are at increased risk of psychological distress including anxiety and depressive symptoms. However, less is known about sexual satisfaction and self-esteem as well as the relationship of these aspects of psychological function with clinical and hormonal profiles associated with PCOS. This cross-sectional study compared women with PCOS (N = 96) and healthy controls (N = 47). This study assessed sexual function (primary outcome), self-esteem, anxiety, and depression as well as evaluation of clinical, endocrine, and metabolic parameters. Overall, sexual satisfaction scores were comparable among women with and without PCOS. However, psychosexual function of women with PCOS exhibited distinguishing characteristics. The unconscious aspect of sexuality: frequency of erotic dreams, significantly correlated with free testosterone (ρ = 0.24, P = 0.03) and DHEAS (ρ = 0.31, P = 0.004) only in the PCOS group. In contrast, in women with PCOS, the frequency of masturbation did not correlate with endocrine profiles, but correlated with trait anxiety (ρ = 0.21, P = 0.049) and depression (ρ = 0.21, P = 0.05). Only one aspect of self-esteem (body appearance) was reduced in the PCOS group (P = 0.02) and was related to BMI and androgen. Women with PCOS had greater state anxiety (P = 0.02) and depression (P < 0.001); these scores correlated with BMI. However, anxiety and depression correlated with testosterone only in women without PCOS. The above findings indicate that PCOS is associated with a broad range of alterations of psychological function including psychosexual aspects; these alterations are in complex relationship with BMI and androgen levels.

Childhood and Adolescent Obesity: A Review

Obesity is a complex condition that interweaves biological, developmental, environmental, behavioral, and genetic factors; it is a significant public health problem. The most common cause of obesity throughout childhood and adolescence is an inequity in energy balance; that is, excess caloric intake without appropriate caloric expenditure. Adiposity rebound (AR) in early childhood is a risk factor for obesity in adolescence and adulthood. The increasing prevalence of childhood and adolescent obesity is associated with a rise in comorbidities previously identified in the adult population, such as Type 2 Diabetes Mellitus, Hypertension, Non-alcoholic Fatty Liver disease (NAFLD), Obstructive Sleep Apnea (OSA), and Dyslipidemia. Due to the lack of a single treatment option to address obesity, clinicians have generally relied on counseling dietary changes and exercise. Due to psychosocial issues that may accompany adolescence regarding body habitus, this approach can have negative results. Teens can develop unhealthy eating habits that result in Bulimia Nervosa (BN), Binge- Eating Disorder (BED), or Night eating syndrome (NES). Others can develop Anorexia Nervosa (AN) as they attempt to restrict their diet and overshoot their goal of "being healthy." To date, lifestyle interventions have shown only modest effects on weight loss. Emerging findings from basic science as well as interventional drug trials utilizing GLP-1 agonists have demonstrated success in effective weight loss in obese adults, adolescents, and pediatric patients. However, there is limited data on the efficacy and safety of other weight-loss medications in children and adolescents. Nearly 6% of adolescents in the United States are severely obese and bariatric surgery as a treatment consideration will be discussed. In summary, this paper will overview the pathophysiology, clinical, and psychological implications, and treatment options available for obese pediatric and adolescent patients.

Fertility Treatment Options for Women With Polycystic Ovary Syndrome

Polycystic ovary syndrome is the most common endocrinological disorder in women of reproductive age. It is commonly associated with anovulatory subfertility, for which there are a range of treatment options available to help them conceive. These options are given in a step-wise manner with an appropriate selection of patients to maximise success rates with minimal complications. This review discusses the importance and involvement of multidisciplinary care when offering treatment to women with subfertility. Multidisciplinary care gives an excellent opportunity to identify, assess risk, and potentially prevent future morbidities and complications while treating women for fertility issues. We have also summarised the various options available for fertility treatment: pharmacological treatments, nonpharmacological intervention, and assisted reproductive technology.

Neurotransmitter, neuropeptide and gut peptide profile in PCOS-pathways contributing to the pathophysiology, food intake and psychiatric manifestations of PCOS

Polycystic ovary syndrome (PCOS) is a major health problem with a heterogeneous hormone-imbalance and clinical presentation across the lifespan of women. Increased androgen production and abnormal gonadotropin-releasing hormone (GnRH) release and gonadotropin secretion, resulting in chronic anovulation are well-known features of the PCOS. The brain is both at the top of the neuroendocrine axis regulating ovarian function and a sensitive target of peripheral gonadal hormones and peptides. Current literature illustrates that neurotransmitters regulate various functions of the body, including reproduction, mood and body weight. Neurotransmitter alteration could be one of the reasons for disturbed GnRH release, consequently directing the ovarian dysfunction in PCOS, since there is plenty evidence for altered catecholamine metabolism and brain serotonin or opioid activity described in PCOS. Further, the dysregulated neurotransmitter and neuropeptide profile in PCOS could also be the reason for low self-esteem, anxiety, mood swings and depression or obesity, features closely associated with PCOS women. Can these altered central brain circuits, or the disrupted gut-brain axis be the tie that would both explain and link the pathogenesis of this disorder, the occurrence of depression, anxiety and other mood disorders as well as of obesity, insulin resistance and abnormal appetite in PCOS? This review intends to provide the reader with a comprehensive overview of what is known about the relatively understudied, but very complex role that neurotransmitters, neuropeptides and gut peptides play in PCOS. The answer to the above question may help the development of drugs to specifically target these central and peripheral circuits, thereby providing a valuable treatment for PCOS patients that present to the clinic with GnRH/LH hypersecretion, obesity or psychiatric manifestations.

Effectiveness of cognitive-behavioral therapy (CBT) in improving the quality of life and psychological fatigue in women with polycystic ovarian syndrome: a randomized controlled clinical trial

Introduction: Given the increasing prevalence of complications caused by the polycystic ovarian syndrome (PCOS) such as medical and psychological problems and also the chronicity of this disease, patients with the PCOS tend to experience lower quality of life and greater psychological fatigue similar to other patients with chronic diseases. This study was conducted to determine the effects of cognitive-behavioral therapy (CBT) on the quality of life and psychological fatigue in women with the PCOS. Methods: This randomized controlled clinical trial study, conducted from 2016 to 2017, enrolled 74 women aged between 18 and 35 years from the Iranian city of Saqqez. The participants were assigned to a CBT group and a control group via block randomization. The intervention group received 8 weekly CBT sessions between 45 and 60 minutes each. The Polycystic Ovary Syndrome Health-Related Quality of Life Questionnaire (PCOSQ) and the Fatigue Impact Scale (FIS) were completed by the patients before and after the intervention. Results: No significant differences were observed between the two groups before the intervention in terms of sociodemographic characteristics and the mean scores of quality of life and psychological fatigue. After the intervention, the mean (standard deviation [SD]) of the quality of life score was 60.2 (13.3) in the intervention group and 24.4 (15) in the control group, with the mean score of quality of life being significantly higher in the intervention group than in the control group (adjusted mean difference = 33.1). The mean (SD) score of psychological fatigue was 28.2 (13.9) in the intervention group and 78.2 (37.1) in the control group, with the mean score of psychological fatigue being significantly lower in the intervention group than in the control group (-54.8). Conclusions: The results showed that CBT was able to reduce fatigue and improve quality of life in our sample of women with the PCOS and ultimately boost their health.

Body image, personality profiles and alexithymia in patients with polycystic ovary syndrome (PCOS)

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.