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Andlib N, Sajad M, Thakur SC. Association of diabetes mellitus with risk of reproductive impairment in females: A comprehensive review. Acta Histochem 2024; 126:152173. [PMID: 39004007 DOI: 10.1016/j.acthis.2024.152173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/31/2024] [Accepted: 07/04/2024] [Indexed: 07/16/2024]
Abstract
Reproductive impairment is the most prevalent yet most ignored complication of diabetes mellitus. In diabetes, the problem associated with reproductive health is comprehensive in both males and females. Diabetic females have problems like delayed menarche, irregular menstrual cycle, subfertility, complications in pregnancy and early menopause. This may decrease reproductive age in diabetic females as the menarche is delayed and menopause is early in them. Like diabetic males, diabetic females also have the negative effect of oxidative stress on the reproductive system. This may lead to dysfunction of the ovary. It affects the physiological cycle like the ovary's maturation, embryo development and pregnancy. These complications also affect the offspring, and they may also become diabetic. This review aims to concentrate on the effect of diabetes on the reproductive system of females and the impairment caused by it. We will also discuss in detail the role of the hypothalamus-pituitary ovary axis, diabetes impact on different reproductive phases of females, and the sexual disorders that occur in them.
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Affiliation(s)
- Nida Andlib
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi 110025, India
| | - Mohd Sajad
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi 110025, India
| | - Sonu Chand Thakur
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi 110025, India..
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Ashraf A, Singh R, Ganai BA, Mir S. Hypermethylation and down-regulation of vitamin D receptor (VDR) as contributing factors for polycystic ovary syndrome (PCOS): a case-control study from Kashmir, North India. Arch Gynecol Obstet 2024; 309:1091-1100. [PMID: 38227018 DOI: 10.1007/s00404-023-07326-9] [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] [Received: 03/07/2023] [Accepted: 11/30/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Polycystic ovarian syndrome (PCOS) is a prevailing endocrinopathy affecting a significant population of women of reproductive age across the globe. A myriad set of complex intertwined factors ranging from etiological, genetic, and epigenetic reasons cause this disorder. Out of the different factors, vitamin D shows an imperative aspect in health and fertility of women with polycystic ovary syndrome (PCOS). The importance of vitamin D is facilitated by vitamin D receptor (VDR), a ligand-dependent transcription factor in the steroid/ thyroid hormone receptor superfamily that controls the pleiotropic biological properties of vitamin D. PURPOSE The purpose of this study was to evaluate the role of promoter methylation of the VDR gene, a transcription factor with numerous biological utilities, with its relative expression and clinico-pathological findings and outcomes. METHODOLOGY A total of 200 blood samples were collected, 100 from PCOS case subjects, and 100 from the normal healthy controls respectively, which were assessed by qRT-PCR for determining the expression summary. MS-PCR technique was used for analyzing the promoter methylation status of the VDR gene. Blood samples were withdrawn, respectively, for each case and the control study separately experimented for different stages for the given study, of which estimation of vitamin D was also a part. RESULTS In this test-versus-control study, first, the promoter methylation status of VDR gene was identified which was found more prominent i.e., hyper-methylation of the VDR gene was identified in 84 cases (84%), and in the normal healthy controls, it was found (62%). The promoter methylation status of the VDR gene has remarkably shown the results with a significant difference (p value < 0.0001*). Second, the expression analysis of VDR gene was found to be strongly downregulated in majority (64%) of PCOS case samples analyzed by means fold change of 0.8743 (± 0.06466) (p value 0.0054**). This result is, therefore, indicative of VDR gene role in PCOS pathogenesis as the said gene is downregulated. Moreover, compared to the vitamin D parameter, hyper-methylation and expression analysis of the VDR promoter gene were found to correspond to some associations with PCOS. Certain case-and-control study analyses showed that patients with normal vitamin D levels showed less indicative effects of PCOS and vice versa. CONCLUSION Our study, being exclusive from Kashmir, one of the foremost specified that VDR confirms anomalous methylation configuration in PCOS with subsequent downregulation in the gene expression i.e., there is an inverse correlation among VDR gene expression (downregulated) and methylation status (hyper-methylated) from the conclusion of our PCOS case-versus-control study.
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Affiliation(s)
- Ahila Ashraf
- Department of Biochemistry, School of Applied Sciences, Shri Venkateshwara University, Gajraula Amroha, UP, 244236, India.
- Centre of Research for Development, University of Kashmir, Srinagar, J&K, 190006, India.
| | - Rajesh Singh
- Department of Biochemistry, School of Applied Sciences, Shri Venkateshwara University, Gajraula Amroha, UP, 244236, India
| | - Bashir Ahmad Ganai
- Centre of Research for Development, University of Kashmir, Srinagar, J&K, 190006, India
| | - Shahnawaz Mir
- Department of Endocrinology, Government Medical College, Super Speciality Hospital, Srinagar, J&K, India
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Mohile AA, Hedaoo RP, Jadhav SJ, Ainapure AS, Patil MV, Khatwani NR. Unraveling the Link: A Comprehensive Literature Review of Type 2 Diabetes and Menopause Onset. Cureus 2023; 15:e50743. [PMID: 38234930 PMCID: PMC10794094 DOI: 10.7759/cureus.50743] [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: 12/18/2023] [Indexed: 01/19/2024] Open
Abstract
Women with diabetes mellitus (DM), a metabolic endocrine illness, may experience a variety of reproductive problems. The age at menopause onset has been extensively studied as a major predictor of women's health in the future; however, its relationship to diabetes in Indian women has received less attention. This literature review looked at the consequences of diabetes in women as well as the association between diabetes and the age at which menopause begins. The average age at menopause onset among women with type 2 diabetes mellitus (T2DM) has decreased globally. According to one Indian study, the average menopause age dropped to 45 years for 26% of women with T2DM. In the current review, 10 studies indicated that women with T2DM displayed an imbalanced hormonal profile resulting in an extended anovulatory period. Two investigations highlighted the significance of altered body composition of women with T2DM, thereby suggesting obesity as the primary risk factor of ovarian aging and early climacteric symptoms. T2DM may lower the average age at menopause onset; however, further research on Indian women is necessary. There is a need of studies on T2DM in premenopausal women are needed to demonstrate how the changes in body composition impact the age at which menopause begins. Delaying the onset of menopause in women with T2DM necessitates diet and lifestyle interventions to minimize ovarian aging and hormonal imbalance.
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Affiliation(s)
- Anuja A Mohile
- Nutrition and Dietetics, Symbiosis International (Deemed) University, Pune, IND
- School of Beauty, Wellness, Nutrition and Dietetics, Symbiosis Skills and Professional University, Pune, IND
| | - Radhika P Hedaoo
- Nutrition and Dietetics, Symbiosis Institute of Health Sciences, Symbiosis International (Deemed) University, Pune, IND
| | - Sammita J Jadhav
- Pathology, Symbiosis Institute of Health Sciences, Symbiosis International (Deemed) University, Pune, IND
| | - Archana S Ainapure
- School of Beauty, Wellness, Nutrition and Dietetics, Symbiosis Skills and Professional University, Pune, IND
| | | | - Nalini R Khatwani
- School of Beauty, Wellness, Nutrition and Dietetics, Symbiosis Skills and Professional University, Pune, IND
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Huang YM, Chien WC, Cheng CG, Chang YH, Chung CH, Cheng CA. Females with Diabetes Mellitus Increased the Incidence of Premenstrual Syndrome. Life (Basel) 2022; 12:life12060777. [PMID: 35743808 PMCID: PMC9224876 DOI: 10.3390/life12060777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/10/2022] [Accepted: 05/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Premenstrual syndrome (PMS) is a multifactorial disorder caused by hormone and autonomic imbalance. In our study, hyperglycemia-induced insulin secretion increased progesterone secretion and progressive autonomic imbalance. The young patients with diabetes mellitus (DM) revealed hypo-parasympathetic function and hypersympathetic function compared with nondiabetic controls. Young female patients with DM with higher blood sugar and autonomic malfunction may be associated with PMS. However, there is a lack of evidence about DM in females related to PMS. We evaluated female patients with DM who subsequently followed PMS in a retrospective cohort study. Methods: We retrieved data from the National Health Insurance Research Database in Taiwan. Female patients with DM between 20 and 50 years old were assessed by the International Classification of Disease, 9 Revision, Clinical Modification (ICD-9-CM) disease code of 250. Patients who were DM-free females were fourfold matched to the control group by age and disease index date. The ICD-9-CM disease code of 625.4 identified the incidence of PMS followed by the index date as events. The possible risk factors associated with PMS were detected with a Cox proportional regression. Results: DM was a significant risk factor for PMS incidence with an adjusted hazard ratio of 1.683 (95% confidence interval: 1.104−2.124, p < 0.001) in females after adjusting for age, other comorbidities, season, urbanization status of patients and the hospital status of visiting. Conclusions: This study noted an association between DM and PMS in female patients. Healthcare providers and female patients with DM must be aware of possible complications of PMS, aggressive glycemic control, decreased hyperglycemia and autonomic dysfunction to prevent this bothersome disorder.
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Affiliation(s)
- Yao-Ming Huang
- Department of Emergency Medicine, Taoyuan Armed Forces General Hospital, National Defense Medical Center, Taoyuan 32549, Taiwan; (Y.-M.H.); (C.-G.C.)
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (W.-C.C.); (C.-H.C.)
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 11490, Taiwan
| | - Chun-Gu Cheng
- Department of Emergency Medicine, Taoyuan Armed Forces General Hospital, National Defense Medical Center, Taoyuan 32549, Taiwan; (Y.-M.H.); (C.-G.C.)
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
- Emergency Department, Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Yin-Han Chang
- Department of Psychology, National Taiwan University, Taipei 10621, Taiwan;
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (W.-C.C.); (C.-H.C.)
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan
| | - Chun-An Cheng
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
- Correspondence: ; Tel.: +886-2-87927173
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Rate of polycystic ovary syndrome in mental health disorders: a systematic review. Arch Womens Ment Health 2022; 25:9-19. [PMID: 34499230 DOI: 10.1007/s00737-021-01179-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 08/31/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is associated with increased risk of many mental health conditions, including mood and anxiety disorders. Whether PCOS is more common in mental health conditions than in the general population is less clear. A systematic review investigating this question may provide clarity regarding whether increased prevalence of PCOS is seen in particular mental health disorders, and thus, whether screening female mental health patients for PCOS is warranted. AIMS To systematically synthesise and review research examining rates of PCOS in mental health disorders. METHODS Peer-reviewed articles assessing the prevalence of PCOS within a sample of reproductive-aged females with a diagnosis of Axis I or II mental health disorder were included. Key studies were identified through a comprehensive search of PubMed and Web of Science. RESULTS Eleven studies met inclusion criteria, assessing rate of diagnosed PCOS in samples with bipolar disorder (n = 7), autism spectrum disorders (ASD; n = 2), bulimia nervosa (n = 1), and post-traumatic stress disorder (PTSD; n = 1). Overall, there was limited evidence of elevated rates of PCOS in bipolar disorder, compared with population estimates or healthy control group rates. In ASD, bulimia nervosa, and PTSD samples, significantly increased rates of PCOS were reported compared with healthy control samples, although studies were relatively small. CONCLUSIONS This review highlights complexities and methodological considerations in this area of research. There are a limited number of studies assessing PCOS in mental health samples, and thus, important areas of future research have been identified. TRIAL REGISTRATION This systematic review was registered on PROSPERO (ID: CRD42020151420; https://www.crd.york.ac.uk/prospero/ ) on 28 April 2020.
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Long C, Feng H, Duan W, Chen X, Zhao Y, Lan Y, Yue R. Prevalence of polycystic ovary syndrome in patients with type 2 diabetes: A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2022; 13:980405. [PMID: 36120432 PMCID: PMC9471325 DOI: 10.3389/fendo.2022.980405] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE With type 2 diabetes mellitus (T2DM) occurring at a younger age, a greater number of women with T2DM experience reproductive health problems. The prevalence of polycystic ovary syndrome (PCOS), a common reproductive disease associated with T2DM, remains unknown in women with T2DM. This systematic review and meta-analysis aimed to determine the prevalence of PCOS in women with T2DM. METHODS Stata 15.1 was used to perform a meta-analysis on the prevalence of PCOS in patients with T2DM included in this study. Additionally, a narrative review of the effects of different diagnostic methods, obesity, state, and other factors on the prevalence of PCOS was conducted. RESULTS Meta-analysis showed that the overall prevalence of PCOS in women with T2DM was approximately 21%. Subgroup analysis showed that the incidence of PCOS in female patients aged 25-45 years was higher than that in female patients aged < 25 years. The prevalence of PCOS in obese women was 14%, which was lower than that in normal weight women and normal weight or overweight or obese women. Women with T2DM in Oceania had the highest incidence of PCOS, followed by those in Europe and Asia; women with T2DM in North America had the lowest incidence. In terms of PCOS diagnostic standards, the prevalence of PCOS diagnosed by the National Institutes of Health was the lowest. The prevalence of PCOS diagnosed on the basis of clinical symptoms and biochemical characteristics was the highest, and the prevalence of PCOS diagnosed on the basis of medical records was 20%. CONCLUSIONS PCOS is a common disease in female patients with T2DM. The prevalence of PCOS in women with T2DM at childbearing age was higher than that in adolescent females. Women with T2DM at childbearing age should pay attention to the screening and prevention of PCOS to avoid the hazards of PCOS to reproductive health. SYSTEMATIC REVIEW REGISTRATION PROSPERO, identifier CRD42022318657.
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Affiliation(s)
- Caiyi Long
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Haoyue Feng
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wen Duan
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xin Chen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuemeng Zhao
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ying Lan
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- *Correspondence: Rensong Yue, ; Ying Lan,
| | - Rensong Yue
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- *Correspondence: Rensong Yue, ; Ying Lan,
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Ganie MA, Chowdhury S, Suri V, Joshi B, Bhattacharya PK, Agrawal S, Malhotra N, Sahay R, Rozati R, Jabbar PK, Sreenivas V, Sriwastva M, Wani IA, Singh S, Sharma RS. Evaluation of the Prevalence, Regional Phenotypic Variation, Comorbidities, Risk Factors, and Variations in Response to Different Therapeutic Modalities Among Indian Women: Proposal for the Indian Council of Medical Research-Polycystic Ovary Syndrome (ICMR-PCOS) Study. JMIR Res Protoc 2021; 10:e23437. [PMID: 34448720 PMCID: PMC8433859 DOI: 10.2196/23437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/30/2020] [Accepted: 01/06/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND There is scanty data in India on polycystic ovary syndrome (PCOS) from several small, undersized, convenience-based studies employing differing diagnostic criteria and reporting varied regional prevalence. It is difficult to draw clear-cut conclusions from these studies; therefore, the present multicentric, well-designed, large-scale representative countrywide epidemiological study on PCOS across India was conceived with the aim to generate the actual prevalence rates of PCOS in India with a total sample size of approximately 9000 individuals. OBJECTIVE The primary objectives of the study are to estimate the national prevalence of PCOS in India and the burden of comorbidities and to compare the variation in efficacy of standard therapeutic modalities for metabolic dysfunction in women with PCOS. METHODS This multicentric umbrella study consists of three different substudies. Substudy 1 will involve recruitment of women aged 18-40 years using a multistage sampling technique from randomly selected polling booths across urban and rural areas to estimate national prevalence, phenotypic variation, and risk factors among regions. Substudy 2 involves recruitment of subjects from the community pool of substudy 1 and the institutional pool for quantitation of comorbidities among women with PCOS. Substudy 3, an interventional part of the study, aims for comparison of variation in efficacies of common treatment modalities and will be conducted only at 2 centers. The eligible consenting women will be randomized in a 1:1 ratio into 2 arms through a blinding procedure. All these women will undergo clinical, biochemical, and hormonal assessment at baseline and at 3 and 6 months. The data generated will be analyzed using the reliable statistical software SPSS (version 26). RESULTS The study is ongoing and is likely to be completed by April 2022. The data will be compiled and analyzed, and the results of the study will be disseminated through publications. CONCLUSIONS The Indian Council of Medical Research-PCOS study is the first of its kind attempting to provide accurate and comprehensive data on prevalence of PCOS in India. TRIAL REGISTRATION Clinical Trials Registry-India CTRI/2018/11/016252; ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=26366. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/23437.
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Affiliation(s)
- Mohd Ashraf Ganie
- Department of Endocrinology & Clinical Research, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Subhankar Chowdhury
- Department of Endocrinology & Metabolism, Institute of Postgraduate Medical Education & Research, Kolkata, India
| | - Vanita Suri
- Department of Obstetrics & Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Beena Joshi
- Department of Operational Research, National Institute for Research in Reproductive Health, Indian Council of Medical Research, Mumbai, India
| | - Prasanta Kumar Bhattacharya
- Department of Community Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India
| | - Sarita Agrawal
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, Raipur, India
| | - Neena Malhotra
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, India
| | - Roya Rozati
- Department of Obstetrics & Gynaecology, Maternal Health & Research Trust, Hyderabad, India
| | | | | | - Mukesh Sriwastva
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Imtiyaz Ahmad Wani
- Department of Endocrinology & Clinical Research, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Shalini Singh
- Reproductive Biology and Maternal Health, Child Health, Indian Council of Medical Research, New Delhi, India
| | - Radhey Shyam Sharma
- Reproductive Biology and Maternal Health, Child Health, Indian Council of Medical Research, New Delhi, India
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Abstract
PCOS is a common and heterogeneous endocrine disorder in women of reproductive age, frequently associated with metabolic abnormalities. It was estimated that about 75% of these subjects have an impairment of insulin action, as measured by gold standard methods. While the relationship between insulin resistance and PCOS is consistently shown by a number of studies, the mechanisms underlying its primary origin still remains an unsolved issue. Insulin resistance and the associated hyperinsulinemia can induce both the endocrine and reproductive traits of PCOS. However, androgen excess, in turn, can impair insulin action, directly and/or through several changes occurring in different tissues. Body fat excess, which is another common feature in these women, can contribute to worsening the whole picture. Nevertheless, insulin resistance may also be found in many normal-weight individuals. Endocrine and metabolic abnormalities can develop in different moments, and probably there is fetal programming of these alterations. However, a number of vicious circles, with bidirectional relationships between androgen excess and insulin resistance, and with the contribution of several other factors, make it extremely difficult to understand where this process really originates. This review summarizes available evidence on this topic, in order to better understand the complex relationships linking hyperandrogenism and impaired insulin action in women with PCOS.
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Affiliation(s)
- P Moghetti
- Unit of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, P.le Stefani, 1, 37126, Verona, Italy.
| | - F Tosi
- Unit of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, P.le Stefani, 1, 37126, Verona, Italy
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Creţu D, Cernea S, Onea CR, Pop RM. Reproductive health in women with type 2 diabetes mellitus. Hormones (Athens) 2020; 19:291-300. [PMID: 32613536 DOI: 10.1007/s42000-020-00225-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 06/21/2020] [Indexed: 01/12/2023]
Abstract
As type 2 diabetes mellitus (T2DM) reaches epidemic proportions in the developed world and the age at diagnosis decreases, more women of reproductive age are being affected. In this article, we provide a synoptic view on potential mechanisms and relevant factors underlying menstrual cycle disorders and fertility issues in women with T2DM. The article discusses the function of the hypothalamic-pituitary-ovarian (HPO) axis, the central role of the hypothalamus in the homeostasis of this system, the central modulators of the axis, and the peripheral metabolic signals involved in neuroendocrine control of reproduction. The available literature on the relationship between T2DM and the female reproductive lifespan, menstrual cycle disorders, fertility issues, and gestational health in women with T2DM are also discussed. The data so far indicate that there is a "U-shaped" relationship between menarche, menopause, and T2DM, both early and late menarche/menopause being risk factors for T2DM. Hyperglycemia and its consequences may be responsible for the effects of T2DM on reproductive health in women, but the exact mechanisms are not as yet fully understood; thus, more studies are needed in order to identify factors causing disruption of the HPO axis.
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Affiliation(s)
- Doina Creţu
- Mureș County Clinical Hospital, 38 Gheorghe Marinescu Street, 540139, Târgu-Mureș, Romania
| | - Simona Cernea
- Department M4/Internal Medicine IV, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu-Mureș, 38 Gheorghe Marinescu Street, 540139, Târgu-Mureș, Romania
- Diabetes, Nutrition and Metabolic Diseases Outpatient Unit, Emergency County Clinical Hospital, 50 Gheorghe Marinescu Street, 540136, Târgu-Mureş, Romania
| | - Corina Roxana Onea
- Emergency County Clinical Hospital, 50 Gheorghe Marinescu Street, 540136, Târgu-Mureş, Romania
| | - Raluca-Monica Pop
- Research Methodology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu-Mureș, 38 Gheorghe Marinescu Street, 540139, Târgu-Mureș, Romania.
- Endocrinology Department, Mureș County Clinical Hospital, 38 Gheorghe Marinescu Street, 540139, Târgu-Mureș, Romania.
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Reproductive Health and Metabolic Parameters in Women with Type 2 Diabetes. JOURNAL OF INTERDISCIPLINARY MEDICINE 2020. [DOI: 10.2478/jim-2020-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Aim: This study evaluated the correlations between metabolic parameters and reproductive health data in women with type 2 diabetes mellitus (T2DM).
Material and methods: In this observational retrospective study, data from the medical records of 324 adult women with T2DM attending their regular diabetes check-ups were collected and analyzed (i.e., anthropometric parameters at first outpatient visit and yearly thereafter, first recorded HbA1c and all HbA1c for the entire follow-up duration, as well as obstetrical/gynecological information).
Results: Age at the diagnosis of T2DM correlated positively with age at menarche (r = 0.21, [95% CI: 0.09, 0.31], p = 0.0002) and age at menopause (r = 0.18 [95% CI: 0.07, 0.29], p <0.01). Age at menarche correlated negatively with mean weight (r = –0.21 [95% CI: –0.31, –0.10], p: 0.0002) and mean BMI (–0.22 [–0.32, –0.11], p <0.0001) over the follow-up time. Patients with shorter time difference between age at menarche and age at onset of T2DM (≤45 years) had higher mean weight (83.8 ± 14.5 kg vs. 78.4 ± 16.0 kg, p = 0.0001), BMI (33.2 ± 5.6 kg/m2 vs. 31.8 ± 5.7 kg/m2, p <0.05), and HbA1c over time (6.9 ± 0.8% vs. 6.6 ± 0.9%, p <0.0001). Women with T2DM with earlier menarche (<12 years old), with irregular menses during their reproductive life, and ≥3 pregnancies had higher overall BMI, but mean HbA1c were not significantly different. However, women diagnosed with T2DM before menopause had a higher mean HbA1c over time (7.1 ± 0.8% vs. 6.7 ± 0.9%, p <0.01).
Conclusion: The BMI correlated with several indicators of reproductive health (earlier menarche, irregular menses, and higher number of pregnancies), while earlier onset of T2DM influenced metabolic control in women with T2DM.
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Thong EP, Codner E, Laven JSE, Teede H. Diabetes: a metabolic and reproductive disorder in women. Lancet Diabetes Endocrinol 2020; 8:134-149. [PMID: 31635966 DOI: 10.1016/s2213-8587(19)30345-6] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/27/2019] [Accepted: 09/03/2019] [Indexed: 02/07/2023]
Abstract
Reproductive dysfunction is a common but little studied complication of diabetes. The spectrum of reproductive health problems in diabetes is broad, and encompasses delayed puberty and menarche, menstrual cycle abnormalities, subfertility, adverse pregnancy outcomes, and potentially early menopause. Depending on the age at diagnosis of diabetes, reproductive problems can manifest early on in puberty, emerge later when fertility is desired, or occur during the climacteric period. Historically, women with type 1 diabetes have frequently had amenorrhoea and infertility, due to central hypogonadism. With the intensification of insulin therapy and improved metabolic control, these problems have declined, but do persist. Additional reproductive implications of contemporary diabetes management are now emerging, including polycystic ovary syndrome and hyperandrogenism, which are underpinned by insulin action on the ovary. The sharp rise in type 2 diabetes incidence in youth suggests that more women of reproductive age will encounter diabetes-related reproductive problems in their lifetimes. With an ever increasing number of young women living with diabetes, clinicians need to be aware of and equipped for the challenges of navigating reproductive health concerns across the lifespan.
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Affiliation(s)
- Eleanor P Thong
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia; Department of Endocrinology and Diabetes, Monash Health, Clayton, VIC, Australia
| | - Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia; Department of Endocrinology and Diabetes, Monash Health, Clayton, VIC, Australia.
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Qadri S, Hussain A, Bhat MH, Baba AA. Polycystic Ovary Syndrome in Bipolar Affective Disorder: A Hospital-based Study. Indian J Psychol Med 2018; 40:121-128. [PMID: 29962567 PMCID: PMC6008988 DOI: 10.4103/ijpsym.ijpsym_284_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Preliminary studies suggest a multidimensional relationship of mood pathology with endocrine disturbances. Studies have found an increased risk of mood disorders in polycystic ovary syndrome (PCOS), and conversely, many of the medications commonly used in the treatment of bipolar affective disorder (BPAD) can have deleterious effects on blood levels of reproductive hormones and consequently on the hypothalamic-pituitary-gonadal (HPG) axis and reproductive function. Furthermore, there is evidence of reproductive dysfunction in women with BPAD before treatment. OBJECTIVES To assess the comorbidity of PCOS in patients of BPAD and to study risk factors associated with this comorbidity. MATERIALS AND METHODS Two hundred female patients with the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition diagnosis of BPAD, between ages of 15 and 45 years, were evaluated by an endocrinologist. Patients reporting menstrual disturbances or having any stigmata of PCOS were further subjected to hormonal analysis, which included luteinizing hormone, follicle-stimulating hormone, prolactin, and testosterone, in the early follicular phase of menstrual cycle. Diagnosis of PCOS was made as per the NIH criteria. RESULTS Of 200 patients, 46 (23%) were diagnosed as having PCOS. Forty-five percent (n = 90) reported menstrual disturbances while 27% (n = 54) had polycystic ovaries on ultrasonography. 19.2% of the patients diagnosed as PCOS had a history of valproate intake while 27.90% patients had no such history (P = 0.15). No significant difference (P = 0.07) was found in the prevalence of PCOS among various drug groups (including group on multiple mood stabilizers). CONCLUSION A higher prevalence of PCOS is seen in BPAD, irrespective of pharmacotherapy, suggesting a common link between the disorders which might be in the form of disturbance in HPG axis.
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Affiliation(s)
- Sabreena Qadri
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Arshad Hussain
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Mohammad Hayat Bhat
- Department of Medicine, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Aadil Ashraf Baba
- Department of Medicine, Government Medical College, Srinagar, Jammu and Kashmir, India
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13
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Wellons MF, Matthews JJ, Kim C. Ovarian aging in women with diabetes: An overview. Maturitas 2016; 96:109-113. [PMID: 28041589 DOI: 10.1016/j.maturitas.2016.11.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 11/28/2016] [Indexed: 12/21/2022]
Abstract
Type 2 diabetes is a global epidemic, and the prevalence and incidence of type 1 diabetes are increasing. The negative effects of diabetes on kidneys, nerves, and vessels are well established. The effect of diabetes on reproductive function is less well understood, but important to characterize, given the increasing numbers of young women with diabetes. In this review, we summarize the available literature on how women with diabetes experience ovarian aging, from menarche to menopause. We report that women with type 1 diabetes appear more likely to have ovarian dysfunction, manifested by delayed menses, menstrual irregularities, and possibly earlier menopause. Studies of women with type 2 diabetes are inconsistent but suggest increased anovulation and earlier menopause. Differences in reproductive aging between women with type 1 and type 2 diabetes raise questions about potential differences in the mechanisms contributing to ovarian aging. Although there is shared glycemic dysregulation, fundamental differences in insulin presence and processing distinguish the two diseases. This review suggests that insulin, age at diagnosis, and weight play a role in ovarian dysfunction. More long-term studies are needed to evaluate the multitude of factors that may disrupt hypothalamic, pituitary, and ovarian function in women with diabetes.
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Affiliation(s)
- Melissa F Wellons
- Vanderbilt University Medical Center, Department of Medicine, Nashville, Tenn. 2525 West End Avenue, Suite 600, Nashville, TN 37203, USA.
| | - Juliana J Matthews
- Vanderbilt University Medical Center, Department of Medicine, Nashville, Tenn. 2525 West End Avenue, Suite 600, Nashville, TN 37203, USA
| | - Catherine Kim
- University of Michigan, Department of Medicine, 2800 Plymouth Road, Building 16, Room 430W, Ann Arbor, MI 48109, USA
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14
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Sim SYT, Chin SL, Tan JLK, Brown SJ, Cussons AJ, Stuckey BGA. Polycystic ovary syndrome in type 2 diabetes: does it predict a more severe phenotype? Fertil Steril 2016; 106:1258-1263. [PMID: 27456547 DOI: 10.1016/j.fertnstert.2016.06.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 06/28/2016] [Accepted: 06/28/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the prevalence of a history of polycystic ovary syndrome (PCOS) in women with type 2 diabetes (DM2) and to compare metabolic and reproductive outcomes between women with and without PCOS. DESIGN Cross-sectional study. SETTING Tertiary hospital. PATIENT(S) Female inpatients age 18-75 years with DM2. INTERVENTION(S) A face-to-face questionnaire was administered. MAIN OUTCOME MEASURE(S) Age at diagnosis of diabetes, history of gestational diabetes, family history of diabetes, and reproductive history, fertility history, number of miscarriages, and morbidity in pregnancy. RESULT(S) One hundred seventy-one inpatients with DM2 participated. The prevalence of a history of PCOS was 37%. Women with PCOS had an earlier mean age of diagnosis of DM2 (44.2 vs. 48.8 years), higher recalled peak body mass index (BMI; 43.1 kg/m2 vs. 36.8 kg/m2), higher rate of gestational diabetes (28% vs. 18%), and higher rate of hypertension in pregnancy (40% vs. 22%). Women with PCOS were less likely to have a family history of DM2 than those without PCOS (45% vs. 67%). CONCLUSION(S) A history of PCOS in women with DM2 is associated with earlier onset of DM2, higher BMI, and a more severe phenotype. Since PCOS subjects were less likely to have a family history of DM2, lack of a family history of DM2 in women with PCOS is not reassuring for DM2 risk. We recommend identifying PCOS in early life and intervening to reduce the risk of diabetes and its comorbidities and suboptimal reproductive outcomes.
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Affiliation(s)
- Stephanie Y T Sim
- School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia, Australia
| | - Sian L Chin
- School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia, Australia
| | - Jocelyn L K Tan
- Keogh Institute for Medical Research, Nedlands, Western Australia, Australia
| | - Suzanne J Brown
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Andrea J Cussons
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Bronwyn G A Stuckey
- School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia, Australia; Keogh Institute for Medical Research, Nedlands, Western Australia, Australia; Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
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15
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Jacob R, Ramachandran C, Jude C, Venkatachalam U, Rao SK. Peroxisome proliferator activated receptor gamma polymorphism Pro12Ala in polycystic ovary syndrome (PCOS) of South Indian Population. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2016. [DOI: 10.1016/j.apjr.2016.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Mirzaei F, Kazemi N. Prevalence of Polycystic Ovary Syndrome in Women with Type 2 Diabetes in Kerman, Iran. Metab Syndr Relat Disord 2008; 6:215-7. [DOI: 10.1089/met.2008.0015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Fatemeh Mirzaei
- Obstetrics & Gynecology Department, Afzalipour Hospital, Kerman University of Medical Sciences and Health Services, Kerman, Iran
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Amini M, Horri N, Farmani M, Haghighi S, Sattari G, Pornaghshband Z, Aminorroaya A. Prevalence of polycystic ovary syndrome in reproductive-aged women with type 2 diabetes. Gynecol Endocrinol 2008; 24:423-7. [PMID: 18850378 DOI: 10.1080/09513590802306143] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Women with polycystic ovary syndrome (PCOS) are at higher risk of type 2 diabetes and cardiovascular disease. The present study was conducted to investigate the prevalence of PCOS in type 2 diabetic patients. METHODS Type 2 diabetic women (n = 157) of reproductive age were selected by a convenience sampling method. PCOS was confirmed using the clinical diagnosis criteria proposed in 1990 by the National Institute of Child Health and Human Development Conference of PCOS. The diabetic patients were divided into two groups according to the presence of PCOS. Baseline demographic characteristics were obtained by questionnaire, and body weight, height, waist circumference, blood pressure and some biochemical indices were measured in both groups. RESULTS The prevalence of PCOS was high (8.3%, 95% confidence interval 4.5-13.4%) in these type 2 diabetic women. The onset of diabetes occurred at a lower age in the PCOS group, who also displayed significantly greater waist circumference and body mass index (p<0.05). No difference in lipid profile, glycosylated hemoglobin or blood pressure was observed between the two groups. CONCLUSIONS PCOS is highly prevalent in type 2 diabetic patients. Hence, focusing the treatment on insulin sensitizers in these patients should improve both the metabolic and non-metabolic complications of PCOS.
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Affiliation(s)
- Massoud Amini
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Kelestimur F, Unluhizarci K, Baybuga H, Atmaca H, Bayram F, Sahin Y. Prevalence of polycystic ovarian changes and polycystic ovary syndrome in premenopausal women with treated type 2 diabetes mellitus. Fertil Steril 2006; 86:405-10. [PMID: 16762349 DOI: 10.1016/j.fertnstert.2006.01.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2005] [Revised: 01/13/2006] [Accepted: 01/13/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate the prevalence of polycystic ovary syndrome (PCOS) and polycystic ovary (PCO) among premenopausal women with type 2 diabetes mellitus (DM). DESIGN Case-control study of women with type 2 DM. SETTING Tertiary referral university hospital. PATIENT(S) Ninety-two premenopausal women with DM, >or=30 years of age, and 20 age- and body mass index-matched healthy premenapousal eumenorrheic women were recruited into the study. INTERVENTION(S) An oral glucose tolerance test was performed according to the American Diabetes Association criteria for each healthy woman. After an overnight fasting, blood samples were obtained for the determination of fasting blood glucose, LH, FSH, free T, androstenedione (A(4)), 17-hydroxyprogesterone (17-OHP), DHEAS, PRL, free T(4), TSH, E(2), and sex hormone-binding globulin (SHBG) levels. A GnRH analog (buserelin) test was carried out in 36 patients with DM and PCO (including PCOS subjects), 20 patients with DM without PCO or PCOS, and 20 healthy subjects. MAIN OUTCOME MEASURE(S) The prevalence of PCO and PCOS in women with type 2 DM. RESULT(S) Fifty-seven (62%) of diabetic patients had normal ovaries, 31 (33.7%) had PCO, and 4 (4.3%) had PCOS. The women with DM (n = 92) and healthy women (n = 20) had similar basal A(4), FSH, E(2), 17-OHP, free T, and DHEAS levels. The LH and SHBG levels were lower and the hirsutism score higher in diabetic patients than in healthy women (P<.05). Peak and area under the curve LH and FSH levels after buserelin testing were significantly higher in healthy women than in the patients (P<.05). Peak A(4) levels after buserelin were significantly higher in the patients than in the healthy women (P<.05). Ovarian volume was significantly greater in the patients with PCO (10.1 +/- 0.7 mL) than in the healthy women (7.0 +/- 0.9 mL) (P<.05). CONCLUSION(S) We conclude that PCO but not PCOS is a common finding in premenopausal women with type 2 DM. Suppression of gonadotropins, particularly LH secretion, may play a role in the absence of increased PCOS prevalence among type 2 diabetic patients.
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Affiliation(s)
- Fahrettin Kelestimur
- Department of Endocrinology, Erciyes University Medical School, Kayseri, Turkey.
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