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Werner L, van der Schouw YT, de Kat AC. A systematic review of the association between modifiable lifestyle factors and circulating anti-Müllerian hormone. Hum Reprod Update 2024; 30:262-308. [PMID: 38402486 DOI: 10.1093/humupd/dmae004] [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: 08/06/2023] [Revised: 01/21/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Levels of anti-Müllerian hormone (AMH) are known to be associated with lifestyle determinants such as smoking and oral contraception (OC) use. When measuring AMH in clinical practice, it is essential to know which factors may influence circulating levels or ovarian reserve in general. OBJECTIVE AND RATIONALE To date, there is no systematic review or summarizing consensus of the nature and magnitude of the relation between AMH and modifiable lifestyle factors. The purpose of this review was to systematically assess the evidence on association of lifestyle behaviors with circulating AMH levels. SEARCH METHODS We performed a pre-registered systematic review of publications in Embase and PubMed on the lifestyle factors BMI, smoking, OC use, alcohol consumption, caffeine consumption, physical activity, and waist-hip ratio (WHR) in relation to circulating AMH levels up to 1 November 2023. The search strategy included terms such as 'Anti-Mullerian hormone', 'lifestyle', and 'women'. Studies were considered eligible if the association between at least one of the lifestyle factors of interest and AMH was assessed in adult women. The quality of included studies was assessed using the Study Quality Assessment Tools of the National Heart, Lung, and Blood Institute. The results were presented as ranges of the most frequently used association measure for studies that found a significant association in the same direction. OUTCOMES A total of 15 072 records were identified, of which 65 studies were eligible for inclusion, and 66.2% of the studies used a cross-sectional design. The majority of studies investigating BMI, smoking, OC use, and physical activity reported significant inverse associations with AMH levels. For WHR, alcohol, and caffeine use, the majority of studies did not find an association with AMH. For all determinants, the effect measures of the reported associations were heterogeneous. The mean difference in AMH levels per unit increase in BMI ranged from -0.015 to -0.2 ng/ml in studies that found a significant inverse association. The mean difference in AMH levels for current smokers versus non-smokers ranged from -0.4 to -1.1 ng/ml, and -4% to -44%, respectively. For current OC use, results included a range in relative mean differences in AMH levels of -17% to -31.1%, in addition to a decrease of 11 age-standardized percentiles, and an average decrease of 1.97 ng/ml after 9 weeks of OC use. Exercise interventions led to a decrease in AMH levels of 2.8 pmol/l to 13.2 pmol/l after 12 weeks in women with polycystic ovary syndrome or a sedentary lifestyle. WIDER IMPLICATIONS Lifestyle factors are associated with differences in AMH levels and thus should be taken into account when interpreting individual AMH measurements. Furthermore, AMH levels can be influenced by the alteration of lifestyle behaviors. While this can be a helpful tool for clinical and lifestyle counseling, the nature of the relation between the observed differences in AMH and the true ovarian reserve remains to be assessed. REGISTRATION NUMBER PROSPERO registration ID: CRD42022322575.
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Affiliation(s)
- Lotte Werner
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annelien C de Kat
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
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Xing NN, Ren F, Yang H. Effects of ketogenic diet on weight loss parameters among obese or overweight patients with polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trails. Food Nutr Res 2024; 68:9835. [PMID: 38571924 PMCID: PMC10989237 DOI: 10.29219/fnr.v68.9835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 04/05/2024] Open
Abstract
Aim To evaluate how effective a low carbohydrate ketogenic diet (KD) is for changing key physical measurements such as weight, waist circumference (WC), body mass index (BMI), and fat mass (FM) in women with polycystic ovary syndrome (PCOS) who were obese or overweight. Methods Several online databases, including PubMed, Scopus, EMBASE, Cochrane Library, and Web of Science (WOS), were searched systematically to find relevant randomized controlled trials (RCTs) up until June 2023. The Q-test and I2 statistics were used to assess the level of heterogeneity among the included studies. The data were then combined using either a fixed or random effects model and presented as a weighted mean difference (WMD) along with a 95% confidence interval (CI). Results Of the 682 citations, 11 RCTs were included. The pooled results showed a significant decrease in the WMD of weight levels [WMD = -9.13 kg; 95% CI, -11.88, -6.39, P < 0.001; I2 = 87.23%] following KD. Moreover, KD significantly reduced BMI levels [WMD = -2.93 kg/m2; 95% CI, -3.65, -2.21, P < 0.001; I2 = 78.81%] compared to the controls. Patients with PCOS received KD demonstrated significant decrease in WC [WMD = -7.62 cm; 95% CI, -10.73, -4.50, P < 0.001; I2 = 89.17%] and FM [WMD = -5.32 kg; 95% CI, -7.29, -3.36, P < 0.001; I2 = 83.97%]. Conclusion KD was associated with lower weight loss (WL) parameters, including weight, BMI, WC, and FM, in obese or overweight women with PCOS, highlighting the significance of physicians and nurses in taking care of the nutritional needs of overweight/obese patients with PCOS.
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Affiliation(s)
- Nan-nan Xing
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fang Ren
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hui Yang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
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Agajani Delavar M, Esmaeilzadeh S, Farhadi Z, Mirabi P. A policy brief on improving the lifestyle of women with polycystic ovary syndrome. CASPIAN JOURNAL OF INTERNAL MEDICINE 2024; 15:176-183. [PMID: 38463925 PMCID: PMC10921094 DOI: 10.22088/cjim.15.1.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/12/2023] [Accepted: 10/17/2023] [Indexed: 03/12/2024]
Abstract
Polycystic ovary syndrome (PCOS) in women is a significant public health issue. We searched the relevant databases using the sensitive keywords to receive the available evidence for successful lifestyle interventions among PCOS women. The systematic reviews related to PCOS were evaluated for an effective lifestyle intervention that was identified. The lifestyle interventions include three components: weight management, physical exercise, and behavioral coaching or combined interventions for developing exercise and modifying diet. Evidence shows that the impact of starting lifestyle intervention as the first-line management to improve obstetric and reproductive outcomes is high. There is evidence that proves health coaching can improve health behaviors and lifestyle. Thus, it is recommended to improve the lifestyle of women with PCOS.
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Affiliation(s)
- Mouloud Agajani Delavar
- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Sedighe Esmaeilzadeh
- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Zynab Farhadi
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Parvaneh Mirabi
- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Liimatta J, Flück CE, Mäntyselkä A, Häkkinen MR, Auriola S, Voutilainen R, Jääskeläinen J, Lakka TA. Effects of 2-Year Physical Activity and Dietary Intervention on Adrenarchal and Pubertal Development: The PANIC Study. J Clin Endocrinol Metab 2023; 108:e1603-e1613. [PMID: 37329220 PMCID: PMC10655527 DOI: 10.1210/clinem/dgad367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/10/2023] [Accepted: 06/15/2023] [Indexed: 06/18/2023]
Abstract
CONTEXT Childhood overweight has been linked to earlier development of adrenarche and puberty, but it remains unknown if lifestyle interventions influence sexual maturation in general populations. OBJECTIVE To investigate if a 2-year lifestyle intervention influences circulating androgen concentrations and sexual maturation in a general population of children. METHODS We conducted a 2-year physical activity and dietary intervention study in which 421 prepubertal and mostly normal-weight 6- to 9-year-old children were allocated either to a lifestyle intervention group (119 girls, 132 boys) or a control group (84 girls, 86 boys). The main outcome measures were serum dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS), androstenedione (A4), and testosterone concentrations, and clinical adrenarchal and pubertal signs. RESULTS The intervention and control groups had no differences in body size and composition, clinical signs of androgen action, and serum androgens at baseline. The intervention attenuated the increase of DHEA (P = .032), DHEAS (P = .001), A4 (P = .003), and testosterone (P = .007) and delayed pubarche (P = .038) in boys but it only attenuated the increase of DHEA (P = .013) and DHEAS (P = .003) in girls. These effects of lifestyle intervention on androgens and the development of pubarche were independent of changes in body size and composition, but the effects of intervention on androgens were partly explained by changes in fasting serum insulin. CONCLUSION A combined physical activity and dietary intervention attenuates the increase of serum androgen concentrations and sexual maturation in a general population of prepubertal and mostly normal-weight children, independently of changes in body size and composition.
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Affiliation(s)
- Jani Liimatta
- Kuopio Pediatric Research Unit (KuPRU), University of Eastern Finland, 70029 Kuopio, Finland
- Department of BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
- Pediatric Endocrinology, Diabetology, and Metabolism, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
| | - Christa E Flück
- Department of BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
- Pediatric Endocrinology, Diabetology, and Metabolism, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
| | - Aino Mäntyselkä
- Kuopio Pediatric Research Unit (KuPRU), University of Eastern Finland, 70029 Kuopio, Finland
- Department of Pediatrics, Kuopio University Hospital, 70029 Kuopio, Finland
| | - Merja R Häkkinen
- School of Pharmacy, University of Eastern Finland, 70211 Kuopio, Finland
- Department of Health Security, Finnish Institute for Health and Welfare (THL), 70701 Kuopio, Finland
| | - Seppo Auriola
- School of Pharmacy, University of Eastern Finland, 70211 Kuopio, Finland
| | - Raimo Voutilainen
- Kuopio Pediatric Research Unit (KuPRU), University of Eastern Finland, 70029 Kuopio, Finland
- Department of Pediatrics, Kuopio University Hospital, 70029 Kuopio, Finland
| | - Jarmo Jääskeläinen
- Kuopio Pediatric Research Unit (KuPRU), University of Eastern Finland, 70029 Kuopio, Finland
- Department of Pediatrics, Kuopio University Hospital, 70029 Kuopio, Finland
| | - Timo A Lakka
- Institute of Biomedicine, School of Medicine, University of Eastern Finland, 70211 Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, 70210 Kuopio, Finland
- Foundation for Research in Health Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, 70211 Kuopio, Finland
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Wei J, Ban T, Shi D, Mo F, Wei Q, Wei L, Qu C. The clinical application value of gonadotropin-releasing hormone antagonist combined with low-dose HCG regimen in patients with ovarian hyper-stimulation based on clinical characteristics and laboratory indicators. Am J Transl Res 2023; 15:5477-5485. [PMID: 37692927 PMCID: PMC10492074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/15/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE To explore the clinical application value of gonadotropin-releasing hormone antagonist (GnRH-A) combined with low-dose HCG regimen in patients with high ovarian response based on clinical characteristics and laboratory indicators. METHODS The clinical data of 305 patients who received IVF/ICSI in the Hechi People's Hospital Reproductive Medicine Center from March 2018 to December 2021 were retrospectively included, and all patients were treated with GnRH-A combined with low-dose HCG regimen protocol. The patients were separated into an ovarian hyper-response group and a normal ovarian reaction group according to their ovarian reactivity. Risk factors for ovarian hyper-response in IVF/ICSI patients were screened by univariate and multivariate logistic analysis. The ROC curve area was used to evaluate the prediction effect. RESULTS Of the 305 patients, 6 (1.97%) had poor ovarian reaction, 123 (40.33%) had ovarian hyper response, and 176 (57.70%) had normal ovarian reaction. The proportion of ovarian hyper response and normal ovarian reaction was 98.03% (299/305); the basic serum FSH level, AMH level, E2 on HCG level on HCG injection day and the incidence of moderate to severe OHSS in the Ovarian hyper-response group were compared with those in the normal ovarian reaction group (P < 0.05). Logistic reversion analysis showed that AMH (OR = 1.246, 95% CI = 1.107-1.402), E2 level on HCG injection day (OR = 1.050, 95% CI = 1.028-1.072) and P level on HCG injection day (OR = 5.831, 95% CI = 1.231-27.616) were factors for ovarian hyper response. Basal serum FSH (OR = 0.781, 95% CI = 0.647-0.94) and LH level on HCG injection day (OR = 0.594, 95% CI = 0.405-0.871) were negatively correlated with the occurrence of high response (P < 0.05). ROC curve analysis showed that AMH (AUC = 0.779), E2 level on HCG injection day (AUC = 0.802), P level on HCG injection day (AUC = 0.636), combined detection (AUC = 0.843), AUC > 0.5. Among them, the prediction effect of joint detection is better. CONCLUSION GnRH-A combined with low-dose HCG regimen is feasible for patients with ovarian hyper-response during IVF-ET/ICSI, and does not affect the implantation rate, clinical pregnancy rate, live birth rate, and early abortion rate of such patients. Combined detection of basal serum FSH, AMH, LH, E2 and P levels on HCG injection day can effectively predict the occurrence of ovarian hyper-response.
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Affiliation(s)
- Jiyun Wei
- Hechi People's Hospital Reproductive Medicine Center Hechi 547000, Guangxi, China
| | - Ting Ban
- Hechi People's Hospital Reproductive Medicine Center Hechi 547000, Guangxi, China
| | - Demin Shi
- Hechi People's Hospital Reproductive Medicine Center Hechi 547000, Guangxi, China
| | - Fengming Mo
- Hechi People's Hospital Reproductive Medicine Center Hechi 547000, Guangxi, China
| | - Qingmiao Wei
- Hechi People's Hospital Reproductive Medicine Center Hechi 547000, Guangxi, China
| | - Lanjing Wei
- Hechi People's Hospital Reproductive Medicine Center Hechi 547000, Guangxi, China
| | - Chunfeng Qu
- Hechi People's Hospital Reproductive Medicine Center Hechi 547000, Guangxi, China
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Weng Y, Zhang Y, Wang D, Wang R, Xiang Z, Shen S, Wang H, Wu X, Wen Y, Wang Y. Exercise-induced irisin improves follicular dysfunction by inhibiting IRE1α-TXNIP/ROS-NLRP3 pathway in PCOS. J Ovarian Res 2023; 16:151. [PMID: 37525261 PMCID: PMC10388501 DOI: 10.1186/s13048-023-01242-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 07/17/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Excessive production of androgen drives oxidative stress (OS) and inflammasome activation in ovarian granulosa cells (GCs). Therefore, the induced follicular developmental disorder is the major cause of infertility in women with polycystic ovary syndrome (PCOS). Exercise-induced upregulation of irisin is capable of regulating metabolism by reducing OS and inflammation. Exercise has been shown to alleviate a range of PCOS symptoms, including maintaining a normal menstrual cycle, in several clinical trials. METHODS Female Sprague-Dawley (SD) rats and primary ovarian cells were treated with two different androgens, dehydroepiandrosterone (DHEA) and dihydrotestosterone (DHT), to simulate a hyperandrogenic environment, followed by eight weeks of exercise training and irisin intervention. The levels of reactive oxygen species (ROS), tissue inflammation and fibrosis were examined using hematoxylin and eosin (H&E) staining, western blot, quantitative real-time PCR (qRT-PCR), dichlorofluorescein diacetate (DCF-DA) probe detection, immunofluorescence staining, immunohistochemistry, and Sirius red staining. RESULTS Exercise for eight weeks improved polycystic ovarian morphology and decreased the levels of inflammation, OS, and fibrosis in PCOS rats. Hyperandrogen increased ROS production in ovarian cells by inducing endoplasmic reticulum stress (ERS) and activating the inositol-requiring enzyme 1α (IRE1α)-thioredoxin-interacting protein (TXNIP)/ROS-NOD-like receptor family pyrin domain containing 3 (NLRP3) signaling pathway, further enhancing the levels of inflammation. Irisin suppressed the expression of IRE1α and its downstream targets, thus improving the ovarian dysfunction of PCOS rats induced by hyperandrogen. CONCLUSION Exercise can alleviate various phenotypes of PCOS rats induced by DHEA, and its therapeutic effect may be mediated by secreting beneficial myokines. IRE1α may be an important target of irisin for reducing OS and inflammation, thereby improving ovarian fibrosis.
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Affiliation(s)
- Yajing Weng
- State Key Laboratory of Analytical Chemistry for Life Science & Jiangsu Key Laboratory of Molecular Medicine, Medical School, Nanjing University, Nanjing, 210093, China
| | - Yaling Zhang
- School of Medicine, Jiaxing University, Jiaxing, 314001, China
| | - Daojuan Wang
- Department of Pain, Medical School, The Affiliated Drum Tower Hospital, Nanjing University, Nanjing, 210008, China
| | - Rong Wang
- State Key Laboratory of Analytical Chemistry for Life Science & Jiangsu Key Laboratory of Molecular Medicine, Medical School, Nanjing University, Nanjing, 210093, China
| | - Zou Xiang
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hong Kong, 999077, China
| | - Shanmei Shen
- Department of Endocrinology, Medical School, The Affiliated Drum Tower Hospital, Nanjing University, Nanjing, 210093, China
| | - Hongwei Wang
- State Key Laboratory of Analytical Chemistry for Life Science & Jiangsu Key Laboratory of Molecular Medicine, Medical School, Nanjing University, Nanjing, 210093, China
| | - Xiaoke Wu
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, 150040, China.
| | - Yanting Wen
- State Key Laboratory of Analytical Chemistry for Life Science & Jiangsu Key Laboratory of Molecular Medicine, Medical School, Nanjing University, Nanjing, 210093, China.
| | - Yong Wang
- State Key Laboratory of Analytical Chemistry for Life Science & Jiangsu Key Laboratory of Molecular Medicine, Medical School, Nanjing University, Nanjing, 210093, China.
- Nanjing University (Suzhou) High-Tech Institute, Suzhou, 215123, China.
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Ghavi F, Shakeri F, Abdolahian S. "Ferula assa-foetida L" or "Foeniculum vulgare"? Which one is more effective in the management of polycystic ovarian syndrome? A randomized, placebo controlled, triple-blinded. AVICENNA JOURNAL OF PHYTOMEDICINE 2023; 13:280-289. [PMID: 37655000 PMCID: PMC10465881 DOI: 10.22038/ajp.2022.21389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 07/30/2022] [Indexed: 09/02/2023]
Abstract
Objective There are few evaluation about the effects of Fennel and Ferula on human polycystic ovary syndrome (PCOS). The goals of this study were to evaluate and compare the effectiveness of two medicinal plants of the Apiaceae family (Fennel and Ferula) in management of PCOS. Materials and Methods The sample size was 47 participants with PCOS who were randomly divided into 3 groups. The Ferula assa-foetida L group received 100 mg of Ferula (n=14), the Foeniculum vulgare group received 46 mg of Fennel (n=15), and the placebo group received placebo twice daily for 3 months (n=14). Results Before the intervention, there were no significant differences between groups in terms of clinical parameters, endometrial thickness, or ovarian volume. After the interventions, the number of ovarian follicles was decreased in the Ferula and Fennel groups as compared to the placebo group (p<0.05). The number of ovarian follicles in both ovaries in the Ferula and Fennel group decreased and this decrease was significant in the right side as compared to placebo group. Our findings showed significant changes in dehydroepiandrosterone sulfate (DEHAS) and thyroid-stimulating hormone (TSH) levels after the intervention (p<0.03) between the Ferula and Placebo groups. Conclusion Since use of Ferula could make significant changes in TSH and DEHAS levels and decrease the number of right and left ovarian follicles compared to Fennel and placebo, it can be concluded that this herbal medicine is more effective than Fennel in managing PCOS.
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Affiliation(s)
- Fatemeh Ghavi
- Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Fars, Iran
| | - Fatemeh Shakeri
- Department of Midwifery, School of Nursing and Midwifery, Jahrom University of Medical Sciences, Fars, Iran
| | - Somayeh Abdolahian
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Cao Y, Li G, Ren Y. Association between self-reported sedentary behavior and health-related quality of life among infertile women with polycystic ovary syndrome. BMC Womens Health 2023; 23:67. [PMID: 36788488 PMCID: PMC9926864 DOI: 10.1186/s12905-023-02222-5] [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: 12/01/2022] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND High sedentary behavior and poor health-related quality of life (HRQoL) were common among women with polycystic ovary syndrome (PCOS). However, the association of sedentary behavior with HRQoL among infertile women with PCOS is still unknown. This study aimed to investigate the association of sedentary behavior with HRQoL among them. METHODS A cross-sectional study was conducted with 283 participants recruited from infertility outpatient clinic. A self-administered, structured questionnaire including the modified PCOS health-related QoL questionnaire (MPCOSQ), the International Physical Activity Questionnaire short form (IPAQ-SF), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7) was used. Anthropometric and laboratory indictors related to PCOS were also collected. Multivariable linear regression analyses were performed to identify the associations. Bonferroni correction was utilized for multiple testing correction. RESULTS Sedentary behavior was associated with reduced HRQoL among this group. Specifically, over seven hours per day of sedentary behavior was strongly associated with total and several aspects of HRQoL (β ranged from - 0.378 to - 0.141, all P < 0.0063) after adjusting for physical activity, anxiety and depression. In addition, elevated BMI (β = - 0.407, P < 0.001) and anxiety (β ranged from - 0.410 to - 0.245, all P < 0.0063) were associated with poor HRQoL, while physical activity and depression were not. CONCLUSION Sedentary behavior is an important behavior among infertile women with PCOS as it was associated with poorer HRQoL. Future interventions seeking to improve HRQoL should be considered to reduce sedentary behavior and psychological burden as primary intervention targets.
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Affiliation(s)
- Yanjun Cao
- grid.27255.370000 0004 1761 1174Department of Neurology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012 Shandong People’s Republic of China
| | - Guopeng Li
- grid.27255.370000 0004 1761 1174Department of Health Psychology, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, 250012 Shandong People’s Republic of China
| | - Yanbei Ren
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, People's Republic of China.
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Meczekalski B, Niwczyk O, Kostrzak A, Maciejewska-Jeske M, Bala G, Szeliga A. PCOS in Adolescents-Ongoing Riddles in Diagnosis and Treatment. J Clin Med 2023; 12:jcm12031221. [PMID: 36769869 PMCID: PMC9918268 DOI: 10.3390/jcm12031221] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. A diagnosis of PCOS is established when a patient exhibits two of three Rotterdam criteria: oligoovulation or anovulation, excess androgen activity, and polycystic ovarian morphology. The pathogenesis of PCOS, as it affects adolescents, is often discussed in terms of a "two-hit" theory. This refers to a stepwise process in which the first "hit" is an inborn congenitally programmed predisposition, while the second "hit" arises from a provocative factor such as insulin resistance. The dynamic physiological and anatomical changes which occur in puberty make for a challenging diagnosis in this group of patients. It is important to be mindful of the physiological particularities in adolescence which often mimic the symptoms of PCOS. In their first-year post-menarche, approximately 75% of menstruating adolescents report their cycle to last between 21-45 days. Recent studies have shown that regular menstrual cyclicity is only achieved within 2-3 years post-menarche. Anovulation, as a crucial diagnostic element for PCOS, features in about half of early-post-menarchal adolescents. Hirsutism and acne are the most common clinical manifestations of hyperandrogenism, and mild features are developed by most adolescents as a result of elevated androgen levels. Distinguishing between a pathological sign and normal features of maturation is often difficult. A polycystic ovarian morphology (PCOM) through ultrasound has been found in up to 40%, 35%, and 33.3% of patients when assessed at 2, 3, and 4 years, respectively, after menarche. PCOM in adolescence is not associated with future abnormalities in ovulatory rate or menstrual cycle duration. For this reason, international guidelines recommend against the use of pelvic ultrasound until 8 years post-menarche. The primary aim of management is focused mainly on improving hormonal and metabolic status, the prevention of future comorbid complications, and generally improving the overall quality of life in young women with PCOS. Considerable controversy surrounds the choice of optimal pharmacological treatment to address PCOS in adolescents. Reliable studies, which include this sub-section of the population, are very limited. There is a lack of robust and reliable trials in the literature addressing the use of combined oral contraceptives. Further work needs to be undertaken in order to provide safe and effective care to the adolescent population in this regard.
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Affiliation(s)
- Blazej Meczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 60-535 Poznan, Poland
- Correspondence: ; Tel.: +48-61-65-99-366; Fax: +48-61-65-99-454
| | - Olga Niwczyk
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 60-535 Poznan, Poland
| | - Anna Kostrzak
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 60-535 Poznan, Poland
| | - Marzena Maciejewska-Jeske
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 60-535 Poznan, Poland
| | - Gregory Bala
- UCD School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Anna Szeliga
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 60-535 Poznan, Poland
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Jungari M, Choudhary A, Gill NK. Comprehensive Management of Polycystic Ovary Syndrome: Effect of Pharmacotherapy, Lifestyle Modification, and Enhanced Adherence Counseling. Cureus 2023; 15:e35415. [PMID: 36994287 PMCID: PMC10042521 DOI: 10.7759/cureus.35415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 02/20/2023] [Indexed: 03/31/2023] Open
Abstract
Introduction Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of childbearing age in India, which often presents as menstrual irregularities, infertility, acanthosis nigricans, etc. Metabolic disturbances associated with PCOS predispose patients to cardiovascular diseases, which may be avoided by effective management. The aim of the current study was to evaluate the role of lifestyle modification (LSM) and metformin in PCOS management. Methods This is a retrospective cohort study conducted among 130 PCOS patients who attended the outpatient department of the tertiary care hospital in central India from October 2019 to March 2020. The study describes the effect of a combined package of LSM (physical exercise and dietary changes) and metformin on anthropometric, clinical, and biochemical parameters at three and six months. Results Out of the total 130 women, 12 were lost to follow-up and were omitted from further analysis. At six months of the treatment package (LSM, metformin, and enhanced adherence counseling (EAC)), a significant decrease was seen in body mass index, blood sugar, follicle-stimulating hormone, luteinizing hormone, and insulin. Following the intervention, the menstruation cycle became regular in 91% of the women while volume, theca, and appearance of polycystic ovaries on ultrasound decreased in 86% of women. Insulin resistance (IR) and hyperinsulinemia are the major causes of pathophysiological changes associated with PCOS. Metformin along with LSM primarily acts by decreasing IR, while EAC ensures treatment compliance. Conclusion Metformin along with LSM in the form of calories restricted, high-protein diet, and physical activity reduce IR and hyperandrogenaemia, resulting in improved anthropometric, glycemic indices, hormonal profiles, and features of hyperandrogenaemia. The combined therapy is beneficial to 85-90% of women with PCOS.
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Affiliation(s)
- Mugdha Jungari
- Obstetrics and Gynaecology, Datta Meghe Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Nagpur, IND
| | - Amruta Choudhary
- Obstetrics and Gynaecology, Datta Meghe Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Nagpur, IND
| | - Naresh Kumar Gill
- Community Medicine, National Center for Vector Borne Diseases Control, Ministry of Health & Family Welfare, New Delhi, IND
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11
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Cowan S, Lim S, Alycia C, Pirotta S, Thomson R, Gibson-Helm M, Blackmore R, Naderpoor N, Bennett C, Ee C, Rao V, Mousa A, Alesi S, Moran L. Lifestyle management in polycystic ovary syndrome - beyond diet and physical activity. BMC Endocr Disord 2023; 23:14. [PMID: 36647089 PMCID: PMC9841505 DOI: 10.1186/s12902-022-01208-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 11/09/2022] [Indexed: 01/18/2023] Open
Abstract
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.
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Affiliation(s)
- Stephanie Cowan
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia.
| | - Siew Lim
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Chelsea Alycia
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Stephanie Pirotta
- Health and Social Care Unit, Monash University, Clayton, Victoria, Australia
| | - Rebecca Thomson
- Robinson Research Institute, The University of Adelaide, North Adelaide, South Australia, Australia
| | - Melanie Gibson-Helm
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
- Te Tātai Hauora o Hine - National Centre for Women's Health Research Aotearoa, Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand
| | - Rebecca Blackmore
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Negar Naderpoor
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Christie Bennett
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
| | - Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Westmead, New South Wales, Australia
| | - Vibhuti Rao
- NICM Health Research Institute, Western Sydney University, Westmead, New South Wales, Australia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Simon Alesi
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Lisa Moran
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
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12
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Tsukui Y, Kitahara Y, Hasegawa Y, Kobayashi M, Osuka S, Iwase A. Anti-Müllerian hormone levels in the diagnosis of adolescent polycystic ovarian syndrome: a systematic review and meta-analysis. Endocr J 2022; 69:897-906. [PMID: 35675999 DOI: 10.1507/endocrj.ej22-0081] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is an endocrine disorder that causes menstrual cycle irregularities and infertility. PCOS is diagnosed based on hyperandrogenism, polycystic ovarian morphology (PCOM), and an-/oligo-ovulation. Upregulation of anti-Müllerian hormone (AMH) in the serum of women with PCOS may be another suitable alternative diagnostic criterion for PCOM. However, previous meta-analyses have reported conflicting results due to the age-dependent decline in serum AMH levels. Therefore, we performed a meta-analysis to evaluate the threshold of AMH for the diagnosis of PCOS in adolescents and women in their early twenties. Fifteen trials were included in this meta-analysis. PCOS is diagnosed with either Rotterdam criteria, NIH, or AE-PCOS. AMH levels were significantly higher in adolescents with PCOS (weighted mean difference, 3.05; 95% confidence interval: 2.09-4.01) than in the control group. The cutoff values of AMH for the diagnosis of adolescent PCOS were 6.1, 6.26, 7.03, 7.11, 7.2, and 7.25 ng/mL in the studies that reported the usefulness of AMH levels. The summary receiver operating characteristic analysis of the diagnostic accuracy demonstrated that the specificity and sensitivity were 81% and 66.3%, respectively. Our meta-analysis demonstrates that AMH may be a useful diagnostic test for adolescent PCOS and, based on the previous studies included in the meta-analysis, its cutoff value was estimated to be 6-7 ng/mL.
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Affiliation(s)
- Yumiko Tsukui
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Yoshikazu Kitahara
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Yuko Hasegawa
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Mio Kobayashi
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Satoko Osuka
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Akira Iwase
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
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13
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Efficacy of multi-strain probiotic along with dietary and lifestyle modifications on polycystic ovary syndrome: a randomised, double-blind placebo-controlled study. Eur J Nutr 2022; 61:4145-4154. [PMID: 35857132 DOI: 10.1007/s00394-022-02959-z] [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: 04/13/2022] [Accepted: 07/08/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE Effect of multi-strain probiotic along with dietary and lifestyle modifications in the management of polycystic ovary syndrome (PCOS) has rarely been reported. We thus aimed to investigate the effect of multi-strain probiotic (Lactobacillus acidophilus UBLA-34, L. rhamnosus UBLR-58, L. reuteri UBLRu-87 (each of 2 billion colony forming units (CFU)); L. plantarum UBLP-40, L. casei UBLC-42, L. fermentum UBLF-31, Bifidobacterium bifidum UBBB-55 (each of 1 billion CFU) and fructo-oligosaccharides (100 mg)) and dietary and lifestyle modifications on restoration of menstrual regularity, weight reduction, metabolic and hormonal profile in women with PCOS. METHODS A 104 participants (age 18-40 years) were randomly allocated to receive probiotic or placebo capsules for 6 months. Baseline and end line assessment were performed for menstrual cycle regularity, ultrasonography scan for ovaries, total testosterone, dehydroepiandrosterone (DHEAS), insulin, luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio, fasting blood sugar (FBS), homeostatic model assessment-insulin resistance (HOMA-IR), weight reduction, waist-/hip circumference (WC, HC), waist to hip ratio (WHR), and body mass index (BMI). Plasma lipopolysaccharide and effect of intervention on quality of life was investigated. Diet and exercise were controlled during the trial. RESULTS Probiotic supplement along with dietary and lifestyle modifications significantly regularised menstrual cycle (p 0.023), improved levels of total testosterone (p 0.043), WC (p 0.030), WHR (p 0.027) and menstrual domain of quality of life (p 0.034) as compared to placebo. No adverse events related to study were reported. CONCLUSION Multi-strain probiotic along with dietary and lifestyle modifications were effective in the management of PCOS. TRIAL REGISTRATION CTRI: CTRI/2016/07/007086, dated 13 July 2016.
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14
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Manique MES, Ferreira AMAP. Polycystic Ovary Syndrome in Adolescence: Challenges in Diagnosis and Management. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:425-433. [PMID: 35623621 PMCID: PMC9948137 DOI: 10.1055/s-0042-1742292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Diagnosing polycystic ovary syndrome (PCOS) during adolescence is challenging since normal pubertal development overlap typical features of this syndrome. The authors aim to summarize the existing evidence concerning PCOS in adolescence, particularly its diagnostic criteria and therapeutic options. A search throughout medical databases such as PubMed and MedScape was performed. Diagnostic criteria include irregular menstrual cycles according to time postmenarche and evidence of clinical hyperandrogenism and/or biochemical hyperandrogenism, provided other causes have been excluded. Polycystic ovarian morphology ought not to be used as a diagnostic criterion. Treatment should target manifestations and/or comorbidities, even in the absence of a definite diagnosis. Lifestyle interventions are the first-line treatment. Combined oral contraceptives, metformin or antiandrogens may also be considered as adjuvants. Screening for PCOS in adolescence is crucial as it allows an early intervention on the symptoms and comorbidities presented leading to better long-term reproductive and metabolic outcomes.
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Affiliation(s)
| | - Ana Margarida Antunes Póvoa Ferreira
- Department of Gynecology, Unit of Reproductive Medicine, Centro Hospitalar Universitário São João, Porto, Portugal.,Department of Gynecology, Obstetrics and Pediatrics, Faculty of Medicine, Universidade do Porto, Porto, Portugal.,Institute for Investigation and Innovation in Health, Universidade do Porto, Porto, Portugal
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15
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Elliott V, Waldrop SW, Wiromrat P, Carreau AM, Green MC. The Interaction of Obesity and Reproductive Function in Adolescents. Semin Reprod Med 2022; 40:53-68. [PMID: 35562099 DOI: 10.1055/s-0042-1744495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Obesity is increasing worldwide, including in pediatrics. Adequate nutrition is required for initiation of menses, and there is a clear secular trend toward earlier pubertal onset and menarche in females in countries around the globe. Similar findings of earlier pubertal start are suggested in males. However, as individuals and populations have crossed into over-nutritional states including overweight and obesity, the effect of excess weight on disrupting reproductive function has become apparent. Hypothalamic hypogonadism and polycystic ovary syndrome are two conditions where reproductive function appears to directly relate to excess weight. Clinical findings in individuals with certain polygenic and monogenic obesity syndromes, which also have reproductive disruptions, have helped elucidate neurologic pathways that are common to both. Clinical endocrinopathies such as hypothyroidism or panhypopituitarism also aide in the understanding of the role of the endocrine system in weight gain. Understanding the intersection of obesity and reproductive function may lead to future therapies which can treat both conditions.
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Affiliation(s)
- Victoria Elliott
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Stephanie W Waldrop
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Pattara Wiromrat
- Division of Endocrinology, Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Anne-Marie Carreau
- Endocrinologue, Centre de Recherche du CHU de Québec-Université Laval, Québec, Canada.,Endocrinologie-Néphrologie, Québec-Université Laval, Québec, Canada
| | - Melanie Cree Green
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado.,Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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16
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Wang L, Liu Y, Tan H, Huang S. Transtheoretical model-based mobile health application for PCOS. Reprod Health 2022; 19:117. [PMID: 35549736 PMCID: PMC9097413 DOI: 10.1186/s12978-022-01422-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/24/2022] [Indexed: 12/19/2022] Open
Abstract
Background Lifestyle modification (diet, exercise, and behavioral interventions) is the first-line treatment for polycystic ovary syndrome (PCOS). The benefits of face-to-face lifestyle modification intervention in a short time have been demonstrated. However, few studies have investigated the mobile technology effects on lifestyle modification in PCOS. Therefore, we examined the effect of transtheoretical model-based mobile health application intervention program for PCOS. Methods A randomised controlled, single-blind trial, was carried out from October 2018 to March 2019, which included 122 participants recruited from gynecology outpatient clinics of affiliated Hospital of Zunyi Medical University in Guizhou. The study participants were randomised into intervention (n = 61) and control groups (n = 61). Participants in the intervention group undertook a TTM-based mobile health application program in addition to routine care, and participants in the control group received only routine care. Results Fifty-one participants in the intervention group and 49 in the control group completed the study. Compared to the control group, participants in the intervention group showed statistically significant decrease for BMI (P < 0.05), WC (P < 0.05), SAS (P < 0.05), and SDS (P < 0.05) scores at 6-month and 12-month, respectively. Behavior stage change of exercise and diet among paticipants with PCOS was significant at 6 months (c2 = 43.032, P < 0.05) and 12th months (c2 = 49.574, P < 0.05) between the intervention and control groups. Conclusions This study showed that the TTM-based mobile health application program can decrease BMI, WC, anxiety, and depression, and improve exercise and diet adherence in patients with PCOS in the long term. The TTM-based mobile health application program can be applied for lifestyle modification in women with PCOS. Trial registration This study was approved by the ethics committee NO.[2019]1-028 in March 2018 and was registered at the Chinese Clinical Trial Registry (website: www.chictr.org.cn, registry number: ChiCTR2000034572) Poor adherence of life management in patients with PCOS and many then go on to adherence poor health outcomes as a result. There is an urgent need for new approach to enhance to life management compliance for patients with PCOS. TTM is a common behavior change model, which can effectively promote the behavior change of patients, but it has not been used in the life management of PCOS patients. Meanwhile, the traditional life management of PCOS is mainly face-to-face intervention, few studies have investigated the mobile technology effects on lifestyle modification in PCOS. This study aimed to evaluate the long-term effects of TTM-based mobile technology (for lifestyle modification) on the maintenance of health-related behavior changes among women with PCOS. This study confirmed that the TTM-based mobile health application program can decrease BMI, WC, anxiety, and depression, and improve exercise and diet adherence in patients with PCOS in the long term. Our study conducted TTM-based mobile health application program can provide a reference for other researchers or research organizations.
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Affiliation(s)
- LianHong Wang
- Nursing Department of Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China.,Nursing College of Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Ying Liu
- Nursing Department of Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China.,Nursing College of Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Huiwen Tan
- Nursing Department of Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China.,Nursing College of Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Shiming Huang
- Nursing Department of Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China. .,Nursing College of Zunyi Medical University, Zunyi, 563000, Guizhou, China.
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17
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Guo Y, Liu Y, Yan X, Ding R, Tan H, Wang L. Factors affecting the adoption of health-promoting behaviours in patients with polycystic ovary syndrome: a cross-sectional study. BMJ Open 2022; 12:e056478. [PMID: 35354623 PMCID: PMC8968562 DOI: 10.1136/bmjopen-2021-056478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- Yunmei Guo
- Family Planning Department, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- Nursing Department, Zunyi Medical University, Zunyi, China
| | - Ying Liu
- Family Planning Department, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- Nursing Department, Zunyi Medical University, Zunyi, China
| | - Xing Yan
- Family Planning Department, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- Nursing Department, Zunyi Medical University, Zunyi, China
| | - Rui Ding
- Family Planning Department, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- Nursing Department, Zunyi Medical University, Zunyi, China
| | - Huiwen Tan
- Family Planning Department, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- Nursing Department, Zunyi Medical University, Zunyi, China
| | - Lianhong Wang
- Family Planning Department, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- Nursing Department, Zunyi Medical University, Zunyi, China
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18
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Joham AE, Peña AS. Polycystic Ovary Syndrome in Adolescence. Semin Reprod Med 2022; 40:e1-e8. [PMID: 36096151 DOI: 10.1055/s-0042-1757138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a common, complex, and chronic condition that presents many diagnostic and management challenges for managing clinicians. PCOS diagnosis in adolescents presents a particular challenge for treating clinicians due to the overlap of diagnostic features with normal physiological changes during adolescence. Adolescent diagnostic criteria include well-defined menstrual irregularity according to time postmenarche and hyperandrogenism, but does not require the use of pelvic ultrasound. Adolescents with only one criterion should be considered at risk of PCOS and be followed up around transition to adult care. While PCOS was traditionally considered to be a reproductive disorder, PCOS is now recognized to have major metabolic and cardiovascular health consequences and psychological sequelae that can be present from adolescence. Management of PCOS includes healthy lifestyle, metformin, combined oral contraceptive pill, and/or antiandrogens according to symptoms of concern even in adolescents at risk of PCOS.
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Affiliation(s)
- Anju E Joham
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Diabetes and Vascular Medicine, Monash Health, Melbourne, Australia
| | - Alexia S Peña
- Discipline of Paediatrics, Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,Department of Endocrinology and Diabetes, Women's and Children's Hospital, North Adelaide, South Australia, Australia
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19
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Billich N, Maugeri I, Calligaro L, Truby H, Davidson ZE. Weight management interventions that include dietary components for young people with chronic health care needs: A systematic review. Nutr Diet 2022; 79:94-109. [PMID: 34369055 DOI: 10.1111/1747-0080.12698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/06/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022]
Abstract
AIMS To identify and describe weight management interventions that include a dietary component for young people with chronic healthcare needs and overweight or obesity and their effect on body mass index (BMI) or weight. METHODS Six databases were searched in 2017 and 2020 for experimental studies in English: Ovid MEDLINE, Ovid Embase, Ovid AMED, EBSCO CINAHL, Scopus and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews. Two independent reviewers conducted data extraction and quality assessment using the Cochrane Risk of Bias tool. Eligible studies included young people with chronic healthcare needs ≤18 years with overweight or obesity with an intervention that included a dietary component. Eligible outcomes were BMI or weight. Data were synthesised narratively. RESULTS The search identified 15 293 references, 12 studies were included (randomised controlled trials n = 5, before-after comparisons n = 7). Participant diagnoses were neurodevelopmental disabilities (n = 5) and mental illness (n = 1); survivors of cancers or tumours (n = 4); congenital heart disease (n = 1) and; migraine (n = 1). No studies addressed weight management in physical disabilities. Eight studies demonstrated a significant reduction in BMI or weight. Of these, most interventions used dietary counselling or an energy deficit, were family-focused, multicomponent and delivered by a multidisciplinary team including dietitians. A high risk of bias was detected across studies. CONCLUSIONS There is limited high-quality evidence about effective dietary solutions for the management of overweight and obesity for young people with chronic healthcare needs. While more research is required, dietary management appears to be important to manage weight in these populations.
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Affiliation(s)
- Natassja Billich
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
- Neurology Department, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Weight Management Service, Department of Neurodevelopment and Disability, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Isabella Maugeri
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Lara Calligaro
- Monash School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - Helen Truby
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
- School of Primary and Allied Health Care Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Zoe E Davidson
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
- Neurology Department, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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20
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Wang D, He B. Current Perspectives on Nonalcoholic Fatty Liver Disease in Women with Polycystic Ovary Syndrome. Diabetes Metab Syndr Obes 2022; 15:1281-1291. [PMID: 35494531 PMCID: PMC9048954 DOI: 10.2147/dmso.s362424] [Citation(s) in RCA: 2] [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] [Received: 02/14/2022] [Accepted: 03/31/2022] [Indexed: 12/29/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is one of the most common reproductive, endocrine, and metabolic disorders in premenopausal women. Clinically, PCOS is mainly caused by androgen excess and ovarian dysfunction, manifested by anovulatory menstrual cycles, infertility, and hirsutism. In addition, PCOS increases the risk of insulin resistance, obesity, cardiovascular disease, anxiety and depression, dyslipidemia, and endometrial cancer. Nonalcoholic fatty liver disease (NAFLD) is defined as ≥5% fat accumulation in the liver in the absence of remaining secondary causes and has become one of the most common chronic liver diseases worldwide. The prevalence of NAFLD is significantly higher and more severe in women with PCOS, and its pathogenesis can be associated with various risk factors such as hyperandrogenemia, insulin resistance, obesity, chronic low-grade inflammation, and genetic factors. Although there is no definitive solution for the management of NAFLD in PCOS, some progress has been made. Lifestyle modification should be the basis of management, and drugs to improve metabolism, such as insulin sensitizers and glucagon-like peptide-1 agonists, may show better efficacy. Bariatric surgery may also be a treatment of NAFLD in obese women with PCOS. This paper reviews three aspects of prevalence, risk factors, and management, in order to better understand the current state of research on NAFLD in PCOS, to explore the pathogenesis of NAFLD in PCOS, and to encourage further research on the application of drugs in this field.
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Affiliation(s)
- Dongxu Wang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Bing He
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
- Correspondence: Bing He, Department of Endocrinology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, 110004, People’s Republic of China, Tel/Fax +86-24-96615-23111, Email
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21
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Lathia T, Joshi A, Behl A, Dhingra A, Kalra B, Dua C, Bajaj K, Verma K, Malhotra N, Galagali P, Sahay R, Mittal S, Bajaj S, Moorthy S, Sharma S, Kalra S. A Practitioner's Toolkit for Polycystic Ovary Syndrome Counselling. Indian J Endocrinol Metab 2022; 26:17-25. [PMID: 35662757 PMCID: PMC9162262 DOI: 10.4103/ijem.ijem_411_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 01/23/2022] [Accepted: 01/30/2022] [Indexed: 11/14/2022] Open
Abstract
Polycystic ovary syndrome (PCOS), a frequently occurring health issue, has a significant effect on the cosmetic, metabolic, psychosocial and fertility aspects of women. A multidisciplinary team approach based on the core pillars of screening, assessment and counselling to detect, prevent and treat physiological and psychological issues in PCOS is very essential. Women are treated medically, but the psychosocial part is often forsaken. Hence, counselling forms an integral part of PCOS management that enables enhanced clinical outcomes and patient satisfaction. Digital tools and PCOS support groups have built an opportunity for physicians to create awareness, help timely diagnosis and overcome PCOS symptoms. The absence of clear guidelines to tackle the often less discussed aspects of PCOS warrants the need for consensus on PCOS counselling. This review summarizes the biopsychosocial health, clinical assessment and treatment strategies of PCOS and associated co-morbidities. The review article will discuss the clinician's role in patient education with the special focus on counselling of females with PCOS regardless of age group.
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Affiliation(s)
- Tejal Lathia
- Department of Endocrinology, Fortis, Apollo, MGM and Cloud Nine Hospitals, Navi Mumbai, Maharashtra, India
| | - Ameya Joshi
- Department of Endocrinology, Bhaktivedanta Hospital and Research Institute, Mira Road, Maharashtra, India
| | - Arti Behl
- Department of Psychiatry, Apollo BGS Hospital, Adichuchanagiri Road, Mysore, Karnataka, India
| | - Atul Dhingra
- Department of Endocrinology, Gangaram Bansal Superspeciality Hospital, Sri Ganganagar, Rajasthan, India
| | - Bharti Kalra
- Department of Gynaecology, Bharti Hospital and B.R.I.D.E, Karnal, Haryana, India
| | - Charu Dua
- Clinical Nutrition and FandB - Max Healthcare Patparganj and Vaishali, Delhi, India
| | - Kiran Bajaj
- Department of Dermatology, Kiran Bajaj Skin and Laser Centre, Karnal, Haryana, India
| | - Komal Verma
- Department of Psychology, Amity Institute of Behavioral and Allied Sciences, Amity University Rajasthan, India
| | - Neharika Malhotra
- Department of Gynaecology and Obstetrics, Rainbow IVF, Agra, Uttar Pradesh, India
| | - Preeti Galagali
- Department of Pediatrics, Bangalore Adolescent Care and Counseling Centre, Bangalore, Karnataka, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College and Osmania General Hospital, Hyderabad, Telangana, India
| | - Samta Mittal
- Department of Oral Medicine and Radiology, I.T.S. Dental College, Hospital and Research Centre, Greater Noida, Uttar Pradesh, India
| | - Sarita Bajaj
- Department of Medicine, MLN Medical College, Prayagraj, Uttar Pradesh, India
| | - Smitha Moorthy
- Department of Gynaecology and Obstetrics, Sanjeevani Hospital, Mira Road, Thane, Maharashtra, India
| | - Suresh Sharma
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and B.R.I.D.E, Karnal, Haryana, India
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22
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Mizgier M, Watrowski R, Opydo-Szymaczek J, Jodłowska-Siewert E, Lombardi G, Kędzia W, Jarząbek-Bielecka G. Association of Macronutrients Composition, Physical Activity and Serum Androgen Concentration in Young Women with Polycystic Ovary Syndrome. Nutrients 2021; 14:73. [PMID: 35010948 PMCID: PMC8746804 DOI: 10.3390/nu14010073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 02/08/2023] Open
Abstract
The roles of dietary macronutrients and physical activity (PA) in patients with PCOS have not been sufficiently reported, especially in adolescent girls. To address this knowledge gap, we evaluated the associations between serum concentrations of total testosterone (tT), free testosterone (fT), androstenedione (A), dehydroepiandrosterone-sulfate (DHEA-S), sex hormone-binding globulin (SHBG) and dietary macronutrients intake as well as different types and levels of PA. The study population consisted of 96 girls of Caucasian ancestry, aged 14-18 years: 61 participants with polycystic ovary syndrome (PCOS) and 35 healthy controls. Serum tT, fT, A, DHEA-S, and SHBG were determined in fasting blood. Macronutrient intake and PA levels were assessed by using the three-day food record method and the Beliefs and Eating Habits Questionnaire (KomPAN), respectively. We found several positive correlations between dietary macronutrients such as total fat, saturated fatty acids (SFA), monounsaturated (MUFA) and polyunsaturated fatty acids (PUFA), and hormonal parameters across the entire cohort and in healthy girls. A positive correlation between SHBG and total protein consumption as well as an inverse correlation between SHBG and carbohydrate intake could be determined. No correlation between androgens and macronutrients was found in the PCOS group. In contrast, we observed an inverse correlation between androgen concentrations (except of DHEA-S) and "work/school" and/or "leisure time" PA only in PCOS patients. Moreover, the hormone levels differed according to PA intensity. In conclusion, the impact of diet and PA was strikingly different in adolescents with and without PCOS. These findings indicate that disturbed hormonal homeostasis in PCOS, at least in the youngest patients, likely "overtrump" dietary influences, and otherwise, PA offers a therapeutic potential that requires further evaluation of the long-term effects in randomized studies. (ClinicalTrial.gov Identifier: NCT04738409.).
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Affiliation(s)
- Małgorzata Mizgier
- Dietetic Department, Faculty of Physical Culture, Poznan University of Physical Education, 66-400 Gorzów Wielkopolski, Poland
| | - Rafał Watrowski
- Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Justyna Opydo-Szymaczek
- Department of Pediatric Dentistry, Poznan University of Medical Sciences, 60-812 Poznan, Poland;
| | - Elżbieta Jodłowska-Siewert
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, 60-806 Poznan, Poland;
| | - Giovanni Lombardi
- Laboratory of Experimental Biochemistry and Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy;
- Department of Athletics, Strength and Conditioning, Poznań University of Physical Education, 61-871 Poznań, Poland
| | - Witold Kędzia
- Department of Perinatology and Gynecology, Division of Developmental Gynecology and Sexology, Poznan University of Medical Sciences, 60-535 Poznan, Poland; (W.K.); (G.J.-B.)
| | - Grażyna Jarząbek-Bielecka
- Department of Perinatology and Gynecology, Division of Developmental Gynecology and Sexology, Poznan University of Medical Sciences, 60-535 Poznan, Poland; (W.K.); (G.J.-B.)
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Saadati N, Haidari F, Barati M, Nikbakht R, Mirmomeni G, Rahim F. The effect of low glycemic index diet on the reproductive and clinical profile in women with polycystic ovarian syndrome: A systematic review and meta-analysis. Heliyon 2021; 7:e08338. [PMID: 34820542 PMCID: PMC8600081 DOI: 10.1016/j.heliyon.2021.e08338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/07/2021] [Accepted: 11/03/2021] [Indexed: 12/29/2022] Open
Abstract
Background Treatment for polycystic ovary syndrome (PCOS) usually initiates with a series of lifestyle modifications such as diet, weight loss, and exercise. Aims We, therefore, conducted this meta-analysis to systematically review and evaluate the possible benefits of LGD on a range of anthropometric, clinical, and biochemical parameters in women with PCOS. Methods We performed a systematic search through major indexing databases, including Scopus, Pubmed/Medline, ISI web of science, Embase, Cochrane central, and CINAHL (1966-April 30, 2021) using key concepts of PCOS. Results Of 935 initial publications, 542 remain after duplicates removal. Then, 141 records were removed at the title and abstract screening level. After excluding 392 literatures, we finally included 8 articles. The final selected studies included 412 overweight and obese individuals with PCOS (207 cases in LGID group and 205 patients in comparators) with a mean age of 21-32 years. Measured emotional health (3 studies, 132 participants, SMD: -1.97; 95%CI:-3.54, -0.40, P = 0.01, I 2 = 89%) and body hair (3 studies, 132 participants, SMD: -0.40; 95%CI:-0.46, -0.35, P < 0.0001, I 2 = 0%), were found to be significantly lower in women in LGD vs control diet groups. Moreover, infertility (3 studies, 132 participants, SMD: 1.45; 95%CI: 0.30, 2.61, P = 0.01, I 2 = 79%) was significantly higher in women in LGD vs control diet groups. Conclusion The present meta-analysis has shown that LGD may play a significant role in reducing the risk and improving the clinical and biochemical features of PCOS. So far the evidences for choosing the best dietary modalities for PCOS are not strong to make a definite recommendation.
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Affiliation(s)
- Najmieh Saadati
- Fertility, Infertility, and Perinatology, Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fatemeh Haidari
- Department of Nutrition Sciences, Nutrition and Metabolic Diseases Research Center, School of Paramedical Sciences, Ahvaz Jundishapur University of Medical Sciences, 61357-15794, Ahvaz, Iran
| | - Mojgan Barati
- Department of Nutrition Sciences, Nutrition and Metabolic Diseases Research Center, School of Paramedical Sciences, Ahvaz Jundishapur University of Medical Sciences, 61357-15794, Ahvaz, Iran
| | - Roshan Nikbakht
- Department of Nutrition Sciences, Nutrition and Metabolic Diseases Research Center, School of Paramedical Sciences, Ahvaz Jundishapur University of Medical Sciences, 61357-15794, Ahvaz, Iran
| | - Golshan Mirmomeni
- School of Medicine, Fertility Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Hearing Research Center, Department of Audiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fakher Rahim
- Health Research Institute, Thalassemia and Hemoglobinopathies Research Centre, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Hearing Research Center, Department of Audiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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24
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Fatima I, Yaqoob S, Jamil F, Butt A. Relationship between loci of control and health-promoting behaviors in Pakistani women with polycystic ovary syndrome: coping strategies as mediators. BMC WOMENS HEALTH 2021; 21:356. [PMID: 34627210 PMCID: PMC8502314 DOI: 10.1186/s12905-021-01489-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 09/24/2021] [Indexed: 11/17/2022]
Abstract
Background/Objectives Understanding the factors that promote healthy lifestyle behaviors in women with polycystic ovary syndrome is of substantial importance. Health-promoting lifestyle behaviors (HPLB) have been observed to be effective in managing various symptoms related to PCOS. This study aimed to examine the relationship between loci of control and health-promoting lifestyle behaviors in Pakistani women with polycystic ovary syndrome and the mediating role of coping strategies. Method A correlational study was carried out with 145 unmarried women with polycystic ovary syndrome diagnosed by a gynecologist using the Rotterdam Criteria of 2003 (M age = 24.75 years). Participants were recruited from public sector hospitals in Lahore, Punjab, Pakistan and a series of hierarchical regression analyses were used to analyze results. Results Findings suggest that women with internal and powerful others locus of control use more active practical coping strategies and less active distractive coping strategies. These women also get more involved in health-promoting behaviors. On the other hand, those with a high level of chance locus of control use less active practical coping strategies and more active distractive coping strategies. In turn, they engage less in health-promoting behaviors. Conclusion Health professionals should consider the effects of different types of locus of control and coping strategies when planning interventions for women with polycystic ovary syndrome.
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Affiliation(s)
- Iram Fatima
- Institute of Applied Psychology, University of the Punjab, Canal Road, Quaid-e-Azam Campus, Lahore, Pakistan.
| | - Sahar Yaqoob
- Institute of Applied Psychology, University of the Punjab, Canal Road, Quaid-e-Azam Campus, Lahore, Pakistan
| | - Farhat Jamil
- Institute of Psychology, Beaconhouse National University, Lahore, Pakistan
| | - Amna Butt
- Institute of Psychology, Beaconhouse National University, Lahore, Pakistan
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25
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Nahidi F, Tehrani FR, Ghodsi D, Jafari M, Majd HA, Abdolahian S. The effectiveness of lifestyle training program promoting adolescent health with polycystic ovarian syndrome: A study protocol for a randomized controlled study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:351. [PMID: 34761037 PMCID: PMC8552287 DOI: 10.4103/jehp.jehp_15_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 03/27/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Lifestyle training is of a key important in adolescent age for better life in the future. Healthy lifestyle in adolescents can management of any disease such as diabetes and polycystic ovarian syndrome (PCOS). Schools can provide an important environment to identify and change the lifestyle of students. The aim of this protocol is designing and evaluating the effectiveness of school-based lifestyle training program improving the PCOS of adolescents. MATERIALS AND METHODS A cluster-randomized controlled trial will be conducted to examine the effectiveness of school-based lifestyle training program in 16 to 18 years old adolescent girls. The healthy lifestyle program will be designed by modification of behavioral habit, dietary intake, and physical activity and educated in eight sessions for adolescents and one session for parents in the intervention groups with sixty participants. RESULTS Changes in primary and secondary outcomes in PCOS and healthy adolescents before and after intervention in the intervention and control groups will be analyzed for evaluation effectiveness by one-way ANOVA or other nonparametric equivalents. CONCLUSION The current study will provide information on the effectiveness of school-based lifestyle training programs for adolescents. With increasing numbers of PCOS at risk for long-term and/or late effects of treatment and other chronic diseases, efforts for promoting the healthy lifestyle of this important group are urgently needed. This lifestyle program may provide valuable information relating to the development of other healthy lifestyle interventions for PCOS and result in appropriate behavior change and self-management strategies.
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Affiliation(s)
- Fatemeh Nahidi
- Department of Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Delaram Ghodsi
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Jafari
- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Alavi Majd
- Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somayeh Abdolahian
- Department of Midwifery and Reproductive Health, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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26
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Moore JM, Waldrop SW, Cree-Green M. Weight Management in Adolescents with Polycystic Ovary Syndrome. Curr Obes Rep 2021; 10:311-321. [PMID: 34043216 PMCID: PMC8898097 DOI: 10.1007/s13679-021-00437-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW Polycystic ovary syndrome (PCOS) is a common condition that clinically presents during adolescence. PCOS is associated with increased rates of overweight and obesity, as well as higher rates of metabolic disease, especially type 2 diabetes. Weight loss decreases PCOS symptoms and risk for metabolic disease. The goal of this review is to evaluate recent studies describing the hormonal, metabolic, and weight effects of different weight loss strategies: dietary, physical activity, pharmacotherapy, bariatric surgery, mood modification, and sleep. RECENT FINDINGS Calorie restriction continues to be supported as the primary nutrition intervention to achieve weight loss in individuals with PCOS, and a dietary macronutrient composition with lower compared to higher glycemic carbohydrates may be more effective. There is limited data that vitamins, nutraceuticals, and probiotics may improve hormonal and metabolic outcomes. Most types of physical activity are effective in improving outcomes in PCOS and lowering weight. Whereas there are promising data on anti-obesity medications such as glucagon-like peptide-1 receptor agonists in adults with PCOS and adolescents with obesity, further work is needed to know if these therapies are effective in youth with PCOS. Research is lacking on the effectiveness of other anti-obesity medications in PCOS. Bariatric surgery is especially promising for decreasing weight in adults and youth, and reversing type 2 diabetes in youth, though PCOS data are lacking. Treatment of depression in adolescents with insulin resistance and women with PCOS is associated with improved weight loss. Adolescents with PCOS and obesity may have greater sleep-related risks including circadian misalignment and obstructive sleep apnea, interventions for which have not yet been conducted. Clinical trials on weight loss strategies in adolescents with PCOS remain limited, with most information inferred from studies in women with PCOS or adolescents with obesity. However, there are multiple options to optimize weight loss in dietary, activity, pharmacotherapy, bariatric surgery, mood modification, and sleep domains.
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Affiliation(s)
- Jaime M Moore
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine Children's Hospital Colorado, Aurora, CO, 80045, USA
| | - Stephanie W Waldrop
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine Children's Hospital Colorado, Aurora, CO, 80045, USA
| | - Melanie Cree-Green
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
- Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
- Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, PO Box 265, 13123 E 16th Ave, Aurora, CO, 80045, USA.
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Dondi E, Tufano M, Vigone MC, Lucaccioni L, Pozzobon G, Ubertini G, Mozzillo E, Delvecchio M. Polycystic ovary syndrome in pediatric obesity and diabetes. Minerva Pediatr (Torino) 2021; 73:523-536. [PMID: 34286948 DOI: 10.23736/s2724-5276.21.06542-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Polycystic ovary syndrome is characterized by anovulation (amenorrhea, oligomenorrhea, irregular menstrual cycles) combined with symptoms of androgen excess (hirsutism, acne, alopecia). The clear definition and diagnosis in adolescents could be challenging considering that most of symptoms occur as part of the expected physiological hormonal imbalance of puberty. Therefore, different diagnostic criteria have been elaborated. Polycystic ovary syndrome could be associated to obesity, diabetes mellitus, and metabolic syndrome. In adolescents with polycystic ovary syndrome, adiposity is associated with higher androgen concentrations and greater menstrual irregularity. Polycystic ovary syndrome in youth is considered a risk factor for type 2 diabetes mellitus in adulthood. On the other hand, increased prevalence of polycystic ovary syndrome has been shown in type 1 diabetes mellitus. EVIDENCE The treatment of polycystic ovary syndrome in adolescents is controversial considering that adequate trials are lacking. First line treatment comprises lifestyle modification (preferably multicomponent including diet, exercise and behavioural strategies) that should be recommended overall in the patients with polycystic ovary syndrome and overweight, central obesity and insulin resistance. Beyond non-pharmacological therapy, pharmacological agents include combined hormonal contraceptives, metformin and antiandrogens, used separately or in combination. The aim of therapy is to bring back ovulation, to normalize menses, to reduce hirsutism and acne, to reduce weight. Other important goal is the treatment of hyperlipidaemia and of hyperglycaemia. CONCLUSIONS This narrative review aims to review the most pertinent literature about polycystic ovary syndrome in adolescents with obesity or diabetes. We overviewed the diagnostic criteria, the pathophysiology and the possible treatment approaches.
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Affiliation(s)
- Elena Dondi
- Department of Pediatrics, S. Andrea Hospital, Vercelli, Italy
| | - Maria Tufano
- Department of Pediatrics and Neonatology, Usl Central Tuscany, Florence, Prato, Italy
| | - Maria C Vigone
- Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Lucaccioni
- Pediatric Unit, Departmente of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Gabriella Pozzobon
- Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Enza Mozzillo
- Section of Pediatrics, Department of Translational Medical Science, Regional Center of Pediatric Diabetes, Federico II University of Naples, Naples, Italy
| | - Maurizio Delvecchio
- Metabolic Disorders and Genetic Unit, Giovanni XXIII Children Hospital, Bari, Italy -
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Hajivandi L, Noroozi M, Mostafavi F, Ekramzadeh M. Assessing the impact of an educational intervention program based on the theory of planned behavior on the nutritional behaviors of adolescents and young adults with PCOS in Iran: a field trial study. BMC Pediatr 2021; 21:316. [PMID: 34261468 PMCID: PMC8278740 DOI: 10.1186/s12887-021-02784-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 06/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome is the most common endocrine disorder among adolescents and adults. Given the importance of healthy nutritional behaviors in management of this disease, the present study was conducted to determine the impact of an educational intervention program based on the theory of planned behavior on the nutritional behaviors of adolescents and young adults with polycystic ovary syndrome. METHODS In this field trial study, 72 participants aged between 15 and 21 years old from four gynecology clinics in Shiraz, Iran, were assigned into the intervention and control groups. Educational intervention program was implemented based on the theory of planned behavior over 4 sessions during two weeks. The data collection tools were researcher-made questionnaires of demographic information, knowledge assessment, and assessment of theory of planned behavior constructs, as well as a questionnaire for assessing consumption of food groups, fast food, and snacks. The data were collected at two stages (once at baseline and once three months after the intervention), and then the changes in knowledge, attitude, subjective norms, the perceived behavioral control, behavioral intention, and nutritional behavior were analyzed using descriptive and inferential statistical methods (t-test, Chi-square, Mann- Whitney U, and Wilcoxon tests; as well as one- way ANOVA, repeated measures ANOVA, and ANCOVA, respectively). RESULTS Statistically significant increases were observed in the mean scores of knowledge, attitude, subjective norms, the perceived behavioral control, behavioral intention, and nutritional behavior in the intervention group by passing three months from the intervention compared to the scores before the intervention (P < 0.001). However, these differences were not statistically significant in the control group (P > 0.05). Moreover, the mean scores of knowledge, attitude, subjective norms, perceived behavioral control, behavioral intention, and nutritional behavior had no statistically significant difference before the intervention between the two groups; however, this was statistically significant by passing three months from the intervention (P < 0.001). CONCLUSION Considering the effect of an educational intervention program based on the theory of planned behavior on creating healthy nutritional behaviors in adolescents and young adults with polycystic ovary syndrome, it is recommended to use it in order to improve the nutritional health of them. TRIAL REGISTRATION IRCT, IRCT20160224026756N6. Registered 18 Aug 2018, https://en.irct.ir/user/trial/32693/view.
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Affiliation(s)
- Leila Hajivandi
- Department of Nursing and Midwifery, Kazerun Medical Sciences Branch, Islamic Azad University, Kazerun, Iran
| | - Mahnaz Noroozi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Firoozeh Mostafavi
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Ekramzadeh
- Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Mohseni M, Eghbali M, Bahrami H, Dastaran F, Amini L. Yoga Effects on Anthropometric Indices and Polycystic Ovary Syndrome Symptoms in Women Undergoing Infertility Treatment: A Randomized Controlled Clinical Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:5564824. [PMID: 34221076 PMCID: PMC8213483 DOI: 10.1155/2021/5564824] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/28/2021] [Accepted: 06/02/2021] [Indexed: 11/18/2022]
Abstract
The aim of this study was to investigate the effects of yoga exercises on anthropometric parameter and clinical sign of PCOS among women undergoing infertility treatment. This clinical trial study was performed on 61 women with PCOS who have undergone infertility treatment at Sarem Hospital in Tehran, Iran. The patients were first selecting based on purposeful and then randomly assigning to the intervention and control groups. In the intervention group, yoga exercises were performed for 6 weeks and the patients in the control group only received routine care. Anthropometric parameters and clinical signs were performed and recorded. After the intervention, here was a significant reduction in hirsutism, abdominal circumference, and hip circumference scores in the intervention group compared to the control group (P < 0.05). Given the effects of yoga exercises on the improvement of hirsutism, abdominal circumference, and hip circumference, it is suggested to use yoga as a treatment strategy in women with PCOS.
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Affiliation(s)
- Maryam Mohseni
- School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Eghbali
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Homa Bahrami
- Sarem Fertility and Infertility Research Center (SAFIR), Sarem Women's Hospital, Tehran, Iran
| | - Farzaneh Dastaran
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Amini
- Nursing Care Research Center (NCRC), Iran University of Medical Sciences, Tehran, Iran
- Department of Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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Song J, Park Y, Cho HW, Lee SG, Kim S, Lim JB. Age-group-specific reference intervals for anti-Müllerian hormone and its diagnostic performance for polycystic ovary syndrome in a Korean population. J Clin Lab Anal 2021; 35:e23861. [PMID: 34097316 PMCID: PMC8274997 DOI: 10.1002/jcla.23861] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/25/2021] [Accepted: 05/17/2021] [Indexed: 01/02/2023] Open
Abstract
Background We established age‐group‐specific reference intervals for serum anti‐Müllerian hormone (AMH) levels in a Korean population and investigated the effectiveness of AMH assay for polycystic ovary syndrome (PCOS) diagnosis. Methods We analyzed serum levels of AMH, follicle‐stimulating hormone (FSH), and luteinizing hormone (LH) from 1540 Korean women. Subjects were divided into three groups: healthy, benign gynecologic diseases, and PCOS. Age‐group‐specific reference intervals and AMH diagnostic performance were estimated. Results The PCOS group had a median AMH level of 7.0 µg/L, which was higher than for the healthy (1.8 µg/L) and the benign gynecologic diseases (2.7 µg/L) groups. The upper 97.5% reference limits for age groups 12–20 years, 21–34 years, and 35–46 years were 13.2 µg/L, 15.8 µg/L, and 6.6 µg/L, respectively. The area under the curve (AUC) values to estimate AMH ability to discriminate PCOS from healthy women for each age group were 0.741, 0.785, and 0.789, respectively. AUCs for LH/FSH were 0.719, 0.672, and 0.590. Conclusions The better diagnostic ability of AMH over LH/FSH in women of late childbearing ages indicates that age and other clinical characteristics should be considered when interpreting these test results.
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Affiliation(s)
- Junhyup Song
- Department of Laboratory Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yongjung Park
- Department of Laboratory Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae Weon Cho
- Department of Laboratory Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang-Guk Lee
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sinyoung Kim
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Baeck Lim
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Pérez-López FR, Ornat L, López-Baena MT, Santabárbara J, Savirón-Cornudella R, Pérez-Roncero GR. Circulating kisspeptin and anti-müllerian hormone levels, and insulin resistance in women with polycystic ovary syndrome: A systematic review, meta-analysis, and meta-regression. Eur J Obstet Gynecol Reprod Biol 2021; 260:85-98. [PMID: 33744505 DOI: 10.1016/j.ejogrb.2021.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/05/2021] [Accepted: 03/07/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to summarize the available evidence regarding circulating kisspeptin and anti-müllerian hormone (AMH) and the homeostasis model assessment of insulin resistance (HOMA-IR) index in adolescents and women with and without polycystic ovary syndrome (PCOS). METHOD We performed a comprehensive literature search in Medline, Embase, Cochrane, Scopus, and Web of Science for studies evaluating circulating kisspeptin levels in women with and without PCOS published until September 24th, 2020. Co-primary outcomes were the HOMA-IR index and AMH. The quality of included studies was assessed using the Newcastle-Ottawa Scale. Random-effects models were used to estimate outcomes, and effects reported as mean difference (MD) or standardized MD (SMD) and their 95 % confidence interval (CI). The systematic review and meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO) as number CRD42020205030. RESULTS We evaluated 18 studies including, 1282 PCOS cases and 977 controls. Participants with PCOS were younger (MD = -2.38 years, 95 %CI -4.32 to -0.44), with higher BMI (MD = 1.16, 95 % CI 0.54-1.78), waist-to-hip ratio (MD = 0.04, 95 %CI 0.02 to 0.05), circulating kisspeptin (SMD = 1.15, 95 %CI 0.68-1.62), luteinizing hormone (SMD = 1.29, 95 %CI 0.76-1.83), AMH (SMD = 0.97, 95 %CI 0.60-1,34), total testosterone (SMD = 2.48, 95 %CI 1.73-3.23), free testosterone (SMD = 1.37, 95 %CI 0.56-2.17), and dehydroepiandrosterone sulphate (SMD = 0.72, 95 %CI 0.32-1.13) levels, and Ferriman-Gallwey score (SMD = 5.08, 95 %CI 2.76-7.39), and lower sex hormone-binding globulin level (SMD = -1.34, 95 %CI -2.15 to -0.52). Besides, participants with PCOS had higher HOMA-IR index (SMD = 0.76, 95 %CI 0.35-1.17), and circulating insulin (SMD = 0.75, 95 %CI 0.30-1.19), leptin (SMD = 2.82, 95 %CI 1.35-4.29), and triglycerides (SMD = 2.15, 95 %CI 1.08-3.23) levels than participants without the syndrome. The meta-regression did not identify significant factors influencing circulating kisspeptin. CONCLUSION Patients with PCOS showed higher kisspeptin, LH, insulin, AMH, and androgen levels and HOMA-IR index, and lower sex hormone-binding globulin levels than those without the syndrome.
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Affiliation(s)
- Faustino R Pérez-López
- Department of Obstetrics and Gynecology, University of Zaragoza Faculty of Medicine, Zaragoza, 50009, Spain; Aragón Health Research Institute, Zaragoza, 50009, Spain.
| | - Lía Ornat
- Department of Obstetrics and Gynecology, University of Zaragoza Faculty of Medicine, Zaragoza, 50009, Spain
| | | | - Javier Santabárbara
- Aragón Health Research Institute, Zaragoza, 50009, Spain; Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza Faculty of Medicine, Zaragoza, 50009, Spain
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Shpakov AO. Improvement Effect of Metformin on Female and Male Reproduction in Endocrine Pathologies and Its Mechanisms. Pharmaceuticals (Basel) 2021; 14:ph14010042. [PMID: 33429918 PMCID: PMC7826885 DOI: 10.3390/ph14010042] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/02/2021] [Accepted: 01/06/2021] [Indexed: 02/07/2023] Open
Abstract
Metformin (MF), a first-line drug to treat type 2 diabetes mellitus (T2DM), alone and in combination with other drugs, restores the ovarian function in women with polycystic ovary syndrome (PCOS) and improves fetal development, pregnancy outcomes and offspring health in gestational diabetes mellitus (GDM) and T2DM. MF treatment is demonstrated to improve the efficiency of in vitro fertilization and is considered a supplementary drug in assisted reproductive technologies. MF administration shows positive effect on steroidogenesis and spermatogenesis in men with metabolic disorders, thus MF treatment indicates prospective use for improvement of male reproductive functions and fertility. MF lacks teratogenic effects and has positive health effect in newborns. The review is focused on use of MF therapy for restoration of female and male reproductive functions and improvement of pregnancy outcomes in metabolic and endocrine disorders. The mechanisms of MF action are discussed, including normalization of metabolic and hormonal status in PCOS, GDM, T2DM and metabolic syndrome and restoration of functional activity and hormonal regulation of the gonadal axis.
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Affiliation(s)
- Alexander O Shpakov
- I.M. Sechenov Institute of Evolutionary Physiology and Biochemistry of Russian Academy of Sciences, 194223 Saint Petersburg, Russia
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