Hyperandrogenism correlates with psychological symptoms in adolescents with polycystic ovary syndrome

International evidence-based recommendations for polycystic ovary syndrome in adolescents

BACKGROUND

During adolescence, accurate diagnostic criteria and/or identification of adolescents "at risk" of polycystic ovary syndrome (PCOS) are critical to establish appropriate screening, treatment, and lifelong health plans. The 2023 International Evidence-Based Guideline for PCOS aimed to provide the most up-to-date evidence-based recommendations to improve health outcomes for individuals with PCOS, emphasizing accurate and timely diagnosis of PCOS from adolescence.

METHODS

The best practice methods following the Appraisal of Guidelines for Research and Evaluation (AGREE-II) criteria were applied. Healthcare professionals and patients/consumers reviewed extensive evidence synthesis/meta-analysis for 55 prioritized clinical questions. Databases (OVID MEDLINE, All EBM, PsycInfo, EMBASE, CINAHL) were searched until August 2022 as part of the 2023 update of the Guideline. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework guided experts on evidence quality, feasibility, acceptability, cost, implementation, and ultimately recommendation strength.

RESULTS

This manuscript focuses on the adolescent-specific recommendations of the 2023 Guideline. The diagnosis is based on the presence of both irregular menstrual cycles (defined according to the time postmenarche) and clinical/biochemical hyperandrogenism following the exclusion of other disorders that mimic PCOS. Adolescents with only one of these features can be considered "at risk" of PCOS requiring the management of symptoms and ongoing follow-up. Polycystic ovarian morphology on pelvic ultrasonography or anti-Müllerian hormone levels should not be used for diagnosis during adolescence. Lifelong health planning is recommended to include healthy lifestyles, screening for depression and metabolic features and the transition to adult care, all underpinned by shared decision-making. Healthcare professionals should explain weight-related health risks to adolescents, while minimizing weight stigma. In adolescents with PCOS or "at risk" of PCOS, combined oral contraceptive pills are indicated for menstrual irregularity and clinical hyperandrogenism, focusing on low dose preparations, and metformin could be considered for metabolic features and cycle regulation. Overall, the evidence is limited in adolescents with PCOS, and recommendations are based on low to moderate certainty evidence.

CONCLUSIONS

Extensive international engagement and rigorous processes generated International Guideline diagnostic criteria for adolescents that differ from adult criteria and clarified appropriate screening and management strategies for PCOS during adolescence.

Salivary testosterone is associated with feelings of senselessness and self-dislike in women with borderline personality disorder

Background: Women with borderline personality disorder (BPD) show increased basal levels of testosterone. We investigated whether salivary testosterone levels in women with BPD were indicative of specific symptoms associated with BPD. Based on the assumed link between testosterone and interpersonal dominance, we hypothesized a positive association between testosterone and externalising, i.e. aggressive or impulsive behaviour, potentially contributing to higher burden of interpersonal reactivity and conflict.Methods: Saliva was collected from 98 women with BPD (average age in years: 28, range 18-46) between 1 and 2 pm. Self-rating scales were administered to assess severity of BPD (Borderline Symptom Checklist, BSL-23) and depressive symptoms (Beck's Depression Inventory, BDI-II). Regression analyses targeted associations between individual testosterone levels and BSL-23 and BDI-II total and by-item scores.Results: Higher testosterone levels were associated with higher overall disease burden indicated by BSL-23 and BDI-II total scores. When analysed by item, higher testosterone levels were significantly associated with increased feelings of self-dislike, senselessness and pessimism, and the feeling of being a failure.Conclusion: Our findings show that in women with BPD testosterone levels are positively associated with increased borderline and depressive symptomatology. Contrary to our expectations, rather than predicting externalising symptoms, higher testosterone is associated with a well-defined cluster of internalising symptoms characterized by a pessimistic and derogatory view towards oneself.

Depression, anxiety and self-esteem in adolescent girls with polycystic ovary syndrome: a systematic review and meta-analysis

Objective

Studies have shown the adverse psychological impact of polycystic ovary syndrome (PCOS), but the state of mental health in adolescents with PCOS remains unclear. Thus, we performed a systematic review and meta-analysis to investigate the prevalence and severity of depression and anxiety, as well as potential effects on self-esteem and quality of life (QoL) in this specific population.

Methods

We systematically searched four electronic databases: PubMed, Embase, Web of Science, and the Cochrane Reviews database for articles published until 25/8/2024. We considered observational studies in which the subjects were adolescent girls with PCOS who had reported symptoms including anxiety, depression, self-esteem, and QoL. The Review Manager version 5.4 was used to analyze the available data extracted. We used the Newcastle-Ottawa Quality Assessment Scale (NOS) to evaluate the quality of selected studies. A funnel plot was utilized to assess the risk of literature bias, and a forest plot was used to represent the combined outcomes. This systematic review was previously registered in PROSPERO with the registration number CRD42022382036.

Results

We included 11 studies in the systematic review and conducted meta-analyses on 10 of them. Adolescents with PCOS reported a higher risk of depression (OR = 2.21, 95% CI: 1.23 to 4.00, p = 0.008) and a higher level of depression scores (SMD = 0.43, 95% CI: 0.16 to 0.71, p = 0.002) than controls. There were no significant differences in anxiety (OR = 1.90, 95% CI: 0.52 to 6.96, p = 0.33; SMD = 0.19, 95% CI: -0.21 to 0.59, p = 0.36), self-esteem (SMD = -0.17, 95% CI: -0.85 to 0.52, p = 0.64), and QoL (SMD = -0.15, 95% CI: -0.42 to 0.11, p = 0.26) between the two groups.

Conclusions

Our research indicated that adolescents with PCOS experienced more severe depressive symptoms than those without PCOS. This highlights the importance of evaluation and early treatment of mental health in PCOS. More clinicians should pay attention to the mental health of adolescent girls with PCOS through this study.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022382036.

Management of polycystic ovary syndrome must include assessment and treatment of mental health symptoms

Polycystic ovary syndrome (PCOS) is an endocrine disorder with reproductive and metabolic manifestations affecting millions of women worldwide. The health risks associated with PCOS, however, go beyond physical health. Over the past decade, data have emerged demonstrating a high risk of concurrent mental health conditions, specifically depression and anxiety, but extending into other aspects of psychological health, including body image distress, eating disorders, and sexual dysfunction. International surveys suggest physician knowledge about the mental health associations with PCOS is poor and that patients are often dissatisfied regarding counseling-related psychological issues. We performed a review of mental health comorbidities in individuals with PCOS, including depression, anxiety, body image distress, eating disorders, psychosexual dysfunction, and decreased quality of life, as well as evaluated the impact of common PCOS treatments on these conditions. Most meta-analyses in reproductive age women demonstrate increased risks of these conditions, although data are more limited in adolescents and older adults. In addition, the impact of PCOS treatments on these conditions as well as data on first-line treatments in the PCOS population is limited. All providers involved in the multidimensional care of individuals with PCOS should be aware of these mental health risks to provide appropriate screening, counseling and referral options. Future studies should be designed to evaluate targeted treatment for individuals with PCOS.

Quality of Life in Children and Young People With Congenital Adrenal Hyperplasia-UK Nationwide Multicenter Assessment

CONTEXT

Quality of life (QoL) has been inconsistently reported in children and young people (CYP) with congenital adrenal hyperplasia (CAH).

OBJECTIVE

Assess QoL in CYP with CAH in the UK alongside biometric and androgen profiles.

DESIGN

To define the evidence base for health care delivery, we conducted a cross-sectional study in CYP with CAH in the UK. Questionnaire results were compared with normative data and between groups, and modelled for association with sex, height, weight, body mass index, or steroid biomarkers of CAH control.

SETTING

Tertiary care in 14 UK centers.

PATIENTS

Results from 104 patients, 55% female, mean age 12.7 years (SD 3.0), paired responses from parents.

INTERVENTIONS

Strengths and Difficulties questionnaire (SDQ) and pediatric QoL questionnaire.

MAIN OUTCOME MEASURE

Total QoL scores as assessed by SDQ and a pediatric QoL questionnaire in comparison to normative data.

RESULTS

Total scores were worse in parents than normative data, but similar in patients. Patient QoL was rated better in social functioning but worse in emotional, school, and peer domains by patients, and worse in total scores and domains of peer problems, and psychosocial, emotional, and school functioning by parents. Parents consistently scored QoL of their children lower than their child. Larger height-SD score and lower weight-SD score were associated with better QoL. Girls with lower steroid biomarkers had worse SDQ scores.

CONCLUSIONS

In CYP with CAH, reduced height, increased weight, and hormonal biomarkers consistent with overtreatment were associated with worse QoL; addressing these problems should be prioritized in clinical management.Clinical Trials Registration Number: SCH/15/088.