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Briggs AM, Slater H, Van Doornum S, Pearson L, Tassone EC, Romero L, Chua J, Ackerman IN. Chronic primary or secondary non-inflammatory musculoskeletal pain is associated with disrupted sexual function and relationships: a systematic review. Arthritis Care Res (Hoboken) 2021; 74:1019-1037. [PMID: 34057305 DOI: 10.1002/acr.24711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/14/2021] [Accepted: 05/20/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Evidence points to the impact of chronic musculoskeletal pain conditions on sexual function, yet there is little systematic appraisal and synthesis of evidence examining these associations across non-inflammatory conditions. We aimed to systematically review evidence surrounding the association between chronic primary and secondary musculoskeletal pain with intimate relationships and sexual function. METHODS Four electronic databases were searched from 1st January 1990 to 5th September 2019 for cross-sectional or prospective epidemiologic and qualitative studies among cohorts with chronic primary or secondary non-inflammatory musculoskeletal pain, defined by ICD-11 classification criteria. RESULTS Fifty-one eligible studies were included (46 quantitative, 3 qualitative, 2 mixed-methods designs). Sample sizes ranged from 13 to 12,377 and mean age from 32.6 to 69.2 years. Cross-sectional controlled cohort studies consistently reported poorer sexual function outcomes among cohorts with pain relative to comparison groups. Of 15 studies reporting outcomes for the Female Sexual Function Index, 14 demonstrated mean scores ≤26.55 for the pain group, indicating sexual dysfunction. In four studies reporting the International Index of Erectile Function, the pain cohorts demonstrated consistently lower mean subscale scores and the erectile function subscale scores were ≤25.0, indicating erectile dysfunction. Three key themes emerged from a meta-synthesis of qualitative studies: impaired sexual function; compromised intimate relationships; and impacts of pain on sexual identity, body image and self-worth. CONCLUSION Sexual dysfunction and negative impacts on intimate relationships are highly prevalent among people with chronic non-inflammatory musculoskeletal pain. Consideration of these associations is relevant to the delivery of holistic, person-centred musculoskeletal pain care.
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Affiliation(s)
- Andrew M Briggs
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Curtin, Australia
| | - Helen Slater
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Curtin, Australia
| | - Sharon Van Doornum
- University of Melbourne, Department of Medicine, (Royal Melbourne Hospital), Victoria, Australia.,Department of Medicine, Royal Melbourne Hospital, Victoria, Australia
| | - Lauren Pearson
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Eliza C Tassone
- Department of Nutrition and Dietetics, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - Lorena Romero
- Alfred Medical Research and Education Precinct, Alfred Hospital, Victoria, Australia
| | - Jason Chua
- Centre for Musculoskeletal Outcomes Research, University of Otago, Dunedin, New Zealand
| | - Ilana N Ackerman
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
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2
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Moran LJ, Tassone EC, Boyle J, Brennan L, Harrison CL, Hirschberg AL, Lim S, Marsh K, Misso ML, Redman L, Thondan M, Wijeyaratne C, Garad R, Stepto NK, Teede HJ. Evidence summaries and recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome: Lifestyle management. Obes Rev 2020; 21:e13046. [PMID: 32452622 DOI: 10.1111/obr.13046] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/13/2020] [Accepted: 04/17/2020] [Indexed: 12/14/2022]
Abstract
Lifestyle is fundamental in chronic disease prevention and management, and it has been recommended as a first-line treatment in the Australian polycystic ovary syndrome (PCOS) guideline 2011. The first international evidence-based guideline on PCOS was developed in 2018, which expanded the scope and evidence in the Australian guideline. This paper summarizes the lifestyle recommendations and evidence summaries from the guideline. International multidisciplinary guideline development groups delivered the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2018. The process followed the Appraisal of Guidelines for Research and Evaluation II and The Grading of Recommendations, Assessment, Development and Evaluation framework. Extensive communication and meetings addressed six prioritized clinical questions through five reviews. Evidence-based recommendations were formulated before consensus voting within the panel. Evidence shows the benefits of multicomponent lifestyle intervention, efficacy of exercise and weight gain prevention with no specific diet recommended. Lifestyle management is the first-line management in the intervention hierarchy in PCOS. Multicomponent lifestyle intervention including diet, exercise and behavioural strategies is central to PCOS management with a focus on weight and healthy lifestyle behaviours. The translation programme optimizes reach and dissemination for health professionals and consumers.
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Affiliation(s)
- Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicineh, Monash University, Clayton, Melbourne, Victoria, Australia.,Department of Endocrinology and Diabetes, Monash Health, Clayton, Melbourne, Victoria, Australia
| | - Eliza C Tassone
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicineh, Monash University, Clayton, Melbourne, Victoria, Australia
| | - Jacqueline Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicineh, Monash University, Clayton, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash Health, Clayton, Melbourne, Victoria, Australia
| | - Leah Brennan
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicineh, Monash University, Clayton, Melbourne, Victoria, Australia
| | | | - Siew Lim
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicineh, Monash University, Clayton, Melbourne, Victoria, Australia
| | - Kate Marsh
- Northside Nutrition & Dietetics, Chatswood, New South Wales, Australia
| | - Marie L Misso
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicineh, Monash University, Clayton, Melbourne, Victoria, Australia
| | - Leanne Redman
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Mala Thondan
- Harp Family Medical, Kew East, Victoria, Australia
| | - Chandrika Wijeyaratne
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Rhonda Garad
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicineh, Monash University, Clayton, Melbourne, Victoria, Australia
| | - Nigel K Stepto
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicineh, Monash University, Clayton, Melbourne, Victoria, Australia.,Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia.,Medicine Western Health, Faculty of Medicine, Dentistry and Health Sciences, Melbourne University, Melbourne, Victoria, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicineh, Monash University, Clayton, Melbourne, Victoria, Australia.,Department of Endocrinology and Diabetes, Monash Health, Clayton, Melbourne, Victoria, Australia
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3
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Stepto NK, Patten RK, Tassone EC, Misso ML, Brennan L, Boyle J, Boyle RA, Harrison CL, Hirschberg AL, Marsh K, Moreno-Asso A, Redman L, Thondan M, Wijeyaratne C, Teede HJ, Moran LJ. Exercise Recommendations for Women with Polycystic Ovary Syndrome: Is the Evidence Enough? Sports Med 2020; 49:1143-1157. [PMID: 31166000 DOI: 10.1007/s40279-019-01133-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In this opinion piece, we summarize, discuss implications of implementation, and critically evaluate our 2018 evidence-based guideline recommendations for exercise and physical activity in women with polycystic ovary syndrome (PCOS). We developed recommendations as part of a larger international guideline development project. The overall guideline scope and priorities were informed by extensive health professional and consumer engagement. The lifestyle guideline development group responsible for the exercise recommendations included experts in endocrinology, exercise physiology, gynecology, dietetics, and obstetrics, alongside consumers. Extensive online communications and two face-to-face meetings addressed five prioritized clinical questions related to lifestyle, including the role of exercise as therapy for women with PCOS. The guideline recommendations were formulated based on one narrative and two evidence-based reviews, before consensus voting within the guideline panel. The development process was in accordance with the Appraisal of Guidelines for Research and Evaluation (AGREE) II, and used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework to assess evidence quality, desirable and undesirable consequences, feasibility, acceptability, cost, implementation, and recommendation strength. Given the evidence for exercise as therapy in PCOS being of low quality, a consensus recommendation was made based on current exercise guidelines for the general population. Women with PCOS and clinicians are forced to adopt generic approaches when recommending exercise therapy that perpetuates clinical management with pharmacological solutions. The current status of evidence highlights the need for greater international co-operation between researchers and funding agencies to address key clinical knowledge gaps around exercise therapy in PCOS to generate evidence for appropriate, scalable, and sustainable best practice approaches.
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Affiliation(s)
- Nigel K Stepto
- Institute for Health and Sport (iHES), Victoria University, Footscray, PO Box 14428, Melbourne, VIC, 8001, Australia. .,Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Monash Health, Melbourne, VIC, Australia. .,Australian Institute for Musculoskeletal Science (AIMSS) Victoria University, St Albans, VIC, Australia. .,Department Medicine Western Health, Faculty of Medicine, Dentistry and Health Sciences, Melbourne University, Melbourne, VIC, Australia.
| | - Rhiannon K Patten
- Institute for Health and Sport (iHES), Victoria University, Footscray, PO Box 14428, Melbourne, VIC, 8001, Australia
| | - Eliza C Tassone
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Monash Health, Melbourne, VIC, Australia
| | - Marie L Misso
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Monash Health, Melbourne, VIC, Australia
| | - Leah Brennan
- School of Behavioural and Health Sciences, Australian Catholic University, Victoria, Australia.,Centre for Eating, Weight and Body Image, Melbourne, VIC, Australia
| | - Jacqueline Boyle
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Monash Health, Melbourne, VIC, Australia
| | - Russell A Boyle
- Institute for Health and Sport (iHES), Victoria University, Footscray, PO Box 14428, Melbourne, VIC, 8001, Australia
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Monash Health, Melbourne, VIC, Australia
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Department of Gynecology and Reproductive Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Kate Marsh
- Private Practice, Sydney, NSW, Australia
| | - Alba Moreno-Asso
- Institute for Health and Sport (iHES), Victoria University, Footscray, PO Box 14428, Melbourne, VIC, 8001, Australia.,Australian Institute for Musculoskeletal Science (AIMSS) Victoria University, St Albans, VIC, Australia
| | - Leanne Redman
- Reproductive Endocrinology and Women's Health Laboratory, Clinical Sciences Division Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Mala Thondan
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Monash Health, Melbourne, VIC, Australia.,Harp Family Medical Centre, Kew East, VIC, Australia
| | - Chandrika Wijeyaratne
- Faculty of Medicine, University of Colombo and De Soyza Hospital for Women Colombo, Colombo, Sri Lanka
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Monash Health, Melbourne, VIC, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Monash Health, Melbourne, VIC, Australia
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4
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Teede H, Tassone EC, Piltonen T, Malhotra J, Mol BW, Peña A, Witchel SF, Joham A, McAllister V, Romualdi D, Thondan M, Costello M, Misso ML. Effect of the combined oral contraceptive pill and/or metformin in the management of polycystic ovary syndrome: A systematic review with meta-analyses. Clin Endocrinol (Oxf) 2019; 91:479-489. [PMID: 31087796 DOI: 10.1111/cen.14013] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/08/2019] [Accepted: 05/12/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) has a prevalence of 8%-13%. Given the prevalence, diverse health impacts and variation in care, rigorous evidence-based guidelines are needed in PCOS management. This systematic review with meta-analyses aimed to investigate the effect of the combined oral contraceptive pill (COCP) and/or metformin in the management of hormonal and clinical features of PCOS, to inform international guidelines. METHODS Electronic databases were searched systematically from inception until 11 January 2017 to inform the guideline process. Eligible studies were randomized controlled trials which investigated the effect of COCPs and/or metformin alone or combined on hormonal and clinical features in women with PCOS. Outcomes were prioritized as critical for informing a decision about an intervention or important or not important, according to GRADE. Articles were assessed by one author against selection criteria, in consultation with a second author. Data were double extracted independently by four authors, and data quality appraisal was completed. Meta-analyses were conducted, where appropriate. RESULTS Fifty-six studies were eligible for inclusion. Outcomes prioritized by women and health professionals included the following: irregular cycles, insulin resistance, weight, BMI, thromboembolic events and gastrointestinal effects. In low-quality evidence in adolescents, meta-analyses demonstrated that metformin was better than COCP for BMI (mean difference [MD] -4.02 [-5.23, -2.81], P < 0.001); COCP was better than metformin for menstrual regulation (MD -0.19 [-0.25, -0.13], P < 0.00001). In low-quality evidence in adults, meta-analyses demonstrated that metformin was better than placebo for BMI (MD -0.48 [-0.94, -0.02], P = 0.04); metformin was better than COCP for fasting insulin (MD 4.00 [2.59, 5.41], P = 0.00001), whereas COCP was better than metformin for irregular cycles (MD 12.49 [1.34, 116.62], P = 0.03). Combined oral contraceptive pill alone was better than the combination with an anti-androgen for BMI (MD -3.04 [-5.45, -0.64], P = 0.01). Metformin was associated with generally mild gastrointestinal adverse events. Differences in statistical significance were observed when outcomes were subgrouped by BMI. CONCLUSIONS This review identified that COCP therapy has benefits for management of hyperandrogenism and menstrual regulation. Metformin combined with the COCP may be useful for management of metabolic features. There is minimal evidence of benefits of adding an anti-androgen to COCP therapy. Metformin alone has benefits for adult women for management of weight, hormonal and metabolic outcomes, especially for women with BMI ≥ 25 kg/m2 . There is inadequate evidence to suggest the optimal COCP formulation, or dosing regimen and formulation of metformin.
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Affiliation(s)
- Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Department of Diabetes and Vascular Medicine, Monash Health, Clayton, Victoria, Australia
| | - Eliza C Tassone
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Terhi Piltonen
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Jaideep Malhotra
- Rainbow Hospital & Malhotra Nursing and Maternity Home, Agra, India
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Alexia Peña
- Discipline of Paediatrics, Endocrinology and Diabetes Department, Women's and Children's Hospital, The University of Adelaide and Robinson Research Institute, North Adelaide, South Australia, Australia
| | - Selma F Witchel
- Peadiatric Endocrinology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anju Joham
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Department of Diabetes and Vascular Medicine, Monash Health, Clayton, Victoria, Australia
| | - Veryan McAllister
- Polycystic Ovary Association of Australia, Sydney, New South Wales, Australia
| | - Daniela Romualdi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Mala Thondan
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- HARP Family Medical, Kew, Victoria, Australia
| | - Michael Costello
- University of New South Wales, Sydney, New South Wales, Australia
| | - Marie L Misso
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
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5
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Costello MF, Misso ML, Balen A, Boyle J, Devoto L, Garad RM, Hart R, Johnson L, Jordan C, Legro RS, Norman RJ, Moran L, Mocanu E, Qiao J, Rodgers RJ, Rombauts L, Tassone EC, Thangaratinam S, Vanky E, Teede HJ. A brief update on the evidence supporting the treatment of infertility in polycystic ovary syndrome. Aust N Z J Obstet Gynaecol 2019; 59:867-873. [DOI: 10.1111/ajo.13051] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 08/05/2019] [Indexed: 01/19/2023]
Affiliation(s)
| | - Marie L. Misso
- National Health and Medical Research Council Centre for Research Excellence in PCOS Monash University Melbourne Victoria Australia
- Adelaide University Adelaide South Australia Australia
- Monash Centre for Health Research and Implementation Monash Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
- Monash Health Melbourne Victoria Australia
| | - Adam Balen
- Leeds Fertility Leeds Teaching Hospitals London UK
| | - Jacqueline Boyle
- Monash Centre for Health Research and Implementation Monash Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
- Monash Health Melbourne Victoria Australia
| | - Luigi Devoto
- Faculty of Medicine University of Chile Santiago de Chile Chile
| | - Rhonda M. Garad
- Monash Centre for Health Research and Implementation Monash Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
- Monash Health Melbourne Victoria Australia
| | - Roger Hart
- Division of Obstetrics and Gynaecology University of Western Australia Perth Western Australia Australia
| | - Louise Johnson
- Victorian Assisted Reproductive Treatment Authority Melbourne Victoria Australia
| | - Cailin Jordan
- Genea Hollywood Fertility Perth Western Australia Australia
| | - Richard S. Legro
- Department of Obstetrics and Gynecology Penn State College of Medicine Hershey PA USA
| | - Rob J. Norman
- National Health and Medical Research Council Centre for Research Excellence in PCOS Monash University Melbourne Victoria Australia
- Adelaide University Adelaide South Australia Australia
- Robinson Research Institute University of Adelaide and Fertility SA Adelaide South Australia Australia
| | - Lisa Moran
- National Health and Medical Research Council Centre for Research Excellence in PCOS Monash University Melbourne Victoria Australia
- Adelaide University Adelaide South Australia Australia
- Monash Centre for Health Research and Implementation Monash Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
- Monash Health Melbourne Victoria Australia
| | - Edgar Mocanu
- Royal College of Surgeons Rotunda Hospital Dublin Ireland
| | - Jie Qiao
- Department of Obstetrics and Gynaecology Medical Center for Human Reproduction Peking University Third Hospital Beijing China
| | - Ray J. Rodgers
- Robinson Research Institute The University of Adelaide Adelaide South Australia Australia
| | - Luk Rombauts
- Department of Obstetrics and Gynaecology Monash University Melbourne Victoria Australia
| | - Eliza C. Tassone
- Monash Centre for Health Research and Implementation Monash Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
- Monash Health Melbourne Victoria Australia
| | - Shakila Thangaratinam
- Barts Research Centre for Women's Health (BARC) Barts and The London School of Medicine and Dentistry Queen Mary University of London London UK
| | - Eszter Vanky
- Department of Clinical and Molecular Medicine Norwegian University of Science and Technology Trondheim Norway
| | - Helena J. Teede
- Monash Centre for Health Research and Implementation Monash Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
- Monash Health Melbourne Victoria Australia
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6
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Teede H, Misso M, Tassone EC, Dewailly D, Ng EH, Azziz R, Norman RJ, Andersen M, Franks S, Hoeger K, Hutchison S, Oberfield S, Shah D, Hohmann F, Ottey S, Dabadghao P, Laven JSE. Anti-Müllerian Hormone in PCOS: A Review Informing International Guidelines. Trends Endocrinol Metab 2019; 30:467-478. [PMID: 31160167 DOI: 10.1016/j.tem.2019.04.006] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 04/16/2019] [Accepted: 04/22/2019] [Indexed: 12/27/2022]
Abstract
Polycystic ovary syndrome (PCOS) affects 8-13% of women. The Rotterdam diagnostic criteria include polycystic ovarian morphology (PCOM) on ultrasound, but given recognized challenges, serum anti-Müllerian hormone (AMH) is proposed as an alternative. To inform international PCOS guidelines, a systematic review was completed. Key identified gaps include large international studies in well-defined populations across the lifespan, clustering of AMH with PCOS features, relationships to long-term health outcomes, and improved quality, assay standardization, and sample handling, all needed to determine cut offs. Here we identify research priorities to address these gaps and enhance AMH utility in PCOS. Once issues are addressed, AMH levels could replace more costly and less accessible ultrasound in PCOS diagnosis.
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Affiliation(s)
- Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University and Monash Health, Locked Bag 29, Clayton, VIC 3168, Australia.
| | - Marie Misso
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University and Monash Health, Locked Bag 29, Clayton, VIC 3168, Australia
| | - Eliza C Tassone
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University and Monash Health, Locked Bag 29, Clayton, VIC 3168, Australia
| | | | - Ernest Hy Ng
- Department of Obstetrics and Gynaecology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ricardo Azziz
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, SUNY, Albany, NY 12144, USA
| | - Robert J Norman
- Robinson Research Institute, University of Adelaide and Fertility SA, Adelaide, SA, Australia
| | - Marianne Andersen
- Department of Endocrinology, Odense University Hospital, Clinical Institute, University of Southern Denmark, 5000 Odense C, Denmark
| | - Stephen Franks
- Imperial College London, Institute of Reproductive and Developmental Biology, Hammersmith Hospital, London W12 0NN, UK
| | - Kathleen Hoeger
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Rochester, Rochester, NY 14642, USA
| | - Samantha Hutchison
- Diabetes and Endocrine Units, Monash Health, Clayton, VIC 3168, Australia
| | - Sharon Oberfield
- Department of Pediatrics, Division of Endocrinology, Diabetes, and Metabolism, Columbia University Medical Center, New York, NY 10032, USA
| | - Duru Shah
- Gynaecworld, Center for Women's Health and Fertility, Maharashtra 400036, India
| | - Femke Hohmann
- Huisartsenpraktijk Hohmann & De Vet, Rotterdam 3061, The Netherlands
| | - Sasha Ottey
- PCOS Challenge, Inc., 931 Monroe Drive, NE Suite A-470 Atlanta, GA 30308, USA
| | - Preeti Dabadghao
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow 226014, India
| | - Joop S E Laven
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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7
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Costello MF, Misso ML, Balen A, Boyle J, Devoto L, Garad RM, Hart R, Johnson L, Jordan C, Legro RS, Norman RJ, Mocanu E, Qiao J, Rodgers RJ, Rombauts L, Tassone EC, Thangaratinam S, Vanky E, Teede HJ. Evidence summaries and recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome: assessment and treatment of infertility. Hum Reprod Open 2019; 2019:hoy021. [PMID: 31486807 PMCID: PMC6396642 DOI: 10.1093/hropen/hoy021] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 12/13/2018] [Indexed: 12/12/2022] Open
Abstract
STUDY QUESTION What is the recommended assessment and management of infertile women with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertize and consumer preference? SUMMARY ANSWER International evidence-based guidelines, including 44 recommendations and practice points, addressed prioritized questions to promote consistent, evidence-based care and improve the experience and health outcomes of infertile women with PCOS. WHAT IS KNOWN ALREADY Previous guidelines on PCOS lacked rigorous evidence-based processes, failed to engage consumer and multidisciplinary perspectives or were outdated. The assessment and management of infertile women with PCOS are inconsistent. The needs of women with PCOS are not being adequately met and evidence practice gaps persist. PARTICIPANTS/MATERIALS, SETTING, METHODS Governance included a six continent international advisory and a project board, a multidisciplinary international guideline development group (GDG), consumer and translation committees. Extensive health professional and consumer engagement informed the guideline scope and priorities. The engaged international society-nominated panel included endocrinology, gynaecology, reproductive endocrinology, obstetrics, public health and other experts, alongside consumers, project management, evidence synthesis and translation experts. Thirty-seven societies and organizations covering 71 countries engaged in the process. Extensive online communication and two face-to-face meetings over 15 months addressed 19 prioritized clinical questions involving nine evidence-based reviews and 10 narrative reviews. Evidence-based recommendations (EBRs) were formulated prior to consensus voting within the guideline panel. STUDY DESIGN, SIZE, DURATION International evidence-based guideline development engaged professional societies and consumer organizations with multidisciplinary experts and women with PCOS directly involved at all stages. A (AGREE) II-compliant processes were followed, with extensive evidence synthesis. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was applied across evidence quality, desirable and undesirable consequences, feasibility, acceptability, cost, implementation and ultimately recommendation strength. The guideline was peer-reviewed by special interest groups across our partner and collaborating societies and consumer organizations, was independently assessed against AGREE II criteria and underwent methodological review. This guideline was approved by all members of the GDG and has been approved by the NHMRC. MAIN RESULTS AND THE ROLE OF CHANCE The quality of evidence (QOE) for the EBRs in the assessment and management of infertility in PCOS included very low (n = 1), low (n = 9) and moderate (n = 4) quality with no EBRs based on high-quality evidence. The guideline provides 14 EBRs, 10 clinical consensus recommendations (CCRs) and 20 clinical practice points on the assessment and management of infertility in PCOS. Key changes in this guideline include emphasizing evidence-based fertility therapy, including cheaper and safer fertility management. LIMITATIONS, REASONS FOR CAUTION Overall evidence is generally of low to moderate quality, requiring significantly greater research in this neglected, yet common condition. Regional health systems vary and a process for adaptation of this guideline is provided. WIDER IMPLICATIONS OF THE FINDINGS The international guideline for the assessment and management of infertility in PCOS provides clinicians with clear advice on best practice based on the best available evidence, expert multidisciplinary input and consumer preferences. Research recommendations have been generated and a comprehensive multifaceted dissemination and translation program supports the guideline with an integrated evaluation program. STUDY FUNDING/COMPETING INTEREST(S) The guideline was primarily funded by the Australian National Health and Medical Research Council of Australia (NHMRC) supported by a partnership with ESHRE and the American Society for Reproductive Medicine (ASRM). GDG members did not receive payment. Travel expenses were covered by the sponsoring organizations. Disclosures of conflicts of interest were declared at the outset and updated throughout the guideline process, aligned with NHMRC guideline processes. Dr Costello has declared shares in Virtus Health and past sponsorship from Merck Serono for conference presentations. Prof. Norman has declared a minor shareholder interest in the IVF unit Fertility SA, travel support from Merck and grants from Ferring. Prof. Norman also has scientific advisory board duties for Ferring. The remaining authors have no conflicts of interest to declare. This article was not externally peer-reviewed by Human Reproduction Open.
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Affiliation(s)
- M F Costello
- School of Women's and Children's Health, University of New South Wales, High St, Kensington, Sydney, New South Wales, Australia
| | - M L Misso
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Monash Health, Clayton, Melbourne, Australia
| | - A Balen
- Reproductive Medicine and Surgery, Leeds Centre for Reproductive Medicine, Leeds Teaching Hospitals, Leeds, UK
| | - J Boyle
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Monash Health, Clayton, Melbourne, Australia
| | - L Devoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Chile, Santiago, Chile
| | - R M Garad
- Monash Health, Clayton, Melbourne, Australia.,National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - R Hart
- Division of Obstetrics and Gynaecology, University of Western Australia, Crawley, WA, Australia
| | - L Johnson
- Victorian Assisted Reproductive Treatment Authority, Victoria, Australia
| | - C Jordan
- Victorian Assisted Reproductive Treatment Authority, Victoria, Australia.,Genea Hollywood Fertility, 190 Cambridge St, Wembley WA, Australia
| | - R S Legro
- Department of Obstetrics and Gynecology, Penn State University College of Medicine, USA
| | - R J Norman
- National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash University, Melbourne, Victoria, Australia.,Adelaide University, Adelaide, South Australia, Australia
| | - E Mocanu
- Royal College of Surgeons, Rotunda Hospital, 123 St Stephen's Green, Dublin, Ireland
| | - J Qiao
- Peking University Third Hospital, Haidian Qu, Beijing Shi, China
| | - R J Rodgers
- Robinson Research Institute, University of Adelaide and Fertility SA, Adelaide, South Australia, Australia
| | - L Rombauts
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Melbourne, Victoria 3168, Australia
| | - E C Tassone
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Monash Health, Clayton, Melbourne, Australia
| | - S Thangaratinam
- Barts Research Centre for Women's Health (BARC), Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - E Vanky
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - H J Teede
- Monash Health, Clayton, Melbourne, Australia.,National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Victoria, Australia
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8
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Gibson-Helm M, Tassone EC, Teede HJ, Dokras A, Garad R. The Needs of Women and Healthcare Providers regarding Polycystic Ovary Syndrome Information, Resources, and Education: A Systematic Search and Narrative Review. Semin Reprod Med 2018; 36:35-41. [PMID: 30189449 DOI: 10.1055/s-0038-1668086] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This article aims to identify and summarize the information, resource, and education needs of women with polycystic ovary syndrome (PCOS) and their healthcare providers. A systematic search of peer-reviewed, primary research literature was conducted. A total of 4,230 articles were identified, duplicates were removed, as well as the title and abstract of 2,819 studies and the full texts of 123 studies were screened against predetermined inclusion criteria. Findings from 35 included studies are described narratively. Main outcome measures include women's perceived needs for, and experiences of, PCOS care and information; healthcare providers' delivery of PCOS care and information; and healthcare providers' perceived needs for PCOS information, education programs, or professional development. There is a wealth of literature informing how PCOS information, education, and resources can better meet the needs of women, and about the role women expect healthcare providers to play in providing information within optimal PCOS care. However, few studies evaluate how well existing resources meet women's diverse needs. There is growing indirect evidence about the information and education needed by healthcare providers to provide best-practice PCOS care. However, little research has directly investigated healthcare providers' information needs or efficacy of PCOS-specific educational programs for healthcare providers. PCOS resources for women should be comprehensive, evidence-based, include the bio-psychosocial dimensions of the condition, and available through a variety of modes. The range of healthcare providers that women may seek care from need resources to support consistent use of the recommended diagnostic criteria, effective recommendation of lifestyle management, and early detection and treatment of symptoms and complications.
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Affiliation(s)
- Melanie Gibson-Helm
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Eliza C Tassone
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Anuja Dokras
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rhonda Garad
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
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9
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Zorbas C, McCartan J, De Mel R, Narendra K, Tassone EC, Yin E, Palermo C. Engaging a disadvantaged community with a fruit and vegetable box scheme. Health Promot J Austr 2018; 29:108-110. [PMID: 29700940 DOI: 10.1002/hpja.28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 12/18/2017] [Indexed: 11/09/2022] Open
Abstract
ISSUE ADDRESSED Interventions which target the determinants of unhealthy diets are required to promote healthy eating and reduce the burdens of diet-related diseases such as cardiovascular disease, diabetes and some cancers. METHODS Qualitative interviews (n = 12) were conducted to explore the perspectives and experiences of local stakeholders regarding the implementation and uptake of a healthy eating initiative (a fruit and vegetable box scheme) in a disadvantaged, regional community. RESULTS Factors affecting the community's engagement included marketing strategies, customer experiences, a community-centred approach, partnerships and logistics. CONCLUSIONS Community engagement is often essential for an intervention to be effective. The factors which influence community engagement should be considered during planning, especially when targeting disadvantaged groups. SO WHAT?: Behavioural change interventions may continue to be met with limited success if community engagement and the overarching structural barriers to healthy eating are not addressed.
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Affiliation(s)
- Christina Zorbas
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia
| | - Julia McCartan
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia
| | - Randini De Mel
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia
| | - Karthika Narendra
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia
| | - Eliza C Tassone
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia
| | - Ebony Yin
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia
| | - Claire Palermo
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia
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10
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Tassone EC, Tovey JA, Paciepnik JE, Keeton IM, Khoo AY, Van Veenendaal NG, Porter J. Should we implement mealtime assistance in the hospital setting? A systematic literature review with meta-analyses. J Clin Nurs 2015; 24:2710-21. [PMID: 26234815 DOI: 10.1111/jocn.12913] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2015] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES This review aimed to determine the effect of mealtime assistance provided to hospitalised patients (≥65 years) by nurses, trained staff or volunteers on nutritional and anthropometric outcomes. BACKGROUND Malnutrition is a critical issue in hospitals with a reported prevalence of 20-50%. Nutritional supplementation has been associated with increased weight gain, improved function and decreased mortality; however, other system approaches including mealtime assistance may also contribute to improving nutritional intake. DESIGN A systematic literature review. METHODS Six electronic databases (CINAHL Plus, Cochrane Library, ProQuest Nursing and Allied Health Source, Scopus, PsycINFO and MEDLINE) were searched from their inception to August 2014. Inclusion criteria were hospitalised patients ≥65 years, provided mealtime assistance by nurses, volunteers or trained staff. Studies were examined for quality and risk of bias. Outcome data were combined narratively and by meta-analyses. RESULTS From 5458 publications, five studies met the inclusion criteria. Studies were rated neutral and positive according to the Academy of Nutrition and Dietetics Quality Checklist. Adherence to study protocols was not always reported. Meta-analyses demonstrated significantly greater daily energy and protein intake where mealtime assistance was provided. Anthropometric outcomes generally did not differ significantly with mealtime assistance. Observation and sampling bias were noted in several studies. CONCLUSIONS There is evidence that mealtime assistance increases daily energy and protein intake in hospitalised patients (≥65 years). More robust research is needed to elucidate whether this strategy may be an effective means of addressing the high prevalence of malnutrition in hospitals. RELEVANCE TO CLINICAL PRACTICE The evidence identified suggests that mealtime assistance provided to hospitalised older patients (≥65 years) leads to a statistically significant increase in energy and protein intake. For many patients, this increase in both energy and protein intake will be clinically significant, reducing the gap between requirements and actual intake.
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