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Polycystic Ovarian Syndrome [keywords]
- Carotid intima-media thickness in mainly non-obese women with polycystic ovary syndrome and age-matched controls. [JOURNAL ARTICLE]
- Obstet Gynecol Sci 2013 Jul; 56(4):249-255.
Metabolic disturbances are well-recognized clinical features of polycystic ovary syndrome (PCOS). Carotid intima-media thickness (CIMT) has been widely used as a surrogate marker of atherosclerosis and cardiovascular disease (CVD). CIMT in women with PCOS has been investigated in many studies, but there has been only one report in the Korean population. The aim of the present study was to compare the presence of subclinical atherosclerosis in young untreated Korean women with PCOS and age-matched controls, specifically by measuring their CIMT.CIMT was measured by one radiologist in 56 PCOS patients and 56 controls. To compare the CIMT according to PCOS phenotypes, women with PCOS were divided into two subgroups according to the presence of hyperandrogenism.Although PCOS patients were more obese and had higher blood pressure and insulin resistance index than the age-matched controls, the CIMT was not different between the two groups (0.49 ± 0.09 mm in PCOS patients vs. 0.50 ± 0.11 mm in controls, respectively, p = 0.562). When the CIMT in the control group was compared with hyperandrogenic and non-hyperandrogenic PCOS groups, also no significant differences were found.Despite the significant differences in some vascular risk factors between women with PCOS and controls, PCOS patients did not have a significantly higher CIMT (even in the hyperandrogenic subgroups). Although our study did not show the increased risk of subclinical atherosclerosis in PCOS patients, the role of CIMT continues to be investigated considering the importance of screening and monitoring CVD risk factors in women with PCOS.
- Dyslipidemia in women with polycystic ovary syndrome. [REVIEW]
- Obstet Gynecol Sci 2013 May; 56(3):137-142.
Dyslipidemia is a very common metabolic abnormality in women with polycystic ovary syndrome (PCOS). Insulin resistance is a key pathophysiology of PCOS, thus dyslipidemia in women with PCOS may be consistent with those found in an insulin resistant state. In recent meta-analysis, triglycerides and low-density lipoprotein (LDL) cholesterol levels were 26 mg/dL and 12 mg/dL higher, and high-density lipoprotein cholesterol concentration was 6 mg/dL lower in women with PCOS than those of controls. Alterations in LDL quality also have been reported in women with PCOS: women with PCOS have an increased proportion of atherogenic small dense LDL or decreased mean LDL particle size. However, in a recent Korean study, non-obese Korean women with PCOS had no significant quantitative or qualitative changes in LDL cholesterol profile. Lipoprotein (a) has been identified as an independent risk factor for coronary heart disease, and its elevation in PCOS patients has been consistently reported in diverse studies including non-obese Korean population. Some studies have investigated apolipoprotein (Apo) A-I and ApoC-I levels in women with PCOS and levels of ApoA-I, which has cardio-protective effects, were significantly lower in women with PCOS than those of controls. ApoC-I is known to increase the postprandial serum lipid level that is common in coronary artery disease patients, and one study reported that such an elevation may be the earliest variation of lipid abnormality in women with PCOS. In conclusion, women with PCOS should receive a complete lipid test, and lifestyle modification, including diet and exercise, is the first line therapy for all women with PCOS and is particularly important for those with dyslipidemia.
- Uterine Volume and Endometrial Thickness in the Early Follicular Phase in Patients with Polycystic Ovary Syndrome. [JOURNAL ARTICLE]
- Endocr Pract 2013 Dec 10.:1-23.
Objective: We aimed to evaluate uterine volume and endometrial thickness, in the early follicular phase, in patients with polycystic ovary syndrome (PCOS) and in healthy controls.Methods: We studied 1,016 PCOS patients and 182 healthy controls. Anthropometric, endocrine and metabolic characteristics of PCOS were determined. Uterine volume and endometrial thickness were also recorded.Results: Uterine volume progressively increased with age both in PCOS patients and controls. Patients with PCOS and body mass index (BMI) ≥25 kg/m2 had greater uterine volume than PCOS patients with BMI <25 kg/m2 (p<0.001). Patients with the classic PCOS phenotypes (i.e. with oligo- and/or anovulation (ANOV) and hyperandrogenemia (HA) with or without polycystic ovaries (PCO)) had smaller uterine volume than PCOS patients with the additional phenotypes introduced by the Rotterdam criteria (i.e. with PCO and either ANOV or HA; p=0.033) and controls (p=0.045).Conclusion: Uterine volume increases progressively with age and obesity in PCOS patients. The smaller uterine volume and endometrial thickness in the classic PCOS phenotypes might be attributed to the more severe HA of these patients.
- Office Blood Pressure, Ambulatory Blood Pressure Monitoring, and Echocardiographic Abnormalities in Women With Polycystic Ovary Syndrome: Role of Obesity and Androgen Excess. [JOURNAL ARTICLE]
- Hypertension 2013 Dec 9.
Whether or not blood pressure (BP) and heart function of women with polycystic ovary syndrome (PCOS) are altered remains unclear, albeit subtle abnormalities in the regulation of BP observed in these women might suggest a mild masculinization of their cardiovascular system. To study the influence of obesity and androgen excess on BP and echocardiographic profiles of women with the syndrome, we conducted a cross-sectional case-control study comparing office and ambulatory BP monitoring, as well as echocardiographic assessments, in 63 premenopausal women with the classic phenotype, 33 nonhyperandrogenic women with regular menses, and 25 young men. Forty-nine subjects were lean and 72 had weight excess (body mass index ≥25 kg/m(2)). Participants had no previous history of hypertension and were nonsmokers. Men showed the highest BP readings, and the lowest readings were observed in control women, whereas women with PCOS had intermediate values. Undiagnosed hypertension was more common in subjects with weight excess irrespective of sex and hyperandrogenism. Women with PCOS and weight excess showed frequencies of previously undiagnosed hypertension that were similar to those of men with weight excess and higher than those observed in nonhyperandrogenic women. Lastly, male sex, weight excess and hypertension, the latter in men as well as in women with PCOS, increased left ventricular wall thickness. In summary, our results show that patients with classic PCOS and weight excess frequently have undiagnosed BP abnormalities, leading to target organ damage.
- The impact of self-reported oligo-amenorrhea and hirsutism on fertility and lifetime reproductive success: results from the Northern Finland Birth Cohort 1966. [JOURNAL ARTICLE]
- Hum Reprod 2013 Dec 8.
To what extent do self-reported oligo-amenorrhea and hirsutism affect reproductive performance (childlessness, age at first delivery, family size and miscarriage rates)?At the age of 44, among women with both self-reported oligo-amenorrhea and hirsutism the prevalence of childlessness was not significantly different from non-symptomatic women but they had a smaller family size than non-symptomatic women.Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by oligo-amenorrhea or amenorrhea, hyperandrogenism and hirsutism and it is the most frequent cause of anovulatory infertility, but there are few studies on the reproductive capacity of women with PCOS. In our previous population-based cohort study the women with self-reported oligo-amenorrhea and hirsutism were found to have more infertility problems and smaller family size than non-symptomatic women at the age of 31.A prospective population-based cohort study. The population of the study is derived from the prospective Northern Finland Birth Cohort 1966 (NFBC1966), comprising all expected births from the year 1966 in the two northernmost provinces of Finland (n = 12 058). Of them, 5889 were females. Enrollment in this database begun at the 24th gestational week and so far data have been collected from the subjects at the ages of 1, 14 and 31 years.A postal questionnaire including questions about oligo-amenorrhea and hirsutism was sent to all women at the age of 31 (n = 5608, response rate 81%, n = 4535) and a clinical examination was performed (attendance rate 76.5%). Those who reported both hirsutism and oligo-amenorrhea were defined as women with both symptoms (n = 153). Data on pregnancies/deliveries were obtained from the Finnish Medical Birth Register (FMBR) in 2010 when the women were 44 years old.Women with both symptoms had delivered at least one child as often as non-symptomatic women [75.2 versus 79.0%, adjusted odds ratio (OR) 0.86, 95% confidence intervals (CI) 0.57-1.30], were of similar age [mean (SD)] at first delivery [27.7 (4.81) versus 27.3 (4.71)] and had similar incidence of miscarriages. However, non-symptomatic women had more often ≥2 deliveries (61.6 versus 52.9%, adjusted OR 0.70, 95% CI 0.49-1.00, P = 0.048) and had larger family size [mean (SD)] [2.4 (1.4) versus 1.9 (0.8), P < 0.001]. Women with both symptoms had been treated more often for infertility than non-symptomatic women (6.1 versus 2.4%, adjusted OR 2.74, 95% CI 1.14-6.60, P = 0.024).The diagnosis of oligo-amenorrhea and hirsutism was based on a questionnaire, suggesting a risk of information bias in reporting the symptoms. However, we have previously shown that self-reported oligo-amenorrhea and hirsutism can distinguish most women with the typical profile of PCOS. Only the women who had delivered at least once were recorded in the FMBR, thus excluding from the study those who had experienced miscarriages and/or infertility treatments but did not have a live birth. This feature could potentially decrease the differences in incidence of miscarriages and/or infertility treatment between symptomatic and non-symptomatic subjects.This is one of the few studies, in which the impact of self-reported oligo-amenorrhea and hirsutism on lifetime reproductive success can be measured. Our results suggest that even at more advanced age, women with both symptoms do not quite match the parity of healthy non-symptomatic women, and that infertility treatment does not always restore normal reproductive capacity in these women. Obese women with both symptoms had the worst prognostic as regards reproduction, which emphasizes the importance of life intervention and preventive politics against obesity in this group of women.This work was supported by grants from the Finnish Medical Society Duodecim, the North Ostrobothnia Regional Fund, the Academy of Finland, University Hospital Oulu, Biocenter, University of Oulu, Finland, the European Commission and the Medical Research Council, UK, the National Institute for Health Research (NIHR). None of the authors has any conflict of interest to declare.
- 2D:4D Ratio in children at familial high-risk for eating disorders: The role of prenatal testosterone exposure. [JOURNAL ARTICLE]
- Am J Hum Biol 2013 Dec 10.
Markers of prenatal hormone exposure have been associated with the development of eating disorder (ED) behaviors. Our aim was to determine whether 2D:4D ratio, a marker for in utero testosterone exposure, is associated with risk for ED in a large population-based cohort: the Avon Longitudinal Study of Parents and Children (ALSPAC). Methods: This is the first study to investigate prenatal testosterone exposure in children at high-risk for ED, using 2D:4D as a marker. We compared children whose mothers reported a lifetime ED (anorexia, bulimia, or both; N = 446) to children whose mothers did not (n = 5,367). Results: Daughters of women with lifetime bulimia nervosa (BN) had lower 2D:4D ratio (B: -0.01, 95% CI: -0.02 to -0.002, P = 0.02), indicating higher prenatal testosterone exposure, than daughters of mothers unaffected by ED. No differences were observed in the male children of women with an ED. Conclusions: Findings suggest that children at high-risk for BN may be exposed to higher levels of testosterone in utero. Fetal exposure to androgen excess is thought to be causal in the development of polycystic ovary syndrome (PCOS), a disorder which is highly comorbid with binge eating and BN. Future research should investigate the potential role of testosterone exposure in utero as a risk factor for BN and binge eating. Am. J. Hum. Biol., 2013. © 2013 Wiley Periodicals, Inc.
- Fowler's syndrome-a cause of unexplained urinary retention in young women? [JOURNAL ARTICLE]
- Nat Rev Urol 2013 Dec 10.
Urinary retention in women is an uncommon and poorly understood condition. In 1986, Fowler and colleagues described a syndrome in young women with unexplained urinary retention associated with polycystic ovary syndrome. The underlying abnormality was a poorly relaxing external urethral sphincter that when studied using concentric needle electromyography showed a distinct abnormal pattern suggesting direct spread of impulses between muscle fibres. These findings were subsequently reproduced by other researchers and in larger patient cohorts, but remain the subject of much debate. A poorly relaxing sphincter is thought to cause increased urethral afferent activity, which inhibits bladder afferent signalling leading to poor bladder sensation and detrusor underactivity. Most studies of Fowler's syndrome are limited due to small cohorts with no control group and a lack of videourodynamic data. Whether Fowler's syndrome represents a distinct cause of urinary retention or results from a maladaptive behaviour and is similar to dysfunctional voiding is unclear. Application of sacral neuromodulation in patients diagnosed with Fowler's syndrome can restore normal voiding, in the absence of any effective pharmacotherapy or surgical treatment.
- Metabolic Syndrome and Non-Cardiac Vascular Diseases: an Update from Human Studies. [JOURNAL ARTICLE]
- Curr Pharm Des 2013 Dec 5.
The metabolic syndrome (MetS) is characterized by a cluster of risk factors including central obesity, hypertension, dyslipidemia and insulin resistance, The MetS is associated with an increased risk for cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). Several international organizations have defined MetS using different diagnostic criteria that produced discrepancies in the results of previous studies, thus leading to the latest Joint Interim Societies (JIS) MetS definition. Other risk factors than the diagnostic criteria that have been associated with MetS include lipid abnormalities, uric acid, liver function, prothrombotic factors, cytokines, adipokines, vitamin D, arterial stiffness, polycystic ovary syndrome and obstructive sleep apnea. Apart from CVD and T2DM, MetS has been related to non-cardiac vascular diseases and in particular to stroke, carotid artery disease, peripheral artery disease, chronic kidney disease, atherosclerotic renal artery stenosis and abdominal aortic aneurysms. In this narrative review, the associations of these diseases with MetS and its components will be discussed. These associations may further increase CVD risk in MetS patients, highlighting the importance of treating such high-risk individuals early and "to target". In this context, multifactorial treatment including a statin has been proven beneficial, and thus should be considered, in MetS patients.
- Can Sex-hormone Binding Globulin Considered as a Predictor of Response to Pharmacological Treatment in Women with Polycystic Ovary Syndrome? [JOURNAL ARTICLE]
- Int J Prev Med 2013 Oct; 4(10):1169-1174.
This study aims to evaluate the sex hormone binding globulin (SHBG) level as a predictor of response to pharmacological treatment in women with polycystic ovary syndrome (PCOS).This study was conducted in 2009-2012 in Isfahan, Iran. Anovulatory women with a diagnosis of PCOSwere studied. Metformin was started at 500 mg three times a day. If no ovulation occurred, Clomiphene citrate was added.The study comprised273 infertile women with PCOS completed the study, 75 (28%) of them became pregnant 6 months after treatment (7.36% with metformin and 20.14% with metformin and clomiphene citrate). Patients who responded to metformin treatment had significantly lower mean SHBG levels compared to those who did not (0.88+0.32vs. 0.2642+0.44 nmol/L, respectively, P<0.0001). The area under the ROC curve (AUC) for prediction the response to treatment was 0.85. The baseline level of 27was the most appropriate cut of point HSBG for the prediction of conception. HSBG had a sensitivity of 88%, and specificity of 73.6%. It had a false positive level of 26.4% and false negative level of 12%. Its positive predictive value was 56.4% and its negative predictive value was 94%. The chance of conception increased for reducing a unit of fpg (OR = 0.69; 95% CI = 0.54-0.86; P = .002), as well as reducing of every unit of HSBG (OR = 0.47; 95% CI = 0.39-0.56; P <0.001), and for reducing each unit of insulin in (OR = 0.082; 95% CI = 1.021-0.33; P <0.001).HSBG test is suggested as an appropriate test for predicting pregnancy achievement of PCOs women after pharmacological treatment.
- Risk factors for endometrial cancer. [JOURNAL ARTICLE]
- Ceska Gynekol 2013; 78(5):448-459.
Endometrial cancer is the most common malignancy of women in developed countries, and its incidence is rising among pre- and postmenopausal women. In developed and numerous developing countries endometrial cancer, as well as other types of female cancers are an ever-increasing threat that may be explained, among other reasons, by increased life expectancy and changes in lifestyle factors. Endometrial cancer is more common in postmenopausal women than in premenopausal women. Through a review of the literature it was found that the risk of endometrial cancer is positively correlated with older age, early menarche & late menopause, obesity, family history of endometrial cancer (especially among close relatives), radiation exposure, and infertility particularly in the presence of Polycystic Ovarian Syndrome. Long-term use of unopposed oestrogens for hormone replacement therapy also increases the risk of endometrial cancer. Caucasians have a higher incidence of endometrial cancer than African or Asian women. Obese women were found to be at high risk for developing endometrial cancer, while diabetes, hypertension, and geographical and socioeconomic factors are still inconclusive. Finally, smoking is considered as a protective factor against endometrial cancer due to its anti- estrogenic effect. .Keywords: endometrial cancer - older age - race - early menarche - late menopause - obesity - null parity - tamoxifen.