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Waldrop SW, Buenaventura M, Campoverde Reyes KJ, Stanford FC. Disparities in the Diagnosis and Management of Polycystic Ovarian Syndrome in Adolescents. Endocrinol Metab Clin North Am 2025; 54:233-250. [PMID: 40348565 DOI: 10.1016/j.ecl.2025.02.016] [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] [Indexed: 05/14/2025]
Abstract
Addressing polycystic ovary syndrome health disparities requires increasing provider index of suspicion; eliminating implicit bias in diagnosis; making specialty level care accessible to all; establishing a framework of multidisciplinary management and multisectoral care provision that emphasizes longitudinal sustainable lifestyle modifications; and educating and empowering the patient.
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Affiliation(s)
- Stephanie W Waldrop
- Division of Clinical Sciences, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA; Section on Nutrition, Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Nutrition Obesity Research Center (NORC) - University of Colorado, Aurora, CO, USA.
| | - Michaela Buenaventura
- Section on Pediatric Endocrinology, Department of Pediatrics, Children's Hospital of Colorado, University of Colorado Anschutz Medical Campus, 13123 East 16th Avenue Box B265, Aurora, CO 80045, USA
| | - Karen J Campoverde Reyes
- Pediatric Residency Program, Yale School of Medicine, Department of Pediatrics, 330 Cedar Street, LMP 5039, New Haven, CT 06520, USA
| | - Fatima Cody Stanford
- Obesity Medicine, Department of Internal Medicine and Pediatrics, MGH Weight Center, Massachusetts General Hospital; Division of Endocrinology, Department of Medicine, Nutrition Obesity Research Center at Harvard (NORCH), 50 Staniford Street, Suite 430, Boston, MA 02114, USA; Division of Neuroendocrine, Department of Medicine, Nutrition Obesity Research Center at Harvard (NORCH), Boston, MA, USA; Division of Endocrinology, Department of Pediatrics, Nutrition Obesity Research Center at Harvard (NORCH), Boston, MA, USA
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Silva EL, Lane KJ, Cheng JJ, Popp Z, van Loenen BD, Coull B, Hart JE, James-Todd T, Mahalingaiah S. Polycystic Ovary Syndrome Underdiagnosis Patterns by Individual-level and Spatial Social Vulnerability Measures. J Clin Endocrinol Metab 2025; 110:1657-1666. [PMID: 39394785 PMCID: PMC12086426 DOI: 10.1210/clinem/dgae705] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 08/06/2024] [Accepted: 10/10/2024] [Indexed: 10/14/2024]
Abstract
OBJECTIVE To use electronic health records (EHR) data at Boston Medical Center (BMC) to identify individual-level and spatial predictors of missed diagnosis, among those who meet diagnostic criteria for polycystic ovary syndrome (PCOS). METHODS The BMC Clinical Data Warehouse was used to source patients who presented between October 1, 2003, and September 30, 2015, for any of the following: androgen blood tests, hirsutism, evaluation of menstrual regularity, pelvic ultrasound for any reason, or PCOS. Algorithm PCOS cases were identified as those with International Classification of Diseases (ICD) codes for irregular menstruation and either an ICD code for hirsutism, elevated testosterone lab, or polycystic ovarian morphology as identified using natural language processing on pelvic ultrasounds. Logistic regression models were used to estimate odds ratios (ORs) of missed PCOS diagnosis by age, race/ethnicity, education, primary language, body mass index, insurance type, and social vulnerability index (SVI) score. RESULTS In the 2003-2015 BMC-EHR PCOS at-risk cohort (n = 23 786), there were 1199 physician-diagnosed PCOS cases and 730 algorithm PCOS cases. In logistic regression models controlling for age, year, education, and SVI scores, Black/African American patients were more likely to have missed a PCOS diagnosis (OR = 1.69 [95% CI, 1.28, 2.24]) compared to non-Hispanic White patients, and relying on Medicaid or charity for insurance was associated with an increased odds of missed diagnosis when compared to private insurance (OR = 1.90 [95% CI, 1.47, 2.46], OR = 1.90 [95% CI, 1.41, 2.56], respectively). Higher SVI scores were associated with increased odds of missed diagnosis in univariate models. CONCLUSION We observed individual-level and spatial disparities within the PCOS diagnosis. Further research should explore drivers of disparities for earlier intervention.
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Affiliation(s)
- Emily L Silva
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Kevin J Lane
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA
| | - Jay Jojo Cheng
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI 53726, USA
| | - Zachary Popp
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA
| | - Breanna D van Loenen
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA
| | - Brent Coull
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Jaime E Hart
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Tamarra James-Todd
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Shruthi Mahalingaiah
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA 02114, USA
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Basak S, Dixit AK, Dey RK, Puia L, Bora M, Kumar Y R S, Babu G. An endocrinological perspective on polycystic ovarian syndrome. Mol Cell Endocrinol 2025; 602:112524. [PMID: 40147712 DOI: 10.1016/j.mce.2025.112524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2024] [Revised: 03/04/2025] [Accepted: 03/24/2025] [Indexed: 03/29/2025]
Abstract
Polycystic ovarian syndrome (PCOS) is a complex endocrinological disorder that involves dysfunctions across multiple endocrine axes, including the hypothalamic-pituitary-gonadal (HPG), hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-thyroid (HPT) axes. Our review focuses on understanding the pathophysiology of PCOS through an endocrinological perspective, emphasizing the complex interactions between multiple endocrine axes. We have discussed the roles of the HPG, HPA, and HPT axes in PCOS. Dysregulation of the HPG axis, particularly the altered gonadotropin-releasing hormone pulse frequency resulting in elevated ratio of luteinizing hormone to follicle stimulating hormone, is central to the hyperandrogenism and anovulation, observed in PCOS. We have further highlighted the contributions of the HPA and HPT axes, where elevated adrenal androgen levels and hypothyroidism intensifies the phenotypes of PCOS. Additionally, insulin resistance and hyperinsulinemia, commonly associated with PCOS, aggravates hormonal disturbances and heighten the risk of metabolic complications such as type 2 diabetes and cardiovascular diseases. Elevated levels of anti-Müllerian hormone have also been emphasized as a key factor in inhibiting follicular growth, leading to impaired ovarian function and hyperandrogenism. This review further supports that PCOS is a multifactorial condition involving complex feedback mechanisms between the endocrine, metabolic, and reproductive systems. Furthermore, there remains a huge scope for deciphering the precise molecular interactions between the HPG, HPA, and HPT axes in PCOS, which could pave the way for targeted therapies for better management of both the endocrine and metabolic aspects of this disorder. This review will benefit researchers to get an endocrine perspective on PCOS.
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Affiliation(s)
- Smarto Basak
- Central Ayurveda Research Institute, Central Council for Research in Ayurvedic Sciences, Ministry of AYUSH, Government of India, Kolkata, West Bengal, India
| | - Amit Kumar Dixit
- Central Ayurveda Research Institute, Central Council for Research in Ayurvedic Sciences, Ministry of AYUSH, Government of India, Kolkata, West Bengal, India.
| | - Ranjit Kumar Dey
- Central Ayurveda Research Institute, Central Council for Research in Ayurvedic Sciences, Ministry of AYUSH, Government of India, Kolkata, West Bengal, India
| | - Lalrin Puia
- Central Ayurveda Research Institute, Central Council for Research in Ayurvedic Sciences, Ministry of AYUSH, Government of India, Kolkata, West Bengal, India
| | - Manajit Bora
- Central Ayurveda Research Institute, Central Council for Research in Ayurvedic Sciences, Ministry of AYUSH, Government of India, Guwahati, Assam, India
| | - Sanjay Kumar Y R
- Central Council for Research in Ayurvedic Sciences, Ministry of AYUSH, Government of India, Janakpuri, New Delhi, India
| | - Gajji Babu
- Central Ayurveda Research Institute, Central Council for Research in Ayurvedic Sciences, Ministry of AYUSH, Government of India, Kolkata, West Bengal, India
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Areloegbe SE, Atuma CL, Aturamu A, Ajadi IO, Adelekan OE, Ajadi MB, Akintayo CO, Omoruyi GO, Onyekweli SO, Anifowose OF, Amusa OA, Ajayi K, Oyewole PA, Adegoke TE, Olaniyi KS. Renometabolic disorder in experimental rat model of polycystic ovarian syndrome is reversed by acetate-mediated inhibition of pyruvate dehydrogenase kinase 4. BMC Nephrol 2025; 26:234. [PMID: 40361039 PMCID: PMC12077013 DOI: 10.1186/s12882-025-04157-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2024] [Accepted: 04/25/2025] [Indexed: 05/15/2025] Open
Abstract
BACKGROUND Chronic Kidney disorders is a global public health problem, including in women with polycystic ovarian syndrome (PCOS), and is characterized by renal fibrosis, nephrotoxicity and glomerulonephritis, which increases the possibility of renal failure and organ transplant. Pyruvate dehydrogenase kinase 4 (PDK4) has been implicated in mitochondria dysfunction, contributing to metabolic dysregulation in different organs, including kidney. Studies have shown that short chain fatty acids, particularly acetate, alleviates metabolic alterations in experimental models. Hence, the present study investigated the therapeutic potential of acetate on renometabolic disorders associated with experimental PCOS model. The study in addition elucidates the probable involvement of PDK4 in PCOS-associated renometabolic disorders. METHODS Eight-week-old nulliparous female Wistar rats were randomly allotted into four groups (n = 5). Letrozole (1 mg/kg bw) was used to induce PCOS for 3 weeks. Thereafter, acetate (200 mg/kg bw) was administered for 6 weeks, uninterruptedly. Biochemical parameters from the plasma and renal tissue, as well as histology of ovaries were performed with appropriate methods. RESULTS Experimental PCOS rats were characterized with elevated circulating testosterone and the presence of multiple ovarian cysts. In addition, rat with PCOS also manifested insulin resistance, increased plasma urea and creatinine levels, increased renal Gamma glutamyl transferase (GGT), malondialdehyde (MDA), Nuclear factor -kappa B (NF-kB), Tumor necrosis factor -alpha (TNF-a), Transforming growth factor -beta 1 (TGF-B1), caspase-6, Histone deacetylase 2 (HDAC2), while a decrease in glucose-6 phosphate dehydrogenase (G6PD), reduced glutathione (GSH), renal nitric oxide (NO) and endothelial nitric oxide synthesis (eNOS), when compared with animals in the control group. These were associated with elevated level of PDK4 in the renal tissue. However, administration of acetate ameliorates these renal/metabolic abnormalities. CONCLUSION Altogether, the results from the present study suggests that acetate ameliorates renal dysfunction in PCOS via downregulation of PDK4.
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Affiliation(s)
- Stephanie E Areloegbe
- Cardio/Endo-metabolic and Microbiome Research Unit, Department of Physiology, College of Medicine and Health Sciences, Afe Babalola University, P.M.B. 5454, Ado-Ekiti, 360101, Nigeria
| | - Chukwubueze L Atuma
- Cardio/Endo-metabolic and Microbiome Research Unit, Department of Physiology, College of Medicine and Health Sciences, Afe Babalola University, P.M.B. 5454, Ado-Ekiti, 360101, Nigeria
| | - Ayodeji Aturamu
- Cardio/Endo-metabolic and Microbiome Research Unit, Department of Physiology, College of Medicine and Health Sciences, Afe Babalola University, P.M.B. 5454, Ado-Ekiti, 360101, Nigeria
| | - Isaac O Ajadi
- Department of Physiology, College of Health Sciences, Ladoke Akintola University of Technology, Old Oyo/Ilorin Rd, Ogbomosho, 210214, Nigeria
| | - Oluseyi E Adelekan
- Department of Obstetrics and Gynecology, General Hospital Gbagada, Lagos, Lagos State, Nigeria
| | - Mary B Ajadi
- Department of Chemical pathology, College of Health Sciences, Ladoke Akintola University of Technology, Old Oyo/Ilorin Rd, 210214, Ogbomosho, Nigeria
| | - Christopher O Akintayo
- Department of Internal Medicine, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
| | - Gloria O Omoruyi
- Department of Internal Medicine, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
| | - Samuel O Onyekweli
- Department of Radiation Oncology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Omosola F Anifowose
- Department of Physiology, Faculty of Basic Medical Sciences, Ekiti State University, Ado Ekiti, Ekiti State, Nigeria
| | - Oluwatobi A Amusa
- Cardio/Endo-metabolic and Microbiome Research Unit, Department of Physiology, College of Medicine and Health Sciences, Afe Babalola University, P.M.B. 5454, Ado-Ekiti, 360101, Nigeria
| | - Kayode Ajayi
- Department of Human Nutrition and Dietetics, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, 360101, Nigeria
| | - Paul A Oyewole
- Department of Surgery, Faculty of Clinical Sciences, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria
| | - Tolulope E Adegoke
- Department of Physiology, College of Health Sciences, Lead City University, Ibadan, Oyo Sate, Nigeria
| | - Kehinde S Olaniyi
- Cardio/Endo-metabolic and Microbiome Research Unit, Department of Physiology, College of Medicine and Health Sciences, Afe Babalola University, P.M.B. 5454, Ado-Ekiti, 360101, Nigeria.
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Nandi A, Singh K, Sharma K. Advancement in early diagnosis of polycystic ovary syndrome: biomarker-driven innovative diagnostic sensor. Mikrochim Acta 2025; 192:331. [PMID: 40310524 DOI: 10.1007/s00604-025-07187-w] [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: 02/21/2025] [Accepted: 04/22/2025] [Indexed: 05/02/2025]
Abstract
Polycystic ovary syndrome (PCOS) is a heterogeneous multifactorial endocrine disorder that affects one in five women around the globe. The pathology suggests a strong polygenic and epigenetic correlation, along with hormonal and metabolic dysfunction, but the exact etiology is still a mystery. The current diagnosis is mostly based on Rotterdam criteria, which resulted in a delayed diagnosis in most of the cases, leading to unbearable lifestyle complications and infertility. PCOS is not new; thus, constant efforts are made in the field of biomarker discovery and advanced diagnostic techniques. A plethora of research has enabled the identification of promising PCOS diagnostic biomarkers across hormonal, metabolic, genetic, and epigenetic domains. Not only biomarker identification, but the utilization of biosensing platforms also renders effective point-of-care diagnostic devices. Artificial intelligence also shows its power in modifying existing image-based analysis, even developing symptom-based prediction systems for the early diagnosis of this multifaceted disorder. This approach could affect the future management and treatment direction of PCOS, decreasing its severity and improving the reproductive life of women. The rationale of the current review is to identify the advancements in understanding the pathophysiology through biomarker discovery and the implementation of modern analytical techniques for the early diagnosis of PCOS.
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Affiliation(s)
- Aniket Nandi
- Department of Pharmaceutical Chemistry and Analysis, ISF College of Pharmacy, G.T Road, Ghal Kalan, Moga, Punjab, 142001, India
| | - Kamal Singh
- Bond Life Sciences Center, and Department of Veterinary Pathobiology, University of Missouri, Columbia, MO, 65211, USA
| | - Kalicharan Sharma
- Department of Pharmaceutical Chemistry and Analysis, ISF College of Pharmacy, G.T Road, Ghal Kalan, Moga, Punjab, 142001, India.
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Mallya P, Lewis SA. Curcumin and its formulations for the treatment of polycystic ovary syndrome: current insights and future prospects. J Ovarian Res 2025; 18:78. [PMID: 40234918 PMCID: PMC12001734 DOI: 10.1186/s13048-025-01660-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Accepted: 04/03/2025] [Indexed: 04/17/2025] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common gynaecological complication with alarmingly high incidence of 6-20% in women of reproductive age and leads to multifaceted symptoms such as menstrual irregularities, hyperandrogenism, polycystic ovaries, and insulin resistance. Several therapeutic methods have been recommended for PCOS including lifestyle modification, insulin sensitizer (metformin), ovulation inducers (letrozole, clomiphene citrate), hormonal pills, and surgical intervention (ovarian drilling and oophorectomy); however, these treatment modalities often cause adverse effects. Currently, phytochemicals and plant extracts have been recommended for PCOS. Among these, few phytochemicals and their formulations, curcumin (CUR) (a bioactive polyphenol from Curcuma longa), has emerged as a promising complementary PCOS therapy due to its antioxidant, anti-inflammatory, insulin-sensitizing, and ovulation inducing properties. However, CUR's clinical application is hindered by poor solubility and bioavailability. In this review, we summarize and discuss various formulations of CUR and combination therapies that have demonstrated potential in treating PCOS in animal models.
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Affiliation(s)
| | - Shaila A Lewis
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India.
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Pereira JD, Magalhães FMV, Tameirão FMS, Soriani FM, de O S Jorge KT, Reis FM, Cândido AL, Comim FV, Gomes KB. The possible regulatory role of miRNA-30c-5p, miRNA-545-3p and miRNA-125a-5p in women with polycystic ovary syndrome: A case-control study and signaling pathways. Mol Cell Endocrinol 2025; 599:112492. [PMID: 39952313 DOI: 10.1016/j.mce.2025.112492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Revised: 01/31/2025] [Accepted: 02/11/2025] [Indexed: 02/17/2025]
Abstract
INTRODUCTION Polycystic Ovary Syndrome (PCOS) is one of the most common endocrinopathy in women of reproductive age. MicroRNA (miRNAs) are small non-coding RNAs related to the control of gene expression in biological fluids. Our study analyzed the expression of miRNAs related to inflammation in individuals with PCOS compared to controls. METHODS Twenty patients with PCOS and 20 controls, matched by body mass index and age, were included in the study. The miRNAs evaluated were miRNA-30c-5p; miRNA-545-3p and miRNA-125a-5p. RESULTS The expression of the miRNAs was similar between the two groups. A positive correlation was observed between the expression of miRNA-125a-5p and LDLc levels only in the PCOS group. Subsequent analysis of biological pathways showed that miRNA-125a -5p is significantly involved in the regulation of SREBP/SREBF pathways of cholesterol biosynthesis, glycolysis, insulin receptor signaling, oxidative stress-induced senescence and estrogen-dependent gene expression. CONCLUSION The results suggest that the miRNA-125a-5p shows a potential implication to the regulation of lipid biosynthesis and LDL-c levels in PCOS women.
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Affiliation(s)
- Jessica D Pereira
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Fernanda M V Magalhães
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Fabiana M S Tameirão
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Frederico M Soriani
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Karina T de O S Jorge
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Fernando M Reis
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Lúcia Cândido
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Fábio V Comim
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Karina B Gomes
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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Ayesh H, Nasser SA, Ferdinand KC, Carranza Leon BG. Sex-Specific Factors Influencing Obesity in Women: Bridging the Gap Between Science and Clinical Practice. Circ Res 2025; 136:594-605. [PMID: 40080532 DOI: 10.1161/circresaha.124.325535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Revised: 01/21/2025] [Accepted: 01/21/2025] [Indexed: 03/15/2025]
Abstract
Obesity in women is a significant public health issue with serious implications for cardiovascular-kidney-metabolic syndrome and cardiovascular disease. This complex challenge is influenced by physiological, hormonal, socioeconomic, and cultural factors. Women face unique weight management challenges due to hormonal changes during pregnancy, perimenopause, and menopause, which affect fat distribution and increase cardiovascular-kidney-metabolic syndrome risk. Current clinical guidelines often overlook these sex-specific factors, potentially limiting the effectiveness of obesity management strategies in women. This review explores the sex-specific aspects of obesity's pathophysiology, epidemiological trends, and associated comorbidities, focusing on cardiovascular and metabolic complications. This review synthesizes literature on obesity in women, emphasizing sex-specific factors influencing its development and progression. It examines the limitations of body mass index as an obesity measure and explores alternative classification methods. Additionally it investigates the relationship between obesity and comorbidities such as diabetes, hypertension, and dyslipidemia, with a focus on postmenopausal women. Obesity in women is linked to increased risks of cardiovascular-kidney-metabolic syndrome and cardiovascular disease. Hormonal fluctuations throughout life contribute to weight gain and fat distribution patterns specific to women, increasing cardiovascular disease risk. Effective obesity management strategies in women must account for these sex-specific variations. Postmenopausal women are particularly affected by obesity-related complications. Lifestyle interventions, pharmacotherapy, and bariatric surgery have shown efficacy in weight management, though success rates vary. Addressing obesity in women requires a comprehensive approach that considers sex-specific physiological factors, life-stage challenges, and sociocultural barriers. Integrating precision medicine and emerging therapies offers potential for more personalized and effective interventions. Personalized strategies that consider women's biological and life-stage challenges can enhance obesity management and improve cardiovascular outcomes. Future research and clinical practice should focus on developing tailored strategies that address women's unique vulnerabilities to obesity and its associated health risks and on validating sex-specific interventions to improve obesity management in women.
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Affiliation(s)
- Hazem Ayesh
- Deaconess Clinic Endocrinology, Deaconess Health System, Evansville, IN (H.A.)
| | - Samar A Nasser
- Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, DC (S.A.N.)
| | - Keith C Ferdinand
- Section of Cardiology, Tulane University School of Medicine, New Orleans, LA (K.C.F.)
| | - Barbara Gisella Carranza Leon
- Division of Diabetes, Endocrinology and Metabolism, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN (B.G.C.L.)
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Jiang B. The Global Burden of Polycystic Ovary Syndrome in Women of Reproductive Age: Findings from the GBD 2019 Study. Int J Womens Health 2025; 17:153-165. [PMID: 39882398 PMCID: PMC11776423 DOI: 10.2147/ijwh.s490836] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Accepted: 12/05/2024] [Indexed: 01/31/2025] Open
Abstract
Purpose Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder and the primary cause of anovulatory infertility among women aged 15-49 years. Despite its significance, it has been largely overlooked in global health discussions, with persistently high prevalence and incidence rates. This public health challenge necessitates attention both domestically and internationally. Between 1990 and 2017, the age-standardized prevalence of female infertility and associated DALYs rose by 0.70% and 0.396%, respectively. Economically, addressing women's endocrine and metabolic health can bolster the overall well-being of the female population using existing resources. For judicious utilization of available resources, data regarding the burden of PCOS is pivotal for comprehending women's health status and for devising and refining policies related to women's endocrine health. Consequently, this study scrutinizes and assesses the age-standardized PCOS incidence rate and DALYs for 1990 and 2019, traces the trends of these metrics from 1990 to 2019, examines the composition of various populations and diseases, and offers international comparisons. This aims to furnish critical insights for future health policy development and adjustments in the realm of female endocrine and metabolic health. Patients and Methods This study employed the Global Health Data Exchange to obtain PCOS burden data based on GBD 2019. It collected incidence, DALYs, and age-standardized rates (ASRs) from 1990 to 2019 across global, regional, national, and SDI quintile levels, spanning 21 regions and 204 countries. To analyze trends, ASRs and estimated annual percentage changes (EAPCs) were calculated, with standardization crucial for comparability. EAPC was derived using a generalized linear model with a Gaussian distribution. Results The global burden of PCOS increased significantly from 1990 to 2019, with estimated annual percentage change (EAPCs) of 0.56 for incidence and 0.83 for DALYs. The highest incidence rates were observed in the High-income Asia Pacific region, particularly in Japan and New Zealand, while the lowest rates were in Central Europe. Equatorial Guinea and Qatar exhibited the most pronounced increases in incidence and DALYs, attributed to urbanization and enhanced healthcare infrastructure. The incidence and DALYs of PCOS showed variation across SDI quintiles, with the greatest burden found in the middle-SDI quintile. Women between the ages of 20-29 years had the highest incidence and DALYs, emphasizing the importance of targeted interventions during this critical period. In contrast, regions with lower SDI levels, such as Central and Eastern Europe, reported the lowest burdens of PCOS, likely due to underdiagnosis and limited healthcare resources. Conclusion From 1990 to 2019, there was a significant increase in the global burden of PCOS, with variations seen across regions and SDI quintiles. Countries such as Italy, Japan, New Zealand, and Australia had the highest burdens, while Central and Eastern Europe had the lowest. The age group most affected was women aged 20-29 years, emphasizing the necessity for targeted interventions.
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Affiliation(s)
- Bengui Jiang
- Department of Gynecology and Obstetrics, Ningbo University’s Women’s and Children’s Hospital, Ningbo, Zhejiang, 315000, People’s Republic of China
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10
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Johnson C, Garipoğlu G, Jeanes Y, Frontino G, Costabile A. The Role of Diet, Glycaemic Index and Glucose Control in Polycystic Ovary Syndrome (PCOS) Management and Mechanisms of Progression. Curr Nutr Rep 2025; 14:8. [PMID: 39753786 PMCID: PMC11698792 DOI: 10.1007/s13668-024-00601-4] [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] [Accepted: 10/28/2024] [Indexed: 01/06/2025]
Abstract
PURPOSE OF REVIEW Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder with several causal pathways including impaired glucose tolerance, insulin resistance (IR), compensatory hyperinsulinemia and excess androgens (hyperandrogenism). This heterogeneous condition causes a range of reproductive, metabolic and psychological implications, the severity of which can differ between individuals depending on factors such as age, diet, ethnicity, genetics, medication, contraceptive use, adiposity, and Body Mass Index (BMI). RECENT FINDINGS Dietary interventions that focus on a low glycaemic index and glucose control are an efficient first-line dietary solution for the management of impaired glucose tolerance and IR, which subsequently improves weight management, quality of life and PCOS-related symptoms in individuals with this condition. This review aims to explore the relevance of nutrition and more specifically, the association of glycaemic index and glycaemic load with PCOS, as well as to assess the potential benefits of manipulating those indexes in the dietary approach for this syndrome.
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Affiliation(s)
- Claire Johnson
- School of Life and Health Sciences, University of Roehampton, London, UK
| | - Gökçen Garipoğlu
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Bahçeşehir University, Istanbul, Turkey
| | - Yvonne Jeanes
- School of Life and Health Sciences, University of Roehampton, London, UK
| | - Giada Frontino
- Consultant Obstetrician and Gynaecologist, London, England
| | - Adele Costabile
- School of Life and Health Sciences, University of Roehampton, London, UK.
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11
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Mallya P, Kalthur G, Sravani AB, Lewis SA. Improving the Dehydroepiandrosterone Induced PCOS Rat Model: Interplay of Age, High Fat Diet, and Treatment Regimen on Reproductive and Metabolic Phenotypes. Reprod Sci 2025; 32:187-199. [PMID: 39567467 PMCID: PMC11729200 DOI: 10.1007/s43032-024-01742-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 10/26/2024] [Indexed: 11/22/2024]
Abstract
Polycystic ovary syndrome (PCOS) is a ubiquitous reproductive condition with triggering hallmarks such as glucose intolerance, hyperandrogenism, and dyslipidemia. Despite the existence of various PCOS animal models, an ideal model which could encompass all PCOS-specific phenotype is of dire need. Dehydroepiandrosterone (DHEA) induced PCOS rats are frequently employed; though, determining the superior model among pubertal and prepubertal rats, incorporation of high fat diet (HFD), and their sustainability remains uncertain. This study aims to examine the age factor, impact of HFD, and DHEA regimen in model development. Prepubertal and pubertal Sprague-Dawley rats were subcutaneously injected with DHEA (6 mg/kg and 60 mg/kg/day, respectively) with and without HFD up to 21 days. Serum testosterone, glucose, lipid profile, ovary morphology, and estrous cycle were evaluated. Following 21 days of treatment with DHEA, pubertal PCOS rats exhibited better reproductive phenotype than prepubertal rats. However, there was no significant difference in the lipid profile. Accordingly, both the age-group rats were concomitantly treated with DHEA and HFD for additional 3 weeks on alternate day basis after model development. The persistence of reproductive and metabolic features on treatment withdrawal were also simultaneously investigated by alienating the rats into continuous and stop dosing groups. The DHEA + HFD and DHEA treated pubertal rats in continuous dosing group showed significant PCOS features (p < 0.05) compared to stop dosing, prepubertal, and control groups. To conclude, continual dosing with DHEA on alternate days for 3 weeks is necessary to sustain metabolic and reproductive phenotypes of PCOS.
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Affiliation(s)
- Pooja Mallya
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Guruprasad Kalthur
- Division of Reproductive Biology, Department of Reproductive Science, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Anne Boyina Sravani
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Shaila A Lewis
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India.
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12
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Jian X, Shi C, Xu T, Liu B, Zhou L, Jiang L, Liu K. Efficacy and safety of dietary polyphenol administration as assessed by hormonal, glycolipid metabolism, inflammation and oxidative stress parameters in patients with PCOS: a meta-analysis and systematic review. Crit Rev Food Sci Nutr 2024:1-25. [PMID: 39682053 DOI: 10.1080/10408398.2024.2440063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2024]
Abstract
BACKGROUND The current knowledge about the efficacy and safety of dietary polyphenol administration in patients with polycystic ovarian syndrome (PCOS) is divergent. OBJECTIVE To evaluate the pooled efficacy and safety of dietary polyphenol administration in the treatment of patients with PCOS. METHODS The pubmed, Embase, Scopus, Cochrane Library, and Web of Science databases were searched for randomized controlled trials (RCTs) of dietary polyphenol administration for the treatment of PCOS. English-language RCTs involving adults with PCOS were thoroughly searched in electronic databases from the time of their establishment to May 2024. Random-effects models were used because heterogeneity was derived from differences in intervention materials and study duration, among other confounding factors. The effect sizes of the outcomes in the pooled analysis are expressed as weighted mean differences (WMDs) and 95% confidence intervals (CIs). RESULTS A total of 15 RCTs involving 934 patients were finally included. Compared with control treatments, dietary polyphenol administration significantly reduced luteinizing hormone (LH) (WMD: -0.85, 95% CI [-1.32 to -0.38], p = 0.00), and prolactin levels (WMD: -3.73, 95% CI [-6.73 to -0.74], p = 0.01). Dietary polyphenol administration significantly reduced insulin levels (WMD: -0.85, 95% CI [-1.32 to -0.38], p = 0.00). Regarding lipid metabolism, dietary polyphenol administration only reduced triglyceride levels (WMD: -8.96, 95% CI [-16.44 to -1.49], p = 0.02). Malondialdehyde (MDA) (WMD: -0.65, 95% CI [-0.68 to -0.62], p = 0.00), tumor necrosis factor (TNF-α) (WMD: -1.39, 95% CI [-2.41 to -0.37], p = 0.01) concentrations were significantly reduced by dietary polyphenol administration. None of the interventions significantly affected weight, body mass index (BMI), waist circumference (WC), homeostatic model-insulin resistance (HOMA-IR), fasting blood sugar (FBS), glycated hemoglobin (HBA1c), follicle-stimulating hormone (FSH), testosterone (T), dehydroepiandrosterone (DHEA), estradiol (E2), anti-Müllerian hormone (AMH), quantitative insulin-sensitivity check index (QUICKI), sex hormone-binding globulin (SHBG), total antioxidant capacity (TAC), C-peptide, C-reactive protein (CRP), high-density lipoprotein (HDL), low-density lipoprotein (LDL), cholesterol, cholesterol/HDL, acne score, thyroid-stimulating hormone (TSH), aspartate aminotransferase (AST), alanine aminotransferase (ALT) or alkaline phosphatase (ALP). CONCLUSION Dietary polyphenol administration was efficacious in patients with PCOS in our study. This review might provide new insight into the treatment of patients with PCOS and the potential of daily polyphenol supplementation in patients with PCOS. Nevertheless, these results must be interpreted carefully as a result of the heterogeneity and risk of bias among the studies and we expect that more high-quality RCTs evaluating the efficacy and safety of dietary polyphenol adnimistration in patients with PCOS will be conducted in the future. SYSTEMATIC REVIEW REGISTRATION CRD42024498494.
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Affiliation(s)
- Xian Jian
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang
| | - Chen Shi
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang
| | - Tongtong Xu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang
| | - Boya Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang
| | - Liyuan Zhou
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang
| | - Lili Jiang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang
| | - Kuiran Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang
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13
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Wickham AP, Hewings-Martin Y, Goddard FG, Rodgers AK, Cunningham AC, Prentice C, Wilks O, Kaplan YC, Marhol A, Meczner A, Stsefanovich H, Klepchukova A, Zhaunova L. Exploring Self-Reported Symptoms for Developing and Evaluating Digital Symptom Checkers for Polycystic Ovarian Syndrome, Endometriosis, and Uterine Fibroids: Exploratory Survey Study. JMIR Form Res 2024; 8:e65469. [PMID: 39666967 DOI: 10.2196/65469] [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: 08/16/2024] [Revised: 10/25/2024] [Accepted: 11/13/2024] [Indexed: 12/14/2024] Open
Abstract
BACKGROUND Reproductive health conditions such as polycystic ovary syndrome (PCOS), endometriosis, and uterine fibroids pose a significant burden to people who menstruate, health care systems, and economies. Despite clinical guidelines for each condition, prolonged delays in diagnosis are commonplace, resulting in an increase to health care costs and risk of health complications. Symptom checker apps have the potential to significantly reduce time to diagnosis by providing users with health information and tools to better understand their symptoms. OBJECTIVE This study aims to study the prevalence and predictive importance of self-reported symptoms of PCOS, endometriosis, and uterine fibroids, and to explore the efficacy of 3 symptom checkers (developed by Flo Health UK Limited) that use self-reported symptoms when screening for each condition. METHODS Flo's symptom checkers were transcribed into separate web-based surveys for PCOS, endometriosis, and uterine fibroids, asking respondents their diagnostic history for each condition. Participants were aged 18 years or older, female, and living in the United States. Participants either had a confirmed diagnosis (condition-positive) and reported symptoms retrospectively as experienced at the time of diagnosis, or they had not been examined for the condition (condition-negative) and reported their current symptoms as experienced at the time of surveying. Symptom prevalence was calculated for each condition based on the surveys. Least absolute shrinkage and selection operator regression was used to identify key symptoms for predicting each condition. Participants' symptoms were processed by Flo's 3 single-condition symptom checkers, and accuracy was assessed by comparing the symptom checker output with the participant's condition designation. RESULTS A total of 1317 participants were included with 418, 476, and 423 in the PCOS, endometriosis, and uterine fibroids groups, respectively. The most prevalent symptoms for PCOS were fatigue (92%), feeling anxious (87%), BMI over 25 (84%); for endometriosis: very regular lower abdominal pain (89%), fatigue (85%), and referred lower back pain (80%); for uterine fibroids: fatigue (76%), bloating (69%), and changing sanitary protection often (68%). Symptoms of anovulation and amenorrhea (long periods, irregular cycles, and absent periods), and hyperandrogenism (excess hair on chin and abdomen, scalp hair loss, and BMI over 25) were identified as the most predictive symptoms for PCOS, while symptoms related to abdominal pain and the effect pain has on life, bleeding, and fertility complications were among the most predictive symptoms for both endometriosis and uterine fibroids. Symptom checker accuracy was 78%, 73%, and 75% for PCOS, endometriosis, and uterine fibroids, respectively. CONCLUSIONS This exploratory study characterizes self-reported symptomatology and identifies the key predictive symptoms for 3 reproductive conditions. The Flo symptom checkers were evaluated using real, self-reported symptoms and demonstrated high levels of accuracy.
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14
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Chen M, Jia Q, Chen Y, Shan W, Tang H, Xing T, Wei W, Zheng H, Xue W, Shi R, Xia B, Chen J. A meta-analysis of bariatric surgery in patients with obesity and polycystic ovary syndrome. Asian J Surg 2024; 47:5083-5087. [PMID: 38641528 DOI: 10.1016/j.asjsur.2024.04.003] [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: 11/20/2023] [Revised: 03/03/2024] [Accepted: 04/03/2024] [Indexed: 04/21/2024] Open
Abstract
Polycystic ovary syndrome (PCOS) is a multifactorial disease, which is closely related to obesity. This study evaluated the efficacy of bariatric surgery on obesity complicated with PCOS through meta-analysis. PubMed, Cochrane, EMbase, and WOS databases were searched from 2012 to November 2022. Studies on the efficacy of bariatric surgery in the treatment of obesity combined with PCOS were included. Outcome indicators included menstrual abnormalities, BMI, free testosterone, hypertrichosis, and ovarian volume. Methodological quality of the included studies was evaluated, and statistical analysis was performed using RevMan 5.3 software. Finally, 9 studies were included, and the results of meta-analysis were as follows: After weight loss surgery, menstrual irregularity decreased (RR = -0.83, 95%CI:-1.00∼-0.65, P < 0.00001), and BMI decreased significantly (MD = -13.64, 95%CI:-16.29∼-10.99, P < 0.00001). Free testosterone levels decreased (MD = -22.70, 95 % CI: -36.07 ∼ -9.34, P < 0.00001), the incidence of hypertrichosis decreased (RR = 0.63, 95%CI: 0.45-0.88, p = 0.007 < 0.01), and the ovarian volume decreased (MD = -3.09, 5%CI: -5.76 ∼ -0.42, P < 0.00001).
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Affiliation(s)
- Mengyue Chen
- Dalian Medical University, 116000, Dalian, Liaoning, China
| | - Qiucheng Jia
- Department of Gynecology, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, 213000, Changzhou, Jiangsu, China
| | - Yao Chen
- Department of Gynecology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 230031, Hefei, Anhui, China
| | - Wulin Shan
- Department of Gynecology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 230031, Hefei, Anhui, China
| | - Huimin Tang
- Department of Gynecology, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, 213000, Changzhou, Jiangsu, China
| | - Tingwei Xing
- Department of Gynecology, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, 213000, Changzhou, Jiangsu, China
| | - Weiwei Wei
- Department of Gynecology, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, 213000, Changzhou, Jiangsu, China
| | - Hong Zheng
- Department of Gynecology, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, 213000, Changzhou, Jiangsu, China
| | - Wenpeng Xue
- Department of Gynecology, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, 213000, Changzhou, Jiangsu, China
| | - Ruxia Shi
- Department of Gynecology, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, 213000, Changzhou, Jiangsu, China
| | - Bairong Xia
- Department of Gynecology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 230031, Hefei, Anhui, China.
| | - Jiming Chen
- Department of Gynecology, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, 213000, Changzhou, Jiangsu, China.
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15
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Liu D, Wei C, Guan L, Ju W, Xiang S, Lian F. Combining single-cell RNA sequencing and network pharmacology to explore the target of cangfu daotan decoction in the treatment of obese polycystic ovary syndrome from an immune perspective. Front Pharmacol 2024; 15:1451300. [PMID: 39539629 PMCID: PMC11557475 DOI: 10.3389/fphar.2024.1451300] [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: 06/19/2024] [Accepted: 09/26/2024] [Indexed: 11/16/2024] Open
Abstract
Background Polycystic ovary syndrome (PCOS) is a heterogeneous gynecological endocrine disorder linked to immunity. Cangfu Daotan Decoction (CFDT), a classic Chinese medicine prescription, is particularly effective in treating PCOS, specifically in patients with obesity; however, its specific mechanism remains unclear. Methods Part 1: Peripheral blood mononuclear cells were collected on egg retrieval day from obese and normal-weight patients with PCOS and healthy women undergoing in vitro fertilization (IVF)-embryo transfer. Next, scRNA-seq was performed to screen the key genes of bese patients with PCOS. Part 2: Active ingredients of CFDT and obesity-related PCOS targets were identified based on public databases, and the binding ability between the active ingredients and targets was analyzed. Part 3: This part was a monocentric, randomized controlled trial. The obese women with PCOS were randomized to CFDT (6 packets/day) or placebo, and the healthy women were included in the blank control group (43 cases per group). The clinical manifestations and laboratory outcomes among the three groups were compared. Results Based on the scRNA-seq data from Part 1, CYLD, ARPC3, CXCR4, RORA, JUN, FGL2, ZEB2, GNLY, FTL, SMAD3, IL7R, KIR2DL1, CTSD, BTG2, CCL5, HLA, RETN, CTSZ, and NCF2 were potential key genes associated with obese PCOS were identified. The proportions of T, B, and natural killer cells were higher in patients with PCOS compared to healthy women, with even higher proportions observed in obese patients with PCOS. Gene ontology and the Kyoto encyclopedia of genes and genomes analysis depicted that the differentially expressed genes were related to immune regulation pathways. Network pharmacology analysis identified that the key active components in CFDT were quercetin, carvacrol, β-sitosterol, cholesterol, and nobiletin, and TP53, AKT1, STAT3, JUN, SRC, etc. were the core targets. The core targets and their enrichment pathways overlapped with those in Part 1. Clinical trials in Part 3 found that CFDT reduced the dosage of gonadotropins use in patients with PCOS, increased the number of high-quality embryos, and improved the ongoing pregnancy rate. Conclusion CFDT can improve the immune microenvironment of patients to some extent, reduce their economic burden, and enhance IVF outcomes. The improvement in the immune microenvironment in obese patients with PCOS may be linked to targets such as JUN and AKT.
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Affiliation(s)
- Danqi Liu
- The First Clinical Medicine School, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
| | - Chaofeng Wei
- The First Clinical Medicine School, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Lu Guan
- The First Clinical Medicine School, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Wenhan Ju
- The First Clinical Medicine School, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Shan Xiang
- The First Clinical Medicine School, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Integrative Medicine Research Centre of Reproduction and Heredity, Affiliated Hospital, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Fang Lian
- The First Clinical Medicine School, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Integrative Medicine Research Centre of Reproduction and Heredity, Affiliated Hospital, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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16
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Neven ACH, Forslund M, Ranashinha S, Mousa A, Tay CT, Peña A, Oberfield S, Witchel S, Teede H, Boyle JA. Prevalence and accurate diagnosis of polycystic ovary syndrome in adolescents across world regions: a systematic review and meta-analysis. Eur J Endocrinol 2024; 191:S15-S27. [PMID: 39353075 DOI: 10.1093/ejendo/lvae125] [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: 05/31/2024] [Revised: 08/17/2024] [Accepted: 09/27/2024] [Indexed: 10/04/2024]
Abstract
OBJECTIVES To examine the global prevalence of polycystic ovary syndrome (PCOS) among adolescents across world regions, comparing the 2003 Rotterdam consensus criteria with the current International Evidence-based PCOS Guideline criteria which omits polycystic ovarian morphology (PCOM). DESIGN Systematic review and meta-analysis, Prospero CRD42022372029. METHODS OVID MEDLINE, All EBM, PsycInfo, EMBASE, and CINAHL were searched from 1990 to November 2023 for studies assessing the prevalence of PCOS in unselected adolescent populations. RESULTS Overall, 15 708 articles were identified. After removal of duplicates, 11 868 titles and abstracts and 445 full texts were assessed. Of these, 24 articles reporting on 23 studies from five world regions were included. In meta-analysis of 20 studies (n = 14 010 adolescents), global prevalence was 9.8% (95% CI 7.2, 12.3) according to original Rotterdam criteria, and 6.3% (95% CI 3.9, 8.8) according to International Evidence-based Guideline criteria. Global PCOS prevalence based on self-report was 9.8% (95% CI 5.5, 14.1). Grouped by WHO region, prevalence ranged from 2.9% (95% CI 2.0, 3.9) in the Western Pacific region to 11.4% (95% CI 7.1, 15.7) in the South-East Asia region according to guideline criteria. CONCLUSION This paramount global meta-analysis on adolescent PCOS diagnosis directly informed the 2023 International PCOS Guideline. Guideline criteria generated a global PCOS prevalence of 6.3%, compared with 9.8% on Rotterdam criteria (including PCOM). Excluding PCOM, which overlaps with normal pubertal transition, is expected to deter over-diagnosis. To avoid under-diagnosis, the Guideline recommends identifying those with either irregular cycles or hyperandrogenism as being "at risk"; this group should undergo longitudinal serial evaluations until adulthood.
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Affiliation(s)
- Adriana C H Neven
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia
| | - Maria Forslund
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Blå Stråket 6, 413 45 Gothenburg, Sweden
| | - Sanjeeva Ranashinha
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia
| | - Chau Thien Tay
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia
| | - Alexia Peña
- Discipline of Paediatrics, The University of Adelaide Robinson Research Institute and Endocrine Department, Women's and Children's Hospital, 72 King William Road, North Adelaide, SA 5006, Australia
| | - Sharon Oberfield
- Division of Pediatric Endocrinology, Columbia University Irving Medical Center, Morgan Stanley Children's Hospital, New York, NY 10032, United States
| | - Selma Witchel
- Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA 15224, United States
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia
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17
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Hasegawa Y, Kitahara Y, Kobayashi M, Miida M, Nenoi H, Tsukui Y, Iizuka M, Hiraishi H, Nakazato S, Iwase A. Impact of the difference in diagnostic criteria for adolescent polycystic ovary syndrome excluding polycystic ovarian morphology. J Obstet Gynaecol Res 2024; 50:1289-1294. [PMID: 38806170 DOI: 10.1111/jog.15975] [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: 01/15/2024] [Accepted: 05/07/2024] [Indexed: 05/30/2024]
Abstract
AIM Exclusion of polycystic ovarian morphology (PCOM) from the diagnostic criteria for adolescent polycystic ovary syndrome (PCOS) has been proposed. We analyzed the profiles of adolescent women with suspected PCOS based on the Japan Society of Obstetrics and Gynecology (JSOG) diagnostic and Rotterdam criteria, excluding those with PCOM. METHODS Thirteen- to twenty-one-year-old women with suspected or confirmed diagnosis of PCOS according to the JSOG and Rotterdam criteria were included in this study. Patient characteristics such as hormone levels and body mass index (BMI) were compared between the groups. Correlations between BMI and testosterone, and BMI and time to diagnosis were also analyzed. RESULTS Twenty-nine patients were diagnosed with adolescent PCOS according to the JSOG criteria, and 11 patients according to the Rotterdam criteria after excluding the patients fulfilling the PCOM criteria. Serum testosterone levels were significantly higher in adolescents diagnosed with PCOS using the Rotterdam criteria than in those diagnosed using the JSOG criteria (p < 0.001). The obese group had significantly higher testosterone levels and a longer time from menarche to PCOS diagnosis. A positive correlation was observed between BMI and testosterone levels (r = 0.318, p = 0.014). CONCLUSION Although adolescents with PCOS diagnosed using the Rotterdam criteria exhibited higher testosterone levels, which is a typical characteristic of this condition, the JSOG criteria may be useful for the early diagnosis of adolescent PCOS, including suspected cases. The differences between the two criteria may reflect the natural history of PCOS and its different reproductive and metabolic phenotypes.
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Affiliation(s)
- Yuko Hasegawa
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoshikazu Kitahara
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Mio Kobayashi
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Miki Miida
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hitomi Nenoi
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yumiko Tsukui
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Madoka Iizuka
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hikaru Hiraishi
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Satoko Nakazato
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Akira Iwase
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Japan
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18
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Pinto J, Cera N, Pignatelli D. Psychological symptoms and brain activity alterations in women with PCOS and their relation to the reduced quality of life: a narrative review. J Endocrinol Invest 2024; 47:1-22. [PMID: 38485896 PMCID: PMC11196322 DOI: 10.1007/s40618-024-02329-y] [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: 09/26/2023] [Accepted: 02/03/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is the most common feminine endocrine disorder, characterized by androgen excess, ovulatory dysfunction, and polycystic ovarian morphology. The negative impact of symptoms on the quality of life (QoL) of patients is still not clear. PURPOSE The present review aimed at studying the impact of the symptoms, the psychological symptoms, and brain alterations in women with PCOS. METHODS A systematic search was undertaken for studies that assessed the impact of PCOS symptoms on QoL, psychological symptoms, and brain alterations in PCOS patients. RESULTS Most of the information about QoL came from psychometric studies, which used culture-based questionnaires. Alterations of sleep quality, body image, and mood disorders can negatively affect the QoL of the patients. Sexual satisfaction and desire were affected by PCOS. Brain imaging studies showed functional alterations that are associated with impairments of visuospatial working memory, episodic and verbal memory, attention, and executive function. CONCLUSIONS Several factors can negatively influence the quality of life of the patients, and they are directly related to hyperandrogenism and the risk of infertility. In particular, obesity, hirsutism, acne, and the fear of infertility can have a direct impact on self-esteem and sexual function. Metabolic and psychiatric comorbidities, such as mood, anxiety, and eating disorders, can affect the well-being of the patients. Moreover, specific cognitive alterations, such as impairments in attention and memory, can limit PCOS patients in a series of aspects of daily life.
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Affiliation(s)
- J Pinto
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135, Porto, Portugal
- Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal
| | - N Cera
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135, Porto, Portugal
- Research Unit in Medical Imaging and Radiotherapy, Cross I&D Lisbon Research Center, Escola Superior de Saúde da Cruz Vermelha Portuguesa, Lisbon, Portugal
| | - D Pignatelli
- Department of Endocrinology, Centro Hospitalar Universitário de São João, 4200-319, Porto, Portugal.
- Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal.
- Department of Biomedicine, Faculty of Medicine at University of Porto, Porto, Portugal.
- IPATIMUP Research Institute, Porto, Portugal.
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Gitsi E, Livadas S, Argyrakopoulou G. Nutritional and exercise interventions to improve conception in women suffering from obesity and distinct nosological entities. Front Endocrinol (Lausanne) 2024; 15:1426542. [PMID: 39006367 PMCID: PMC11239444 DOI: 10.3389/fendo.2024.1426542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 06/17/2024] [Indexed: 07/16/2024] Open
Abstract
Infertility among women, particularly those living with obesity, presents a multifaceted challenge with implications for reproductive health worldwide. Lifestyle interventions, mainly focusing on weight loss, have emerged as promising strategies to improve fertility outcomes in this population. This review aims to explore the effectiveness of various lifestyle interventions, encompassing dietary modifications and exercise regimens, in enhancing fertility outcomes among women with obesity and associated conditions such as polycystic ovary syndrome, congenital adrenal hyperplasia, type 2 diabetes mellitus, premenopause, hypothyroidism and eating disorders. Methodology of study search encompass a broad spectrum, ranging from interventions targeting weight management through slow or rapid weight loss to dietary approaches emphasizing whole food groups, specific nutrients, and dietary patterns like low-carbohydrate or ketogenic diets, as well as the Mediterranean diet. By synthesizing existing findings and recommendations, this review contributes to the understanding of lifestyle interventions in addressing infertility, with an emphasis on the population of women of reproductive age with excess weight and known or unknown infertility issues, while promoting their integration into clinical practice to optimize reproductive health and overall well-being.
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Affiliation(s)
- Evdoxia Gitsi
- Diabetes and Obesity Unit, Athens Medical Center, Athens, Greece
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20
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Cera N, Pinto J, Pignatelli D. The Role of Oxytocin in Polycystic Ovary Syndrome: A Systematic Review. Curr Issues Mol Biol 2024; 46:5223-5241. [PMID: 38920985 PMCID: PMC11201948 DOI: 10.3390/cimb46060313] [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: 04/08/2024] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 06/27/2024] Open
Abstract
Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder that affects women of reproductive age, representing the primary cause of anovulatory infertility. The nonapeptide oxytocin (OT) plays an important role in cognitive, emotional, and reproductive functions in human beings. Oxytocin receptors are expressed in several body parts, including the ovaries. Despite this, the possible role played by oxytocin in symptoms of PCOS is not clear. The present systematic review aimed at understanding the presence of possible oxytocin level alterations in PCOS, the connection between alterations of OT levels and the symptoms of PCOS, and the effect of oxytocin administration in PCOS. After a systematic search in the principal databases, eight studies, five human and three animal, were included. Four human studies and one animal study highlighted the role played by oxytocin in fertility issues related to PCOS. Three human and two animal studies investigated the role of body weight and OT levels. Studies that analyzed oxytocin basal levels in women agreed that PCOS is associated with a reduction in the serum level of oxytocin. Two human studies and one animal study agreed about lower levels of oxytocin, confirming a possible implication of the dysfunction of OT in the pathogenesis of PCOS.
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Affiliation(s)
- Nicoletta Cera
- Faculty of Psychology and Education Sciences, University of Porto, 4099-002 Porto, Portugal;
- Research Unit in Medical Imaging and Radiotherapy, Cross I&D Lisbon Research Centre, Escola Superior de Saúde da Cruz Vermelha Portuguesa, 1300-125 Lisbon, Portugal
| | - Joana Pinto
- Faculty of Psychology and Education Sciences, University of Porto, 4099-002 Porto, Portugal;
- Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal;
| | - Duarte Pignatelli
- Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal;
- Department of Endocrinology, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal
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21
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Liu J, Li J, Wu X, Zhang M, Yan G, Sun H, Li D. High levels of fatty acid-binding protein 5 excessively enhances fatty acid synthesis and proliferation of granulosa cells in polycystic ovary syndrome. J Ovarian Res 2024; 17:44. [PMID: 38373971 PMCID: PMC10875862 DOI: 10.1186/s13048-024-01368-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/05/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is one of the most complex endocrine disorders in women of reproductive age. Abnormal proliferation of granulosa cells (GCs) is an important cause of PCOS. This study aimed to explore the role of fatty acid-binding protein 5 (FABP5) in granulosa cell (GC) proliferation in polycystic ovary syndrome (PCOS) patients. METHODS The FABP5 gene, which is related to lipid metabolism, was identified through data analysis of the gene expression profiles of GSE138518 from the Gene Expression Omnibus (GEO) database. The expression levels of FABP5 were measured by quantitative real-time PCR (qRT‒PCR) and western blotting. Cell proliferation was evaluated with a cell counting kit-8 (CCK-8) assay. Western blotting was used to assess the expression of the proliferation marker PCNA, and immunofluorescence microscopy was used to detect Ki67 expression. Moreover, lipid droplet formation was detected with Nile red staining, and qRT‒PCR was used to analyze fatty acid storage-related gene expression. RESULTS We found that FABP5 was upregulated in ovarian GCs obtained from PCOS patients and PCOS mice. FABP5 knockdown suppressed lipid droplet formation and proliferation in a human granulosa-like tumor cell line (KGN), whereas FABP5 overexpression significantly enhanced lipid droplet formation and KGN cell proliferation. Moreover, we determined that FABP5 knockdown inhibited PI3K-AKT signaling by suppressing AKT phosphorylation and that FABP5 overexpression activated PI3K-AKT signaling by facilitating AKT phosphorylation. Finally, we used the PI3K-AKT signaling pathway inhibitor LY294002 and found that the facilitation of KGN cell proliferation and lipid droplet formation induced by FABP5 overexpression was inhibited. In contrast, the PI3K-AKT signaling pathway agonist SC79 significantly rescued the suppression of KGN cell proliferation and lipid droplet formation caused by FABP5 knockdown. CONCLUSIONS FABP5 promotes active fatty acid synthesis and excessive proliferation of GCs by activating PI3K-AKT signaling, suggesting that abnormally high expression of FABP5 in GCs may be a novel biomarker or a research target for PCOS treatment.
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Affiliation(s)
- Jingyu Liu
- Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, People's Republic of China
- Center for Reproductive Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
- Center for Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
- Center for Molecular Reproductive Medicine, Nanjing University, Nanjing, 210008, People's Republic of China
| | - Jie Li
- Center for Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Xin Wu
- Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, People's Republic of China
- Center for Reproductive Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
- Center for Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
- Center for Molecular Reproductive Medicine, Nanjing University, Nanjing, 210008, People's Republic of China
| | - Mei Zhang
- Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, People's Republic of China
- Center for Reproductive Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
- Center for Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
- Center for Molecular Reproductive Medicine, Nanjing University, Nanjing, 210008, People's Republic of China
| | - Guijun Yan
- Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, People's Republic of China
- Center for Reproductive Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
- Center for Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, People's Republic of China
- Center for Molecular Reproductive Medicine, Nanjing University, Nanjing, 210008, People's Republic of China
| | - Haixiang Sun
- Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, People's Republic of China.
- Center for Reproductive Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China.
- Center for Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China.
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, People's Republic of China.
- Center for Molecular Reproductive Medicine, Nanjing University, Nanjing, 210008, People's Republic of China.
| | - Dong Li
- Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, People's Republic of China.
- Center for Reproductive Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China.
- Center for Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China.
- Center for Molecular Reproductive Medicine, Nanjing University, Nanjing, 210008, People's Republic of China.
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He J, Deng R, Wei Y, Zhang S, Su M, Tang M, Wang J, Nong W, Lei X. Efficacy of antioxidant supplementation in improving endocrine, hormonal, inflammatory, and metabolic statuses of PCOS: a meta-analysis and systematic review. Food Funct 2024; 15:1779-1802. [PMID: 38251706 DOI: 10.1039/d3fo02824k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Background and aim: A large number of recent studies have reported on the use of antioxidants in patients with polycystic ovary syndrome (PCOS). This study aimed to evaluate the antioxidant effects on PCOS. Methods: We searched PubMed, Embase, Web of Science, and The Cochrane Library to identify randomized controlled trials investigating the use of antioxidants in treating PCOS. Statistical analysis was performed using Review Manager 5.4. Stata17.0 software was used to conduct sensitivity analyses. Results: This meta-analysis included 49 articles and 62 studies. The sample comprised 1657 patients with PCOS from the antioxidant group and 1619 with PCOS from the placebo group. The meta-analysis revealed that the fasting blood glucose levels [standardized mean difference (SMD): -0.31, 95% confidence interval (CI): -0.39 to -0.22, P < 0.00001], the homeostatic model assessment of insulin resistance (SMD: -0.68, 95% CI: -0.87 to -0.50], P < 0.00001), and insulin levels (SMD: -0.68, 95% CI: -0.79 to -0.58, P < 0.00001) were significantly lower in patients with PCOS taking antioxidants than those in the placebo group. Further, total cholesterol levels (SMD: -0.38, 95% CI: -0.56 to -0.20, P < 0.001), low-density lipoprotein cholesterol levels (SMD: -0.24, 95% CI: -0.37 to -0.10, P = 0.0008), and very low-density lipoprotein levels (SMD: -0.53, 95% CI: -0.65 to -0.41, P < 0.00001) were lower in patients with PCOS taking antioxidant supplements compared with the placebo group. Total testosterone (TT) level (SMD: -0.78, 95% CI: -1.15 to -0.42, P < 0.0001), dehydroepiandrosterone level (SMD: -0.42, 95% CI: -0.58 to -0.25, P < 0.00001), and mean standard deviation modified Ferriman-Gallway (MF-G scores) (SMD: -0.63, 95% CI: -0.98 to -0.28, P = 0.0004) were lower in patients taking antioxidant supplements. C-reactive protein (CRP) levels (SMD: -0.48, 95% CI: -0.63 to -0.34, P < 0.000001), body mass index [mean difference (MD): -0.27, 95% CI: -0.50 to -0.03, P = 0.03], weight (MD: -0.73, 95% CI: -1.35 to -0.11, P = 0.02), and diastolic blood pressure (MD: -3.78, 95% CI: -6.30 to -1.26, P = 0.003) were significantly lower. Moreover, the levels of sex hormone-binding protein (SMD: 0.23, 95% CI: 0.07-0.38, P = 0.004), high-density lipoprotein cholesterol (SMD: 0.11, 95% CI: 0.01-0.20, P = 0.03), total antioxidant capacity (SMD: 0.59, 95% CI: 0.31-0.87, P < 0.0001), and quantitative insulin sensitivity index (SMD: 0.01, 95% CI: 0.01-0.02, P < 0.00001) were higher in patients with PCOS who took antioxidant supplements compared with the placebo group. Antioxidant supplements did not affect other analyzed parameters in these patients, including follicle-stimulating hormone, free androgen index, nitric oxide, glutathione, malondialdehyde, and diastolic blood pressure. Conclusions: Antioxidants are beneficial in treating PCOS. Our study might provide a new treatment strategy for patients with clinical PCOS. We hope that more high-quality studies evaluating the effects of antioxidants on patients with PCOS will be conducted in the future. Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023448088.
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Affiliation(s)
- Junhui He
- Clinical Anatomy & Reproductive Medicine Application Institute, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China.
- Department of Obstetrics and Gynecology, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, 533300, China.
| | - Renhe Deng
- Clinical Anatomy & Reproductive Medicine Application Institute, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China.
| | - Yanhong Wei
- Clinical Anatomy & Reproductive Medicine Application Institute, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China.
- Department of Obstetrics and Gynecology, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, 533300, China.
| | - Shun Zhang
- Department of Reproductive Medical Center, The Affiliated Hospital of Guilin Medical University, Guilin 541001, China
| | - Mingxuan Su
- Clinical Anatomy & Reproductive Medicine Application Institute, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China.
| | - Masong Tang
- Clinical Anatomy & Reproductive Medicine Application Institute, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China.
| | - Jinyuan Wang
- Department of Reproduction and Genetics, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - Weihua Nong
- Clinical Anatomy & Reproductive Medicine Application Institute, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China.
- Department of Obstetrics and Gynecology, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, 533300, China.
| | - Xiaocan Lei
- Clinical Anatomy & Reproductive Medicine Application Institute, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China.
- Department of Obstetrics and Gynecology, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, 533300, China.
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23
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Wang M, Tong J, Zhu Q, Tang H, Tang L. Blood nesfatin-1 levels in patients with polycystic ovary syndrome: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2024; 14:1275753. [PMID: 38327900 PMCID: PMC10847586 DOI: 10.3389/fendo.2023.1275753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/28/2023] [Indexed: 02/09/2024] Open
Abstract
Background Previous studies have investigated the relationship between nesfatin-1 level and polycystic ovary syndrome (PCOS). However, these studies have produced conflicting results. Thus, in this meta-analysis, we aimed to clarify the association between blood nesfatin-1 levels and PCOS, and the ability of nesfatin-1 as a biomarker in PCOS. Methods Meta-analysis was performed using STATA 12.0 software. We computed standard mean difference (SMD) and 95% confidence interval (CI) regarding the comparison of blood nesfatin-1 in patients with PCOS and controls. Results The present meta-analysis showed no significant difference in blood nesfatin-1 level between patients with PCOS and controls with a random effects model (SMD = 0.03; 95%CI: -0.71, 0.77; I2 = 97.1%, p value for Q test < 0.001). Subgroup analysis for different ethnicities reported no significant difference in blood nesfatin-1 level between patients with PCOS and controls in both Caucasian and Asian populations. Subgroup analysis for different sample types reported no significant difference in serum nesfatin-1 level between patients with PCOS and controls. Subgroup studies reported no significant difference in blood nesfatin-1 level between PCOS and controls in both obese and non-obese populations. Conclusion In conclusion, there is no significant relationship between blood nesfatin-1 levels and PCOS.
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Affiliation(s)
| | | | | | | | - Lisha Tang
- *Correspondence: Lisha Tang, ; Huaiyun Tang,
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24
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Peven K, Wickham AP, Wilks O, Kaplan YC, Marhol A, Ahmed S, Bamford R, Cunningham AC, Prentice C, Meczner A, Fenech M, Gilbert S, Klepchukova A, Ponzo S, Zhaunova L. Assessment of a Digital Symptom Checker Tool's Accuracy in Suggesting Reproductive Health Conditions: Clinical Vignettes Study. JMIR Mhealth Uhealth 2023; 11:e46718. [PMID: 38051574 PMCID: PMC10731551 DOI: 10.2196/46718] [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: 02/23/2023] [Revised: 09/06/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Reproductive health conditions such as endometriosis, uterine fibroids, and polycystic ovary syndrome (PCOS) affect a large proportion of women and people who menstruate worldwide. Prevalence estimates for these conditions range from 5% to 40% of women of reproductive age. Long diagnostic delays, up to 12 years, are common and contribute to health complications and increased health care costs. Symptom checker apps provide users with information and tools to better understand their symptoms and thus have the potential to reduce the time to diagnosis for reproductive health conditions. OBJECTIVE This study aimed to evaluate the agreement between clinicians and 3 symptom checkers (developed by Flo Health UK Limited) in assessing symptoms of endometriosis, uterine fibroids, and PCOS using vignettes. We also aimed to present a robust example of vignette case creation, review, and classification in the context of predeployment testing and validation of digital health symptom checker tools. METHODS Independent general practitioners were recruited to create clinical case vignettes of simulated users for the purpose of testing each condition symptom checker; vignettes created for each condition contained a mixture of condition-positive and condition-negative outcomes. A second panel of general practitioners then reviewed, approved, and modified (if necessary) each vignette. A third group of general practitioners reviewed each vignette case and designated a final classification. Vignettes were then entered into the symptom checkers by a fourth, different group of general practitioners. The outcomes of each symptom checker were then compared with the final classification of each vignette to produce accuracy metrics including percent agreement, sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS A total of 24 cases were created per condition. Overall, exact matches between the vignette general practitioner classification and the symptom checker outcome were 83% (n=20) for endometriosis, 83% (n=20) for uterine fibroids, and 88% (n=21) for PCOS. For each symptom checker, sensitivity was reported as 81.8% for endometriosis, 84.6% for uterine fibroids, and 100% for PCOS; specificity was reported as 84.6% for endometriosis, 81.8% for uterine fibroids, and 75% for PCOS; positive predictive value was reported as 81.8% for endometriosis, 84.6% for uterine fibroids, 80% for PCOS; and negative predictive value was reported as 84.6% for endometriosis, 81.8% for uterine fibroids, and 100% for PCOS. CONCLUSIONS The single-condition symptom checkers have high levels of agreement with general practitioner classification for endometriosis, uterine fibroids, and PCOS. Given long delays in diagnosis for many reproductive health conditions, which lead to increased medical costs and potential health complications for individuals and health care providers, innovative health apps and symptom checkers hold the potential to improve care pathways.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Stephen Gilbert
- Else Kröner Fresenius Center for Digital Health, TUD Dresden University of Technology, Dresden, Germany
| | | | - Sonia Ponzo
- Flo Health UK Limited, London, United Kingdom
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25
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Hadidi M, Karimabadi K, Ghanbari E, Rezakhani L, Khazaei M. Stem cells and exosomes: as biological agents in the diagnosis and treatment of polycystic ovary syndrome (PCOS). Front Endocrinol (Lausanne) 2023; 14:1269266. [PMID: 37964963 PMCID: PMC10642184 DOI: 10.3389/fendo.2023.1269266] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/25/2023] [Indexed: 11/16/2023] Open
Abstract
A typical condition of the female reproductive system is polycystic ovary syndrome (PCOS). Hyperinsulinemia, insulin resistance, obesity, and hyperandrogenism are just a few of the metabolic abnormalities linked to this disease. Type 2 diabetes, hypertension, and cardiovascular disease are further issues related to PCOS. One consequence of this syndrome for which numerous treatment procedures have been developed is infertility. Metformin and clomiphene, two common allopathic medications used to treat PCOS, both have drawbacks and are ineffective. It is vital to seek novel therapeutic modalities to address these constraints. Exosomes (EXOs) are a particular class of extracellular vesicles that cells release, and they are known to play a significant role in mediating intercellular communication. A wide range of cargo, including lipids, proteins, mRNA, miRNAs, and numerous other noncoding RNAs, are contained in the nanoscale lipid bilayer exosomes. The cytokine effects of stem cells and EXOs derived from them enable the defense against metabolic diseases like PCOS. Moreover, EXO microRNAs can potentially be employed as biomarkers in the detection and management of PCOS. In this study, the potential of stem cells and exosomes are specifically investigated in the diagnosis and treatment of PCOS as one of the diseases of the female reproductive system.
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Affiliation(s)
- Mahta Hadidi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Keyvan Karimabadi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Elham Ghanbari
- Fertility and Infertility Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Tissue Engineering, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Leila Rezakhani
- Fertility and Infertility Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Tissue Engineering, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mozafar Khazaei
- Fertility and Infertility Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Tissue Engineering, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Zhou Z, Zhang Y, Zhang X, Zhang J, Yi G, Wan B, Li Y, Lu H, Tan C, Lu W. Follicular Fluid-Derived Small Extracellular Vesicles Alleviate DHEA-Induced Granulosa Cell Apoptosis by Delivering LINC00092. Reprod Sci 2023; 30:3092-3102. [PMID: 37188981 DOI: 10.1007/s43032-023-01251-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/23/2023] [Indexed: 05/17/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a perplexing condition in females of reproductive age. Dysplasia of ovarian granulosa cell (GC) is implicated in PCOS. Follicular fluid (FF)-extracellular vesicles (Evs) are important in cell-cell communication during follicular development. The current study elaborated on the function and mechanism of FF-Evs in the viability and apoptosis of GC cells in PCOS development. Human GC cells KGN were treated with dehydroepiandrosterone (DHEA) to mimic a PCOS-like condition in vitro, which were further co-cultured with the FF-derived Evs (FF-Evs). The FF-Evs treatment significantly reduced DHEA-induced apoptosis of KGN cells while promoting cell viability and migration. The lncRNA microarray analysis showed that FF-Evs mainly deliver LINC00092 into the KGN cells. Knockdown of LINC00092 negated the protective effect of FF-Evs against DHEA-induced damage on KGN cells. Moreover, by performing bioinformatics analyses and biotin-labeled RNA pull-down assay, we found that LINC00092 could bind to the RNA binding protein LIN28B and inhibit its binding to pre-microRNA-18-5p, which allowed biogenesis of pre-miR-18-5p and increased the expression of miR-18b-5p, a miRNA with known alleviating role in PCOS by suppressing the PTEN mRNA. Collectively, the present work demonstrates that FF-Evs can alleviate DHEA-induced GC damage by delivering LINC00092.
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Affiliation(s)
- Zhi Zhou
- Reproductive Medical Center, Hainan Women and Children's Medical Center, 75 South Longkun Road, Haikou, 570206, Hainan, People's Republic of China
| | - Yong Zhang
- Department of Pharmacology, School of Basic Medicine and Life Science, Hainan Medical University, Haikou, 571199, Hainan, People's Republic of China
| | - Xiaopo Zhang
- Key Laboratory of Tropical Translational Medicine of the Ministry of Education, Hainan Key Laboratory for Research and Development of Tropical Herbs, School of Pharmacy, Hainan Medical University, Haikou, 571199, Hainan, People's Republic of China
| | - Juan Zhang
- Reproductive Medical Center, Zhuzhou Central Hospital, Zhuzhou, 412007, Hunan, People's Republic of China
| | - Guohui Yi
- Public Research Laboratory, Hainan Medical University, Haikou, 571199, Hainan, People's Republic of China
| | - Bangbei Wan
- Reproductive Medical Center, Hainan Women and Children's Medical Center, 75 South Longkun Road, Haikou, 570206, Hainan, People's Republic of China
| | - Yejuan Li
- Reproductive Medical Center, Hainan Women and Children's Medical Center, 75 South Longkun Road, Haikou, 570206, Hainan, People's Republic of China
| | - Hui Lu
- Reproductive Medical Center, Hainan Women and Children's Medical Center, 75 South Longkun Road, Haikou, 570206, Hainan, People's Republic of China
| | - Can Tan
- Feinberg School of Medicine, Feinberg Cardiovascular and Renal Research Institute, Northwestern University, Chicago, IL, 60611, USA
| | - Weiying Lu
- Reproductive Medical Center, Hainan Women and Children's Medical Center, 75 South Longkun Road, Haikou, 570206, Hainan, People's Republic of China.
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27
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Clarke S, Jangid G, Nasr S, Atchade A, Moody BL, Narayan G. Polycystic Ovary Syndrome (PCOS): A Cross-Sectional Observational Study Analyzing the Quality of Content on YouTube. Cureus 2023; 15:e45354. [PMID: 37849574 PMCID: PMC10578195 DOI: 10.7759/cureus.45354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/19/2023] Open
Abstract
INTRODUCTION Polycystic ovary syndrome (PCOS), a chronic multifactorial disorder in women of reproductive age group, is a major public health problem. With most women resorting to platforms like "YouTube" that form a perfect source of edutainment, our aim was to analyze the quality of content available regarding the same. AIMS The aims and objectives of this study were to assess the quality and reliability of content related to PCOS on YouTube by analyzing the DISCERN score, global quality score (GQS), and video power index (VPI). METHODOLOGY It was a facility-based cross-sectional study undertaken on a single day with each author reviewing 10 videos from YouTube on PCOS using predetermined keywords. The number of likes, dislikes, views, comments, and uploader backgrounds were evaluated. DISCERN score, GQS, and VPI were also calculated for each video. While data entry was done using Microsoft Excel 2020 (Microsoft Corporation, Washington, United States), the analysis was carried out using SPSS Statistics version 16 (SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc.). Categorical variables were expressed as frequency and percentages, and statistical significance was determined using the Kruskal-Wallis test/one-way ANOVA. RESULTS A total of 80 videos that fit the inclusion criteria were analyzed. A majority of the videos (80%) were posted a year back with no updates. Only 28.8% of the video content was posted by doctors. Though most videos (96.25%) shared information pertaining to symptomatology, only 45% spoke regarding prevention. Promotional content was noted in 28.75% of the video content. GQS and VPI were better with information being provided by doctors, hospitals, and healthcare organizations (p-value 0.033 and 0.006, respectively). CONCLUSIONS With women reaching out to edutainment platforms like YouTube to clarify their concerns surrounding lifestyle diseases such as PCOS in the digital era, it becomes relevant to evaluate the quality of content available on such platforms. The findings of the study form a prototype for addressing the existing gaps in the knowledge available on YouTube. Furthermore, the findings warrant frequent monitoring of such available web-based content and delivery of such content only from qualified wellness experts.
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Affiliation(s)
- Shereece Clarke
- Department of Obstetrics and Gynecology, University of the West Indies, Montego Bay, JAM
| | - Gurusha Jangid
- Department of Obstetrics and Gynecology, Dr. Sampurnanand Medical College, Jodhpur, IND
| | - Summer Nasr
- Department of Medicine, St. George's University, True Blue, GRD
| | - Axelle Atchade
- Department of Medicine, St. George's University, True Blue, GRD
| | - Britney L Moody
- Department of Medicine, St. George's University, True Blue, GRD
| | - Gaurang Narayan
- Department of Obstetrics and Gynecology, Indira Gandhi Government Medical College and Hospital, Nagpur, IND
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Dar MA, Maqbool M, Ara I. The PCOS puzzle: putting the pieces together for optimal care. Int J Adolesc Med Health 2023; 35:299-311. [PMID: 37596861 DOI: 10.1515/ijamh-2023-0102] [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: 07/23/2023] [Accepted: 07/30/2023] [Indexed: 08/20/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a multifaceted hormonal disorder that has significant ramifications for both women's reproductive and metabolic well-being. This analysis aims to offer a thorough comprehension of PCOS by investigating the various contributing factors that are crucial for its effective management. We delve into the topic of hormonal imbalances, such as elevated androgens and disrupted estrogen-progesterone dynamics, and their effects on reproductive and metabolic health. Furthermore, we explore the intricate connection between insulin resistance, hyperinsulinemia, and PCOS, highlighting their pivotal role in metabolic dysfunction. Additionally, we examine fertility challenges, irregular menstrual patterns, and metabolic complications while also reviewing current treatment methodologies. Moreover, we address the latest research concerning genetic, environmental, and epigenetic influences on PCOS. By piecing together these essential elements, healthcare professionals can attain a comprehensive understanding of PCOS and deliver optimal care for those affected by the condition.
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Affiliation(s)
- Mohd Altaf Dar
- Department of Pharmacology, CT Institute of Pharmaceutical Sciences, PTU, Jalandhar, Punjab, India
| | - Mudasir Maqbool
- Department of Pharmaceutical Sciences, University Of Kashmir, Srinagar, Jammu and Kashmir, India
| | - Irfat Ara
- Regional Research Institute of Unani Medicine, Srinagar, Jammu and Kashmir, India
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Vajravelu ME, Tas E, Arslanian S. Pediatric Obesity: Complications and Current Day Management. Life (Basel) 2023; 13:1591. [PMID: 37511966 PMCID: PMC10381624 DOI: 10.3390/life13071591] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Obesity affects approximately 1 in 5 youth globally and increases the risk of complications during adolescence and young adulthood, including type 2 diabetes, dyslipidemia, hypertension, non-alcoholic fatty liver disease, obstructive sleep apnea, and polycystic ovary syndrome. Children and adolescents with obesity frequently experience weight stigma and have an impaired quality of life, which may exacerbate weight gain. Pediatric obesity is typically defined using sex-, age-, and population-specific body mass index percentiles. Once identified, pediatric obesity should always be managed with lifestyle modification. However, adolescents with obesity may also benefit from anti-obesity medications (AOM), several of which have been approved for use in adolescents by the US Food and Drug Administration, including liraglutide, phentermine/topiramate, and semaglutide. For children with specific, rare monogenic obesity disorders, setmelanotide is available and may lead to significant weight loss. Metabolic and bariatric surgery may be used for the management of severe obesity in youth; though highly effective, it is limited to specialized centers and has had relatively low pediatric uptake. In this narrative review using pediatric-focused data from original research, reviews, clinical practice guidelines, governmental agencies, and pharmaceutical companies, we review obesity-related metabolic complications in youth and management strategies, including AOM and bariatric surgery.
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Affiliation(s)
- Mary Ellen Vajravelu
- Center for Pediatric Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave., Faculty Pavilion 6th Floor, Pittsburgh, PA 15224, USA
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Emir Tas
- Center for Pediatric Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave., Faculty Pavilion 6th Floor, Pittsburgh, PA 15224, USA
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Silva Arslanian
- Center for Pediatric Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave., Faculty Pavilion 6th Floor, Pittsburgh, PA 15224, USA
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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Calcaterra V, Rossi V, Massini G, Casini F, Zuccotti G, Fabiano V. Probiotics and Polycystic Ovary Syndrome: A Perspective for Management in Adolescents with Obesity. Nutrients 2023; 15:3144. [PMID: 37513562 PMCID: PMC10384396 DOI: 10.3390/nu15143144] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 06/26/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) affects a considerable percentage of females of reproductive age. PCOS is an obesity-related condition and its effects are greatly amplified by obesity. Even though the pathogenesis of PCOS remains complex and has not been fully elucidated, a link between obesity, PCOS, and dysbiosis has been described. The potential role of the gut microbiota in the development and progression of PCOS and its associated symptoms has also been reported. The aim of this narrative review is to present a non-systematic analysis of the available literature on the topic of probiotics and PCOS in adolescents with obesity in order to revise the beneficial effects of probiotics/symbiotic supplementation on hormonal and metabolic profiles and inflammatory conditions. The effectiveness of probiotics/synbiotics in PCOS has been supported. The literature suggests that probiotic/symbiotic supplementation may ameliorate hormonal profiles, inflammatory indicators, and lipid metabolism disturbances caused by PCOS. Studies also show improvements in weight, BMI, insulin, and HOMA-IR, including a potential role it plays in protecting fertility. Even though further studies are needed to confirm these findings, particularly in adolescent patients, probiotic supplementation may be considered a solution for managing PCOS in adolescents with obesity.
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Affiliation(s)
- Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Virginia Rossi
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Giulia Massini
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Francesca Casini
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science, University of Milano, 20157 Milan, Italy
| | - Valentina Fabiano
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science, University of Milano, 20157 Milan, Italy
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de Oliveira NM, Machado J, Lopes L, Criado MB. A Review on Acupuncture Efficiency in Human Polycystic Ovary/Ovarian Syndrome. J Pharmacopuncture 2023; 26:105-123. [PMID: 37405111 PMCID: PMC10315877 DOI: 10.3831/kpi.2023.26.2.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 03/14/2022] [Accepted: 02/28/2023] [Indexed: 07/06/2023] Open
Abstract
Objectives Human Polycystic Ovary/Ovarian Syndrome (PCOS), a frequent endocrine pathophysiology among women of fertile age, is associated with woman's lifespan endocrine, metabolic and psychological implications. Long-term usage side effects of allopathic strategies and their low efficacy made complementary medicine treatments a relevant subject for these patients. The main aim of this work is to review the efficiency of the acupuncture treatment reported in the latest studies on literature regarding PCOS patients. Methods A comprehensive literature search, in English language, about the use of acupuncture on the management of PCOS, was conducted in October 2020 using EBSCO, Cochrane, PubMed, Medline, Embase, databases for randomised and non-randomised controlled trials between 2015 and 2020 (09/2015-10/2020), following the PRISMA protocol. Results This research led us to an analysis, according to PICOS, of six final papers selected among 178 in total. The articles addressed distinct aspects of the PCOS condition, diverse acupuncture techniques and different main and secondary outcomes in agreement to the respective main objective. According to this review, acupuncture seems to be useful for the treatment of this debilitating and chronic health condition which affects millions of women worldwide, many of them part of the workforce in their community. Conclusion Despite of the display of these positive results addressing acupuncture treatments to manage PCOS major symptoms - whether they are reproductive, metabolic, or mental health features - more research is urgent. Randomized, double blinded controlled trials with improved quality design and following STRICTA and/or CONSORT recommendations are necessary to engage acupuncture as a standardized and scientific validated technique in PCOS condition.
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Affiliation(s)
- Natália M. de Oliveira
- ICBAS - Institute of Biomedical Sciences Abel Salazar, School of Medicine and Biomedical Sciences, University of Porto-UP, Porto, Portugal
- CBSin, Center of BioSciences in Integrative Health, Porto, Portugal
| | - Jorge Machado
- ICBAS - Institute of Biomedical Sciences Abel Salazar, School of Medicine and Biomedical Sciences, University of Porto-UP, Porto, Portugal
- CBSin, Center of BioSciences in Integrative Health, Porto, Portugal
- LABIOMEP – Porto Biomechanics Laboratory, University of Porto-UP, Porto, Portugal
| | - Lara Lopes
- ICBAS - Institute of Biomedical Sciences Abel Salazar, School of Medicine and Biomedical Sciences, University of Porto-UP, Porto, Portugal
- CBSin, Center of BioSciences in Integrative Health, Porto, Portugal
| | - Maria Begoña Criado
- CBSin, Center of BioSciences in Integrative Health, Porto, Portugal
- TOXRUN – Toxicology Research Unit, University Institute of Health Sciences, CESPU, Gandra, Portugal
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Liu Y, Guo Y, Ding R, Yan X, Tan H, Wang X, Wang Y, Wang L. Heterogeneity and associated factors of patients with polycystic ovary syndrome health behaviors: a latent class analysis. BMC Endocr Disord 2023; 23:135. [PMID: 37357262 DOI: 10.1186/s12902-023-01385-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/07/2023] [Indexed: 06/27/2023] Open
Abstract
OBJECTIVE Using latent class to analyze whether there are subtypes of health behaviors in patients with PCOS can be addressed using targeted interventions. METHODS October 2021 to June 2022, 471 PCOS patients were surveyed using the Health Promoting Lifestyle Profile Questionnaire. Latent class analysis (LCA) was used to identify subgroups of PCOS patients. Subsequent multinomial latent variable regressions identified factors that were associated with health behaviors. RESULTS A three-class subtypes was the optimum grouping classification: (1)High healthy behavior risk; (2)high healthy responsibility and physical activity risk; (3)low healthy behavior risk. The multinomial logistic regression analysis revealed that (1)Single (OR = 2.061,95% CI = 1.207-3.659), Education level is primary school or below (OR = 4.997,95%CI = 1.732-14.416), participants is student (OR = 0.362,95%=0.138-0.948), participants with pregnancy needs (OR = 1.869,95%=1.009-3.463) were significantly more likely to be in the high healthy behavior risk subtypes; (2)The older the age (OR = 0.953,95%=0.867-1.047) and the larger the WC (OR = 0.954,95%=0.916-0.993), participants is married (OR = 1.126,95%=0.725-1.961), participants is employed ( OR = 1.418,95%=0.667-3.012) were significantly more likely to be in the high health responsibility and physical activity risk subtypes. CONCLUSION Patients with PCOS are a heterogeneous population with potential subtypes that may be suitable for customized multi-level care and targeted interventions.
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Affiliation(s)
- Ying Liu
- Nursing Department, Affiliated Hospital of Zunyi Medical University, 563000, ZunYi, Guizhou, China
- Nursing College, ZunYi Medical University, 563000, ZunYi, Guizhou, China
| | - Yunmei Guo
- Nursing Department, Affiliated Hospital of Zunyi Medical University, 563000, ZunYi, Guizhou, China
- Nursing College, ZunYi Medical University, 563000, ZunYi, Guizhou, China
| | - Rui Ding
- Nursing Department, Affiliated Hospital of Zunyi Medical University, 563000, ZunYi, Guizhou, China
- Nursing College, ZunYi Medical University, 563000, ZunYi, Guizhou, China
| | - Xin Yan
- Nursing Department, Affiliated Hospital of Zunyi Medical University, 563000, ZunYi, Guizhou, China
- Nursing College, ZunYi Medical University, 563000, ZunYi, Guizhou, China
| | - Huiwen Tan
- Nursing Department, Affiliated Hospital of Zunyi Medical University, 563000, ZunYi, Guizhou, China
- Nursing College, ZunYi Medical University, 563000, ZunYi, Guizhou, China
| | - Xueting Wang
- Nursing Department, Affiliated Hospital of Zunyi Medical University, 563000, ZunYi, Guizhou, China
- Nursing College, ZunYi Medical University, 563000, ZunYi, Guizhou, China
| | - Yousha Wang
- Nursing Department, Affiliated Hospital of Zunyi Medical University, 563000, ZunYi, Guizhou, China
- Nursing College, ZunYi Medical University, 563000, ZunYi, Guizhou, China
| | - LianHong Wang
- Nursing Department, Affiliated Hospital of Zunyi Medical University, 563000, ZunYi, Guizhou, China.
- Nursing College, ZunYi Medical University, 563000, ZunYi, Guizhou, 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: 2.5] [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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Bhandary P, Shetty PK, Manjeera L, Patil P. Hormonal, genetic, epigenetic and environmental aspects of polycystic ovarian syndrome. GENE REPORTS 2022. [DOI: 10.1016/j.genrep.2022.101698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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de Oliveira NM, Machado J, Huang Z, Criado MB. Acupuncture in Women with Human Polycystic Ovary/Ovarian Syndrome: Protocol for a Randomized Controlled Trial. Healthcare (Basel) 2022; 10:1999. [PMID: 36292446 PMCID: PMC9602079 DOI: 10.3390/healthcare10101999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/04/2022] [Accepted: 10/08/2022] [Indexed: 11/04/2022] Open
Abstract
(1) Background: Human polycystic ovary/ovarian syndrome (PCOS) is linked to endocrine, metabolic, and psychological complications. We propose a randomized controlled pilot study for an acupuncture protocol regarding the management of PCOS symptoms based on TCM diagnosis; (2) Methods: We will randomly allocate 120 women diagnosed with PCOS into two groups. The study group will be treated with acupuncture for points known to act upon the autonomous regulation of the hormonal, metabolic and emotional components. (3) Results and Conclusions: We expect to provide evidence of high methodological quality related to the effects and safety of an acupuncture protocol based on the perspective of a TCM diagnostic.
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Affiliation(s)
- Natália M de Oliveira
- ICBAS-Abel Salazar Institute for Biomedical Sciences, University of Porto, 4099-002 Porto, Portugal
- CBSin-Center of BioSciences in Integrative Health, 4000-105 Porto, Portugal
| | - Jorge Machado
- ICBAS-Abel Salazar Institute for Biomedical Sciences, University of Porto, 4099-002 Porto, Portugal
- CBSin-Center of BioSciences in Integrative Health, 4000-105 Porto, Portugal
- LABIOMEP-Porto Biomechanics Laboratory, University of Porto, 4200-450 Porto, Portugal
| | - Zaiwei Huang
- IEC-International Education College, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Maria Begoña Criado
- CBSin-Center of BioSciences in Integrative Health, 4000-105 Porto, Portugal
- TOXRUN-CESPU Toxicology Research Unit, University Institute of Health Sciences, CESPU, 4585-116 Gandra, Portugal
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Kara O, Kaymaz N, Uzun ME. The effect of hyperandrogenism and obesity on mindfulness and metacognition in adolescents with polycystic ovary syndrome. Arch Womens Ment Health 2022; 25:911-921. [PMID: 36074275 DOI: 10.1007/s00737-022-01264-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022]
Abstract
The aim of this study was to determine whether serum androgen levels have an effect on mindfulness and metacognition in adolescents with polycystic ovary syndrome (PCOS). Adolescents diagnosed with PCOS were asked to answer a questionnaire that included socio-demographic information and two scales: the Mindful Attention Awareness Scale (MAAS) and the Metacognition Scale Child and Adolescent form (MCQ-C). The patients were divided into two groups, the hyperandrogenism group and the non-hyperandrogenism group, according to serum androgen levels. The scores of MAAS and MCQ-C were compared between the groups. The study sample consisted of 70 adolescents. Of these, 44 had hyperandrogenism according to a blood test. No statistically significant difference was found in MAAS scores between the hyperandrogenism and the non-hyperandrogenism groups (p = 0.79). However, the level of mindfulness was found to be lower in participants with a higher modified Ferriman-Gallwey score (mFGS) (r = 0.26, p = 0.02). Mindfulness levels were also lower for obese patients with PCOS compared to non-obese patients with PCOS (p = 0.02). Cognitive monitoring (MCQ-C-CM), one of the MCQ-C sub-scales, was significantly higher in the non-hyperandrogenism group (p = 0.03), and similarly, a positive correlation was detected between higher androgen levels and the positive meta-worry (MCQ-C-PM) sub-scale of the MCQ-C (for total testosterone; r = 0.348, p = 0.03, and for androstenedione; r = 0.35, p = 0.03). High serum androgen levels in PCOS had no effect on mindfulness, but as the modified Ferriman Gallwey score increased, mindfulness levels decreased. For the sub-scales of MCQ-C,MCQ-C-CM, and MCQ-C-PM, the scores increased as androgen levels increased. In line with the results of the present study, evaluating mindfulness in PCOS patients with increased hair growth and metacognition in PCOS patients with serum hyperandrogenism may contribute well-being in adulthood by reducing the psychological burden caused by the disease.
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Affiliation(s)
- Ozlem Kara
- Department of Pediatric Endocrinology, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Mimar Sinan Mah. Emniyet Cad. Polis Okulu Karşısı Yıldırım, Bursa, 16310, Turkey.
| | - Nazan Kaymaz
- Department of Pediatrics, Faculty of Medicine, Çanakkale Onsekiz Mart University, Canakkale, Turkey
| | - Mehmet Erdem Uzun
- Department of Pediatric and Adolescent Psychiatry, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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Ugurlu C, Yildirim M, Özcan Ö, Karayigit S, Dasiran F, Okan I. Is Polycystic Ovary Syndrome a Predisposing Factor for Pilonidal Sinus Disease? Dis Colon Rectum 2022; 65:1129-1134. [PMID: 35333789 DOI: 10.1097/dcr.0000000000002336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The incidence of pilonidal sinus may be increased in women with polycystic ovary syndrome. OBJECTIVE This study aimed to compare the prevalence and risk factors of pilonidal sinus disease in women with and without polycystic ovary syndrome in the same population. DESIGN This was a case-control study. SETTINGS This study was conducted in a Turkish rural district state hospital. PATIENTS This study included 40 female patients with polycystic ovary syndrome and 120 female patients without polycystic ovary syndrome. MAIN OUTCOME MEASURES The prevalence of pilonidal sinus, age, BMI, number of baths per week, daily sitting time, and family history of pilonidal sinus were recorded. RESULTS Pilonidal sinus was detected in 22.5% (12.5% asymptomatic pits, 10% symptomatic) of patients with polycystic ovary syndrome and 1.7% of the control group ( p < 0.001). No difference was noted between the 2 groups in terms of BMI ( p = 0.219). Family history was similar between the case and control groups ( p = 0.520). No significant difference was noted between the 2 groups in terms of insufficient hygiene and daily sitting time ( p = 0.763, p = 0.706). Multivariate analysis showed that the risk of pilonidal sinus was significantly higher in patients with a positive family history ( p = 0.008). LIMITATIONS The number of patients in the case and control groups in the study was limited. In addition, the control group may not fully reflect the general population because it was composed of only patients who presented to the general surgery and gynecology outpatient clinic for other reasons. The control group was not age matched. CONCLUSIONS In our study, we found that the prevalence of pilonidal sinus was significantly higher in patients with polycystic ovary syndrome. See Video Abstract at http://links.lww.com/DCR/B945 . ES EL SNDROME DE OVARIO POLIQUSTICO UN FACTOR PREDISPONENTE PARA LA ENFERMEDAD DEL SENO PILONIDAL ANTECEDENTES:La incidencia de enfermedad del seno pilonidal puede aumentar en mujeres con síndrome de ovario poliquístico.OBJETIVO:El objetivo fue comparar la prevalencia y los factores de riesgo de la enfermedad del seno pilonidal en una misma poblacion de mujeres con y sin síndrome de ovario poliquístico.DISEÑO:Este fue un estudio de casos y controles.ENTORNO CLÍNICO:Se llevó a cabo en un hospital estatal de un distrito rural turco.PACIENTES:Este estudio incluyó a 40 pacientes mujeres con síndrome de ovario poliquístico y 120 pacientes mujeres sin síndrome de ovario poliquístico.PRINCIPALES MEDIDAS DE VALORACIÓN:Se registraron la prevalencia del seno pilonidal, la edad, el IMC, el número de duchas por semana, el tiempo diario para sentarse y los antecedentes familiares de seno pilonidal.RESULTADOS:El seno pilonidal se detectó en el 22,5 % (12,5 % fosas asintomáticas, 10 % sintomáticas) de las pacientes con síndrome de ovario poliquístico y en el 1,7 % del grupo control ( p < 0,001). No se observaron diferencias entre los dos grupos en términos de IMC ( p = 0,219). Los antecedentes familiares fueron similares entre los grupos de casos y controles ( p = 0,520). No se observaron diferencias significativas entre los dos grupos en términos de higiene insuficiente y tiempo de sedentarismo diario ( p = 0,763, p = 0,706). El análisis multivariante mostró que el riesgo de seno pilonidal fue significativamente mayor en pacientes con antecedentes familiares positivos ( p = 0,008).LIMITACIONES:El número de pacientes en los grupos de casos y controles en el estudio fue limitado. Además, es posible que el grupo de control no refleje completamente a la población general, ya que está compuesto solo por pacientes que acudieron a la consulta externa de cirugía general y ginecología por otras razones. El grupo de control no fue emparejado por edad.CONCLUSIONES:En nuestro estudio encontramos que la prevalencia de seno pilonidal fue significativamente mayor en pacientes con síndrome de ovario poliquístico. Consulte Video Resumen en http://links.lww.com/DCR/B945 . (Traducción-Dr. Ingrid Melo ).
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Affiliation(s)
- Celil Ugurlu
- Department of General Surgery, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Murat Yildirim
- Department of General Surgery, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Özhan Özcan
- Department of Anesthesia and Reanimation, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Serkan Karayigit
- Department of Obstetrics and Gynecology, Erbaa State Hospital, Tokat, Turkey
| | - Fatih Dasiran
- Department of General Surgery, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Ismail Okan
- Department of General Surgery, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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Expression of Serum Omentin, CTRP9, and Vaspin in Patients with Polycystic Ovary Syndrome. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1862404. [PMID: 36034953 PMCID: PMC9402309 DOI: 10.1155/2022/1862404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 11/23/2022]
Abstract
Objective To explore the relationship between serum omentin, C1q/tumor necrosis factor-related protein-9 (CTRP9), and visceral fat-specific serine protease inhibitor (vaspin) levels in different phenotypes in patients with polycystic ovary syndrome (PCOS). Methods One hundred PCOS patients treated at our hospital's clinic of reproductive medicine were chosen and included into the research group, and 100 healthy women who came for physical examination during the same time period were included into the control group. According to the definition of obesity by the WHO (body mass index (BMI) ≥25 kg/m2), 100 patients with PCOS were equally divided into obese (study group A) and nonobese (study group B) groups. 100 healthy women were also divided into obese (control group A) and nonobese (control group B) groups with 50 patients each. Comparison among the 4 groups was performed in factors/indicators including the serum omentin, CTRP9, and vaspin levels and biochemical indexes (triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), fasting insulin (FINS), total testosterone, and homeostasis model assessment of insulin resistance (HOMA-IR) levels), and the correlation analysis was conducted with omentin, CTRP9, and vaspin. Results There was no significant difference in age, TG, TC, and LDL-C among the 4 groups (P > 0.05). The BMI, WHR, HDL-C, and omentin of the obese phenotype were significantly different from those of the nonobese phenotype (P < 0.05). Among the four groups, FINS, HOMA-IR, and vaspin in group A (obesity) was the highest, and the control group B (nonobese) was the lowest. There was no significant difference in the levels of study group B (nonobese) and control group A (obesity). The level of CTRP9 in the study group was significantly lower than that in the control group (P < 0.05). Taking serum omentin, CTRP9, and vaspin levels of patients in the study group as dependent variables, Pearson correlation analysis showed that the omentin level was negatively correlated with BMI, WHR, FINS, TG, TC, LDL-C, HOMA-IR, and TT levels (P < 0.05) and was positively correlated with the HDL-C level (P < 0.05); CTRP9 level was negatively correlated with BMI, TC, and HOMA-IR (P < 0.05) and was not correlated with age, WHR, FINS, TG, HDL-C, LDL-C, HOMA-IR, and TT levels. The vaspin level was positively correlated with BMI, WHR, FINS, TG, TC, LDL-C, HOMA-IR, and TT levels (P < 0.05) and negatively correlated with HDL-C levels (P < 0.05) and was not correlated with age. Conclusion When compared with healthy people, PCOS patients have higher serum vaspin levels and lower CTRP9 levels; BMI, TC, LDL-C, FINS, TG, total testosterone, HDL-C levels, waist-to-hip ratio, and HOMA-IR are all closely related to serum vaspin and CTRP9 levels; increasing serum CTRP9 levels and decreasing vaspin levels help to slow progress and promote prognosis of the disease. Serum omentin level is connected with the obesity index but not with PCOS.
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Peña AS, Codner E, Witchel S. Criteria for Diagnosis of Polycystic Ovary Syndrome during Adolescence: Literature Review. Diagnostics (Basel) 2022; 12:diagnostics12081931. [PMID: 36010282 PMCID: PMC9406411 DOI: 10.3390/diagnostics12081931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 11/11/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is one of the most common endocrine conditions in women. PCOS may be more challenging to diagnose during adolescence due to an overlap with the physiological events of puberty, which are part of the diagnostic criteria in adult women. This review focuses on the evidence available in relation to PCOS diagnostic criteria for adolescents. Adolescent PCOS should be diagnosed using two main criteria irregular -menstrual cycles (relative to number of years post-menarche) and hyperandrogenism (clinical and/or biochemical); after excluding other conditions that mimic PCOS. Accurate definitions of the two main criteria will decrease challenges/controversies with the diagnosis and provide timely diagnosis during adolescence to establish early management. Despite the attempts to create accurate diagnostic criteria and definitions, this review highlights the limited research in this area, especially in the follow up of adolescents presenting with one diagnostic feature that are called “at risk of PCOS”. Studies in adolescents continue to use the Rotterdam diagnostic criteria that uses pelvic ultrasound. This is inappropriate, because previous and emerging data that show many healthy adolescents have polycystic ovarian morphology in the early years post-menarche. In the future, anti-Müllerian hormone levels might help support PCOS diagnosis if adolescents meet two main criteria.
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Affiliation(s)
- Alexia S. Peña
- Discipline of Paediatrics, The University of Adelaide Robinson Research Institute, 72 King William Road, Adelaide, SA 5006, Australia
- Endocrinology and Diabetes Department, Women’s and Children’s Hospital, 72 King William Road, Adelaide, SA 5006, Australia
- Correspondence: ; Tel.: +61-881618134
| | - Ethel Codner
- Institute of Child and Maternal Research, School of Medicine, University of Chile, Santiago 836-0160, Chile
| | - Selma Witchel
- UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA 15224, USA
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Polycystic ovary syndrome and postpartum depression among Hispanics and non-Hispanics: a population-based study. AJOG GLOBAL REPORTS 2022; 2. [PMID: 36060826 PMCID: PMC9438401 DOI: 10.1016/j.xagr.2022.100070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Yuan B, Luo S, Feng L, Wang J, Mao J, Luo B. Resveratrol regulates the inflammation and oxidative stress of granulosa cells in PCOS via targeting TLR2. J Bioenerg Biomembr 2022; 54:191-201. [PMID: 35836030 DOI: 10.1007/s10863-022-09942-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022]
Abstract
Polycystic ovary syndrome (PCOS) is featured as a common endocrine disorder in reproductive-aged women, while its pathophysiology is not fully illustrated. This study examined potential actions of resveratrol in PCOS cellular model and explored the underlying interaction between resveratrol and toll-like receptor 2 (TLR2). This study performed the bioinformatics analysis on two microarray datasets (GSE34526 and GSE138518). We found that TLR2 was one of potential hub genes that may be associated with PCOS. Further examination showed that TLR2 was highly expressed in granulosa cells from PCOS group compared with control. The in vitro studies showed that LPS intervention caused an increased expression of TLR2 and the pro-inflammatory mediators, and induced oxidative stress in the granulosa cells, which was concentration-dependently antagonized by resveratrol treatment. TLR2 silence significantly attenuated LPS-induced increase TNF-α, IL-1β, IL-6 and IL-8 expression and oxidative stress of granulosa cells. Furthermore, TLR2 overexpression promoted inflammatory response and oxidative stress in the granulosa cells, which was antagonized by resveratrol treatment. In conclusion, resveratrol could attenuate LPS-induced inflammation and oxidative stress in granulosa cells, and the underlying mechanisms may be related to the inhibitory effect of resveratrol on TLR2 expression in granulosa cells.
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Affiliation(s)
- Ben Yuan
- Department of Reproductive Medicine, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, 435000, Hubei, China.
| | - Shuhong Luo
- Department of Reproductive Medicine, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, 435000, Hubei, China
| | - Liulian Feng
- Department of Reproductive Medicine, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, 435000, Hubei, China
| | - Junling Wang
- Department of Reproductive Medicine, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, 435000, Hubei, China
| | - Junbiao Mao
- Department of Reproductive Medicine, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, 435000, Hubei, China
| | - Bingbing Luo
- Department of Reproductive Medicine, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, 435000, Hubei, China
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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: 8] [Impact Index Per Article: 2.7] [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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Ciężki S, Kurpiewska E, Bossowski A, Głowińska-Olszewska B. Multi-Faceted Influence of Obesity on Type 1 Diabetes in Children - From Disease Pathogenesis to Complications. Front Endocrinol (Lausanne) 2022; 13:890833. [PMID: 35784568 PMCID: PMC9243381 DOI: 10.3389/fendo.2022.890833] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/13/2022] [Indexed: 01/08/2023] Open
Abstract
The prevalence of overweight and obesity among youth patients with diabetes type 1 is increasing. It is estimated, that even up to 35% of young patients with this type of diabetes, considered so far to be characteristic for slim figure, are overweight or even obese. General increase of obesity in children's population complicates differential diagnosis of the type of diabetes in youths. Coexistence of obesity has clinical implications for all stages of diabetes course. It is confirmed that obesity is the risk factor for autoimmune diabetes, and is connected with the earlier onset of diabetes in predisposed patients. Many diabetic patients with obesity present additional risk factors for macroangiopathy, and are recognised to present metabolic syndrome, insulin resistance, and typical for diabetes type 2 - polycystic ovary syndrome, or non-alcoholic fatty liver disease. The prevalence of obesity rises dramatically in adolescence of diabetic child, more often in girls. It has negative impact on metabolic control, glycaemic variability and insulin demand. The risk for microangiopathic complications increases as well. The treatment is difficult and includes not only insulinotherapy and non-pharmacological trials. Recently treatment of insulin resistance with biguanids, and treatment with typical for type 2 new diabetes drugs like GLP-1 analogues, SGLT-2 receptor inhibitors, or even cases of bariatric surgery also has been reported.
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Emanuel RHK, Roberts J, Docherty PD, Lunt H, Campbell RE, Möller K. A review of the hormones involved in the endocrine dysfunctions of polycystic ovary syndrome and their interactions. Front Endocrinol (Lausanne) 2022; 13:1017468. [PMID: 36457554 PMCID: PMC9705998 DOI: 10.3389/fendo.2022.1017468] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) affects up to 20% of women but remains poorly understood. It is a heterogeneous condition with many potential comorbidities. This review offers an overview of the dysregulation of the reproductive and metabolic systems associated with PCOS. Review of the literature informed the development of a comprehensive summarizing 'wiring' diagram of PCOS-related features. This review provides a justification for each diagram aspect from the relevant academic literature, and explores the interactions between the hypothalamus, ovarian follicles, adipose tissue, reproductive hormones and other organ systems. The diagram will provide an efficient and useful tool for those researching and treating PCOS to understand the current state of knowledge on the complexity and variability of PCOS.
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Affiliation(s)
- Rebecca H. K. Emanuel
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Josh Roberts
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Paul D. Docherty
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
- Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
- *Correspondence: Paul D. Docherty,
| | - Helen Lunt
- Diabetes Services, Te Whatu Ora Waitaha Canterbury, Canterbury, New Zealand
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Rebecca E. Campbell
- School of Biomedical Sciences, Department of Physiology, Centre for Neuroendocrinology, University of Otago, Dunedin, New Zealand
| | - Knut Möller
- Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
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OUP accepted manuscript. Hum Reprod 2022; 37:1919-1931. [DOI: 10.1093/humrep/deac091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/28/2022] [Indexed: 11/13/2022] Open
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Islam H, Masud J, Islam YN, Haque FKM. An update on polycystic ovary syndrome: A review of the current state of knowledge in diagnosis, genetic etiology, and emerging treatment options. WOMEN'S HEALTH 2022; 18:17455057221117966. [PMID: 35972046 PMCID: PMC9386861 DOI: 10.1177/17455057221117966] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Polycystic ovary syndrome is the most common endocrine disorder in women of reproductive age, which is still incurable. However, the symptoms can be successfully managed with proper medication and lifestyle interventions. Despite its prevalence, little is known about its etiology. In this review article, the up-to-date diagnostic features and parameters recommended on the grounds of evidence-based data and different guidelines are explored. The ambiguity and insufficiency of data when diagnosing adolescent women have been put under special focus. We look at some of the most recent research done to establish relationships between different gene polymorphisms with polycystic ovary syndrome in various populations along with the underestimated impact of environmental factors like endocrine-disrupting chemicals on the reproductive health of these women. Furthermore, the article concludes with existing treatments options and the scopes for advancement in the near future. Various therapies have been considered as potential treatment through multiple randomized controlled studies, and clinical trials conducted over the years are described in this article. Standard therapies ranging from metformin to newly found alternatives based on vitamin D and gut microbiota could shine some light and guidance toward a permanent cure for this female reproductive health issue in the future.
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Affiliation(s)
- Hiya Islam
- Biotechnology Program, Department of Mathematics and Natural Sciences, School of Data and Sciences, Brac University, Dhaka, Bangladesh
| | - Jaasia Masud
- Biotechnology Program, Department of Mathematics and Natural Sciences, School of Data and Sciences, Brac University, Dhaka, Bangladesh
| | - Yushe Nazrul Islam
- Biotechnology Program, Department of Mathematics and Natural Sciences, School of Data and Sciences, Brac University, Dhaka, Bangladesh
| | - Fahim Kabir Monjurul Haque
- Microbiology Program, Department of Mathematics and Natural Sciences, School of Data and Sciences, Brac University, Dhaka, Bangladesh
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Gu Y, Zhou G, Zhou F, Wu Q, Ma C, Zhang Y, Ding J, Hua K. Life Modifications and PCOS: Old Story But New Tales. Front Endocrinol (Lausanne) 2022; 13:808898. [PMID: 35498415 PMCID: PMC9045543 DOI: 10.3389/fendo.2022.808898] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is defined as a kind of endocrine and metabolic disorder that affects female individuals of reproductive age. Lifestyle modifications, including diet modifications, exercise, and behavioral modification, appear to alleviate the metabolic dysfunction and improve the reproductive disorders of PCOS patients (particularly in obese women). Therefore, lifestyle modifications have been gradually acknowledged as the first-line management for PCOS, especially in obese patients with PCOS. However, the mechanism of lifestyle modifications in PCOS, the appropriate composition of diet modifications, and the applicable type of exercise modifications for specific female populations are rarely reported. We conducted a systematic review and enrolled 10 randomized controlled trials for inclusion in a certain selection. In this review, we summarized the existing research on lifestyle modifications in PCOS. We aimed to illustrate the relationship between lifestyle modifications and PCOS (referring to hyperandrogenism, insulin resistance as well as obesity) and also considered the priorities for future research. These results might be an invaluable tool to serve as a guide in lifestyle modifications as the intervention for PCOS and other related endocrine disorders.
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Affiliation(s)
- Yuanyuan Gu
- Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai, China
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Guannan Zhou
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Department of Gynecology, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
| | - Fangyue Zhou
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qiongwei Wu
- Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai, China
| | - Chengbin Ma
- Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai, China
| | - Yi Zhang
- Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai, China
- *Correspondence: Yi Zhang, ; Jingxin Ding, ; Keqin Hua,
| | - Jingxin Ding
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Department of Gynecology, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
- *Correspondence: Yi Zhang, ; Jingxin Ding, ; Keqin Hua,
| | - Keqin Hua
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Department of Gynecology, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
- *Correspondence: Yi Zhang, ; Jingxin Ding, ; Keqin Hua,
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Peña AS, Teede H, Hewawasam E, Hull ML, Gibson-Helm M. Diagnosis experiences of adolescents with polycystic ovary syndrome: Cross-sectional study. Clin Endocrinol (Oxf) 2022; 96:62-69. [PMID: 34585425 DOI: 10.1111/cen.14604] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/28/2021] [Accepted: 09/06/2021] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Women with polycystic ovary syndrome (PCOS) report delayed diagnosis of the condition and receiving inadequate information at diagnosis. No studies have investigated the diagnosis experiences of adolescents with PCOS. Our objective was to investigate the adolescents' experiences of PCOS diagnosis and their concerns about the condition. DESIGN Cross-sectional study. PATIENT(S) Eighty-six adolescents (aged 13-19 years) were diagnosed with PCOS by a medical practitioner. Adolescents were recruited consecutively from paediatric and women's outpatient hospital clinics in South Australia and online PCOS support organisations in Australia and the United Kingdom (May 2017-June 2019). MEASUREMENTS PCOS diagnosis experience and information received at the time of diagnosis were evaluated using a validated questionnaire. RESULTS The majority of the adolescents (n = 67, 78%) were diagnosed with PCOS in less than 1 year from their first doctor's visit but 11 (13%) were diagnosed more than 2 years from that visit. Fifty-three adolescents (66%) saw 1-2 health professionals before the diagnosis was made. Forty-nine adolescents (57%) were satisfied with the overall diagnosis experience but adolescents were either dissatisfied or reported that the information was not mentioned after diagnosis in relation to lifestyle management (n = 47, 55%), long-term complications (n = 53, 62%) and emotional support and counselling (n = 65, 76%). CONCLUSIONS The majority of adolescent girls with PCOS are receiving a timely diagnosis, but delayed diagnosis still occurs in a minority of adolescents. Current information provided at diagnosis is not meeting the needs of adolescents and is a lost opportunity for preventive healthcare at a critical transition to adult care period.
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Affiliation(s)
- 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
| | - Helena Teede
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Erandi Hewawasam
- 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
| | - Mary Louise Hull
- Department of Obstetrics and Gynaecology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
- Department of Obstetrics and Gynaecology, Robinson Research Institute, The University of Adelaide, North Adelaide, South Australia, Australia
| | - Melanie Gibson-Helm
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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McCarthy EA, Dischino D, Maguire C, Leon S, Talbi R, Cheung E, Schteingart CD, Rivière PJM, Reed SD, Steiner RA, Navarro VM. Inhibiting Kiss1 Neurons With Kappa Opioid Receptor Agonists to Treat Polycystic Ovary Syndrome and Vasomotor Symptoms. J Clin Endocrinol Metab 2022; 107:e328-e347. [PMID: 34387319 PMCID: PMC8684497 DOI: 10.1210/clinem/dgab602] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Recent evidence suggests that vasomotor symptoms (VMS) or hot flashes in the postmenopausal reproductive state and polycystic ovary syndrome (PCOS) in the premenopausal reproductive state emanate from the hyperactivity of Kiss1 neurons in the hypothalamic infundibular/arcuate nucleus (KNDy neurons). OBJECTIVE We demonstrate in 2 murine models simulating menopause and PCOS that a peripherally restricted kappa receptor agonist (PRKA) inhibits hyperactive KNDy neurons (accessible from outside the blood-brain barrier) and impedes their downstream effects. DESIGN Case/control. SETTING Academic medical center. PARTICIPANTS Mice. INTERVENTIONS Administration of peripherally restricted kappa receptor agonists and frequent blood sampling to determine hormone release and body temperature. MAIN OUTCOME MEASURES LH pulse parameters and body temperature. RESULTS First, chronic administration of a PRKA to bilaterally ovariectomized mice with experimentally induced hyperactivity of KNDy neurons reduces the animals' elevated body temperature, mean plasma LH level, and mean peak LH per pulse. Second, chronic administration of a PRKA to a murine model of PCOS, having elevated plasma testosterone levels and irregular ovarian cycles, suppresses circulating levels of LH and testosterone and restores normal ovarian cyclicity. CONCLUSION The inhibition of kisspeptin neuronal activity by activation of kappa receptors shows promise as a novel therapeutic approach to treat both VMS and PCOS in humans.
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Affiliation(s)
- Elizabeth A McCarthy
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Daniel Dischino
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Caroline Maguire
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Silvia Leon
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Rajae Talbi
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Eugene Cheung
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | | | | | - Susan D Reed
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA 98195, USA
| | - Robert A Steiner
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA 98195, USA
- Department of Physiology & Biophysics, University of Washington, Seattle, WA 98195, USA
| | - Victor M Navarro
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Harvard Program in Neuroscience, Boston, MA 02115, USA
- Correspondence: Victor M. Navarro PhD, Brigham and Women’s Hospital, Division of Endocrinology, Diabetes and Hypertension, 221 Longwood Ave, Boston, MA 02115, USA.
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Schniewind HA, Sattler LM, Haudum CW, Münzker J, Minich WB, Obermayer-Pietsch B, Schomburg L. Autoimmunity to the Follicle-Stimulating Hormone Receptor (FSHR) and Luteinizing Hormone Receptor (LHR) in Polycystic Ovarian Syndrome. Int J Mol Sci 2021; 22:ijms222413667. [PMID: 34948471 PMCID: PMC8706343 DOI: 10.3390/ijms222413667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/18/2021] [Accepted: 12/19/2021] [Indexed: 01/01/2023] Open
Abstract
Hyperandrogenemia and ovulatory dysfunction are hallmarks of polycystic ovary syndrome (PCOS), pointing to a deranged hypothalamus-pituitary-ovarian (HPO) axis. An autoimmune etiology of PCOS is suspected in a subset of patients due to the relatively high concordance of PCOS with common autoimmune diseases. For this reason, we tested the hypothesis that natural autoantibodies (aAb) to the follicle-stimulating hormone receptor (FSHR) or luteinizing hormone receptor (LHR) are prevalent in PCOS. To this end, new luminometric assays for quantifying aAb to the FSHR (FSHR-aAb) or LHR (LHR-aAb) were developed using full-length recombinant human receptors as fusion proteins with luciferase as reporter. Prevalence of FSHR-aAb and LHR-aAb was determined in serum samples from healthy controls and PCOS patients. Steroid hormone profiles were compared between patients with and without FSHR-aAb or LHR-aAb. Signal linearity and detection ranges were characterized and both methods passed basic performance quality checks. The analysis revealed a relatively low prevalence, with 4 out of 430 samples positive for FSHR-aAb in the control versus 11 out of 550 samples in the PCOS group, i.e., 0.9% versus 2.0%, respectively. Similarly, there were only 5 samples positive for LHR-aAb in the control versus 2 samples in the PCOS group, i.e., 1.2% versus 0.4%, respectively. Samples positive for FSHR-aAb displayed steroid hormones in the typical range of PCOS patients, whereas the two samples positive for LHR-aAb showed relatively elevated free testosterone in relation to total testosterone concentrations with unclear significance. We conclude that the FSHR and LHR constitute potential autoantigens in human subjects. However, the prevalence of specific autoantibodies to these receptors is relatively low, both in control subjects and in women with PCOS. It is therefore unlikely that autoimmunity to the LHR or FSHR constitutes a frequent cause of hyperandrogenemia or ovulatory dysfunction in PCOS.
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Affiliation(s)
- Hanna A. Schniewind
- Institute for Experimental Endocrinology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.A.S.); (L.-M.S.); (W.B.M.)
| | - Lisa-Marie Sattler
- Institute for Experimental Endocrinology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.A.S.); (L.-M.S.); (W.B.M.)
| | - Christoph W. Haudum
- Endocrinology Lab Platform, Department of Internal Medicine and Gynecology and Obstetrics, Medical University Graz, A-8036 Graz, Austria; (C.W.H.); (J.M.)
| | - Julia Münzker
- Endocrinology Lab Platform, Department of Internal Medicine and Gynecology and Obstetrics, Medical University Graz, A-8036 Graz, Austria; (C.W.H.); (J.M.)
| | - Waldemar B. Minich
- Institute for Experimental Endocrinology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.A.S.); (L.-M.S.); (W.B.M.)
| | - Barbara Obermayer-Pietsch
- Endocrinology Lab Platform, Department of Internal Medicine and Gynecology and Obstetrics, Medical University Graz, A-8036 Graz, Austria; (C.W.H.); (J.M.)
- Correspondence: (B.O.-P.); (L.S.)
| | - Lutz Schomburg
- Institute for Experimental Endocrinology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.A.S.); (L.-M.S.); (W.B.M.)
- Correspondence: (B.O.-P.); (L.S.)
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