Burden of female infertility in 204 countries and territories, 1990-2021: results from the Global Burden of Disease Study 2021

OBJECTIVE

To explore the global burden of female infertility from 1990 to 2021 by examining trends in prevalence and years lived with disability (YLD).

METHODS

Data from the Global Burden of Disease Study 2021 (GBD 2021) were analyzed with a focus on the prevalence and YLD of female infertility in women aged 15-49 years. Statistical models were used to estimate ASPRs and YLD across regions and countries.

RESULTS

The global prevalence of female infertility was 110.1 million in 2021, with an age-standardized rate of 2,764.6 per 100,000 population. The YLD for infertility in 2021 was 601,134, which represented a 33.1% increase since 1990. Regionally, East Asia and Eastern Europe had the highest rates of infertility, whereas Australasia had the lowest rate.

CONCLUSIONS

The study highlights a significant rise in the burden of female infertility, particularly in high-income regions. Study findings emphasize the need for targeted public health strategies and healthcare interventions to address this growing issue.

An endocrinological perspective on polycystic ovarian syndrome

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.

The association between depression and anxiety with female sexual function in young women with polycystic ovary syndrome

BACKGROUND

PCOS and its associated symptoms might be related to anxiety and depressive symptoms which may influence sexual function.

AIM

To investigate the association between depression and anxiety with female sexual function among women with polycystic ovary syndrome (PCOS) during reproductive age.

METHODS

The study group included 268 women with PCOS and 158 women without PCOS between the ages of 18 and 35 years. Serum testosterone, androstenedione, dehydroepiandrostenedione sulfate (DHEA-S), fasting glucose, sex-hormone binding globulin, and fasting insulin levels were analyzed. The McCoy Female Sexual Questionnaire (MFSQ), and Beck Anxiety and Depression Inventories (BAI and BDI) were distributed to women with PCOS and controls.

OUTCOMES

MFSQ, BDI, and BAI scores were compared between women with PCOS and controls.

RESULTS

There was a significant difference between the PCOS and non-PCOS groups when BDI (18.92 ± 11.09 vs 10.20 ± 8.66, p = 0.001) and BAI (12.45 ± 9.67 vs 8.08 ± 8.90, p = 0.001) subgroups were compared. A weak negative correlation was present between McCoy's sexuality domain (r = -0.304), McCoy's Sexual partner domain (r = -0.215), and BAI score among PCOS women. A moderate negative correlation between McCoy's sexuality domain (r = -0.515), and a weak correlation between McCoy's Sexual partner domain (r = -0.271) and BDI score among PCOS women were found.

CLINICAL IMPLICATIONS

Women with PCOS report more severe depression, anxiety, and sexual dysfunction than non-PCOS women.

STRENGTHS & LIMITATIONS

Socio-cultural identity, awareness, perceptions of body image, and interpersonal relations were not investigated in the current study. These play a role in the interactions between sexual dysfunction and mood disorder. The strength of our study was that the prevalence of PCOS features was different between the various depression and anxiety subgroups.

CONCLUSION

The women with PCOS were more likely to have moderate-severe anxiety and moderate-severe depression while their mean total scores of the two domains of MFSQ were lower when compared to non-PCOS women.

Psychiatric disorders, impulsivity and borderline personality in patients with polycystic ovary syndrome

INTRODUCTION

Polycystic ovarian syndrome (PCOS) is a common endocrine condition in women. Studies have shown that PCOS is associated with poor quality of life, anxiety, sadness, dissatisfaction with one's appearance, and sexual dysfunction.

OBJECTIVE

This study was conducted to determine whether a strong psycho-pathological personality is related to PCOS and whether this personality is related to the hyperandrogenic state.

METHODS

Anthropometric, metabolic, hormonal, clinical, and psychological characteristics were examined in 90 Bahraini women with PCOS. After confirming the diagnosis of PCOS via Rotterdam criteria, including ovarian ultrasound, each patient was evaluated via the following questionnaires: 1) the GAD-7 (General Anxiety Disorder-7) to measure the severity of anxiety; 2) the Patient Health Questionnaire-9 (PHQ-9) to confirm and measure the severity of depression; 3) the Barratt Impulsiveness Scale (BIS-11) to measure aggression; and 4) the McLean Screening Instrument to identify borderline personality disorders (MSI-BPDs). The study was approved by the Institutional Review Board.

RESULTS

Compared to controls, PCOS patients exhibited significantly higher rates of severe depression (8% vs. 0%, p < 0.001), severe anxiety (7% vs. 0%, p < 0.001), impulsivity (BIS-11: 39.43 ± 9.69 vs. 26.64 ± 2.92, p < 0.001), and borderline personality traits (McLean: 2.41 ± 2.44 vs. 1.2 ± 0.94, p < 0.001). Metabolic comorbidities, including obesity (BMI 28.88 vs. 20.27, p < 0.001) and hypothyroidism (48% vs. 0%, p < 0.001), were prevalent in PCOS. Hyperandrogenism correlated weakly with psychiatric outcomes (all p > 0.05).

CONCLUSION

Women with PCOS demonstrate markedly elevated psychiatric and medical burdens compared to healthy controls. While hyperandrogenism showed limited direct associations, metabolic dysfunction (e.g., obesity) may mediate psychiatric risk. These findings underscore the need for multidisciplinary care integrating psychological and endocrine management, particularly in populations where cultural norms exacerbate PCOS-related distress.

Advancement in early diagnosis of polycystic ovary syndrome: biomarker-driven innovative diagnostic sensor

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.

Rising Incidence, Health Resource Utilization, and Costs of Polycystic Ovary Syndrome in the United Kingdom

CONTEXT

Trends in incidence of polycystic ovary syndrome (PCOS) and effects on health resource utilization are unclear.

OBJECTIVE

To describe trends in prevalence and incidence of PCOS in the United Kingdom. To establish healthcare resource use and associated costs.

METHODS

Data were extracted from the Clinical Practice Research Datalink Aurum and Hospital Episode Statistics databases. Point prevalence and incidence were calculated (2004-2020). Patients with PCOS were matched to controls (1:1) by age, body mass index, and primary care practice. Primary care contacts were assigned an average cost and prescription items assigned a net ingredient cost. Inpatient admissions and outpatient consultations were processed into healthcare resource groups and costed to the national tariff.

RESULTS

PCOS incidence increased from 1.22 per 1000 person years in 2004 to 1.77 (2012) and 2.20 (2019). Point prevalence increased from 1.02% (2004) to 2.2% (2012) and 3.5% (2020), and was highest in Asians. Mean contacts per person year (ppy) for patients with PCOS vs controls were 0.48 vs 0.29 for inpatients (P < .001), 3.81 vs 2.15 for outpatients (P < .001), and 6.43 vs 4.68 (P < .001) for primary care. Mean healthcare costs (ppy) were £837 vs £493 (P < .001) for inpatients, £444 vs £253 (P < .001) for outpatients, £157 vs £112 for primary care, and £109 vs £83 (P < .001) for primary care prescriptions. Total healthcare contacts ppy were 10.72 vs 7.11 (P < .001) and total associated costs £1546 vs £940 (P < .001).

CONCLUSION

The incidence of PCOS has risen significantly. Health resource utilization and costs of PCOS are significantly greater than controls.

Association between triglyceride glucose index and depression in polycystic ovary syndrome

OBJECTIVE

The relationship between the triglyceride glucose (TyG) index and the incidence of depression in populations with polycystic ovary syndrome (PCOS) remains unclear. This study aims to investigate the relationship between the TyG index and depression incidence in PCOS populations.

METHODS

We conducted a study on 725 women aged 18 to 45 who visited our hospital from January 2021 to December 2023. Demographic and anthropometric data were collected, and serum assays were performed. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess the past week's feelings and determine depression status. Statistical methods such as binary logistic regression analysis were used to analyze the relationship between the TyG index, Homeostatic model assessment insulin resistance index(HOMA-IR), and depression in PCOS patients. The TyG index, HOMA-IR, was tested for its ability to predict depression using receiver operating characteristic (ROC) curves.

RESULTS

In logistic regression models, a significant positive association was observed between the TyG index and depression after the adjusted analysis(4.552(2.975 ∼ 6.966), P<0.001). Compared to HOMA-IR(1.224(1.122 ∼ 1.336), P<0.001), the TyG index was a more significant risk factor for depression. ROC analysis showed that the AUC of the TyG index(0.724, 0.684 ∼ 0.765) was higher than the HOMA-IR(0.698,0.656~0.74).

CONCLUSIONS

A high TyG index was associated with higher odds of having depression in the population with PCOS. This indicated that the TyG index may be an independent predictor of depression development.

CLINICAL TRIAL NUMBER

Not applicable.

The association between meat consumption and polycystic ovary syndrome in Iranian women: a case-control study

BACKGROUND

In light of the observed association between nutritional factors and polycystic ovary syndrome (PCOS) in recent decades, the present study was conducted to investigate the association between the consumption of various types of meat and PCOS in Iranian women.

MATERIAL AND METHODS

This frequency-matched case-control study included 108 women with newly diagnosed PCOS and 108 age and body-mass-index-matched women without PCOS, as a control group, who were referred to the Yazd Diabetes Clinic and Khatam Clinic between January 2018 and March 2019. The validated 178-item food frequency questionnaire was used to assess the usual dietary intake. Logistic regression analysis was used to estimate the association between meat consumption and PCOS.

RESULTS

The findings of this study showed, the individuals in the third tertile of red meat intake, had higher odds of PCOS in the crude model (Odds Ratio (OR) = 4.29; 95% Confidence Interval (CI), 2.13-8.64; P-value = 0.001) compared with those in the first tertile. These results remained significant after adjustments for energy intake, marital status, physical activity, education, pregnancy history and chronic disease history (OR = 3.87; 95% CI, 1.78-8.40; P-value = 0.001). Higher consumption of red meat increased the risk of PCOS by 3.87 times. Furthermore, higher consumption of processed meats increased the risk of PCOS by 2.15 times (OR = 2.15; 95% CI, 1.05-4.39; P-value and trend = 0.035). We did not find an association between other types of meat consumption and PCOS.

CONCLUSION

The results of the present study showed that a higher consumption of red and processed meat is associated with a higher risk of PCOS, whereas no significant correlation was found between the consumption of poultry, fish, and organ meat and PCOS. However, more studies are needed to support these findings in the future.

Weight loss effects of non-pharmacological interventions in women with polycystic ovary syndrome: a systematic review and network meta-analysis

Objective

To compare the effectiveness of non-pharmacologic interventions in improving weight loss management in overweight patients with polycystic ovary syndrome (PCOS).

Methods

Five databases, PubMed, Embase, Cochrane, Web of Science and China Knowledge, were searched for this study. The Cochrane risk of bias tool was used to assess the risk of bias of eligible studies. The included randomized controlled trials were subjected to traditional meta-analysis (TMA) and network meta-analysis (NMA), and the cumulative number of surfaces under the ranking curve (SUCRA) was calculated for each intervention to derive the optimal intervention.

Results

The study ultimately included 29 articles involving 22 different interventions and 1,565 patients. The results of the NMA showed that the optimal intervention for the four outcome measures (body weight, body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR)) was nutritional supplement + low-calorie diet, Taichi, continuous aerobic exercise and Taichi.

Conclusion

Current evidence suggests that nutritional supplements + hypocaloric diet; Taichi; continuous aerobic exercise have the greatest clinical advantage in weight loss and deserve to be promoted in the clinic. One of the best interventions for both outcome indicators, Taichi, suggests that it may be a common misconception that simply increasing the intensity of exercise is not the only way to lose weight and improve health.

Dietary Patterns and Metabolic and Hormonal Parameters in Women with Suspected PCOS

Background: Insulin resistance, visceral adiposity, excess body weight, and symptoms of hyperandrogenism often accompanies Polycystic Ovary Syndrome (PCOS). A balanced diet plays a key role in improving the metabolic and biochemical parameters in affected women. This study aims to assess whether dietary improvements in patients with suspected PCOS may affect the severity of the disease and the metabolic and hormonal profile. Methods: The analysis of the relationships between self-declared nutritional changes and biochemical and metabolic parameters included 154 women at the same stage of PCOS diagnosis. Results: Over half of participants reported dietary modifications. Women reducing sweets, fatty red meat, and alcohol intake for >6 months had significantly lower total testosterone (TT) levels compared to those who did not (p < 0.05). Mean TT levels were: 0.375 ± 0.18 ng/mL (median 0.340) vs. 0.787 ± 2.19 ng/mL (median 0.390) for red meat (p = 0.008), 0.359 ± 0.18 ng/mL (median 0.335) vs. 0.681 ± 1.9 ng/mL (median 0.4) for sweets (p = 0.02), and 0.388 ± 0.19 ng/mL (median 0.34) vs. 0.917 ± 2.65 ng/mL (median 0.425) for alcohol (p = 0.004). Patients with dietary changes in the past 6 months had higher androgen levels, BMI, systolic blood pressure and triglycerides than patients with long-term dietary changes (p < 0.05). There were no statistically significant differences in key metabolic and biochemical parameters when comparing self-reported diets based on glycemic index (low vs. high). Conclusions: A healthy, balanced diet for women with PCOS requires a multifaceted approach with clear, defined goals. This leads to better results than broad, general dietary recommendations. Long-term dietary changes improve biochemical and metabolic parameters, but maintaining these benefits requires continuous patient motivation.

What do users in a polycystic ovary syndrome (PCOS) forum think about the treatments they tried: Analysing treatment sentiment using machine learning

Polycystic ovary syndrome (PCOS) is a heterogenous condition that is estimated to effect up to 21% of reproductive aged people with ovaries. In previous work, a dataset of PCOS features was derived from approximately 100,000 PCOS subreddit users via machine learning. In this study, an exploration of treatment response within the PCOS subreddit was undertaken with the derived dataset. The treatment or symptom features in the dataset had sentiment labels indicating when a treatment was perceived to improve or worsen a condition or symptom. When different features were mentioned within two sentences of each other without conflicting sentiment, it could be assumed that they were related. This assumption allowed for a broad analysis of the perceived effect of popular treatments on the most frequently mentioned symptoms. In general, lifestyle changes and supplements were the most positively regarded, while contraceptives were frequently associated with considerable negative sentiment. For PCOS weight loss, unspecified dieting (RR 5.19, 95% CI 3.28-8.19, n = 99) and intermittent fasting (RR 33.50, 95% CI 8.54-131.34, n = 69) were the most successful interventions. Inositol was associated with a large range of favourable outcomes and was one of the few treatments associated with improved mental health [depression (RR 4.25, 95% CI 1.72-10.51, n = 21), anxiety (RR 5.83, 95% CI 2.76-12.35, n = 41) and mood issues (RR 25.00, 95% CI 3.65-171.10, n = 26)]. Combined oral contraceptive pills as a whole were strongly associated with adverse effects such as worsening depression (RR 0.06, 95% CI 0.02-0.25, n = 33), anxiety (RR 0.10, 95% CI 0.03-0.36, n = 23), fatigue (RR 0, n = 45) and low libido (RR 0.03, 95% CI 0.01-0.24, n = 30). However, combined contraceptives with anti-androgenic progestins were associated with more favourable experiences. This study demonstrates the utility of machine learning to derive measurable patient experience data from an internet forum. While patient experience data derived using machine learning is not a substitute for traditional clinical trials, it is useful for mass validation and hypothesis generation. This paper may serve as the first exploration into this category of clinical internet forum research.

PCOS - the many faces of a disorder in women and men

PURPOSE

Polycystic ovary syndrome (PCOS) is a very common endocrine, metabolic and reproductive disorder. The underlying pathophysiology is not yet fully understood and both genetic and environmental factors contribute to its development. We aimed to explore clinical and genetic aspects of familial clustering in PCOS, shedding light on its reproductive and metabolic consequences in both male and female first-degree relatives of the affected women.

METHODS

Searching the electronic database of PubMed up to October 2023, we synthesized findings from available prospective and retrospective studies and review articles, investigating the familial clustering of PCOS and incorporating data on its metabolic consequences and genetic associations.

RESULTS

There is a significant clustering of reproductive and metabolic abnormalities in first-degree relatives of women with PCOS. Genetic studies, including genome-wide association studies (GWAS), reveal a complex molecular etiology, emphasizing polygenic architecture. This is supported by the identification of two distinct PCOS subtypes, termed "reproductive" and "metabolic" which exhibit differential genetic underpinnings.

CONCLUSION

Clinicians should be aware of increased reproductive and metabolic dysfunction both in female and male first-degree relatives of PCOS probands. Current challenges include refining genetic risk scores and understanding the impact of PCOS genetic factors on diverse outcomes, necessitating a sex-specific approach in research and clinical practice. Future directions should address causality, improve diagnostic capability, and unravel the long-term consequences in both genders, emphasizing the importance of proactive clinical assessment in PCOS probands and their families.

Depression, higher level of tension induction, and impaired coping strategies in response to stress in women with PCOS correlate with clinical and laboratory indices of hyperandrogenism and not with central obesity and insulin resistance

PCOS is characterized by ovarian hyperandrogenism and insulin resistance (IR), which give rise to symptoms of hyperandrogenism and central obesity, which in turn may cause depression, lower self-esteem, and deteriorate coping strategies in stressful situations.

THE PURPOSE

to examine the mental condition, self-esteem, and ways of coping with stress in women with PCOS compared to age and BMI-matched healthy controls and to correlate them with clinical and laboratory hyperandrogenism, central obesity, and IR.

METHODS

42 women with PCOS and 39 controls were assessed for the above-mentioned psychological measures and correlated with serum hormonal and metabolic parameters.

RESULTS

Compared to controls, women with PCOS had more symptoms of depression (p = 0.026), a higher level of tension induction (p = 0.032), were more prone to alcohol consumption (p = 0.015), and were less likely to use the strategy of active coping in stressful situations (p = 0.014) and to seek instrumental (p = 0.048) and emotional support (p = 0.043). The presence of hirsutism correlated negatively with the level of emotional induction (R = -0.32, p < 0.05), and androgenic alopecia positively with the hedonistic tone (R = 0.36, p < 0.05). Serum testosterone (TST) correlated positively with the likelihood of seeking instrumental support in stressful situations (R = 0.31, p < 0.05) and with emotional focus (R = 0.34, p < 0.05). Serum androstenedione (A4-dione) correlated negatively with the escape behavior (R = -0.32, p < 0.05). No correlations were found between waist circumference and IR with the studied psychological measures.

CONCLUSIONS

Women with PCOS are characterized by depression, higher levels of tension induction, and impaired coping strategies in stressful situations, which correlate with clinical and laboratory indices of hyperandrogenism and not with central obesity and IR.

A Pilot Study on Ad Libitum Mediterranean Diet Intervention for Women with PCOS: A Mixed-Methods Exploration of Acceptability, Adherence, and Participant Lived Experience

Background/Objectives: A healthy diet is essential for managing Polycystic Ovary Syndrome (PCOS), yet optimal recommendations remain unclear, highlighting the need to explore alternative lifestyle interventions. The Mediterranean diet (MedDiet) supports cardiometabolic health; however, challenges with adherence within this population are unknown. This study examines the acceptability and experiences of an ad libitum MedDiet in women with PCOS, offering recommendations for implementation. Methods: A 12-week MedDiet intervention was conducted with women aged 18-45 years, diagnosed with PCOS and a BMI ≥ 25 kg/m2 (n = 12). Adherence was assessed using the Mediterranean Diet Adherence Screener. Surveys and semi-structured interviews, guided by the Capability, Opportunity, Motivation-Behaviour (COM-B) model, explored participants' experiences. Thematic analysis identified barriers and facilitators, which were mapped to the COM-B and Theoretical Domains Framework (TDF), with all findings subsequently aligned with the Behaviour Change Wheel to inform implementation strategies. Results: MedDiet adherence significantly improved from baseline to week 12 (Baseline: 4.1 ± 1.8; week 12: 8.3 ± 2.3; p = 0.001), alongside increases in knowledge (p = 0.004), cooking confidence (p = 0.01), and time management (p = 0.01). Adherence factors were mapped to 12 of the 14 TDF domains. Key facilitators included health benefits, reduced weight pressure, educational resources, and simple guidelines. Barriers involved organisation, food availability, and external influences. Effective implementation should integrate MedDiet education, behaviour change support, practical resources, and professional training for nutrition professionals and healthcare providers to support referrals and weight-neutral dietary management. Conclusions: A short-term ad libitum MedDiet is acceptable for women with PCOS. Strategies for patients and healthcare providers, aligned with the intervention functions of education, training, and enablement, are key to supporting adherence.

Surya Namaskar as a Gender-sensitive Intervention: Addressing Social Physique Anxiety (SPA) Issues in Women with PCOS

Background

Polycystic ovary syndrome (PCOS) is a common, lifelong condition affecting about 20% of women, characterised by symptoms such as infertility, obesity, acne and excess facial hair, which can negatively impact both physical and mental health.

Purpose

This study aimed to assess the effect of Surya Namaskar on reducing social physique anxiety (SPA) in women diagnosed with PCOS.

Methods

The study applied a pre- and post-test design with 60 women diagnosed with PCOS; there were 100 participants in the study. Out of these 100, only 70 participants had high levels of SPA. Out of these 70 participants, only 60 responded and agreed to participate in the study. The participants were selected from colleges in Dehradun, India, and were between the ages of 18 and 30 years. Split into intervention and control groups. The intervention group practiced Surya Namaskar for 12 weeks, while the control group did not participate in any structured physical activity. SPA and body dissatisfaction were measured using established scales at the beginning and end of the study. Statistical analyses, including paired and independent samples t-tests, were conducted to assess changes within and between the groups.

Results

The results indicated that Surya Namaskar significantly improved overall health and well-being, with the intervention group showing notable reductions in SPA and body dissatisfaction compared to the control group. Statistical analyses confirmed significant differences in psychological outcomes, supporting the effectiveness of Surya Namaskar in this context.

Conclusion

Surya Namaskar significantly alleviates SPA and body dissatisfaction, enhancing the psychological health of women with PCOS. Given its accessibility and low cost, Surya Namaskar shows potential as an effective complementary treatment to improve the quality of life for women with PCOS. Further research is needed to explore its long-term effects and the mechanisms behind these improvements.

Analysis of risk factors for depression and anxiety in women with polycystic ovary syndrome

Background

Polycystic ovary syndrome (PCOS) is one of the most common reproductive endocrine disorders among women of reproductive age, often accompanied by a series of symptoms such as hirsutism, hair loss, menstrual disorders and obesity, resulting in an increasing risk of depression and anxiety in such patients.

Methods

A total of 413 patients in the Reproductive Medicine Center of the Second Hospital of Lanzhou University from June 2021 to June 2023 were enrolled. We collected sociodemographic information and lifestyle-related factors using a structured questionnaire. Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Scale (GAD-7) were used to evaluate the psychological status of the subjects. Sleep-related variables were assessed using the Pittsburgh Sleep Quality Index (PSQI), and metabolic measures were collected from patients' medical records.

Results

Compared with the control group, PCOS patients were younger, the average age was (27.39 ± 3.48) years old, and the BMI value was higher, the difference was statistically significant (p < 0.05). The proportions of depression and anxiety in PCOS patients were 47.7% and 39.9%, respectively. In PCOS patients with depressive anxiety symptoms, the proportions of mild, moderate, moderately severe and severe depression were 31.6%, 12.4%, 1.6% and 2.1%, respectively. The proportions of mild, moderate, moderately severe and severe anxiety were 30.6%, 6.2%, 1.0% and 2.1%, respectively. Depression was significantly associated with serum free triiodothyronine (FT3) OR (95% CI) = 3.33 (1.30-8.55), sleep duration 4.99 (1.45-17.23) and daytime dysfunction 8.24 (3.53-19.22). Anxiety was significantly associated with daytime dysfunction OR (95% CI) = 3.45 (1.78-6.70). No association was found between mental health and other metabolic characteristics in PCOS patients (p > 0.05).

Conclusion

According to the results of the current study, a high proportion of women with PCOS have mental health disorders, and there is a significant correlation between mental health disorders and sleep conditions.

Depression, Anxiety, and Risk of Metabolic Syndrome in Women With Polycystic Ovary Syndrome: A Longitudinal Study

CONTEXT

Patients with polycystic ovary syndrome (PCOS) are at high risk of depression, anxiety, and metabolic syndrome (MetSyn), a key predictor of cardiovascular disease. The impact of depression and/or anxiety on MetSyn is unknown in this population.

OBJECTIVE

To compare the risk of developing MetSyn in patients with PCOS with and without a history of depression and/or anxiety.

METHODS

Retrospective longitudinal cohort study (2008-2022) with median follow-up of 7 years at a tertiary care ambulatory practice. Patients with hyperandrogenic PCOS and at least 2 evaluations for MetSyn ≥3 years apart (n = 321) were included. The primary outcome was risk of developing MetSyn. We hypothesized that this risk would be higher with a history of depression and/or anxiety.

RESULTS

At the first visit, 33.0% had a history of depression and/or anxiety, with a third prescribed antidepressants or anxiolytics. Depression and/or anxiety increased risk of developing MetSyn during the study period (adjusted hazard ratio [aHR] 1.45, 95% CI 1.02-2.06, P = .04) with an incidence of MetSyn of 75.3 compared with 47.6 cases per 100 person-years among those without (P = .002). This was primarily driven by depression (aHR 1.56, 95% CI 1.10-2.20, P = .01).

CONCLUSION

Patients with PCOS and depression and/or anxiety have a high risk of developing MetSyn, with a stronger association between depression and MetSyn. Our findings highlight the urgent need for guideline-directed screening for depression and anxiety at time of diagnosis of PCOS as well as screening at subsequent visits to facilitate risk stratification for metabolic monitoring and early intervention in this high-risk group.

Health-related quality of life and mental state in women with polycystic ovary syndrome and migration or minority background - A cross-sectional study

Introduction

Polycystic Ovary Syndrome (PCOS) is the most prevalent endocrine disorder among women of reproductive age on a global scale. The severity of symptoms and individual distress can vary greatly and may also depend on the respective ethnic and cultural background. This study aimed to investigate potential variations in health-related quality of life (HRQOL), depression, and anxiety between PCOS patients with a migration (MB) or minority background (Min) and those without (Non-MB/Non-Min).

Methods

An online questionnaire was anonymously distributed to gynecologists, hospitals, and women's clinics in Austria, Germany, and Switzerland, along with social media channels to reach women with PCOS. The survey was conducted between November 14th, 2023, and February 5th, 2024. Various aspects including HRQOL, levels of anxiety/depression and self-esteem were evaluated using the Modified-PCOS-Questionnaire (MPCOSQ), Hospital Anxiety and Depression Scale (HADS) and Rosenberg Self-Esteem Scale (RSE) respectively. The participants were screened for migration background and self-identification with a socially relevant minority. The selection of potential confounding variables was based on their plausibility and estimated impact. Adjusted odds ratios and their corresponding 95 % confidence intervals were calculated using regression analysis.

Results

The study involved 587 participants with PCOS. MB and Min exhibited significantly poorer HRQOL, and greater symptoms of depression compared to PCOS patients in the two control groups. (MPCOSQ-Total: MB/Non-MB p = 0.02; Min/Non-Min p < 0.001; HADS-Depression: MB/Non-MB p = 0.03; Min/Non-Min p = 0.01) Additionally, MB and Min had significantly lower self-esteem according to the RSE (RSE: MB/Non-MB p = 0.04; Min/Non-Min p = 0.049). In the univariate analysis, Non-MB and Non-Min were associated with partially better HRQOL and lower depression (or respectively poorer HRQOL and depression for MB and Min). However, in the multivariate analysis only Non-Min showed a statistically significant association with higher HRQOL (B: 0.34; CI: 0.04; 0.63; p = 0.03) and only Non-MB was associated with lower depression (B:1.28; CI:2.31; -0.24; p = 0.02).

Conclusion

This study highlights the association between MB or Min and poorer HRQOL, higher depression rates, and lower self-esteem among PCOS patients. While genetic and epigenetic factors may contribute, socioeconomic and sociocultural influences likely play significant roles. Healthcare professionals should remain attuned to the diverse needs of women with PCOS, especially those from migration or minority backgrounds, to ensure equitable access to care.

Multiple effects of kisspeptin on neuroendocrine, reproduction, and metabolism in polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a highly prevalent and heterogeneous disease characterized by a combination of reproductive and endocrine abnormalities, often associated with metabolic and mental health disorders. The etiology and pathogenesis of PCOS remain unclear, but recent research has increasingly focused on the upstream mechanisms underlying its development. Among these, kisspeptin (KISS) signaling has emerged as a pivotal component in the regulation of the hypothalamic-pituitary-gonadal axis, with significant roles in reproductive function, energy regulation, and metabolism. Women with PCOS commonly exhibit disruptions in gonadotropin secretion, including elevated luteinizing hormone (LH) levels, imbalanced LH/follicle-stimulating hormone (FSH) ratios, and increased androgen levels, all of which are usually parallel with abnormal KISS signaling. Furthermore, alterations in the KISS/KISS1R system within the central and circulatory systems, as well as peripheral tissues, have been implicated in the development of PCOS. These changes affect multiple pathophysiological domains, including reproductive function, energy regulation, metabolic homeostasis, inflammatory response, and emotional disorders, and are further influenced by lifestyle and environmental factors. This review aims to comprehensively summarize the existing experimental and clinical evidence supporting these roles of KISS in PCOS, with the goal of establishing a foundation for future research and potential clinical applications.

Characteristics and Clinical Outcomes of Women with Polycystic Ovary Syndrome After Bariatric Surgery

BACKGROUND

Polycystic ovary syndrome (PCOS) commonly co-occurs with obesity, medical comorbidities, and psychiatric symptoms. Bariatric surgery is an effective treatment for co-occurring obesity and PCOS. While the incidence of PCOS declines substantially after bariatric surgery, the condition is still present for a subset of women. Examining characteristics and clinical outcomes of those with and without PCOS post-surgery may underscore potential risk factors or intervention targets.

METHODS

Individuals up to four years after bariatric surgery were invited to participate in this cross-sectional survey study, which included validated measures of depression, anxiety, eating disorder pathology, and quality of life. Post-surgical weight outcomes, medical comorbidities, and mental health treatment engagement were also assessed. Regression analyses were performed to examine differences in outcomes between those with and without a PCOS diagnosis after bariatric surgery.

RESULTS

Of the 657 female (sex assigned at birth) participants who underwent bariatric surgery, 7% (n = 46) reported having a current diagnosis of PCOS. All females identified as women. Women with PCOS were significantly younger (p < 0.001) and were more likely to endorse migraines (p < 0.007) and loss of control (LOC) eating episodes (< 0.001) since undergoing surgery. Additionally, 47.8% of women with PCOS endorsed clinically significant anxiety, compared to 25.7% of women without PCOS (p = 0.03). There were no differences in other demographic, psychiatric, or medical characteristics.

CONCLUSION

Despite the low prevalence of PCOS diagnoses in the four years after bariatric surgery, this subpopulation may be particularly susceptible to migraines, disinhibited eating behavior, and anxiety, although weight and cardiometabolic outcomes were comparable to those without a diagnosis of PCOS post-surgically.

Body image, illness perception, and psychological distress in women coping with polycystic ovary syndrome (PCOS)

Objective: While symptoms of polycystic ovary syndrome (PCOS) and psychological distress (PD) are directly linked, indirect effects are also apparent. The present study aims to develop an explanatory model for the effect of PCOS on women' PD and identify possible protective and risk factors. It examines the development of PD in women with PCOS and further investigates the association between body image, both positive (body appreciation) and negative (body dissatisfaction) dimensions, and PD as well as the potential mediating effect of illness perception on this association. Methods: This study comprised a total of 316 women aged 20-50 (M = 30.9, SD = 6.3) - 197 women with PCOS and 119 healthy peers-who completed questionnaires regarding demographic characteristics, anxiety (GAD-7), depression (PHQ-9), body appreciation (BAS-2), body dissatisfaction (EDI-BD), and the Brief Illness Perception Questionnaire (BIPQ). Results: Significant differences between groups were found in all measures. Body appreciation mediated the link between PCOS and PD, while body appreciation and illness perception also mediated the link between symptom level and PD among PCOS patients. Conclusion: Women with PCOS face considerable psychological strain and highlight body appreciation and illness perception as two underlying psychological mechanisms that contribute to the increased risk of distress. Interventions addressing both mechanisms may help improve PD in women with PCOS.

Association of Gut Microbiota With Fatigue in Black Women With Polycystic Ovary Syndrome

BACKGROUND

Fatigue is a highly prevalent symptom for individuals with polycystic ovary syndrome (PCOS); however, characterization of fatigue and investigation into the gut microbiome-a pathway that may contribute to fatigue-remains inadequately explored in Black women with PCOS.

OBJECTIVES

The purpose of this cross-sectional study was to examine fatigue and its relationship to the gut microbiome in adult Black women with PCOS.

METHODS

Adult Black women with a diagnosis of PCOS were recruited for this cross-sectional study. The Multidimensional Fatigue Inventory-20 (MFI-20) and the PROMIS Fatigue Short Form were used to measure fatigue. The V3/V4 region of the bacterial 16S rRNA gene was sequenced to investigate gut microbial composition. Relative abundance and diversity values were calculated.

RESULTS

We found that Black women with PCOS experience mild to moderate levels of fatigue. An inverse relationship between fatigue scores and alpha diversity values was found for the gut microbiome. We also found distinct beta diversity profiles based on fatigue. Lastly, when controlling for hypertension and body mass index, Ruminococcus bromii, Blautia obeum, Roseburia, and HT002 were associated with three subscales of the MFI-20.

DISCUSSION

Black women with PCOS experience mild to moderate fatigue. Clinicians should be cognizant of this population's increased risk for fatigue to adequately address their healthcare needs. We also found that gut microbial composition was associated with fatigue in Black women with PCOS. Specifically, a higher relative abundance of certain gut bacteria involved in short-chain fatty acid production and anti-inflammatory pathways was correlated with lower fatigue levels. Future studies should further investigate the link between the gut microbiome and fatigue to determine whether this relationship is causal as better insight could inform tailored diet and exercise interventions to alter the gut microbiome and reduce fatigue.

Exploring the Factors Associated with Attrition in a Lifestyle Intervention Trial amongst Women with Polycystic Ovarian Syndrome Desiring Fertility - An Interview based Study

Background

Previous studies exploring the barriers to weight management have suggested psychological, social and logistical barriers were important reasons for high attrition and non-adherence.

Aim

The aim of this study was to assess the possible reasons for high attrition and non-adherence to lifestyle interventions in a trial setting amongst women with polycystic ovarian syndrome (PCOS) who wish to conceive.

Setting and Design

The study was conducted in a tertary level hospital and employed a qualitative study paradigm.

Materials and Methods

The study was nested within a feasibility study that explored the possibility of conducting lifestyle interventional trials in women with PCOS who wish to conceive. Eligible participants who refused participation in the trial were interviewed under three major categories: refusal before randomisation, refusal after randomisation and non-adherence.

Statistical Analysis Used

Thematic analysis was used to analyse textual data.

Results

The participants considered PCOS as a 'fairly common' condition and did not perceive the need to address the impact of PCOS on their health. The second recurring theme was the perception of being overweight as 'healthy' and 'normal' and downplaying lifestyle changes to focus only on fertility treatment for achieving pregnancy. Finally, the decision to pursue weight loss or to discontinue it seems to be a shared decision making among family memebers which limits the ability of the clinicians and healthcare practitioners to effectively deliver appropriate advice on lifestyle interventions.

Conclusion

The current findings would help in planning and designing adequately powered randomised controlled trials to evaluate the impact of lifestyle intervention in women with PCOS.

Journal of Women's Health Clinical Update

The Clinical Update series is intended to help busy clinicians stay up-to-date with recently published important and potentially practice-changing articles on topics pertinent to the care of women. In this update on sexual health, we review studies on the sexual health content of healthcare professional curricula, sexual health and intimacy after cancer in women of color, sexual function in women with polycystic ovarian syndrome, as well as the risks associated with the use of testosterone in women.

Prevalence of Body Dysmorphia in Polycystic Ovary Syndrome (PCOS) Patients

Background

Polycystic ovary syndrome (PCOS), a significant hormonal disorder that primarily affects young women, has a substantial impact on both their health-related quality of life and their mental well-being.

Objective

To assess the prevalence and patterns of body dysmorphia in polycystic ovary syndrome (PCOS) patients in Kingdom of Bahrain and to reach a consensus regarding the relationship between body dysmorphia and PCOS.

Methods

There were 132 participants involved in the study: 66 were control cases, 66 were PCOS cases. Each was given a survey form. The scoring was based on the Głębocka's self-perception scale and modified Ferriman-Gallwey hirsutism scale were used to assess about own perception to appearance, and pressure to change body shape.

Results

Most of the PCOS patients in the Kingdom of Bahrain who are above 30 years old experienced body dysmorphia along with other physical changes in appearance and psychological disorders such as social anxiety and depression. About 86% of them have hirsutism which significantly affects their self-esteem and self-confidence within themselves. However, the average hair distribution volume ranges only from 1.82 to 2.53 in the different parts of the body.

Conclusion

Body dysmorphia is prevalent in patients diagnosed with PCOS. It is important to understand that these manifestations of PCOS in women significantly impact their quality of life..

Polycystic ovary syndrome: Criteria, phenotypes, race and ethnicity

Background

Polycystic ovary syndrome (PCOS) is a complex endocrinopathy, which leads to ovulation dysfunction and infertility, as well as metabolic and mental disorders. Women with PCOS exhibit several characteristic symptoms, with marked heterogeneity across different races and ethnicities.

Methods

In this review, the author outlines the phenotypic disparities of PCOS among various racial and ethnic populations. First, the prevalence of major symptoms in different racial and ethnic groups with PCOS is summarized. Next, the effects of four phenotypes, derived from the Rotterdam criteria for PCOS, on metabolic and reproductive features are recapitulated.

Main Findings

A growing body of evidence suggests that East Asian populations exhibit less hirsutism and adiposity compared with other groups. However, hirsutism is more prevalent in South Asian, Middle Eastern, and Hispanic populations. Hispanic and African American populations have more frequent obesity and insulin resistance. With regard to the association between mental disorders and racial and ethnic differences, limited studies exist; therefore, no conclusions can be drawn.

Conclusion

Race and ethnicity-specific factors related to PCOS must be considered in clinical practice. The diagnostic criteria of PCOS should be specific to race and ethnicity to avoid missing treatment opportunities.

Hyperandrogenism in polycystic ovary syndrome and adrenal hyperplasia: finding differences to make a specific diagnosis

PURPOSE

Polycystic Ovary Syndrome (PCOS) and Adrenal hyperplasia (CAH) are two pathologic conditions sharing several clinical features (hirsutism, acne, polycystic ovary morphology, metabolic alterations, ovulatory dysfunctions) and especially hyperandrogenism as a common clinical hallmark. Therefore, making a differential diagnosis of the two conditions still remains a great medical challenge.

METHODS

In particular, the comparison discussed in this review referred to non-classical form of adrenal hyperplasia (NCAH), which regards the adult population, and the Endocrine Metabolic Syndrome (EMS), following the new set of PCOS diagnostic criteria proposed by the Experts Group on Inositol and Clinical Research, and on PCOS (EGOI-PCOS). To support this review, a literature search was conducted using PubMed, Google Scholar and Web of Science, supplemented by articles known to the authors. Keywords included: polycystic ovary syndrome, non-classical adrenal hyperplasia, hyperandrogenism, and 17-Hydroxyprogesterone.

RESULTS

Considering the different pathophysiology of the two conditions, the recommended strategy to differentiate diagnosis is testing the blood values of 17-hydroxyprogesterone (17-OHP) in fertile aged women with suspicious hyperandrogenism. Basal values of 17-OHP higher than 2 ng/mL likely indicate NCAH, while values lower than 2 ng/mL exclude the diagnosis of NCAH; in case of borderline values stimulation test with adrenocorticotropic hormone may eventually confirm the diagnosis.

CONCLUSION

This review contributes to make the differential diagnosis between hyperandrogenic PCOS and NCAH clearer, thus also aiming to achieve tailored therapeutic approaches for patients with hyperandrogenism.

Regulatory emotional self-efficacy and self-compassion mediate anxiety, depression, body image distress and subjective well-being in women with polycystic ovary syndrome: A cross-sectional study

AIMS

This study aims to investigate the mediating role of regulatory emotional self-efficacy and self-compassion in the relationship among anxiety, depression, body image distress and subjective well-being among women with polycystic ovary syndrome.

DESIGN

A cross-sectional study.

METHODS

The study recruited 510 women with polycystic ovary syndrome from a tertiary hospital affiliated with a university in Hunan Province, China. The study employed several tools to collect data, including the Generalized Anxiety Scale, the Patient Health Questionnaire-9, the Body Image States Scale, the Self-Compassion Scale, the Regulatory Emotional Self-Efficacy Scale and the Index of Well-being questionnaire. Data analysis was carried out using descriptive analysis, spearman correlation analysis, ordinary least squares regression and bootstrapping.

RESULTS

The study's findings indicate that regulatory emotional self-efficacy and self-compassion both act as mediators in the connection between anxiety, depression, body image distress and subjective well-being among women with polycystic ovary syndrome.

CONCLUSION

The study emphasizes the significance of regulatory emotional self-efficacy and self-compassion in promoting well-being among women with polycystic ovary syndrome. It also implies that interventions targeted at enhancing these factors could potentially enhance the subjective well-being of women affected by PCOS.

IMPACT

Our study's primary contribution is to underscore the crucial mediating roles of regulatory emotional self-efficacy and self-compassion in the relationship among anxiety, depression, body image distress and subjective well-being. Our study indicates that clinical practitioners should prioritize improving the regulatory emotional self-efficacy and self-compassion of women with polycystic ovary syndrome, reducing their anxiety, depression and body image distress and improving their subjective well-being.

REPORTING METHOD

This study was reported according to the Standards for Reporting Qualitative Research (SRQR).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution outside of participation in the actual study for purposes of data collection.

Prevalence of depression among women with polycystic ovary syndrome in mainland China: a systematic review and meta-analysis

OBJECTIVE

Polycystic ovary syndrome (PCOS), a prevalent endocrine disorder among women, is frequently comorbid with depression. This systematic review and meta-analysis aimed to estimate the prevalence of depression among women with PCOS in mainland China.

METHOD

A comprehensive literature search was conducted in PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and Chinese databases (CNKI, WanFang, and VIP) up to August 2024. Random-effects models were applied to estimate the pooled prevalence of depression with 95% confidence intervals. The methodological quality assessment was assessed using the risk of bias tool. The primary outcome was the pooled prevalence of depression in women with PCOS.

RESULTS

Thirty-nine studies encompassing 9796 participants were analyzed. The pooled prevalence of depression was 37% (95% CI, 29%-44%), with substantial heterogeneity (I2 = 96%, p < 0.001). In subgroup analysis, the prevalence of depression among women with PCOS in West, Central, East, and Northeast China was 37%, 37%, 38%, and 25%, respectively. The prevalence of depression among women with PCOS surveyed before and after 2015 was 40% and 35%, respectively. The prevalence of depression among women with PCOS aged < 26 and > / = 26 years were 42% and 33%, respectively. The prevalence of depression among women with PCOS that participants' BMI < 24 and > / = 24 kg/m2 were 38% and 34%, respectively. The prevalence of depression among women with PCOS that used Self-rating Depression Scale (SDS), Patient Health Questionnaire-9 (PHQ-9), Beck Depression Inventory (BDI), and Hospital Anxiety and Depression Scale (HADS) were 40%, 34%, 31%, and 24%, respectively. Sensitivity analysis and meta-regression confirmed the stability of the findings. Evidence of publication bias was detected.

CONCLUSIONS

The high prevalence of depression among women with PCOS in China underscores the need for integrated screening and management. The results of this meta-analysis show high heterogeneity and indicate publication bias, which reduces the generalizability of the findings. Future research should address heterogeneity and enhance the applicability of results.

N6-Methyladenosine Modification on the Function of Female Reproductive Development and Related Diseases

BACKGROUND

N6-methyladenosine (m6A) modification is a widespread and reversible epigenetic alteration in eukaryotic mRNA, playing a pivotal role in various biological functions. Its significance in female reproductive development and associated diseases has recently become a focal point of research.

OBJECTIVE

This review aims to consolidate current knowledge of the role of m6A modification in female reproductive tissues, emphasizing its regulatory dynamics, functional significance, and implications in reproductive health and disease.

METHODS

A comprehensive analysis of recent studies focusing on m6A modification in ovarian development, oocyte maturation, embryo development, and the pathogenesis of reproductive diseases.

RESULTS

m6A modification exhibits dynamic regulation in female reproductive tissues, influencing key developmental stages and processes. It plays critical roles in ovarian development, oocyte maturation, and embryo development, underpinning essential aspects of reproductive health. m6A modification is intricately involved in the pathogenesis of several reproductive diseases, including polycystic ovary syndrome (PCOS), premature ovarian failure (POF), and endometriosis, offering insights into potential molecular mechanisms and therapeutic targets.

CONCLUSION

The review highlights the crucial role of m6A modification in female reproductive development and related diseases. It underscores the need for further research to explore innovative diagnostic and therapeutic strategies for reproductive disorders, leveraging the insights gained from understanding m6A modification's impact on reproductive health.

Assessment of factors related to poly cystic ovarian syndrome - A comparative and correlational study

Polycystic ovarian syndrome (PCOS) is a common endocrine disorder that primarily affects women of reproductive age. It is particularly prevalent among adolescent females who receive an insufficient diagnosis despite having potentially adverse consequences. The use of PCOS screening questionnaires has the potential to aid in the early detection of symptoms. The goal of this study is to observe if a self-administered questionnaire may be useful for a clear cognizance of the associated conditions like mental stress and menstrual characteristics correlated to polycystic ovary syndrome. In this study, we selected women within an age group of 17-40 with and without PCOS based on the modified Rotterdam criteria to fill out a self-administrated questionnaire based on the signs and symptoms of PCOS majorly focusing on mental stress and menstrual characteristics. SPSS software, univariate analyses were employed to elucidate the associations among the components of PCOS, demographic factors, and lifestyle characteristics, hence providing insights into the interrelationships among those variables. 64 women with PCOS and 141 women without PCOS participated in the present study. The present study revealed PCOS is greatly influenced by age at menarche (p-value= .043), typical cycle length (p-value = .000) mental health problems during menstruation (p-value = .032), and body mass index (p-value = .001). Multivariate hierarchical logistic regression analysis showed only 2 variables BMI (a-OR 1.156,95% CI (1.067-1.242), p-value = .000), and typical cycle length (a-OR 2.278, 95% CI (1.079-4.809), p-value = .003) were significant. The present study showed that BMI and menstrual cycle length were most closely associated with the incidence of PCOS, which is important in diagnosing and treating the condition. Considering the high incidence of PCOS among women of reproductive age and its potential for significant health implications, it would be prudent to incorporate inquiries regarding mental health concerns and menstrual patterns into routine medical assessments for this demographic analysis. This approach aims to ascertain whether additional diagnostic evaluations and screenings for PCOS are warranted.

Research trend and hotspots of polycystic ovary syndrome with depression from 1993 to 2024: a bibliometric analysis

Background

Polycystic ovary syndrome (PCOS), a common endocrine disorder, affects women of reproductive age, and its adverse consequences affect women throughout their lifespan, from adolescence to postmenopause. The prevalence of depression is much higher in women with PCOS than in healthy controls. Thus, it is recommended that depressive syndrome be screened routinely in all patients with PCOS at diagnosis. To date, no comprehensive bibliometric analysis has been conducted in this field. Therefore, we conducted a bibliometric analysis to describe the current status, trends, and hotspots of PCOS research related to depression.

Materials and methods

Using data retrieved from the Web of Science (WoS) Core Collection database from 1993 to 2024, bibliometric analyses were performed using WoS and CiteSpace software.

Results

Since the first paper was published in 1993, studies related to PCOS and depression have remained rare in the following decade. Since the establishment of the Rotterdam criteria in 2003, research on the etiology, pathogenesis, and treatment of PCOS with depressive syndrome has entered a booming period. The United States and Australia indisputably took leading positions in this area, with the most outstanding institutions in the world being the University of Pennsylvania and Monash University. Although achievements have flourished since 2003, the exact pathogenesis of PCOS remains uncertain owing to its heterogeneity. New research is rapidly increasing to fill these gaps and to push forward the goal of improving the quality of life in women with PCOS and depression. Along with progress in research, the world's leading societies organize conferences every 5 years to update guidelines for the assessment and management of PCOS. "Oxidative stress," "inflammation," "obstructive sleep apnea," "gut microbiota," and "single nucleotide polymorphism" appeared as new hotspots in the recent 5 years.

Conclusion

A bibliometric analysis was performed to describe the trends and hotspots of research in women with PCOS and depression to attract the attention of more researchers to this topic.

Systematic Review Registration

https://www.webofscience.com/wos/woscc/basic-search.

Increased Prevalence of Binge Eating Disorder and Bulimia Nervosa in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

CONTEXT

Polycystic ovary syndrome (PCOS) is associated with disordered eating/eating disorders, but prior meta-analyses are limited by small numbers.

OBJECTIVE

To inform the 2023 International PCOS Guideline, we performed a systematic review and meta-analysis evaluating the prevalence of disordered eating/eating disorders among women with and without PCOS.

METHODS

Ovid MEDLINE, EMBASE, PsycInfo, and All EMB were searched from inception through February 1, 2024, for studies that compared prevalences of eating disordered/disordered eating in adolescent or adult women. Random effects meta-analyses were used to estimate the pooled odds ratios (OR) or standardized mean differences (SMD) of outcomes in women with PCOS compared to controls. Methodological quality was assessed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system, and included studies were assessed for risk of bias.

RESULTS

Of 1352 articles identified, 20 were included, with a total of 28 922 women with PCOS and 258 619 controls. Individuals with PCOS had higher odds of any eating disorder (OR: 1.53 [1.29, 1.82], 8 studies), which persisted in studies where PCOS was diagnosed by Rotterdam criteria (OR: 2.88 [1.55, 5.34], 4 studies). Odds of bulimia nervosa, binge eating disorder, and disordered eating, but not anorexia nervosa, were increased in PCOS. Mean disordered eating scores were higher in PCOS (SMD: 0.52 [0.28, 0.77], 13 studies), including when stratified by normal and higher weight body mass index. Most included studies were of moderate quality, with no evidence of publication bias.

CONCLUSION

Our study informs the 2023 PCOS Guideline recommendations for consideration of the risk of disordered eating/ eating disorders in care of women with PCOS, regardless of weight, especially during providing lifestyle counseling.

Prevalence of depression and anxiety in women with polycystic ovary syndrome (PCOS) and associated factors in a quaternary hospital in Thailand: a cross-sectional study

BACKGROUND

Polycystic ovary syndrome (PCOS) is a common gynaecological problem for women of reproductive age. Depression and anxiety are common conditions that occur in women with PCOS and have an impact on mental well-being. However, there is a lack of data on their prevalence and its associated factors in the Thai population. This cross-sectional study aimed to evaluate the prevalence of depression and anxiety among women with PCOS and identify the factors associated with depression and anxiety in women with PCOS as well as their impact on mental well-being in Thailand.

METHODS

A total of 260 women aged 15 to 40 years diagnosed with PCOS based on the Rotterdam criteria were included in the study. Physical examinations were conducted, and participants completed Hospital Anxiety and Depression Scale (HADS) and Thai version WHO-Five Well-Being Index (WHO-5 Thai) questionnaires to assess depression, anxiety, and mental well-being, respectively. The prevalence and prevalence rations (PR) with 95% confidence interval (CI) for depression and anxiety were analysed using modified Poisson regression analyses with robust variance estimators.

RESULTS

The prevalence of depression, anxiety, and poor mental well-being among women with PCOS was found to be 3.85%, 11.92%, and 16.92%, respectively. Abdominal obesity (PR 24.25, 95% CI: 2.75-219.50; p = 0.004), poor mental well-being (PR 16.68, 95% CI: 4.02-69.18; p = < 0.001), and snoring (PR 10.26, 95% CI: 2.06-51.14; p = 0.005) were identified as factors associated with depression in women with PCOS. Having children (PR 6.22, 95% CI: 2.90-13.35; p = < 0.001), alcohol drinking (PR 3.41, 95% CI: 1.52-7.65; p = 0.003), poor mental well-being (PR 2.32, 95% CI: 1.14-4.74; p = 0.021), and hirsutism (PR 2.23, 95% CI: 1.18-4.22; p = 0.014) were found to be relative factors for anxiety in women with PCOS.

CONCLUSION

Women with PCOS is associated with high prevalences of depression and anxiety. Poor mental well-being was identified as key factors associated with both depression and anxiety in women with PCOS. Based on these findings, the present study suggests that screening for depression and anxiety should be conducted for all women with PCOS, especially those who present with poor mental well-being.

Mental Health Across the Menstrual Cycle in Polycystic Ovary Syndrome: Insights and Implications

PURPOSE OF REVIEW

We reviewed a wide body of emerging research highlighting the possibility for premenstrual exacerbations of mood symptoms in polycystic ovary syndrome (PCOS).

RECENT FINDINGS

Neuroendocrine dysregulation, sensitivity to ovarian hormone fluctuations as well as higher levels and types of adverse childhood experiences and demographic factors are emerging factors explaining high rates of psychiatric disorders in PCOS. Ovulatory dysfunction, common in PCOS, significantly interferes with one's identity and quality of life. Results on pharmacologic and non-pharmacologic treatments for mood symptoms are mixed, though improvements in the physical sequalae of PCOS could also improve mood symptoms. However, significant improvements on the methodological quality are needed, particularly the evaluation of mood symptoms across the menstrual cycle. Evidence is preliminary on whether there are premenstrual exacerbations of psychiatric symptoms in PCOS. Prospective, longitudinal studies with larger sample sizes are needed to comprehensively understand the psychiatric profile in PCOS.

The effects of MIND diet on depression, anxiety, quality of life and metabolic and hormonal status in obese or overweight women with polycystic ovary syndrome: a randomised clinical trial

Polycystic ovary syndrome (PCOS) is a common hormonal disorder in women of reproductive age, associated with increased risks of metabolic disorders, depression and reduced quality of life. This study examined the impact of the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet on mental health, PCOS-related quality of life (PCOSQ), anthropometric indices, hirsutism, and metabolic/hormonal parameters in women with PCOS. Total of 52 women with PCOS, aged between 18 and 45 years, were randomly assigned to either the low calorie MIND diet group or the control group. Anthropometric data, depression and anxiety scores, serum levels of gonadotropins (luteinizing hormone [LH], follicle-stimulating hormone [FSH]), PCOSQ, and Ferriman-Gallwey score were evaluated before and after the intervention. Outcomes were assessed at baseline and at the end of the 8-week follow-up period. After 8 weeks, the MIND diet significantly reduced depression (β -3·03; 95 % CI: [-5·36, -0·70]; P = 0·011) and anxiety (β -3·54; 95 % CI: [-6·60, -0·49]; P = 0·024) scores compared with the control group. The MIND diet group exhibited significant increases in the emotion (β 0·63; 95 % CI: [0·18, 1·08]; P = 0·007) and body hair (β 0·65; 95 % CI: [0·03, 1·28]; P = 0·04) domains of the PCOSQ compared to the control group. The changes in other parameters did not show significant differences between the two groups. Both the MIND diet and control groups showed improvements in weight and BMI, with a slight advantage for the MIND diet group. These findings suggest that the MIND diet may be beneficial for improving mental health and some aspects of PCOSQ in women with PCOS.

The prevalence and risk of anxiety and depression in polycystic ovary syndrome: an overview of systematic reviews with meta-analysis

PURPOSE

To summarize the pooled prevalence rates of anxiety and depression in women with polycystic ovary syndrome.

METHODS

An overview of systematic reviews with meta-analysis was conducted. The CINAHL, Embase, PsycINFO, and PubMed databases were searched up to April 22, 2024. The methodological quality of systematic reviews was assessed using AMSTAR 2. The degree of overlap between reviews was analyzed by calculating the corrected covered area.

RESULTS

Ten systematic reviews were selected. Regarding anxiety disorders, the pooled prevalence of panic disorder, social phobia, and anxiety disorders without specifying the type of disorder were 4%, 5%, and 16.9%, respectively. This prevalence was higher in depressive disorders, reaching 34.8%. Anxiety symptoms were very prevalent in women with PCOS, although the prevalence varied depending on the self-reported questionnaire used: the Hamilton Anxiety Scale 69.4%, the Hospital Anxiety and Depression Scale 41.5%, and the Self-rating Anxiety Scale 32.4%. Additionally, the highest prevalence of depression symptoms was associated with the Beck Depression Inventory 46.0%, followed by the Self-rating Depression Scale 39.2%, and the Hospital Anxiety and Depression Scale, which ranged from 31% to 33.8%.

CONCLUSIONS

Meta-analyses found mainly anxiety and depression symptoms and disorders are prevalent in women with PCOS. Meta-analyses also showed women with PCOS had a higher risk of having anxiety disorders, and depression symptoms than women without PCOS.

HIGHLIGHTS

• Anxiety symptoms were prevalent, although the prevalence varied depending on the self-reported questionnaire. • The highest prevalence of depression symptoms was associated with the Beck Depression Inventory (46.0%). • The pooled prevalence of anxiety disorders without specifying the type of disorder was 16.9%.

Treatment and complications of PCOS in adolescents - what's new in 2023?

Polycystic ovary syndrome (PCOS) is a disease affecting as many as about 10% of women of reproductive age, also 3-11% of teenage patients, and can lead to numerous complications and coexists with many diseases. Research is ongoing to establish an appropriate diagnostic and therapeutic path for adolescent girls with PCOS. It is also important to implement appropriate check-ups among teenagers with PCOS in order to prevent PCOS complications and initiate appropriate treatment as soon as possible and prevent the long-term consequences of these complications. The relationship between the co-occurrence of PCOS and diseases such as metabolic syndrome, hypertension, obesity, insulin resistance, type 2 diabetes and non-alcoholic fatty liver disease (NAFLD) is increasingly being investigated. A great attention is also being paid to the problem of mental health in this group of patients. In our study, we will review the latest reports on the treatment of PCOS and look at the complications that this syndrome can cause.

Exercise in the management of polycystic ovary syndrome: A position statement from Exercise and Sports Science Australia

Polycystic ovary syndrome (PCOS) is the most prevalent endocrine condition amongst females of reproductive age, leading to lifelong cardiometabolic, reproductive, psychological, and dermatologic symptoms as well as a reduced quality of life. Lifestyle interventions, which can include structured exercise programmes delivered by appropriately trained exercise professionals such as clinical exercise physiologists, are considered first-line strategies in PCOS management due to their therapeutic effects on various health outcomes and quality of life. This position statement builds on the 2023 International Evidence-based Guideline for the Assessment and Management of PCOS and describes the role of the exercise professional in the context of the multidisciplinary care team which includes physicians and allied health professionals. This position statement aims to equip exercise professionals with a broad understanding of the pathophysiology of PCOS, how it is diagnosed and managed in clinical practice, and evidence- and consensus-based recommendations for physical activity and exercise in PCOS management. In line with the physical activity recommendations for the general public, individuals with PCOS should aim to undertake between 150 to 300min of moderate-intensity or 75 to 150min of vigorous-intensity aerobic activity per week, or an equivalent combination of both spread throughout the week. Additionally, muscle-strengthening activities on two non-consecutive days per week are recommended to maintain health and prevent weight gain. For further health benefits and to achieve modest weight loss, individuals with PCOS should aim for a minimum of 250min of moderate-intensity or 150min of vigorous-intensity aerobic activity per week, or an equivalent combination of both spread throughout the week, plus muscle-strengthening activities on two non-consecutive days per week. Adolescents with PCOS should aim for a minimum of 60min moderate- to vigorous-intensity activity each day, incorporating muscle- and bone-strengthening activities three times per week. Finally, exercise professionals should consider the significant psychological burden, including weight stigma, and the high prevalence of comorbidities amongst individuals with PCOS and take appropriate measures to deliver safe and efficacious exercise interventions.

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

Objective

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

Methods

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

Results

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

Conclusions

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

Systematic Review Registration

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

Fertility Stress, Psychological Resilience, and Depressive Symptoms in Women With Polycystic Ovary Syndrome

BACKGROUND

Infertility is a common problem for patients with polycystic ovary syndrome (PCOS), which is closely related to stress and raises the risk of depression, while psychological resilience has been revealed to be protective for mental health. However, the associations of fertility stress, psychological resilience, and depressive symptoms in individuals with PCOS are not thoroughly explored. Our study aims to examine the associations of fertility stress and psychological resilience with depressive symptoms among patients with PCOS, as well as the mediating role of psychological resilience.

METHODS

A cross-sectional study was conducted in a reproductive clinic. The participants completed structured questionnaires on fertility stress (Fertility Problem Inventory (FPI)), psychological resilience (10-Item Connor-Davidson Resilience Scale (CD-RISC 10)), and depressive symptoms (Beck Depression Inventory-II (BDI-II)). Hierarchical regression was utilized to explore the relationship between fertility stress, psychological resilience, and depressive symptoms in PCOS patients after controlling for covariates. Psychological resilience was included in the final layer of the regression model to determine its potential mediating roles by comparing changes in the effect sizes between models. The percentage of mediating effect was then determined using structural equation modeling (SEM).

RESULTS

A total of 192 women with PCOS were included. Of them, 50 (26%) presented depressive symptoms, 18% of which were severe. Hierarchical regression showed that after adjusting for sociodemographic and health-related characteristics, both fertility stress (β=0.361; p<0.001) and resilience (β=-0.453; p<0.001) were significantly correlated with depressive symptoms. SEM demonstrated that fertility stress was directly linked to depressive symptoms in women with PCOS (β=0.050; 95% CI (0.028, 0.084); p<0.001). Psychological resilience mediated 21.9% of the relationship between fertility stress and depressive symptoms (β=0.014; 95% CI (0.005, 0.034); p=0.001).

CONCLUSION

This study demonstrated that among women with PCOS, fertility stress was, directly and indirectly through psychological resilience, associated with depressive symptoms. However, this study was cross-sectional, and the participants were recruited from a single clinical hospital. If replicated in longitudinal studies, the findings provide fertility stress and psychological resilience as potential intervention targets for better mental health in this population.

The impact of type 2 diabetes on polycystic ovary syndrome in patients undergoing sleeve gastrectomy

STUDY QUESTION

Does the concurrent type 2 diabetes mellitus (T2DM) aggravate the features and prognosis of PCOS in patients undergoing sleeve gastrectomy (SG)?

SUMMARY ANSWER

For patients undergoing SG with obesity, concurrent T2DM is associated with aggravated metabolic but milder reproductive features of PCOS and did not attenuate the resumption of regular menstruation for up to 1 year after surgery.

WHAT IS KNOWN ALREADY

Women with T2DM have an increased risk of PCOS. However, whether concurrent T2DM further increases the disease burden and treatment difficulty of PCOS in patients with obesity requires further investigation.

STUDY DESIGN, SIZE, DURATION

This was a single-center, two-arm, prospective, cohort study enrolling a total of 329 women with PCOS and scheduled for SG because of obesity at an university-affiliated hospital between January 2020 and August 2023, with a 1-year follow-up after surgery.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Comparisons were made between patients with T2DM (PCOS+T2DM) and without (PCOS) to examine the impact of T2DM on the metabolic, reproductive, and psychological features of PCOS. The follow-up data of weight loss and menstruation were analyzed to determine the impact of T2DM on PCOS prognosis for up to 1 year after SG.

MAIN RESULTS AND THE ROLE OF CHANCE

After controlling for confounders, patients in the PCOS+T2DM group (n = 98) showed more severe insulin resistance, glucose intolerance, dyslipidemia, and non-alcoholic fatty liver disease (NAFLD) (NAFLD activity score 4.31 ± 1.15 versus 3.52 ± 1.42, P < 0.001) than those in the PCOS group (n = 149). In addition, the PCOS+T2DM group had a lower level of total testosterone (1.63 ± 0.69 versus 1.82 ± 0.76, P = 0.045), a lower ratio between luteinizing hormone and follicle-stimulating hormone (median 1.48 versus 1.68, P = 0.030), and a lower proportion of patients with polycystic ovarian morphology (88% versus 96%, P = 0.022) than the PCOS group. As a result, the two groups differed significantly in terms of the Rotterdam classification of PCOS (P = 0.009). No significant difference was detected by group in the psychological features of PCOS except a lower degree of emotional eating in the PCOS+T2DM group (P = 0.001). Although the PCOS+T2DM group took longer to resume regular menstruation after SG (P = 0.037), the two groups had similar proportions of patients with regular menstruation (85% versus 87%, P = 0.758) 1 year after SG, which was further confirmed by subgroup analyses by body mass index.

LIMITATIONS, REASONS FOR CAUTION

The prognosis of PCOS after SG mainly focused on the results of menstruation rather than a complete evaluation of the remission of the disease.

WIDER IMPLICATIONS OF THE FINDINGS

Our study showed that, for patients with obesity, concurrent T2DM is associated with aggravated metabolic but milder reproductive features of PCOS and did not attenuate the resumption of regular menstruation for up to 1 year after surgery. Our study also highlights the need for high-quality studies with a more comprehensive evaluation of the impact of T2DM on the prognosis of patients with PCOS after SG.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by the National Natural Science Foundation of China Grants (82100853), the Natural Science Foundation of Shandong Province of China (ZR2021QH028), and the Clinical Research Project of Shandong University (2020SDUCRCC024). The authors have no conflicts of interest.

TRIAL REGISTRATION

Chinese Clinical Trial Registry with No. ChiCTR1900026845.

Lack of adequate counseling about pregnancy complications in patients with polycystic ovary syndrome: a cross-sectional survey study

Objective

To assess the counseling experiences of patients with polycystic ovary syndrome (PCOS) related to obstetric complications and preconception management of comorbidities.

Design

Cross-sectional survey study.

Setting

Not applicable.

Patients

Patients with PCOS with a history of or attempt at pregnancy.

Interventions

Not applicable.

Main Outcome Measures

Demographic characteristics, medical history, and counseling experiences.

Results

Of the 302 respondents, 72.9% had a previous pregnancy, with 66.8% reporting complications during pregnancy. Of the entire cohort, 52.7% received preconception counseling on PCOS-related obstetric complications, and 41.5% were satisfied with their counseling experience. Five percent were counseled on related postpartum complications, and 43.4% received counseling about prepregnancy weight management, with the minority satisfied with their counseling. Among the respondents with existing comorbidities including hypertension, diabetes, and anxiety or depression, the minority received counseling on their preconception management. Although there were no racial disparities in the overall counseling of pregnancy complications, more black patients were counseled about preeclampsia, cesarean section, and preterm birth than white patients. Of the patients who had a single provider managing their PCOS care, 78.6% who saw a reproductive endocrinologist, 53.2% who saw a general gynecologist, and 35.0% who saw a primary care physician reported receiving counseling on related pregnancy complications.

Conclusions

Despite the high prevalence of obstetric complications associated with PCOS, our study revealed inadequate patient counseling about both the antepartum and postpartum periods and preconception management of existing comorbidities. Our findings highlight the urgent need to increase provider education and patient awareness to optimize maternal and neonatal outcomes.

Assessment of the Validity and Quality of Polycystic Ovarian Syndrome (PCOS) Screening Tools Available for Women Globally: A Systematic Review

Background: This systematic review has the following aims: (1) to identify measurement tools used globally by healthcare providers to diagnose PCOS in women at elevated risk; (2) to assess the comprehensiveness of these tools regarding mental health and chronic pain; (3) to list strategies for validating, disseminating, and implementing these tools; and (4) to provide future recommendations for experts in healthcare settings. Methods: This review utilized the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and the Arksey and O'Malley York methodology. Studies were sourced from the PubMed, Embase, and Cochrane Library databases, with inclusion criteria focusing on peer-reviewed articles addressing PCOS diagnosis and associated comorbidities. Data extraction and analysis followed the Joanna Briggs Institute (JBI) recommendations. Results: A total of 63 studies met the inclusion criteria. Findings indicate that current screening tools for PCOS often lack comprehensive integration of mental health and chronic pain assessments. Tools like the PCOSQ and its updated version, PCOSQ-50, inadequately address pain-related symptoms, highlighting a gap in holistic patient evaluation. This review identified significant associations between PCOS and mental health disorders, including anxiety and depression, emphasizing the need for mental health screenings as part of PCOS management. Conclusions: There is a critical need for validated PCOS screening tools that encompass both physical and psychological aspects of the condition. Educating healthcare providers on the cultural and social determinants influencing PCOS can improve diagnosis and patient outcomes. Future research should focus on developing holistic screening tools and culturally relevant educational resources, aiming to enhance the overall quality of life for women with PCOS.

Broadening horizons: the role of ferroptosis in polycystic ovary syndrome

Polycystic ovarian syndrome (PCOS) is a common heterogeneous reproductive endocrine metabolic disorder in women of reproductive age characterized by clinical and biochemical hyperandrogenemia, ovulation disorders, and polycystic ovarian morphology. Ferroptosis is a novel type of cell death driven by iron accumulation and lipid peroxidation. Ferroptosis plays a role in maintaining redox balance, iron metabolism, lipid metabolism, amino acid metabolism, mitochondrial activity, and many other signaling pathways linked to diseases. Iron overload is closely related to insulin resistance, decreased glucose tolerance, and the occurrence of diabetes mellitus. There is limited research on the role of ferroptosis in PCOS. Patients with PCOS have elevated levels of ferritin and increased reactive oxygen species in ovarian GCs. Studying ferroptosis in PCOS patients is highly important for achieving personalized treatment. This article reviews the progress of research on ferroptosis in PCOS, introduces the potential connections between iron metabolism abnormalities and oxidative stress-mediated PCOS, and provides a theoretical basis for diagnosing and treating PCOS.

Cut-off value for anti-Müllerian hormone in the diagnostic criteria for polycystic ovary syndrome in the Japanese population

AIM

To establish cut-off values for anti-Müllerian hormone (AMH) and antral follicle count (AFC) in the diagnostic criteria for polycystic ovary syndrome (PCOS) applicable to the Japan Society of Obstetrics and Gynecology (JSOG) 2024 criteria and the Rotterdam/International Evidence-Based Guideline for the assessment and management of PCOS (IEBG) 2023 criteria based on a nationwide survey, respectively, taking into account age, assays, and structure of the diagnostic criteria.

METHODS

Data were collected for 986 PCOS cases and 965 control cases using a national survey in Japan and used to establish cut-off values for AMH and AFC.

RESULTS

Serum AMH levels were significantly higher in the PCOS group compared to the control group. Serum AMH showed a significant negative correlation with age and significant positive correlation with AFC in both groups. In multiple regression analysis, serum AMH level was independently affected by AFC and total testosterone. AMH cut-off values suitable for the JSOG 2024 criteria and the Rotterdam/IEBG 2023 criteria were separately established for the 20-29 and 30-39 years of age groups, respectively, and for Access, Lumipulse and Elecsys/ECLusys, respectively. AFC cut-off values suitable for the JSOG 2024 criteria and Rotterdam/IEBG 2023 criteria were also established separately. AFC exhibited statistically greater variability than AMH.

CONCLUSION

The serum AMH level is the biochemical representation of ovarian findings in PCOS and considered objective and highly reliable. Therefore, it could serve as a surrogate for AFC as a marker of polycystic ovarian morphology in diagnostic criteria.

Supportive care of female hormones in brain health: what and how?

Female hormones, functioning as neuroactive steroids, are utilized beyond menopausal hormone therapy. The rapid onset of allopregnanolone analogs, such as brexanolone and zuranolone, in treating depression, and the effectiveness of megestrol acetate in addressing appetite and weight gain, prompted the Food and Drug Administration to authorize the use of progesterone for treating postpartum depression and cancer-related cachexia. Progesterone has also been found to alleviate neuropathic pain in animal studies. These off-label applications offer a promising option for patients with advanced cancer who often experience various mood disorders such as depression, persistent pain, social isolation, and physical complications like cachexia. These patients have shown low tolerance to opioids and mood-regulating medications. However, the potential risks and uncertainties associated with hormone therapy treatment modalities can be daunting for both patients and medical professionals. This review aims to offer a comprehensive understanding of the non-reproductive functions and mechanisms of female hormones in brain health.

Effects of weight loss intervention on anxiety, depression and quality of life in women with severe obesity and polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women that is associated with an increased risk of anxiety and depression and with a lower health-related quality of life (HRQoL). PCOS is closely associated with obesity, which per se can lead to symptoms of anxiety and depression and lower HRQoL. The first-line treatment for PCOS is weight loss through lifestyle intervention, which has been shown to improve all symptoms of the syndrome. The aim of this study was to investigate symptoms of anxiety and depression and HRQoL in women with severe obesity (BMI ≥ 35) with and without PCOS, and to evaluate the effect of a one-year structured weight loss intervention. A total of 246 women with severe obesity (PCOS n = 63, non-PCOS n = 183) were included. The comprehensive psychopathological rating scale self-rating scale for affective symptoms (CPRS-S-A) and the short form-36 (SF-36) were used to assess symptoms of anxiety and depression and HRQoL. In total 72 women of the 246 women with severe obesity completed a one-year weight loss programme and were followed up and compared with baseline data. In women with severe obesity, there were no differences in symptoms of anxiety and depression and HRQoL between women with and without PCOS at baseline. Clinically relevant anxiety symptoms were present in 71.3% (PCOS) and 65.6% (non-PCOS), and depression symptoms were present in 56.4% (PCOS) and 52.2% (non-PCOS). Significant weight loss improved physical HRQoL in all women, but reduced symptoms of anxiety and depression only in women without PCOS. There were no differences when comparing the changes between the groups. Women with severe obesity are severely affected by symptoms of anxiety and depression, independent of PCOS. Weight loss improved symptoms of anxiety and depression in women without PCOS, but there were no differences between groups in change from baseline to follow-up.Trial registration number: Clinical trial.gov: NCT01319162, March 18, 2011. Date of registration and enrolment of the first subject September 2011.

Gut bacteriome and mood disorders in women with PCOS

STUDY QUESTION

How does the gut bacteriome differ based on mood disorders (MDs) in women with polycystic ovary syndrome (PCOS), and how can the gut bacteriome contribute to the associations between these two conditions?

SUMMARY ANSWER

Women with PCOS who also have MDs exhibited a distinct gut bacteriome with reduced alpha diversity and a significantly lower abundance of Butyricicoccus compared to women with PCOS but without MDs.

WHAT IS KNOWN ALREADY

Women with PCOS have a 4- to 5-fold higher risk of having MDs compared to women without PCOS. The gut bacteriome has been suggested to influence the pathophysiology of both PCOS and MDs.

STUDY DESIGN, SIZE, DURATION

This population-based cohort study was derived from the Northern Finland Birth Cohort 1966 (NFBC1966), which includes all women born in Northern Finland in 1966. Women with PCOS who donated a stool sample at age 46 years (n = 102) and two BMI-matched controls for each case (n = 205), who also responded properly to the MD criteria scales, were included.

PARTICIPANTS/MATERIALS, SETTING, METHODS

A total of 102 women with PCOS and 205 age- and BMI-matched women without PCOS were included. Based on the validated MD criteria, the subjects were categorized into MD or no-MD groups, resulting in the following subgroups: PCOS no-MD (n = 84), PCOS MD (n = 18), control no-MD (n = 180), and control MD (n = 25). Clinical characteristics were assessed at age 31 years and age 46 years, and stool samples were collected from the women at age 46 years, followed by the gut bacteriome analysis using 16 s rRNA sequencing. Alpha diversity was assessed using observed features and Shannon's index, with a focus on genera, and beta diversity was characterized using principal components analysis (PCA) with Bray-Curtis Dissimilarity at the genus level. Associations between the gut bacteriome and PCOS-related clinical features were explored by Spearman's correlation coefficient. A P-value for multiple testing was adjusted with the Benjamini-Hochberg false discovery rate (FDR) method.

MAIN RESULTS AND THE ROLE OF CHANCE

We observed changes in the gut bacteriome associated with MDs, irrespective of whether the women also had PCOS. Similarly, PCOS MD cases showed a lower alpha diversity (Observed feature, PCOS no-MD, median 272; PCOS MD, median 208, FDR = 0.01; Shannon, PCOS no-MD, median 5.95; PCOS MD, median 5.57, FDR = 0.01) but also a lower abundance of Butyricicoccus (log-fold changeAnalysis of Compositions of Microbiomes with Bias Correction (ANCOM-BC)=-0.90, FDRANCOM-BC=0.04) compared to PCOS no-MD cases. In contrast, in the controls, the gut bacteriome did not differ based on MDs. Furthermore, in the PCOS group, Sutterella showed positive correlations with PCOS-related clinical parameters linked to obesity (BMI, r2=0.31, FDR = 0.01; waist circumference, r2=0.29, FDR = 0.02), glucose metabolism (fasting glucose, r2=0.46, FDR < 0.001; fasting insulin, r2=0.24, FDR = 0.05), and gut barrier integrity (zonulin, r2=0.25, FDR = 0.03).

LIMITATIONS, REASONS FOR CAUTION

Although this was the first study to assess the link between the gut bacteriome and MDs in PCOS and included the largest PCOS dataset for the gut microbiome analysis, the number of subjects stratified by the presence of MDs was limited when contrasted with previous studies that focused on MDs in a non-selected population.

WIDER IMPLICATIONS OF THE FINDINGS

The main finding is that gut bacteriome is associated with MDs irrespective of the PCOS status, but PCOS may also modulate further the connection between the gut bacteriome and MDs.

STUDY FUNDING/COMPETING INTEREST(S)

This research was funded by the European Union's Horizon 2020 Research and Innovation Programme under the Marie Sklodowska-Curie Grant Agreement (MATER, No. 813707), the Academy of Finland (project grants 315921, 321763, 336449), the Sigrid Jusélius Foundation, Novo Nordisk Foundation (NNF21OC0070372), grant numbers PID2021-12728OB-100 (Endo-Map) and CNS2022-135999 (ROSY) funded by MCIN/AEI/10.13039/501100011033 and ERFD A Way of Making Europe. The study was also supported by EU QLG1-CT-2000-01643 (EUROBLCS) (E51560), NorFA (731, 20056, 30167), USA/NIH 2000 G DF682 (50945), the Estonian Research Council (PRG1076, PRG1414), EMBO Installation (3573), and Horizon 2020 Innovation Grant (ERIN, No. EU952516). The funders did not participate in any process of the study. We have no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

N/A.

Comprehensive transition of care for polycystic ovary syndrome from adolescence to adulthood

Polycystic ovary syndrome (PCOS) is a lifelong chronic condition that affects one in ten females and can be diagnosed in adolescence. As adolescents with PCOS transition to adulthood, counselling for lifestyle management and mental health concerns often transition from involving the family unit to increasingly individual-focused approaches. PCOS is associated with a large range of comorbidities affecting reproductive, metabolic, dermatological, and psychological health. The diagnosis and comorbidities of PCOS are influenced by pubertal hormones and need to be reassessed continuously to ensure that treatment remains appropriate for age and development. As young patients grow up, personal concerns often change, especially in relation to reproductive management. In this Review, we present prevalence rates, screening tools, and treatment recommendations for PCOS-related conditions, and we consider the diagnostic and clinical elements of optimal transition of care models that ensure continuity of comprehensive care for adolescents moving from the paediatric health-care system to the adult health-care system.