Managing polycystic ovary syndrome: a cognitive behavioral strategy

Evaluation of the Salivary Matrix Metalloproteinase-9 in Women With Polycystic Ovaries Syndrome and Gingival Inflammation: A Case-Control Study

Background Polycystic ovary syndrome (PCOS) is an endocrine disease of women of reproductive age that impacts their oral and systemic well-being. This study aimed to compare the gingival inflammation indices and matrix metalloproteinase-9 (MMP-9) of non-obese women with PCOS. Materials and methods This is a case-control study in which 78 women were referred to the Babol Clinic Hospital in Northern Iran between 2018 and 2019. They were divided into three groups: 26 women with PCOS and gingivitis, 26 women with PCOS with no gingivitis, and 26 women with no PCOS and no gingivitis as a control group. After recording the anthropometric and demographic variables, fasting saliva samples were taken from all participants before any periodontal intervention. These samples were transferred to Babol Molecular Cell Research Center under highly guaranteed cold-chain conditions to measure the serum levels of MMP-9. Periodontal status was evaluated for Gingival Index (GI), Plaque Index (PI), and Bleeding on Probing (BOP). Analysis of variance was used to compare the mean results for these indices. The significance level was considered when p ≤ 0.05. Results All the gingival indices were significantly higher for women with PCOS with gingivitis compared to the results for women from the other two groups. Similarly, women with PCOS showed high salivary MMP-9 levels but were within the normal reference ranges. Conclusion The gingival indices (GI, PI, and BOP) and salivary MMP-9 are higher in women with PCOS, regardless of the gingival status.

The effects of cognitive behavioral therapy in women with polycystic ovary syndrome: A meta-analysis

BACKGROUND

Cognitive behavioral therapy (CBT) has well-characterized benefits in alleviating diseases associated with depression, anxiety, and obesity, resulting in a marked improvement in the patient's quality of life. There are some studies regarding the effects of CBT on patients with polycystic ovary syndrome (PCOS). However, there is still no report of a meta-analysis for systematic assessment.

OBJECTIVES

This study aimed to evaluate the effectiveness of CBT in improving weight loss, anxiety, depression, life quality, compliance, and pregnancy outcomes in patients with PCOS.

METHODS

Studies regarding CBT related to PCOS in PubMed, Cochrane library, Embase, ClinicalTrials.gov, CNKI, and WANFANG DATA were searched for up to 19 November 2020. A random-effects model was used to perform a meta-analysis.

RESULTS

Eight trials regarding CBT compared with lifestyle modification and routine treatments were included. No differences in depression (SMD -1.11; 95% CI -2.28, 0.07; P > 0.05), body mass index (BMI) (SMD 0.88; 95% CI -0.94, 2.71; P > 0.05), or overall life quality (SMD 1.24; 95% CI -0.44, 2.92; P > 0.05) were evident between CBT and control groups; however, anxiety (SMD -1.12; 95% CI -2.1, -0.13; P < 0.05) and quality of life in hirsutism (SMD 0.92; 95% CI 0.48, 1.35; P < 0.05) were significantly improved. For secondary outcomes, both patient compliance and pregnancy rate were improved, but no significant change in pregnancy loss rate was identified.

CONCLUSION

CBT exhibited obvious advantages in the alleviation of anxiety, improvement of quality of life in hirsutism, and increase of compliance and pregnancy rate in patients with PCOS. Larger and higher-quality randomized controlled trials are needed to clarify the role of CBT in PCOS.

SYSTEMATIC REVIEW REGISTRATION

[https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021225856].

The Effect of Hydroalcoholic Calendula Officinalis Extract on Androgen-Induced Polycystic Ovary Syndrome Model in Female Rat

Background. Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in women of reproductive age, and the major cause of infertility. Today, using medicinal plants instead of chemical drugs could be an alternative treatment option for PCOS. The purpose of this study was to determine the effect of Calendula officinalis hydroalcoholic extract on PCOS in rats. Method. 60 female adult rats were randomly divided into six groups, including control, sham, PCOS group, and treated PCOS groups receiving hydroalcoholic extract of Calendula officinalis with different dosages of 200, 500, and 1000 mg/kg. PCOS was induced by subcutaneous injection of DHEA 6 mg/100 g bw for 35 days. For two weeks, the extract was taken orally. The serum glucose, insulin, sex hormone levels, and oxidative status were measured at the end of the experiment. The ovaries were dissected for histomorphometric and pathological analysis. Results. When compared to the control and sham groups, the PCOS group showed a significant increase in glucose, insulin, testosterone, and malondialdehyde (MDA) concentrations, cystic and atretic follicles, and thickness of the theca and tunica albuginea layers, and a significant decrease in LH concentration, total antioxidant capacity, corpus luteum, antral follicles, and oocyte diameter. The mean concentration of FSH, on the other hand, did not change significantly. A trend of improvement was found in the treated groups with high doses of Calendula officinalis extract. Conclusion. In rats with PCOS and nonovulation, Calendula officinalis hydroalcoholic extract improved oxidative stress, restored folliculogenesis, and increased ovulation.

An Integrative Model of Tourists’ Pro-Environmental Behavior Based on the Dual Path of Rational Planning and Embodied Emotion

Tourists’ pro-environmental behavior is one of the key factors for the sustainable development of natural scenic spots. Although this behavior depends on the surroundings and context, the existing literature lacks the perspective of specific scenarios, especially that of embodied emotions. This research integrated the theory of planned behavior and embodied theory to construct an integrative model of pro-environmental behavior that combined tourists’ “rational planning” and “embodied emotion” and conducted an empirical study. The results show that in natural scenic spots, “rational planning” and “embodied emotion” affect tourists’ pro-environmental behavior simultaneously on dual paths, and factors such as behavioral attitude, perceived behavioral control, subjective norm, engagement with nature, and connectedness to nature have different effects on high- and low-effort pro-environmental behavioral intentions. The findings of the study provide a new explanatory perspective for individual pro-environmental behaviors and a basis for effectively predicting and guiding tourists’ pro-environmental behaviors in natural scenic spots.

Effectiveness of cognitive-behavioral therapy (CBT) in improving the quality of life and psychological fatigue in women with polycystic ovarian syndrome: a randomized controlled clinical trial

Introduction: Given the increasing prevalence of complications caused by the polycystic ovarian syndrome (PCOS) such as medical and psychological problems and also the chronicity of this disease, patients with the PCOS tend to experience lower quality of life and greater psychological fatigue similar to other patients with chronic diseases. This study was conducted to determine the effects of cognitive-behavioral therapy (CBT) on the quality of life and psychological fatigue in women with the PCOS. Methods: This randomized controlled clinical trial study, conducted from 2016 to 2017, enrolled 74 women aged between 18 and 35 years from the Iranian city of Saqqez. The participants were assigned to a CBT group and a control group via block randomization. The intervention group received 8 weekly CBT sessions between 45 and 60 minutes each. The Polycystic Ovary Syndrome Health-Related Quality of Life Questionnaire (PCOSQ) and the Fatigue Impact Scale (FIS) were completed by the patients before and after the intervention. Results: No significant differences were observed between the two groups before the intervention in terms of sociodemographic characteristics and the mean scores of quality of life and psychological fatigue. After the intervention, the mean (standard deviation [SD]) of the quality of life score was 60.2 (13.3) in the intervention group and 24.4 (15) in the control group, with the mean score of quality of life being significantly higher in the intervention group than in the control group (adjusted mean difference = 33.1). The mean (SD) score of psychological fatigue was 28.2 (13.9) in the intervention group and 78.2 (37.1) in the control group, with the mean score of psychological fatigue being significantly lower in the intervention group than in the control group (-54.8). Conclusions: The results showed that CBT was able to reduce fatigue and improve quality of life in our sample of women with the PCOS and ultimately boost their health.

Predictors of Depression in Iranian Women with Polycystic Ovarian Syndrome

Depression is a major complication of polycystic ovarian syndrome (PCOS). Lifestyle modification can prevent it. This study aimed to determine the predictors of depression in women with PCOS. This cross-sectional study was conducted on 174 women who attended in infertility clinics in Urmia-Iran, 2015. The data were collected through socio-demographic, Beck Depression Inventory-II and Health Promoting Lifestyle Profile-2 questionnaires. The mean (standard deviation) of total score of the depression was obtained 27.4 (10.5) in the range 0-63. The mean (SD) of total score of the health promoting lifestyle was obtained 2.2 (0.3) out of 4. Based on multivariate linear regression, the variables of nutrition, interpersonal relationships, spiritual growth, stress management, BMI, the perceived stress of the disease, the first supporter and menstrual bleeding were predictors of the depression. Given the high prevalence of depression in PCOS patients and its relationship with health-promoting behaviors, lifestyle modification to reduce depression is necessary.

The Polycystic Ovary Syndrome Health-Related Quality-of-Life Questionnaire: Confirmatory Factor Analysis

BACKGROUND

The health related quality-of-life (HRQoL) among females with polycystic ovary syndrome (PCOS) is reduced due to emotional, psychosocial, infertility, marital, and hirsutism problems.

OBJECTIVES

The current study aimed at analyzing exploratory and confirmatory factor structures of HRQoL questionnaire for polycystic ovary syndrome (PCOSQ-50) in females with PCOS in order to verify the validity of the developed instrument.

METHODS

The current cross validation study was conducted on females with PCOS using the PCOSQ-50. The PCOSQ-50 was developed based on a qualitative study. The exploratory factor analysis (EFA) and the confirmatory factor analysis (CFA) were conducted to examine the factor structure of PCOSQ-50. After the CFA, the reliability of the new instrument was also evaluated using Cronbach's alpha coefficient.

RESULTS

Totally, 350 females with PCOS were entered into the study. The mean age of the subjects was 26.9 ± 5.1 years. Based on the results of CFA, data were fit to the 43-item model: the comparative fit index (CFI) = 0.91; the normal fit index (NFI) = 0.90; the goodness of fit index (GFI) = 0.60; incremental fit index (IFI) = 0.91; the root mean square error of approximation (RMSEA) = 0.09; standardized root mean square residual (SRMR) = 0.09 and the relative chi-square (x²/df) = 2.20, P < 0.05. The intraclass correlation coefficient ranged 0.91 to 0.94 indicating a satisfactory finding.

CONCLUSION

The 43-item PCOSQ showed appropriate validity and reliability and its psychometric quality was superior to that of the original version. However, further longitudinal studies should be conducted to evaluate its predictive efficacy.

Mental health status assessment in polycystic ovarian syndrome infertility patients: A pilot study

Polycystic ovary syndrome (PCOS) is a major endocrine disorder afflicting women of reproductive age. Women with PCOS are more likely to suffer from mental health disturbances than healthy women. The "infertility" suffered by PCOS patients would also lead to mental health disturbances. Symptom Checklist 90 (SCL-90) and questionnaire which includes patients' socio-economic and demographic data were used to assess the mental health status of PCOS (n=103) and non-PCOS (n=110) infertile patients. Logistic regression analysis and t-tests were used for comparative analysis. The data demonstrated that scores of depression, interpersonal sensitivity, obsessive-compulsive, and hostility symptoms in PCOS infertile patients were significantly higher than those in the non-PCOS infertile patients (P<0.05). Logistic regression analysis revealed that acne had negative effect on mental health status (P<0.05). Secondary infertile PCOS patients were more easily to suffer from somatization, interpersonal sensitivity, obsessive-compulsive, anxiety, hostility and paranoid ideation symptoms than the primary infertile PCOS patients (P<0.05). The results suggested that the PCOS patients especially the secondary infertile PCOS patients had obvious mental health disturbances. The acne might play an importance role in the occurrence of mental health disturbances in PCOS patients. PCOS related symptoms may be risk factors of mental health status in PCOS patients with infertility. More attention should be paid to the PCOS infertile patients, and mental health therapy should be considered if necessary.

A case report demonstrating the efficacy of a comprehensive cognitive-behavioral therapy approach for treating anxiety, depression, and problematic eating in polycystic ovarian syndrome

Despite elevated prevalence of anxiety and depression among women with polycystic ovarian syndrome (PCOS), there is a dearth of evidence-based psychotherapies to treat mood-related symptoms among this population. This case report describes the efficacy of The PCOS Workbook in treating symptoms of anxiety, depression, and problematic eating in a 19-year-old female previously diagnosed with PCOS. Using the cognitive-behavioral framework presented in the workbook, the participant experienced a significant reduction in symptoms of anxiety, depression, problematic eating, and general psychosocial dysfunction while simultaneously losing a significant amount of weight during treatment. Six months after the termination of treatment, the participant maintained several improvements in psychological functioning, although she did report a resumption of problematic eating and experience weight regain. These findings provide initial empirical support for the efficacy of this manualized psychotherapy at improving psychosocial functioning in women with PCOS. Recommendations on ways to best utilize this resource and enhance its long-term efficacy, particularly when intervening for problematic eating, are also discussed.

The experience of women affected by polycystic ovary syndrome: a qualitative study from iran

BACKGROUND

Polycystic ovary syndrome (PCOS) is the most common chronic endocrine disorder. It has significant and diverse clinical consequences including reproductive, metabolic, and psychological morbidities as well as predisposition to malignancies. It is unclear how women with PCOS experience symptoms of this syndrome.

OBJECTIVES

The aim of this study was to clarify the dimensions and components of quality of life in iranian women with PCOS.

PATIENTS AND METHODS

This study was a qualitative study to explore and document perceptions of women with PCOS about their disorder and quality of life. Semi-structured interviews with open ended questions were conducted with 23 women with PCOS. The interviews were continued to reach data saturation. The study was conducted in the Reproductive Endocrinology Research Center of Shahid Beheshti University of Medical Sciences. All the interviews were recorded and transcribed. Constant comparative analysis of the data was conducted manually according to the Strauss and Corbin analysis method.

RESULTS

The study revealed that the most important factors affecting quality of life in women with PCOS were the role functioning items as well as physical, mental, emotional, cognitive, and social dimensions.

CONCLUSIONS

Comprehensive cares concerning various mental, emotional, cognitive, and social dimensions of quality of life should be planned for women with PCOS.

Emotional needs of teens with polycystic ovary syndrome

Teens with polycystic ovary syndrome have serious health issues that impact them on multiple levels-hormonal concerns affecting female health and fertility, disfiguring body changes causing self-image problems, and lifelong health consequences related to metabolic disorders. Health care providers are now beginning to understand underlying pathophysiologic processes and make earlier diagnoses in the 6%-10% of teens with this disorder. However, the profound psychological and social needs are often inadequately recognized by health care providers, causing many teens turn to peers and the Internet for guidance and support. More research is needed to identify and address the emotional aspects of this common disorder in healthcare settings.

HER LIFESTYLE: a mneumonic for addressing polycystic ovary syndrome in adolescents

PCOS affects up to 10 percent of women of childbearing age, including adolescents. The emotional and physical consequences of PCOS can be significant. Early diagnosis and initiation of lifestyle changes can have a positive impact on risk for long-term sequelae.