Metabolic Features of Women With Polycystic Ovary Syndrome in Latin America: A Systematic Review

Evaluation of the evidence-based practices for the management of PCOS in the Latin America context: the consensus of the Latin American Association of Gynecological Endocrinology (ALEG)

OBJECTIVES

Polycystic Ovary Syndrome (PCOS) is a complex condition affecting approximately 1 in 10 women of reproductive age. However, limited data are available regarding the specific characteristics and needs of women with PCOS in Latin America. This consensus sought to evaluate the evidence-based practices for the management of PCOS for Latin American populations, consolidate regional insights, identify eventual gaps in implementation and identify key research opportunities.

METHODS

Using the Delphi strategy, experts from various Latin American countries selected and reviewed a subset of recommendations from the 2023 International Evidence-Based Guideline (EBG) for the Assessment and Management of PCOS. Virtual and in-person meetings facilitated discussions on the selected recommendations, followed by voting rounds to achieve consensus.

RESULTS

A total of 33 recommendations for PCOS diagnosis and treatment were evaluated. In the initial voting round, 25 recommendations achieved strong agreement (80%-100% support), while eight received less than 80% agreement. After further discussions on their relevance and potential to influence behavior change among health professionals and public health policies, the remaining recommendations achieved near-unanimous support in the second round.

CONCLUSIONS

This consensus underscored evidence-based practices for PCOS diagnosis and treatment deemed appropriate for the Latin American context. It also highlighted implementation barriers such as cost and accessibility, while identifying opportunities for research to improve PCOS management and address regional challenges. These findings aim to enhance clinical care and inform public health strategies tailored to the needs of Latin American women living with PCOS.

Topiramate added to metformin for obesity control in women with polycystic ovary syndrome: a randomized clinical trial

CONTEXT

Polycystic ovary syndrome (PCOS) is often linked with obesity, and weight management can improve endocrine and cardiometabolic features.

OBJECTIVE

To evaluate the effects of adding topiramate (TPM) to metformin (MTF) on weight control, hormonal and metabolic outcomes in women with PCOS.

METHODS

In a randomized, double-blind, placebo-controlled trial, participants with PCOS and body mass index ≥30 kg/m² or ≥27 kg/m² associated with hypertension, type 2 diabetes, or dyslipidemia followed a 20 kcal/kg diet in addition to 850 mg of MTF or a previous MTF regimen. They were randomized to receive either TPM or placebo (P) alongside MTF. Anthropometric measurements, blood pressure, modified Ferriman-Gallwey score (mFGS), and adverse events were assessed every 4 weeks for 6 months.

MAIN OUTCOME MEASURES

The primary endpoint was the percent change in body weight from baseline in both groups. Secondary endpoints included changes in clinical, cardiometabolic, and hormonal parameters and psychosocial features.

RESULTS

Thirty-one participants were in the MTF+P group and 30 in the MTF+TPM group. The MTF+TPM group showed greater mean weight loss at 3 months (-3.4% vs. -1.6%, p=0.03) and 6 months (-4.5% vs. -1.4%, p=0.03). Both groups improved androgens, lipids, and psychosocial scores. Participants with ≥3% weight loss at 6 months improved mFGS (8.4 to 6.5, p=0.026). Paresthesia was more common in the MTF+TPM group (23.3% vs. 3.2%, p=0.026).

CONCLUSIONS

Combining TPM with MTF and a low-calorie diet may be an effective, low-cost, easy-to-use, and safe strategy for weight management in women with PCOS, with mild adverse effects.

Phenotypic Characterization of Patients with Polycystic Ovary Syndrome in a Population from the Ecuadorian Andes: A Cross-Sectional Study

Background: Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine-metabolic disorder in women of reproductive age. Diagnosis is based on the evidence-based international guideline 2018 and the Rotterdam Consensus to classify PCOS phenotypes. This study aims to characterize the biodemographic, clinical, metabolic, and reproductive variables and their relationship with PCOS phenotypes in a population from the Ecuadorian Andes. Methodology: A cross-sectional study was conducted with a non-random consecutive sample of 92 women who attended the outpatient gynecology and endocrinology clinic at the Hospital of the Technical University of Loja (UTPL)-Santa Inés, Loja, Ecuador, between January 2022 and July 2023. Descriptive statistics, mean calculations, standard deviation, parametric and nonparametric tests, odds ratios (OR), confidence intervals (CI), and p-values were employed. Results: The average age was 22 ± 3.4 years, with a predominantly mestizo, urban, single, highly educated, and medium-high socioeconomic level population. It was identified that phenotypes A + B are at a higher risk of developing oligomenorrhea and hypertriglyceridemia compared to phenotypes C + D, with statistically significant differences (p < 0.05). Furthermore, in terms of reproductive variables, phenotypes A + B exhibit a significantly higher frequency of elevated anti-Müllerian hormone (AMH) compared to phenotypes C + D, also with statistical significance (p < 0.05). Conclusions: The classical phenotypes A and B of PCOS are the most common in Ecuadorian Andean women and carry a higher risk of insulin resistance, anovulation, metabolic disorders, and elevated triglyceride levels compared to phenotypes C and D. Ethnic diversity and sociocultural habits influence the prevalence and clinical manifestations of these phenotypes.

Clinical and laboratory features in women with different phenotypes of polycystic ovary syndrome

BACKGROUND

Misdiagnosis is still an obstacle in the workup of polycystic ovary syndrome. We compared patients' characteristics among phenotypes of the syndrome and assessed the association of the characteristics with oligo-anovulation, hyperandrogenism, and polycystic ovary.

METHODS

In the infertility department of a teaching hospital, we performed a cross-sectional study. Based on the Rotterdam Criteria, we included 136 patients with polycystic ovary syndrome and 46 healthy controls.

RESULTS

The most common phenotype was A (N.=45;33%). Overall, A and C had larger Body Mass Index (P=0.019 and 0.030, respectively) and waist circumference (P=0.005 and 0.003) than control. Also, A and D had higher serum anti-mullerian hormone than control (both P<0.001) or phenotype C (P<0.001 and 0.01). Phenotypes A and C had higher insulin than control (both P=0.004). The highest level of estradiol was for control and the lowest for B. The lowest high-density lipoprotein was for C; and A to C phenotypes had higher triglyceride than control (P=0.002, <0.001, and 0.041). Larger body mass was associated with hyperandrogenism (adjusted Odds Ratio 95% CI=1.11 [1.01, 1.23], P=0.034); higher anti-mullerian hormone and high-density lipoprotein were related to oligo-anovulation (1.2 [1.07, 1.37], P=0.004; 1.1 [1.00, 1.13], P=0.041). Higher insulin and lower high-density lipoprotein were associated with polycystic ovary (1.11 [1.03, 1.21], P=0.013; 0.9 [0.82, 0.97], P=0.014).

CONCLUSIONS

There are potentials in Body Mass Index, waist circumference, serum anti-mullerian hormone, insulin, estradiol, high-density lipoprotein, and triglyceride concentration for differentiating the phenotypes of polycystic ovary syndrome and for more precise diagnosis of hyperandrogenism, oligo-anovulation, and polycystic ovary morphology.

Polycystic Ovarian Syndrome: a Risk Factor for Cardiovascular Disease

PURPOSE OF REVIEW

Characterize the risk of cardiovascular disease (CVD) in individuals with polycystic ovarian syndrome (PCOS). Review the pathophysiological pathways that confers CVD risk in individuals with PCOS and interventions to reduce CVD risk.

RECENT FINDINGS

PCOS is a complex syndrome characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovaries that has metabolic and cardiovascular implications. Intrinsic hormonal dysregulation and chronic low-grade inflammation play an important role in the progression of atherosclerosis in young premenopausal individuals and development of CVD independently of associated traditional risk factors. Management with metformin reduces CVD risk by reducing atherosclerosis progression. PCOS is an important CVD risk factor among individuals of reproductive age. Early detection and interventions are needed to mitigate development of CVD.

The role of obstetrician-gynecologists and reproductive endocrinologists in the blood glucose management of polycystic ovary syndrome

Background: This study aimed to compare the differences between reproductive endocrinologists (Repro-Endo) and obstetricians-gynecologists (Ob-Gyn; non-reproductive medicine specialty) in diagnosing, evaluating, and treating PCOS women with insulin resistance (IR).Methods: Repro-Endo and Ob-Gyn in China participated in this survey, and their responses were analyzed using χ² tests, Fisher exact tests, and multivariable logistic regression analysis.Results: The study analyzed 2412 survey responses (92.3% OB-Gyn; 98.5% women). Physician's age, hospital grade, specialty, and the number of PCOS patients who visit the physicians, revealed that Repro-Endo participants were more likely to suggest an oral glucose tolerance test (OR, 1.727; 95% CI, 1.272-2.345) as their first choice than Ob-Gyn participants. The most common treatments for patients with PCOS were lifestyle modification (>95%) and metformin use (>80%). More Repro-Endo participants prescribed metformin at a dose of 1.5 g/day compared with OB-Gyn (46.5% vs. 23.5%), and more OB-Gyn participants reported being unclear about the appropriate dosage of metformin for patients with obesity and PCOS (12.5% vs. 1.6%).Conclusion: This survey identified knowledge gaps in metabolic screening for patients with IR and PCOS. Similarly, it highlights the need to improve IR management education for physicians caring for PCOS women.

Hirsutism, Normal Androgens and Diagnosis of PCOS

Hirsutism is defined as the presence of terminal hair with male pattern distribution in women. While in the general population, hirsutism affects around 4-11% of women, it is the main manifestation of hyperandrogenism in women with polycystic ovary syndrome (PCOS), with a prevalence estimated at 65-75%. Hirsutism in PCOS is associated with both androgen excess and individual response of the pilosebaceous unit to androgens. The modified Ferriman-Gallwey (mFG) scoring system has been widely used in clinical practice to visually score excessive terminal hair, thus standardizing hirsutism evaluation and facilitating data comparison. Although a universal mFG score cutoff would be useful for comparisons, ethnic variations, as well as skin type and other factors, should be considered when evaluating hirsutism in distinct populations. In turn, androgen levels, measured by conventional techniques, have been shown to correlate poorly with the severity of hirsutism. Indeed, while most women with PCOS and hirsutism also have higher than reference values for serum androgen levels, some of them may not present with biochemical hyperandrogenism, representing a challenge to the diagnosis of PCOS. In this article, we critically review this not uncommon condition in women with PCOS presenting with hirsutism but normal androgen levels.