Abstract
Polycystic ovary syndrome (PCOS) is an endocrine condition associated with reproductive and psychiatric disorders, and with obesity. Eating disorders, such as bulimia and recurrent dieting, are also linked to PCOS. They can lead to the epigenetic dysregulation of the hypothalamic–pituitary–gonadal (HPG) axis, thereby impacting on ovarian folliculogenesis. We postulate that PCOS is induced by psychological distress and episodes of overeating and/or dieting during puberty and adolescence, when body dissatisfaction and emotional distress are often present. We propose that upregulated activation of the central HPG axis during this period can be epigenetically altered by psychological stressors and by bulimia/recurrent dieting, which are common during adolescence and which can lead to PCOS. This hypothesis is based on events that occur during a largely neglected stage of female reproductive development. To date, most research into the origins of PCOS has focused on the prenatal induction of this disorder, particularly in utero androgenization and the role of anti-Müllerian hormone. Establishing causality in our peripubertal model requires prospective cohort studies from infancy. Mechanistic studies should consider the role of the gut microbiota in addition to the epigenetic regulation of (neuro) hormones. Finally, clinicians should consider the importance of underlying chronic psychological distress and eating disorders in PCOS.
Highlights
Polycystic ovary syndrome (PCOS) is the most common disorder in women during the reproductive period, accounting for around 80% of anovulatory subfertility [1]
PCOS, we propose a novel and complementary hypothesis that considers as an adverse of PCOS, we propose a novel and complementary hypothesis that considers PCOS as an adverse psychological condition which develops in women at the onset of puberty and throughout psychological condition which develops in women at the onset of puberty and throughout adolescence adolescence as a consequence of stress, mood problems and low self-esteem, together with metabolic as a consequence of stress, mood problems and low self-esteem, together with metabolic disturbances disturbances arising from eating disorders, which constitute a secondary confounder (Figure 1)
We postulate that exposure to a variety of psychological stressors during puberty and adolescence induces chronic psychiatric disorders which, in some individuals, result in repeated episodes of overeating and dieting, collectively contributing to the development of PCOS (Figure 2A)
Summary
Polycystic ovary syndrome (PCOS) is the most common disorder in women during the reproductive period, accounting for around 80% of anovulatory subfertility [1]. The diagnostic criteria for PCOS, during adolescence, are controversial polycystic ovarian morphology [8]. The diagnostic criteria for PCOS, during adolescence, because many features usedmany in adult women, as acne, irregular and polycystic ovary are controversial because features used such in adult women, such as menses acne, irregular menses and morphology can be normal physiological characteristics puberty [9]. In women with PCOS, the function of the gonadotropin-releasing hormone (GnRH) pulse generator is generator is perturbed, giving rise to luteinizing hormone (LH) overproduction and a relative follicleperturbed, giving rise to luteinizing hormone overproduction a relative follicle-stimulating stimulating hormone (FSH) shortage This over-secretion of LH further increases androgen production theca production by the theca cells surrounding the follicle.
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