Androgen Excess Society Research Articles

Diabetes screening among women with polycystic ovary syndrome: a descriptive study of commercial claims, 2011–2019

BackgroundPolycystic ovary syndrome (PCOS) is a hormonal disorder that affects 6–12% of United States women of reproductive age. Because women with PCOS are at an increased risk of developing type 2 diabetes, clinical practice guidelines from a number of organizations (e.g. American Diabetes Association, American College of Obstetricians and Gynecologists, US Preventive Services Task Force) recommend that individuals with PCOS are routinely screened for diabetes. Guidelines further indicate that an oral glucose tolerance test (OGTT) should be used for diabetes screening in women with PCOS as opposed to an A1C or fasting plasma glucose test. The purpose of this study is two-fold: 1) to estimate rates of diabetes screening among a nationwide sample of commercially insured women with PCOS and 2) to report the percentage of women screened using each test (OGTT, A1C, fasting plasma glucose) among those who were screened.MethodsWe used the MarketScan Commercial Claims database (2011–2019) to identify a sample of women aged 18–64 years with PCOS who were free from diabetes at baseline and had ≥ 5 years of continuous enrollment in their insurance plan. PCOS was ascertained using International Classification of Disease diagnosis codes (ICD-9: 256.4; ICD-10: E28.2). Diabetes screening was ascertained using Current Procedural Terminology (CPT) codes (A1C: 8303683037; Fasting blood sugar: 82947; OGTT: 82950). Diabetes screening rates were calculated for the overall study sample as well as across subgroups defined by age, overweight/obesity, hypertension, hypercholesterolemia, and vascular disease.ResultsIn our sample of 191,110 commercially insured women with PCOS, 73.40% were screened at least once for diabetes during a five-year period. Among the women screened, 19.24% were screened using the Androgen Excess Society (AES)-recommended OGTT, 61.58% were screened using A1C, and 23.37% were screened using fasting blood sugar.ConclusionsIn a sample of commercially insured individuals spanning the timeframe 2011–2019, nearly 75% of women with PCOS complied with the ACOG screening guidelines for diabetes. Although OGTT is recommended as the preferred screening tool for women with PCOS it was less commonly used than A1C and fasting blood sugar tests.

ASSESSMENT OF CARDIOVASCULAR RISK IN WOMEN WITH PCOS: A NARRATIVE REVIEW

Polycystic ovarian syndrome (PCOS) is one of the commonest endocrinopathy of women of reproductive age globally. This clinical condition not only dysregulates the reproductive axis, but also a risk factor for hyperinsulinemia, insulin resistance, dyslipidaemia, T2DM. All these metabolic states aggravate the cardiovascular risk in women with PCOS. The aim of this review is to provide an overview of evidences of subclinical cardiovascular risk in PCOS women and synthesize the result. To attain this aim, the published research articles were reviewed using the databases PubMed, Google scholar and EMBASE employing key words PCOS, cardiovascular risk, arterial stiffness, endothelial function to obtain relevant information. Total 162 articles were searched and after applying eligibility criteria, 12 articles have been included for qualitative synthesis of the information. Most of the studies are cross-sectional, case-control study conducted on pre-, peri and menopausal, obese, lean women with PCOS. The study participants were mostly diagnosed on the basis of Rotterdam criteria. But, other criteria such as National Institutes of Health criteria (NIH), Androgen Excess Society criteria (AES) were also used to diagnose the condition. Mostly these studies recorded arterial stiffness as assessed by pulse wave velocity (PWV), augmentation index (AIx) and endothelial dysfunction as assessed by brachial artery ow mediated vasodilatation (FMD). The ndings of few cardinal systematic review and metaanalysis were also reported. These studies mainly analysed the data obtained for subclinical cardiovascular status of women with PCOS as assessed by carotid intima media thickness (cIMT), carotid artery calcium (CAC) score and FMD. Majority of the studies concluded that women with PCOS display enhanced arterial stiffness and endothelial dysfunction in comparison to age and BMI-matched healthy control group, though controversy exists is the literature. In this regard, the existing traditional cardiovascular risk factors in PCOS women, make them more prone to cardiovascular disease. It needs further prospective study with hard cardiovascular outcome to prove this point undoubtedly. It must be emphasized that regular cardiovascular screening might be advocated for this vulnerable population to prevent any major cardiovascular eventuality.

Rotterdam, Androgen Excess Society ve National Institutes of Health Kriterlerine Göre Tanı Alan Polikistik Over Sendromlu Hastaların Biyokimyasal Değerleri ve İnsülin Direncinin Karşılaştırılması

Objective: There are different criteria to diagnose polycystic ovary syndrome (PCOS) such as Rotterdam Consensus, Androgen Excess Society (AES), and National Institutes of Health (NIH). We aimed to investigate the biochemical and insulin resistance-related markers of PCOS patients according to different diagnostic criteria.
 Material and methods: 1299 patients admitted to our clinic retrospectively analyzed. Following the inclusion and exclusion criteria, 200 patients with Rotterdam (Group 1), 182 patients with AES (Group 2), and 180 patients with NIH (Group 3) criteria were included in the study. Results: Waist/hip ratio among all groups (p1 = 0.002; p2 = 0.0001; p3 = 0.0001), LH/FSH ratio between Group 1 and 3 (p2=0.017), AST between Group 2 and 3 (p3 =0.012), DHEA-S and modified Ferriman–Gallwey score between Group 1 and 2 (p1 = 0.041; p1 = 0.013, respectively) and Group 1 and 3 (p2= 0.003; p2 = 0.04, respectively) were significantly different. A significant difference was detected between Group 1 and 3 in body mass index ≥ 25 (kg/m2) (p = 0.006). A significant difference was detected among all groups in waist circumference ≥ 88 cm (p1 = 0.0001, p2 = 0.0012, p3 = 0.004). 
 Conclusion: The rate of metabolic syndrome was found to be higher in patients diagnosed with Rotterdam criteria, the rate of insulin resistance with NIH criteria, and the rate of dyslipidemia with AES criteria. However, these differences were not statistically significant.

Effects of carnitine on glucose and lipid metabolic profiles and fertility outcomes in women with polycystic ovary syndrome: A systematic review and meta-analysis.

To quantify the effect of carnitine on glucose and lipid metabolic profiles and fertility outcomes in women with Polycystic ovary syndrome (PCOS). A systematic review and meta-analysis were conducted. Women with PCOS diagnosed by Rotterdam or Androgen Excess Society (AES) criteria and taking carnitine supplement were assessment. Fertility outcomes (ovulation, clinical pregnancy, live birth, and miscarriage), lipid parameters (BMI, triglyceride, total cholesterol, high-density lipoprotein, low-density lipoprotein), fasting glucose and insulin, and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). In total, 839 participants were included in this analysis. The dosage of carnitine and treatment duration reported by studies varied from 250 mg to 3000 mg daily and 84 to 90 days, respectively. The publication bias was absent. Compared with placebo, carnitine significantly improved ovulation rates (RR 3.42, 95% CI 2.39 to 4.89, I2 = 0%) and pregnancy rates (RR 11.05, 95% CI 1.21 to 100.58, I2 = 79%). None of included studies reported live birth. After treatment, carnitine resulted in significant reductions relative to baseline in body mass index (BMI, MD -0.93 kg/m2, 95% CI -1.15 to -0.70, I2 = 55.0%), insulin levels (MD -2.47 mIU/L, 95% CI -4.49 to -0.45, I2 = 0%) and the Homeostasis Model Assessment index (MD -0.67, 95% CI -1.20 to -0.14, I2 = 0%) than placebo, but not for lipid profiles including triglyceride, total cholesterol, and low-density lipoprotein. With the available literature, carnitine seems to improve ovulation and clinical pregnancy and insulin resistance, BMI in women with PCOS. These effects are warranted to be further validated, due to insufficient statistical power.

The diagnostic performance of antimullerian hormone for polycystic ovarian syndrome and polycystic ovarian morphology.

The diagnosis of polycystic ovary syndrome (PCOS) remains a challenge to clinicians due to heterogeneous clinical presentation and diagnostic criteria. This study investigated the utilization of Anti-Müllerian hormone (AMH) alone or replacing polycystic ovarian morphology (PCOM) in the PCOS diagnostic criteria. A total of 401 women were categorised as PCOS (n:154), nonPCOS with polycystic ovarian morphology (PCOM) (n:105), and nonPCOS with normal ovarian morphology (NOM) (n:142). First, the diagnostic performance of AMH for PCOS diagnosis in Rotterdam, Androgen Excess Society, and National Institutes of Health (NIH) criteria was analyzed. Second, AMH was used instead of PCOM in Rotterdam criteria and we searched diagnostic performance for PCOS phenotypes. AMH levels were positively correlated with LH, testosterone, hirsutism score, menstrual cycle length, and antral follicle count (p < 0.05). AMH alone had specificity and sensitivity for PCOS diagnosis were 84.9% and 72.4% in Rotterdam (AUC: 0.866); 84.4% and 72% in Androgen Excess Society (AUC: 0.857); 83.3% and 66.4% in National Institute of Health criteria (AUC: 0.825). AMH alone had satisfactory diagnostic potential for phenotype A, but not other phenotypes. The replacement of PCOM with AMH in Rotterdam criteria had a high diagnostic potential for PCOS (AUC: 0.934, sensitivity:97.4%, specificity: 90.67%). Phenotype A and phenotype D were diagnosed with 100% sensitivity and 94.5% specificity. Phenotype C was recognised with 96.15% sensitivity and 94.5% specificity. AMH may be used with high diagnostic accuracy instead of PCOM in the Rotterdam PCOS criteria.

Prevalence of Polycystic Ovarian Syndrome in India: A Systematic Review and Meta-Analysis.

Stein-Leventhal syndrome, often known as polycystic ovarian syndrome (PCOS), is a syndrome that affects women's reproductive health. PCOS is one of the most common endocrine and metabolic disorders in women of reproductive age. The etiology of PCOS remains unknown mainly, and the estimation of PCOS burden in a specific geographical location will impact disease control strategies. Hence, this study estimated the pooled prevalence of PCOS in Indian women. Databases such as PubMed, CINHAL, Scopus, and Google Scholar were thoroughly searched. Only those published Indian studies that reported the prevalence of PCOS from 2010 to 2021 and had at least one of the following diagnostic PCOS criteria were included in the systematic review: the National Institutes of Health (NIH), Rotterdam's criteria, or/and Androgen Excess Society (AES). MetaXL version 5.3 software was used for data analysis. The risk of bias was assessed using modified Joanna Briggs Institutecriteriafor cross-sectional studies. Out of 17132 articles, 11 articles were selected for systematic review and meta-analysis. The pooled prevalence of PCOS was 11.33(7.69-15.59) using the random effect. The proportion of Hirsute using the Ferriman-Gallwey score was highly variable, ranging from 1.6% to 37.9% (n=6). The prevalence rate of PCOS is high among Indian women. The pooled prevalence of PCOS was close to 10% using Rotterdam's criteria and AES criteria, while it was 5.8% using NIH criteria. The study's overall finding emphasizes the need for more acceptable and uniform diagnostic criteria for screening PCOS. At the same time, policy-makers should consider giving more importance to PCOS in their effort to control non-communicable diseases.

Effectuality of Aerobic Exercise in Alleviating Signs and Symptoms of PCOS Among Female Nursing Students at Selected Nursing College of Hubballi, Karnataka

Introduction: Polycystic ovarian syndrome (PCOS) is a common multifaceted disorder found among females of the reproductive age. The disease is on its rise because of lifestyle and environmental changes occurring with modernization. Prevalence of PCOS is highly variable ranging from 2.2% to 26% globally. In India the prevalence was reported 9.13% and 22.5% by Rotterdam’s criteria and androgen excess society criteria respectively. Aerobic Exercise increases energy expenditure and physical activity in PCOS have shown to have a good impact on improving the anthropometric measurements such as body mass index, waist circumference, and metabolic parameters such as total cholesterol, IR, and lipid profile thus reducing metabolic syndrome and other risk factors associated with PCOS such as type 2 diabetes mellitus, cardiovascular and infertility. Statement of Problem: “Effectuality of aerobic exercise in alleviating signs and symptoms of PCOS among female nursing students at selected nursing college of Hubballi.” Objectives: To assess the signs and symptoms of nursing students with PCOS in both the experimental and control group. To evaluate the effectiveness of aerobic exercise in alleviating signs and symptoms PCOS among nursing students with PCOS in experimental group. To compare the post-test scores regarding signs and symptoms of PCOS of nursing students in experimental and control group. To find out an association between pre-test scores of experimental group with their selected socio-demographical variables. To find out an association between pre-test scores of control group with their selected socio-demographical variables. Methodology: A study was conducted to evaluate the effectiveness aerobic exercise in alleviating signs and symptoms of PCOS among nursing students of selected Nursing College, Hubballi. The research design used for the study was Quasi-experimental; Pre-Test, Post- Test Control Group Design. The setting of the study was KLES’s Institute of Nursing Sciences, Vidyanagar, Hubballi and SVP MVP Institute of Nursing Sciences, Hubballi. Results: Revealed that in experimental group, majority of subjects 9(60%) had moderate PCOS symptoms, 6(40%) had severe menstrual symptoms in pre-test, where as in post test 9(60%) had mild PCOS symptoms and 6(40%) had moderate PCOS symptoms. In control group, majority of the subjects 10(66%) severe PCOS symptoms and 5(34%) had moderate PCOS symptoms in pre test, where as in post-test all of the subjects 15(100%) had moderate PCOS symptoms. In Experimental Group The calculated value of paired ‘t’ value (tcal= 13.62)* was greater than the tabulated value (ttab=2.14). Hence H1 was accepted. In Control Group. The calculated value of paired ‘t’ value (tcal= 9.81)* was greater than the tabulated value (t tab=2.14). Hence H2 was accepted. The calculated unpaired ‘t’ value for experimental and control group t cal value (8.00)* was greater than the ttab value (2.043). This indicates that the mean reduction in PCOS symptom scores of nursing students in the experimental group who have practiced aerobic exercises was higher than those in the control group Hence H3 was accepted. There was no statistical association between pre test PCOS symptom scores of the subjects in experimental group and their selected demographic variables Hence H4 was rejected. There was no statistical association between pre-test PCOS symptom scores of the subjects in control group and their selected demographic variables. Hence H5 was not accepted. Conclusion: Therefore, the study concluded that, the overall pre-test PCOS score was moderate to severe. The post-test scores of nursing students who performed aerobic exercise showed significant reduction in signs &amp; symptoms of PCOS. There was no significant association between the pre test hemoglobin level of subjects and their selected demographic variable. Keywords: PCOS, Aerobic exercise, nursing students, experimental group, control group.

Evaluation of Cardiovascular Disease Risk in Women having Poly Cystic Ovarian Syndrome

PCOS, also known as Stein-Leventhal syndrome, is a common endocrine disease characterized by two of the following three characteristics: Once the associated endocrinological and gynecological diseases have been ruled out, oligo-ovulation or anovulation, ii) clinical and/or biochemical indications of hyperandrogenism, or iii) polycystic ovaries should be considered. Cardiovascular disease (CVD) risk factors are common in women with polycystic ovarian syndrome (PCOS). The Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society established a panel to offer evidence-based evaluations of research examining the PCOS-CVD risk connection and to produce CVD prevention recommendations. The main pathophysiological abnormality in polycystic ovarian syndrome is a source of much debate (PCOS). Chronic anovulation in conjunction with androgen excess, hyperinsulinemia, and changes in gonadotropin production are now widely accepted as symptoms of this disease in women. Polycystic ovarian syndrome (PCOS) is linked to obesity and low-grade inflammation, and it may raise the risk of cardiovascular disease (CVD). This study examines the assessment of cardiovascular disease risk in women with PCOS.

Use of community-based reference ranges to estimate the prevalence of polycystic ovary syndrome by the recognised diagnostic criteria, a cross-sectional study.

Does the application of reference ranges for sex steroids and the modified Ferriman-Gallwey (mFG) scale established in the community from which the study sample was drawn, combined with the most conservative polycystic ovary morphology (PCOM) criteria to the recognised diagnostic criteria for polycystic ovary syndrome (PCOS) improve the certainty of diagnosis of PCOS in non-healthcare-seeking women? Despite application of the stringent definitions of the elements used to diagnose PCOS in a non-healthcare seeking community-based sample, the risk of diagnostic uncertainty remains. There is heterogeneity in prevalence estimates for PCOS due, in part, to lack of standardisation of the elements comprising the recognised National Institutes of Health (NIH), Rotterdam and Androgen Excess Society (AE-PCOS) diagnostic criteria. The AE-PCOS Society proposed refinements to the definitions of biochemical androgen excess and PCOM that can now be incorporated into these sets of diagnostic criteria to estimate PCOS prevalence. An Australian cross-sectional study of 168 non-healthcare-seeking women. The 168 included women were aged 18-39 years, euthyroid and normoprolactinemic, not recently pregnant, breast feeding or using systemic hormones. Each provided menstrual history and assessment of the mFG, had measurement of sex steroids by liquid chromatography, tandem mass spectrometry, and a pelvic ultrasound. The presence of PCOS was determined using modified (m) NIH, Rotterdam, and AE-PCOS criteria according to AE-PCOS Society recommendations. Overall, 10.1% of the included participants met the mNIH PCOS criteria, which requires the presence of menstrual dysfunction, while 18.5% met the mRotterdam and 17.5% the AE-PCOS criteria, with the latter requiring hyperandrogenism. Eight of the 27 participants with menstrual dysfunction, 10 of 31 women with PCOM, and 39 of 68 women with hyperandrogenism had no other feature of PCOS. Of the 19 participants with hyperandrogenaemia, 10 met the mNIH criteria (52.5%) and 14 met both the mRotterdam and AE-PCOS criteria (78.9%). Women who had the combination of hyperandrogenism and PCOM explained the greatest discrepancy between the mNIH and the other criteria. Clinical androgenisation relied on participant self-assessment, which has been shown to be valid when compared with clinician assessment. The sample size was a function of both the strict inclusion criteria and the requirements of non-healthcare-seeking women having a blood draw and pelvic ultrasound which may have introduced a selection bias. Despite applying stringent cut-offs for serum androgens, the mFG scale and the ovarian follicle count, these criteria remain arbitrary. Accordingly, healthy women may be captured by these criteria, and misidentified as having PCOS, while women with the condition may be missed. Consequently, PCOS remains a diagnosis to be made with care. The study was supported by the Grollo-Ruzzene Foundation. Dr S.R.D. is an NHMRC Senior Principal Research Fellow (Grant no. 1135843). S.R.D. has been paid for developing and delivering educational presentations for Besins Healthcare, BioFemme and Pfizer Australia, has been on Advisory Boards for Theramex, Abbott Laboratories, Mayne Pharmaceuticals and Roche and a consultant to Lawley Pharmaceuticals and Que Oncology and has received has received institutional grant funding for Que Oncology research; there are no other relationships or activities that could appear to have influenced the submitted work. N/A.

Polycystic ovarian syndrome: need for life course approach

Polycystic ovarian syndrome (PCOS) is one of the leading but treatable causes of infertility among women. PCOS is a heterogeneous condition therefore it involves multiple disciplines and there is a wide research and clinical agenda. The prevalence of PCOS in India among 15-24 year old adolescents and young girls was found by Rotterdam criteria to be 22.5% and by Androgen Excess Society criteria to be 10.7%. Earlier it was considered only as a reproductive disorder but now it includes metabolic and psychological features as well. Under diagnosis of PCOS remains to be problematic. This is a complex syndrome and has an influence throughout the lifespan and requires multidisciplinary treatment approach as well as self-management. The life course approach or life course theory or the life course perspective was explored in 1960’s. In this approach individual's lives are analyzed within structural, social, and cultural contexts.

Triglycerides and TG/HDL-C ratio as surrogate markers for insulin resistance in Nigerian women with polycystic ovary syndrome

Background: Dyslipidemia is one of the most perplexing metabolic consequences in polycystic ovary syndrome (PCOS). Obesity, insulin resistance (IR), and hyperandrogenism, the pervasive features of PCOS, play significant pathophysiological roles in the lipidemic aberrations associated with the syndrome. Objective: This study aimed to assess the diagnostic utility of triglyceride (TG) and triglyceride to high-density lipoprotein-cholesterol (TG/HDL-C) ratio as surrogate markers for identifying IR in infertile Nigerian women with PCOS. Materials and Methods: Eighty-seven infertile women with PCOS were selected according to the Androgen Excess Society criteria and categorized into two groups. After anthropometric measurements, fasting blood samples were assayed for plasma glucose, serum insulin, total cholesterol, TG, HDL-C while lipoprotein ratios were calculated. Homeostasis model assessment for IR (HOMA-IR) was used in defining IR. The areas under the receiver operating characteristic (ROC) curve analysis were used to compare the power of the serum markers, and to obtain the optimal cutoffs of TG and TG/HDL-C with HOMA-IR. Results: TGs correlated significantly with HOMA-IR in the obese PCOS women. However, the areas under the ROC of potential markers showed no significant marker for HOMA-IR. The highest area under the curve of ROC for TG belongs to the obese group with a sensitivity of 56% and specificity of 53% (TG ≥ 92.5mg/dL) as a marker of IR in obese PCOS women. Conclusion: TG and TG/HDL-C would not be reliable markers of IR, and a concerted approach in finding surrogate markers will benefit future investigations.

A comparison of the effects of oral contraceptives on the clinical and biochemical manifestations of polycystic ovary syndrome: a crossover randomized controlled trial.

Do oral contraceptives (OCs) containing progestins with low androgenic or antiandrogenic activities have different effects to those containing levonorgestrel (LNG) on clinical, androgenic and metabolic manifestations of polycystic ovarian syndrome (PCOS)? The three OCs tested had similar effects on clinical findings of hyperandrogenism (HA), whereas products containing LNG were less effective on androgenic profiles and had detrimental effects on lipid profiles. Despite data available on the effects of OCs, the superiority of products with low androgenic or antiandrogenic progesterone components in comparison with older products used in women with PCOS has not been clarified. This study is a crossover randomized controlled six-arm trial, with all six arms including two 6-month treatment periods, one period with OCs containing LNG, and the other with one of three OCs containing desogestrel (DSG), cyproterone acetate (CPA) or drospirenone (DRSP). The trial was conducted between February 2016 and January 2018 and enrolled 200 patients with PCOS. Two hundred women with PCOS (ages 18-45years) were recruited at the endocrine outpatient clinic of the Research Institute for Endocrine Sciences (RIES) of the Shahid Beheshti University of Medical Sciences, Tehran, Iran. A blocking or stratification random allocation (block size = 6) using a computer-based random number generator was prepared to assign participants to treatment groups. Both the clinical examiner and data analyst were blinded to participants during the trial. Outcomes of interest, including anthropometric and clinical manifestations and hormonal, and biochemical parameters were assessed at baseline, after 3 and 6months of each treatment and after the washout period. This study detected a higher decrease in free-androgen index (FAI) levels after 3months of treatment with OCs containing DSG (95% CI: -2.3, -1.0), CPA (95% CI: -2.4, -1.1) and DRSP (95% CI: -2.6, -1.4), compared with products containing LNG (P< 0.001). Use of OCs containing DSG (95% CI: -3.6, -1.5), CPA (95% CI: -3.1, -0.8) and DRSP (95% CI: -3.4, -1.1) for 6months was associated with more decrease in FAI, compared with products containing LNG (P< 0.001). The study showed that use of OCs containing DSG, CPA and DRSP for 3-6months was associated with a higher increase of sex hormone-binding globulin (SHBG), compared with products containing LNG (P< 0.001). We also observed more decrease in dehydroepiandrosterone sulfate levels after use of OCs containing DSG (P= 0.003), CPA (P= 0.012) and DRSP (P< 0.001) for 6months, compared with products containing LNG. Our results showed that the use of OCs containing DRSP for 6months was associated with more improvement in acne, compared with products containing LNG (P= 0.007). Women treated with OCs containing CPA, and DRSP for 3months had higher TG and HDL levels and lower LDL levels, compared with those treated with products containing LNG (P< 0.05). After 6months of treatment, patients treated with OCs containing DRSP had a sharper decline in LDL levels and more increase in HDL levels, compared to those treated with products containing LNG (P= 0.001). Considering this trial was conducted in women diagnosed with Androgen Excess Society criteria, the results may not be generalizable for mild phenotypes diagnosed using Rotterdam criteria. Other limitations of the study include the high dropout rate, the lack of a gold standard androgen assay and the multiple end points. Our results support the views of clinicians, who suggest an OC with a low androgenic or antiandrogenic progestin, if available, to treat PCOS. This study was supported by the RIES, Shahid Beheshti University of Medical Sciences, Tehran, Iran. There are no conflicts of interest. IRCT201702071281N2. 21 February 2017. 21 March 2017.

Negative impact of polycystic ovary syndrome on bone health: a systematic review and meta-analysis.

Polycystic ovary syndrome (PCOS) has reproductive and metabolic aspects that may affect bone health. Controversial results from different studies regarding the risk of fractures, bone mineral density (BMD) or bone markers led to uncertainty whether PCOS might improve or deteriorate bone health. This study aimed to investigate the impact of PCOS on bone markers, BMD and fracture risk. A systematic review and a meta-analysis were carried out. PubMed, EMBASE and Cochrane databases were searched for eligible studies from 1st of January of 1990 to 9th of October of 2018. Eligible studies enrolled women older than 18years with PCOS, which should be diagnosed according to the Rotterdam Consensus, the Androgen Excess Society, the National Institutes of Health Consensus or the International Classification of Diseases. The studies were grouped according to patient mean BMI: <27kg/m2 or ≥27kg/m2. The results were polled as mean difference (MD), standardized MD (SMD) and hazard ratio (HR). Overall, 921 studies were retrieved, and 31 duplicated studies were removed. After screening the titles and abstracts, 80 studies were eligible for full text reading. Of those, 23 studies remained for qualitative synthesis. With the exception of one study, all studies were considered high quality based on the Newcastle-Ottawa scale (NOS; score ≥6). Meta-analysis was performed in 21 studies, with a total of 31 383 women with PCOS and 102 797 controls. Women with PCOS with BMI <27kg/m2 had lower BMD of the total femur (MD, -0.04; 95% CI, -0.07 to 0.00; I2= 31%; P= 0.22) and spine (MD, -0.07; 95% CI, -0.13 to -0.01; I2= 70%; P< 0.01) when compared with the control group, whereas for women with BMI ≥27kg/m2 no difference was observed (femur: MD, 0.02; 95% CI, -0.02 to 0.05; I2= 20%, P= 0.29; spine: MD, 0.02; 95% CI, -0.06 to 0.05; I2= 0%; P= 0.84). Osteocalcin was remarkably reduced in women with PCOS with BMI <27kg/m2 (SMD, -2.68; 95% CI, -4.70 to -0.67; I2= 98%; P< 0.01), but in women with BMI ≥27kg/m2, there were no differences between PCOS and controls. Few studies (n= 3) addressed the incidence of bone fractures in women with PCOS. The HR for total bone fractures did not identify differences between women with PCOS and controls. On the basis of the available evidence, it is possible to assume that PCOS in women with BMI <27kg/m2 is associated with reduced BMD in the spine and femur, and decreased bone formation, as manifested by lower levels of circulating osteocalcin. These findings suggest that bone parameters in PCOS may be linked, to some extent, to adiposity. These studies included premenopausal women, who have already achieved peak bone mass. Hence, further prospective studies are necessary to clarify the existence of increased risk of fractures in women with PCOS.

Challenges in the Assessment and Diagnosis of Polycystic Ovary Syndrome.

Polycystic ovary syndrome (PCOS)7 is a complex endocrine-mediated disorder in women with a prevalence of 8% to 13%. Women with PCOS typically present with heterogeneous clinical signs and symptoms such as excess hair growth, irregular menstrual cycles, infertility, and metabolic issues. PCOS is associated with cardiometabolic risk factors such as type 2 diabetes, and it may increase risks for other comorbidities like endometrial cancer and nonalcoholic fatty liver disease. PCOS is also associated with anxiety, depression, and other psychosocial manifestations. To date, there are no universal criteria for PCOS diagnosis. As a result, women with the disorder often report significant delays (>2 years) in diagnosis and poor follow-up care. Three sets of diagnostic criteria currently exist to define PCOS: ( a ) NIH, ( b ) Rotterdam, and ( c ) Androgen Excess Society criteria. Recently the International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2018 endorsed the use of the Rotterdam criteria in adult women. To diagnose PCOS using the Rotterdam criteria, women must meet at least 2 of the following: ovulatory abnormalities, hyperandrogenism (clinical, biochemical, or both), or polycystic ovary morphology (PCOM). The clinician must also exclude several disorders with similar manifestations before a diagnosis can be finalized. In this article, 5 experts discuss the challenges surrounding the current diagnostic criteria, available biomarkers, and the timely diagnosis and treatment of women with PCOS. Who should be screened or tested for PCOS and, despite the high prevalence, why is PCOS often overlooked? Chris McCartney: PCOS should be considered in reproductive-aged women with clinical hyperandrogenism (e.g., hirsutism, acne, male-pattern hair loss), abnormal menstrual bleeding (oligo/amenorrhea, irregular bleeding patterns), or subfertility. Early recognition of PCOS is important for several reasons. For example, accurate attribution of patient symptoms and initiation of appropriate treatments are expected to improve patient well-being. PCOS is also associated …

Metabolic Syndrome in Adolescents with Polycystic Ovary Syndrome: Prevalence on the Basis of Different Diagnostic Criteria.

Existing literature on the prevalence of metabolic syndrome (MBS) in adolescents with polycystic ovary syndrome (PCOS) is inconsistent, likely because of the application of differing diagnostic criteria. The objective was to assess the prevalence of MBS in adolescents with PCOS depending on the PCOS diagnostic criteria used. A retrospective chart review of female patients (N=37), ages 11-22years, diagnosed with PCOS between January 2013 and December 2017. Patients were included only if they had received screening allowing comparison across all PCOS diagnostic criteria: National Institutes of Health, Rotterdam, Androgen Excess Society, Amsterdam, Endocrine Society, and the Pediatric Endocrine Society (PES). The presence of MBS was established using the International Diabetes Federation criteria. The proportion of patients having MBS was then calculated for each PCOS diagnostic criteria subgroup. For the entire study cohort, MBS was present in 17/37 patients (45.9%). The highest prevalence of MBS was among the subgroup of patients meeting the PES PCOS diagnostic criteria (13/25; 52.0%), whereas the lowest prevalence was in the subgroup meeting the Amsterdam PCOS criteria (6/15; 40.0%). Those diagnosed using the PES criteria also had the highest percentage of patients with 3 or more risk factors for MBS. The prevalence of MBS varied according to the specific PCOS diagnostic criteria and was highest when PES guidelines were used. The PES criteria are adolescent-specific and have thus refined the diagnosis of PCOS for this population. Our results highlight the importance of validated adolescent-specific PCOS diagnostic criteria.

251. The Prevalence of Metabolic Syndrome In Adolescents With Polycystic Ovary Syndrome Under Different Diagnostic Criteria

There is ample evidence that increased risk of metabolic dysfunction is present in women with polycystic ovary syndrome (PCOS). Existing literature on the prevalence of metabolic syndrome (MBS) in the adolescent population with PCOS is inconsistent. A recently conducted meta-analysis found that the prevalence of MBS ranged from 4.9% to 43.6% in adolescent girls with PCOS. The discrepancy in the prevalence of MBS in adolescents is likely due to application of differing diagnostic criteria for both PCOS and MBS. The impact of the specific PCOS diagnostic criteria used on the prevalence of MBS in adolescents has not yet been evaluated. As such, the objective of the current study was to assess the prevalence of MBS in adolescents with PCOS under different diagnostic criteria. A retrospective chart review was conducted on female patients (N=37), ages 11-22 years, with PCOS who were seen at Nationwide Children’s Hospital between January 2013 and December 2017. Patients were included in the study only if they had received screening that would allow comparison across all PCOS diagnostic criteria including the National Institute of Health (NIH), Rotterdam, Androgen Excess Society (AES), Amsterdam, Endocrine Society (ES) and the Pediatric Endocrine Society (PES). The presence of MBS was established using the International Diabetes Federation criteria. Patients were categorized according to the 6 different PCOS diagnostic criteria and then the presence of MBS and risk factors were evaluated. Mean age of the study population was 15.4 ±1.66 years (range: 11.5-20.4). All patients met the diagnosis of PCOS utilizing the Rotterdam criteria; whereas only 15/37 (40.5%) met the diagnosis using the Amsterdam criteria. The prevalence of a PCOS diagnosis among the other diagnostic guidelines was 30/37 (81.1%) NIH, 32/37 (86.5%) AES, 29/37 (78.4%) ES, and 25/37 (67.6%) with the PES criteria. For the entire study cohort, MBS was present in 17/37 (45.9%) patients. Arterial hypertension was evident in 10/37 (27.0%), and no patients were on antihypertensive medication. Low HDL was observed in 28/37 (75.7%), high triglyceride in 12/37 (32.4%) and no patients were on lipid lowering medication. Elevated blood glucose was found in 9/37 (24.3%), and no patients had Type 2 diabetes mellitus. The highest prevalence of MBS was found among the subgroup of patients meeting the PES diagnostic criteria (13/25, 52.0%), while the lowest prevalence of MBS was in the subgroup meeting the Amsterdam criteria (6/15, 40.0%). Those diagnosed using the PES criteria also had the highest percentage of patients with 3 or more risk factors for MBS. This study of adolescents evaluated for PCOS found that the prevalence of MBS varied according to the specific PCOS diagnostic criteria used and ranged from 40 % to 52 % in the same patient population. Prevalence of MBS was highest when PES guidelines were used. The PES criteria are adolescent-specific, and thus have refined the definition of clinical hyperandrogenism and ovulatory dysfunction for this population. These results highlight the importance of validated adolescent specific PCOS diagnostic criteria.

Visceral Adiposity Index: Simple Tool for Assessing Cardiometabolic Risk in Women with Polycystic Ovary Syndrome.

Aim:To study visceral adiposity index (VAI) and its association with cardiometabolic risk in different phenotypes of polycystic ovary syndrome (PCOS).Materials and Methods:It is a case–control cross-sectional study where 100 reproductive age (18–35 years) women with PCOS were classified in different phenotypes as per Rotterdam criteria and compared with age and Body mass index (BMI) matched 50 eumenorrheic and nonhirsute women. Various anthropometric, clinical, biochemical, and hormonal parameters were measured in both women with PCOS and controls. VAI was calculated using waist circumference (WC), BMI, serum triglyceride, and High density lipoprotein (HDL) cholesterol levels in all the subjects and compared between cases and controls. Subsequently, women with PCOS were assessed for cardiometabolic risk according to androgen excess society statement 2010 as “at risk” and “at high risk.” Finally, risk was correlated with VAI for all the phenotypes of PCOS.Results:Mean VAI was significantly higher (P < 0.001) in cases than controls (2.07 vs. 1.27). Mean VAI in phenotype A (O+P+HA), B (O+HA), C (P+HA), and D (O+P) was 2.46, 2.48, 1.47, and 1.70, respectively. A total of 56% of women with PCOS were at risk and 12% at high risk for cardiometabolic disease. Metabolic syndrome was prevalent in 11% of cases and 1% had type 2 diabetes mellitus. Phenotypically, 88% of women with PCOS with phenotype A (O+P+HA), 67% of B (O+HA), 67% of C (P+HA), and 55% of D (O+P) were at increased risk. VAI was found to be positively correlated with WC (r, 0.550), waist to hip ratio (r, 0.295), Homeostasis model assessment of insulin resistance (HOMA IR) (r, 0.455), and cardiometabolic risk (r, 0.399). Also, it was the best factor associated with cardiometabolic risk (area under curve, 0.793).Conclusion:This study concluded that visceral adiposity index can be used as simple and effective tool for assessing the cardiometabolic risk in women with PCOS as higher VAI values were observed in those cases who were at high risk for developing cardiometabolic disorder in future.

Understanding variation in prevalence estimates of polycystic ovary syndrome: a systematic review and meta-analysis.

Polycystic ovary syndrome (PCOS) prevalence estimates vary when different diagnostic criteria are applied. Lack of standardization of individual elements within these criteria may contribute to prevalence differences. A systematic review of studies reporting prevalence of PCOS, using at least one of the National Institutes of Health (NIH), Rotterdam or Androgen Excess Society (AE-PCOS) criteria, was conducted. The aim was to investigate the impact on prevalence reporting of different definitions of the clinical elements for PCOS diagnosis. A systematic search of Ovid MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Emcare and BIOSIS was conducted. The search was limited to English language and studies published between January 1990 and January 2018. Included articles needed to define PCOS by at least one of the NIH, Rotterdam or AE-PCOS criteria, be of an unselected population and be published as a full text article. Risk-of-bias was assessed. A total of 21 studies met the inclusion criteria. The random-effects pooled prevalence of PCOS in studies that used the NIH criteria (7% [95% CI: 6-7%]), was significantly different from that identified in studies that used the Rotterdam criteria (12% [95% CI: 10-15%], P < 0.0001) but not studies that used the AE-PCOS criteria (10% [95% CI: 6-13%], P = 0.075). The pooled estimates for Rotterdam and AE-PCOS were not significantly different from each other (P = 0.201). Pooled prevalence estimates were compared between studies separated on the basis of: oligo-amenorrhoea vs oligo-amenorrhoea plus short cycles, clinical androgen excess requiring hirsutism vs any clinical androgen excess, use of different versions and cut-offs for the Ferriman-Gallwey (F-G) score, and inclusion vs non-inclusion of oral contraceptive users. There were no statistically significant differences for any of these comparisons. There was insufficient information to allow subgroup analyses of definitions of polycystic ovaries. Inclusion of ovarian morphology results in statistically significantly higher pooled prevalence estimates for PCOS. Heterogeneity in prevalence estimates for PCOS reflect the broad clinical spectrum of the condition, lack of standardization of the elements within each set of diagnostic criteria and the use of a range of diagnostic cut-offs, as well as potential differences between study populations. The use of different definitions for anovulation and clinical androgen excess did not appear to contribute to differences in the estimated prevalence of PCOS in this study. However, as the number of studies in most of the comparison groups was small, real differences may have been missed. Uncertainty surrounding the diagnosis of PCOS urgently needs to be addressed in order to provide clinicians and their patients with greater diagnostic certainty, and hence reduce inappropriate labelling and the potential psychological harm that may accompany misdiagnosis.

The connection between food toxicology and lifestyle disorders - A literature review

Around 39% of the adult world population is overweight and 13 % are obese (WHO). One of the major reasons for this (As per Harvard Researchers) is certain food toxins responsible for increasing “craveability” of junk food. Another study suggests the presence of certain chemical obesogens which disrupt the leptin and ghrelin (appetite hormones) also affect the size of adipocytes. Prevalence of polycystic ovarian syndrome is claimed to be varying between 6-10% in various studies including the major ones from National institute of Health (NIN), Rotterdam and Androgen excess society. Thyroid on the other hand is affecting 10% of the population (as per a study conducted in 8 major cities of India) The sedentary lifestyle, convenience foods & improper cooking practices though are to be blamed for the increasing prevalence of all lifestyle disorders but at the same time the increasing exposure to environmental toxins including microbiological, natural food toxins, polymer leaching and its residues including phthalates and bisphenols and the biological magnification of the pesticides across the food chain are all the more responsible for the hormonal imbalances caused by the chemicals mimicking the hormones in the natural biochemical processes hence causing the lifestyle disorders. The purpose of this presentation is to compile and highlight the most common toxins affecting the nutritional status of the masses, their common sources and mode of action. The presentation also puts light on the solution-based approach (including the importance of an Anti- inflammatory diet) and steps which can be taken to rectify the fundamentals which are going wrong.

Prevalence of Polycystic Ovary Syndrome in Nigerian Women with Infertility: A Prospective Study of the Three Assessment Criteria

Background: Polycystic ovarian syndrome (PCOS) is a frequent diagnosis in oligomenorrheic and infertile Nigerian women. However, to date there is a paucity of data on the prevalence of PCOS in Nigerian women. The objective of this study was to investigate the prevalence of PCOS in a cross-section of women attending Infertility Clinics in Benin City, Nigeria using the three assessment criteria namely: the 1990 National Institutes of Health (NIH), the 2003 Rotterdam and 2006 Androgen Excess Society (AES) criteria. Method: Four hundred and twenty-one consecutive infertile premenopausal women aged 18 - 45 years were recruited and evaluated with a proforma that elicited information about their maternal and reproductive health history. Blood samples were analyzed for hormone levels using standard immunoassay procedures, while trans-vaginal ultrasound scan was carried out to determine the presence of ultrasonic features of PCOS. The control group comprised of eumenorrheics (n = 180). Results: An estimated prevalence of biochemical hyperandrogenism (BHA) was as high as 20.9% (88 women), while 3.6% (15 women) presented with clinical hyperandrogenism (CHA). Also the prevalence of polycystic ovaries (PCO) was 13.8%. The prevalence of PCOS based on NIH, Rotterdam and AES criteria was 16.9% (71 women), 27.6% (116 women) and 20.7% (87 women) respectively. However, women with PCOS were significantly younger and had higher total testosterone levels (p = 0.001) when compared to controls. Conclusion: The prevalence of PCOS is as high in the population under study as in other prevalence studies. The hormonal investigations were clinically useful in assessing the prevalence rates. However, the recruitment criteria, together with the regional and racial factors may have contributed to the estimates obtained, and the high incidence of biochemical hyperandrogenism in this region.