Diagnostic Criteria For Polycystic Ovary Syndrome Research Articles

Japan Society of Obstetrics and Gynecology revised diagnostic criteria for polycystic ovary syndrome: JSOG2024 criteria.

Japanese patients with polycystic ovary syndrome (PCOS) exhibit distinct body type characteristics, such that the rate of overweight/obese women is remarkably low. In addition, hyperandrogenism is relatively rare among Japanese PCOS patients. Therefore, these factors are considered in PCOS diagnostic criteria used in Japan. Diagnostic criteria for PCOS were recently revised by the Japan Society of Obstetrics and Gynecology based on a nationwide survey of PCOS and released on December 5, 2023 (JSOG2024). JSOG2024 criteria diagnosed PCOS according to the following three items: (1) irregular menstrual cycle/chronic anovulation, (2) polycystic ovarian morphology or elevated serum anti-Müllerian hormone (AMH) level, and (3) hyperandrogenism or high luteinizing hormone. The presence of all three items is required to diagnose PCOS, after excluding other diseases with symptoms similar to PCOS. We also established AMH cut-off values by age and a system for evaluating ovarian findings useful for both the JSOG2024 and Rotterdam criteria. We anticipate that the JSOG2024 criteria with cut-off values will enhance the treatment of Japanese patients with PCOS and those of other ethnicities with low obesity and hirsutism.

The Potential for Ketogenic Diets to Control Glucotoxicity, Hyperinsulinemia, and Insulin Resistance to Improve Fertility in Women with Polycystic Ovary Syndrome

Objective: This review aims to summarize the association between insulin resistance (IR) and symptoms of Polycystic Ovary Syndrome (PCOS) while explaining how nutritional interventions, specifically ketogenic diets, help manage PCOS. Mechanism: The effect of IR on diagnostic criteria for PCOS is first described, followed by how a standard diet exacerbates IR. Afterward, nutritional interventions, specifically for women with PCOS, are described. Findings in Brief: IR is associated with ovulatory dysfunction, hyperandrogenism, and polycystic ovarian morphology, which leads to metabolic abnormalities and loss of fertility. Activation of the polyol pathway, advanced glycation end-product accumulation, and hexosamine flux by hyperglycemia and IR are involved in the PCOS phenotypes and reproduction alterations. IR affects oocytes, ovaries, and the endometrium among women with PCOS, leading to infertility. However, nutritional interventions, specifically ketogenic diets, were shown to lower serum cholesterol, triglycerides, androstenedione, testosterone and attenuate IR. At the same time, high-density lipoprotein increased, promoting menstrual regularity and, eventually, providing a better environment for in vitro fertilization. Conclusion: For women with PCOS, managing IR is essential for managing their symptoms and improving fertility. Resolving glucotoxicity caused by excessive dietary glucose with a ketogenic diet is crucial for the prevention and correction of the damage associated with hyperinsulinemia and hyperglycemia, contributing to fertility.

Syndrome of hyperandrogenism in adolescent girls

The diagnosis of hyperandrogenism may be based on clinical manifestations or on determining the blood level of androgens. Causes of hyperandrogenism in the peripubertal period are polycystic ovary syndrome (PCOS), non-classical forms of congenital adrenal hyperplasia (NCCAH), androgen-producing tumors, obesity, idiopathic hirsutism, and other rare causes. Physiological hyperandrogenism of peripubertal period passes within 2 years. PCOS affects from 4 to 21% of women of reproductive age and from 6 to 18% of adolescent girls. To date, there is no consensus on the diagnostic criteria for PCOS in teenage girls. At least, three symptoms are necessary: menstrual disorders, clinical and biochemical hyperandrogenism and polycystic ovaries. Diagnosis of NCCAH includes measurement of the level of 17-hydroxyprogesterone and a test with adrenocorticotropic hormone. The purpose of the treatment of these diseases is to reduce the manifestations of hyperandrogenism, regulate the menstrual cycle and improve the quality of life. Effective methods of pharmacotherapy are combined oral contraceptives and antiandrogens. An important stage is lifestyle changes in PCOS and obesity patients.

Polycystic ovary syndrome in obstructive sleep apnea-hypopnea syndrome: an updated meta-analysis.

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is correlated with metabolic deterioration in patients experiencing polycystic ovary syndrome (PCOS). Women diagnosed with PCOS exhibit a heightened prevalence of OSAHS. This meta-analysis aims to assess the morbidity of OSAHS in women affected by PCOS and to examine the differences in metabolism-related indicators between OSAHS-positive and OSAHS-negative in women with PCOS. A comprehensive literature analysis of OSAHS morbidity in women with PCOS was conducted, utilizing databases such as CNKI, EMBASE, PubMed, Web of Science, and Wanfang. A comparison was carried out between patients with OSAHS-positive and those with OSAHS-negative in terms of their clinical characteristics and metabolic differences. The search language included English and Chinese. The acquired data were analyzed by employing RevMan 5.2 and Stata 11.0. Continuous variables with the same units were combined and analyzed through weighted mean differences (WMDs) as effect sizes, while continuous variables with different units were combined and analyzed through standardized mean differences (SMDs) as effect sizes. A conjoint analysis was performed on the basis of I2 value, using either a fixed effect model (I2 ≤ 50%) or a random effect model (I2 > 50%). A total of 21 articles met the inclusion criteria for this study. The findings indicated that 20.8% of women with PCOS were found to have comorbid OSAHS. The subjects were categorized into various subgroups for meta-analysis on the basis of race, age, disease severity, body mass index (BMI), and diagnostic criteria of PCOS. The results revealed high morbidity of OSAHS in all subgroups. In addition, most metabolic indicators and parameters of metabolic syndrome were notably worse in women suffering from both PCOS and OSAHS in comparison to their counterparts solely diagnosed with PCOS. The current literature indicates higher morbidity of OSAHS among women with PCOS, linking OSAHS with worse metabolic status and obesity in this population. Consequently, clinicians are advised to prioritize the detection and management of OSAHS in women with PCOS. https://www.crd.york.ac.uk/PROSPERO/#myprospero PROSPERO, identifier (CRD42024528264).

Association between anti-Müllerian hormone levels and polycystic ovary syndrome in a general cohort of young women in Japan.

Polycystic ovary syndrome (PCOS) significantly affects women. This study investigated the association between serum anti-Müllerian hormone (AMH) levels and menstrual cycle disorders, and AMH for PCOS in a general cohort of young Japanese women. We measured serum AMH levels in 528 healthy female students at two universities in Japan between 2014 and 2020. We investigated the association between serum AMH levels and hormone levels, menstrual cycle, and body mass index. The mean (±standard deviation) AMH level was 4.78 ± 2.88 ng/mL. Correlations were observed between serum AMH and luteinizing hormone (LH) or LH/follicle-stimulating hormone (FSH) levels in women with irregular menstruation (LH: r = 0.542, p < 0.001; LH/FSH: r = 0.584, p < 0.001). The optimal serum AMH cutoff value that predicted LH ≥7.1 IU/L and LH/FSH ≥1.21 (PCOS diagnostic criteria revised by Japan Society of Obstetrics and Gynecology) in women with menstrual irregularities was 5.30 ng/mL (area under the curve: 0.815, sensitivity: 84.2%, specificity: 70.3%). Serum AMH can be measured during annual health checkups and may be a useful biomarker for early and arcuate diagnosis and intervention in women with PCOS.

Practical considerations for diagnosis and treatment of polycystic ovary syndrome in adolescence - distilling guidelines into clinical practice.

The diagnostic criteria for polycystic ovary syndrome (PCOS) in adults may overdiagnose PCOS in adolescents. Since 2015, three guidelines have developed adolescent-specific diagnostic criteria and treatment recommendations. In this review, we compare and contrast the recommendations to assist in the practical application to clinical practice. The guidelines agree that hyperandrogenism with menstrual irregularity be diagnostic criteria for PCOS in adolescents yet have slight differences in how to diagnose hyperandrogenism and in the definition of menstrual irregularity. The diagnostic option of 'at risk for PCOS' is recommended for those girls presenting with criteria within 3 years of menarche or with hyperandrogenism without menstrual irregularity, with re-assessment later in adolescence. Lifestyle changes is first line treatment. Treatment with combined oral contraceptives or metformin is suggested, using patient characteristics and preferences to guide decision-making. PCOS is associated with long term reproductive and metabolic complications and will present during adolescence. Yet, diagnostic features may overlap with normal adolescent physiology. The recent guidelines strove to develop criteria to accurately identify girls with PCOS allowing early surveillance and treatment yet avoid overdiagnosis of normal adolescents.

The Clinical Manifestations of Polycystic Ovary Syndrome (PCOS) and The Treatment Options

Polycystic Ovary Syndrome is one of the most common endocrine disorders in females. It is important to diagnose early using the correct diagnostic criteria to ensure proper management and to reduce the long-term effects.To aggregate data on females diagnosed with PCOS and study the prevalence, symptoms, diagnostic criteria, and treatment options available till date for this syndrome.A thorough literature search of PubMed, Medline, and Google Scholar for data sources mentioning the symptoms and diagnostic criteria for PCOS in females to date is included in the study. A total of 61 articles were used and a total of 10 were excluded due to repetition of data or studies with sample sizes less than 70.Women clinically diagnosed with PCOS. The prevalence of PCOS was more common in woman aged 21-34 years and varied from 2.2% to 20% in different parts of the world. The most common symptoms found for PCOS were menstrual irregularities, hirsutism, weight gain, and insulin resistance. There are 3 diagnostic criteria currently being used to diagnose PCOS namely Ovulatory Dysfunction, Hyperandrogenism, and Polycystic Ovarian . The symptoms of PCOS vary greatly among women and so treatment is largely based on the presentation of symptoms and prevention of long-term effect. Therefore, the main treatment options for menstrual irregularities areClomiphene Citrate, Letrozole, Oral Contraceptive Pills (OCPs) a second-line therapy includes Gonadotropins, Metformin and Laparoscopic Ovarian Drilling (LOD). Hyperandrogenism treatment options are Finasteride, Isotretinoin, Spironolactone and Flutamide. Simultaneously weight reduction therapy, lifestyle changes can be used to reduce a weight gain.The prevalence of PCOS is influenced the diagnostic criteria used. The Clinical presentations of PCOS vary greatly among women. Rotterdam criteria, most widely used to diagnose PCOS, include the presence of at least two of these three conditions: polycystic ovaries on ultrasound imagining; hyperandrogenism; and chronic ovulatory dysfunction. The treatment of PCOS is not specific. Lifestyle modifications, pharmacotherapy and some surgical approaches have been successfully used to manage the symptoms.

Variation in Clinical Presentation, Metabolic Profile, Hormonal Parameters and Inflammatory Markers in Polycystic Ovary Syndrome Women with and without Polycystic Ovary Morphology Appearance.

Polycystic ovary syndrome (PCOS) is a heterogeneous disorder with a spectrum of presentation. Studies have reported considerably different rates in terms of the incidence of polycystic ovary morphology (PCOM) in patients with PCOS with inconsistent results regarding the effects of PCOM in them. The aim of this study was to determine the differences in clinical presentation, metabolic profile, hormonal parameters and inflammatory markers in PCOS women with and without PCOM on ultrasonography (USG). A total of 70 PCOS women were recruited. To analyse the differences between various parameters, the patients were divided into two groups based on the presence or absence of PCOM on USG of the pelvis as per the Rotterdam criteria. A total of 37 patients had PCOM as per the diagnostic criteria for PCOS (Group 1), while 33 patients did not have PCOM on USG and were designated as Group 2. All participants underwent a detailed clinical evaluation and biochemical investigations, including high-sensitivity C-reactive protein, serum adiponectin, luteinising hormone, follicle-stimulating hormone, total testosterone and serum anti-Mullerian hormone. The homeostasis model assessment of IR (HOMA-IR) was calculated using standard equations. The mean and Standard deviation were computed for all continuous variables. Frequencies and proportions were calculated for categorical variables. Comparisons of the mean scores between the study groups were assessed using the Unpaired Student's t-test. The mean score of the subgroups was also compared using the unpaired Student's t-test. P < 0.05 was considered significant for all statistical inferences. The mean LDL and mean triglyceride were higher in Group 2, which was statistically significant (P = 0.004 and P ≤ 0.001, respectively). The mean hs-CRP was found to be higher in Group 2, which was statistically significant (P = 0.005). The mean AMH was higher in Group 1, which was statistically significant (P = 0.002). Group 1 had higher adiponectin levels, which was statistically significant (P = 0.04). The above findings suggest that patients without diagnostic PCO morphology have a worse metabolic profile compared to those with PCO morphology on USG. Obese patients without PCO morphology probably have a higher cardiovascular risk compared to obese patients with PCO morphology.

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.

PMON219 Disparities in Musculoskeletal Health Profiles Across Race and Ethnicity in United States-Based Women with Polycystic Ovary Syndrome per the 2018 International Guideline

Abstract The magnitude and direction to which alterations in non-fat components of musculoskeletal composition (bone, muscle) may disproportionately impact diverse populations of women with polycystic ovary syndrome (PCOS) are unknown, despite clinical relevance. The uncertainty stems, partly, from heterogeneity in PCOS diagnostic criteria used and technical barriers in the reliable assessment of PCOS. We evaluated whether musculoskeletal (total and regional lean body mass [LBM] and bone mineral density [BMD]) outcomes were different in PCOS (n=126) across 4 prospectively recruited groups matched for age, body mass index, waist to hip ratio, and lack of recent (&amp;lt;3 mos) hormonal contraceptive and metformin use: self-identified (1) White (n=86); (2) Black (n=17); (3) Asian (n=12); and, (4) Hispanic (n=11) women in 3 academic medical centers in NY. PCOS was defined by the Rotterdam criteria using the recommended thresholds of the most recent (2018) PCOS Guideline. Fat and lean tissue mass and BMD were evaluated by dual-energy X-ray absorptiometry. Within the PCOS group, percentages of total body, trunk fat, and appendicular lean mass were comparable across races and ethnicities (All: P≥0.40); in contrast, total LBM and total and regional BMD were different across the groups (All: P&amp;lt;0.002). Post hoc pairwise comparisons revealed Asian women (mean±standard deviation; 39.64±6.42) exhibited lower total LBM vs. Black (53.93±10.60) and White (49.47±8.87; All: P&amp;lt;0.01) but not vs. their Hispanic (46.30±8.77 kg; P=0.29) counterparts. Total, upper, and lower limb BMD were higher in Black women (1.28±1.13; 0.82±0.09; 1.28±0.12) vs. all other counterparts: (White [1.12±0.9; 0.75±0.09; 1.18±0.10;]; Asian [1.09±0.09; 0.67±0.03; 1.08±0.05]; and, Hispanic [1.09±0.09; 0.72±0.15; 1.07±0.10] g/cm2; All: P&amp;lt;0.04), respectively. Similarly, lower limb BMD was compromised in Asian and Hispanic vs. White women (All: P≤0.03). Groups exhibited comparable glucoregulatory status (insulin and glucose responses to a standard 75-g oral glucose tolerance test), blood pressure, androgen status (Ferriman-Gallwey scores, total, free, and bioavailable testosterone), and intermenstrual interval length (All: P≥0.14). Conversely, groups differed by insulin-like-growth-factor-1 (IGF-1) and IGF-2 levels (All: P≤0.05). Post hoc pairwise comparisons showed lower IGF-1 in Black (255.92±145.12) and White (325.42±140.25) vs. Hispanic (549.21±266.26 ng/mL) women (All: P≤0.04). Also, Black women (426.74±82.66) had lower IGF-2 vs. White women (553.07±111.10 ng/mL; P≤0.4). Collectively, Asian women with PCOS show the lowest LBM and BMD, whereas their Black counterparts exhibit higher BMD after matching for age, body mass index, waist to hip ratio, lack of hormonal contraceptive and metformin use, and percentages of total body and trunk fat. Future research should delineate the true effects of PCOS-specific endocrine milieu (e.g., IGF axis) and relevance of genetic variants and/or environmental determinants of musculoskeletal health in this understudied clinical population. If confirmed by larger studies, our observations support the need for population-specific preventative and management considerations in future Guideline recommendations (e.g., PCOS-specific physical activity) to improve musculoskeletal health and associated reproductive and metabolic comorbidities. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Vitamin D status among adolescent females with polycystic ovary syndrome

Background. Polycystic ovary syndrome (PCOS) is a complex disorder affecting the hypothalamic-pituitary-ovarian axis and leading to menstrual irregularities and hyperandrogenism. Studies have suggested that low vitamin D levels may play a role in the pathogenesis of PCOS. There is currently insufficient data regarding association of serum vitamin D levels and PCOS in adolescent females. The purpose of the study was to compare 25-hydroxyvitamin D levels in adolescent females with and without PCOS. Materials and methods. Participants were categorized as having PCOS or as controls based on National Institutes of Health PCOS diagnostic criteria. Exact logistic regression analysis was done to compare normal (≥ 30 ng/mL) versus low (&lt; 30 ng/mL) serum 25(OH)D levels in the PCOS and control groups. Data regarding the participant’s age, body mass index (BMI) percentile, serum 25(OH)D levels, and the season the blood was drawn were recorded in the database. Results. Eighty-two participants (32 were in the PCOS group and 50 were in the control group) met the inclusion criteria and were categorized as either PCOS or control. All participants in PCOS group had BMI greater than the 85th percentile. Therefore, participants with BMI percentile of less than 85th in the control group were excluded from analysis. The mean age of participants was 17.3 years. Vitamin D deficiency and insufficiency were frequently diagnosed in our study population. Sufficient 25(OH)D levels were found in only 7 of 82 participants (8.5 %). The majority of participants with BMI greater than 95th percentile were vitamin D deficient with statistical difference in mean 25(OH)D levels based on each category of BMI percentile. Vitamin D deficiency was noted among 65.6 % of participants with PCOS versus 38.0 % in the control group. The mean serum 25(OH)D level was 16.02 ng/ml in the PCOS group and 22.80 ng/ml in the control group. The difference in 25(OH)D levels between the groups was statistically significant (P = 0.036). Conclusions. Vitamin D deficiency was noted among 65.6 % of participants with PCOS versus 38.0 % in the control group. The mean serum 25(OH)D level was 16.02 ng/ml in the PCOS group and 22.80 ng/ml in the control group.

Criteria for Diagnosis of Polycystic Ovary Syndrome during Adolescence: Literature Review.

Polycystic ovary syndrome (PCOS) is one of the most common endocrine conditions in women. PCOS may be more challenging to diagnose during adolescence due to an overlap with the physiological events of puberty, which are part of the diagnostic criteria in adult women. This review focuses on the evidence available in relation to PCOS diagnostic criteria for adolescents. Adolescent PCOS should be diagnosed using two main criteria irregular -menstrual cycles (relative to number of years post-menarche) and hyperandrogenism (clinical and/or biochemical); after excluding other conditions that mimic PCOS. Accurate definitions of the two main criteria will decrease challenges/controversies with the diagnosis and provide timely diagnosis during adolescence to establish early management. Despite the attempts to create accurate diagnostic criteria and definitions, this review highlights the limited research in this area, especially in the follow up of adolescents presenting with one diagnostic feature that are called “at risk of PCOS”. Studies in adolescents continue to use the Rotterdam diagnostic criteria that uses pelvic ultrasound. This is inappropriate, because previous and emerging data that show many healthy adolescents have polycystic ovarian morphology in the early years post-menarche. In the future, anti-Müllerian hormone levels might help support PCOS diagnosis if adolescents meet two main criteria.

Diagnosis and Management of Polycystic Ovary Syndrome: A Survey of Physicians from the Middle East and Africa

Abstract Background Studies from several regions examined the approach to diagnosing and managing polycystic ovary syndrome (PCOS). Limited data are available from the Middle East and Africa (MEA). Objective The aim of this study was to understand the practice pattern for diagnosing and managing PCOS by relevant specialists across the MEA region. Methods We used an online survey consisting of an established questionnaire. The questionnaire consisted of 25 questions grouped to capture information on (a) the characteristics of the respondents, (b) patients with PCOS seen by respondents, (c) the diagnostic criteria, (d) biochemical parameters for differential diagnosis of hyperandrogenism, (e) long-term concerns, and, finally (f) management choices. Results A total of 190 questionnaires were available for final analysis; 73.7% of the respondents were senior physicians; 59.5% and 17.4% were endocrinologists and gynecologists, respectively. Menstrual irregularity was the most frequent criterion used for the diagnosis of PCOS (90.5%), followed by hirsutism (75.7%), and biochemical hyperandrogenism (71.4%). Dehydroepiandrosterone was the most frequent biochemical parameter used for the differential diagnosis of hyperandrogenism (52.4%) followed by total testosterone (45.4%). Obesity and type 2 diabetes mellitus were the principal long-term concerns for PCOS (45.1%), followed by infertility (29.9%). Metformin was the most commonly prescribed treatment (43.8%), followed by lifestyle modification (27.0%), and oral contraceptives (18.9%). Infertility treatments include metformin alone, clomiphene citrate alone, or their combination prescribed by 23.1, 9.9, or 52.7%, respectively, whereas only 3.8% contemplated ovulation induction. Some differences and similarities were observed in previous studies, including gynecologists and endocrinologists. Conclusions This survey provides a baseline for the perspective in diagnosing and treating PCOS in the MEA region. Some deviation is observed from mainline recommended practices. More education on PCOS diagnostic criteria and treatment of PCOS is needed in line with the recently published evidence international guideline.

005 New insights into polycystic ovary syndrome (PCOS) in adolescents

Polycystic ovary syndrome (PCOS) is a complex heterogenous disorder characterized by hyperandrogenism and chronic anovulation. Six (6%) to 20% of reproductive aged women are affected based on the diagnostic criteria used. Symptoms of PCOS arise during the early pubertal years. Although the Rotterdam criteria are mainly accepted for adult women, different diagnostic criteria for PCOS in adolescent girls have been delineated.

The Role of Glp-1 Receptor Agonists in Insulin Resistance with Concomitant Obesity Treatment in Polycystic Ovary Syndrome.

Insulin resistance is documented in clamp studies in 75% of women with polycystic ovary syndrome (PCOS). Although it is not included in the diagnostic criteria of PCOS, there is a crucial role of this metabolic impairment, which along with hormonal abnormalities, increase each other in a vicious circle of PCOS pathogenesis. Insulin resistance in this group of patients results from defects at the molecular level, including impaired insulin receptor-related signaling pathways enhanced by obesity and its features: Excess visceral fat, chronic inflammation, and reactive oxygen species. While lifestyle intervention has a first-line role in the prevention and management of excess weight in PCOS, the role of anti-obesity pharmacological agents in achieving and maintaining weight loss is being increasingly recognized. Glucagon-like peptide-1 receptor agonists (GLP1-RAs) not only act by reducing body weight but also can affect the mechanisms involved in insulin resistance, like an increasing expression of glucose transporters in insulin-dependent tissues, decreasing inflammation, reducing oxidative stress, and modulating lipid metabolism. They also tend to improve fertility either by increasing LH surge in hypothalamus-pituitary inhibition due to estrogen excess connected with obesity or decreasing too high LH levels accompanying hyperinsulinemia. GLP1-RAs seem promising for effective treatment of obese PCOS patients, acting on one of the primary causes of PCOS at the molecular level.

Prevalence of Polycystic Ovary Syndrome in Patients With Pediatric Type 2 Diabetes

The prevalence of pediatric type 2 diabetes (T2D) is increasing globally. Girls with T2D are at risk of developing polycystic ovary syndrome (PCOS), but the prevalence of PCOS among girls with T2D is unknown. To determine the prevalence of PCOS in girls with T2D and to assess the association of obesity and race with this prevalence. In this systematic review and meta-analysis, MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science: Conference Proceedings Citation Index-Science, and the gray literature were searched from inception to April 4, 2021. Two reviewers independently screened for studies with observational study design that recruited 10 or more participants and reported the prevalence of PCOS in girls with T2D. Risk of bias was evaluated using a validated tool, and level of evidence was assessed using the Oxford Centre for Evidence-Based Medicine criteria. A random-effects meta-analysis was performed. This study follows the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline. The main outcome of this systematic review was the prevalence of PCOS in girls with T2D. Secondary outcomes included assessing the associations of obesity and race with PCOS prevalence. Of 722 screened studies, 6 studies involving 470 girls with T2D (mean age at diagnosis, 12.9-16.1 years) met the inclusion criteria. The prevalence (weighted percentage) of PCOS was 19.58% (95% CI, 12.02%-27.14%; I2 = 74%; P = .002). Heterogeneity was moderate to high; however, it was significantly reduced after excluding studies that did not report PCOS diagnostic criteria, leading to a calculated prevalence (weighted percentage) of 24.04% (95% CI, 15.07%-33.01%; I2 = 0%; P = .92). Associations with obesity and race could not be determined because of data paucity. In this meta-analysis, approximately 1 in 5 girls with T2D had PCOS, but the results of this meta-analysis should be considered with caution because studies including the larger numbers of girls did not report the criteria used to diagnose PCOS, which is a challenge during adolescence. The associations of obesity and race with PCOS prevalence among girls with T2D need further evaluation to help define at-risk subgroups and implement early assessment and treatment strategies to improve management of this T2D-related comorbidity.

Different pregnancy outcomes according to the polycystic ovary syndrome diagnostic criteria: a systematic review and meta-analysis of 79 studies

To correlate the distinct diagnostic criteria of polycystic ovary syndrome (PCOS) with the development of maternal and neonatal complications. Systematic review and meta-analysis. Not applicable. Pregnant women with PCOS. Maternal and neonatal complications were compared among women with PCOS diagnosed with different criteria. The primary outcomes of gestational diabetes mellitus and preeclampsia (PE) were assessed for every diagnostic criterion. Seventy-nine studies were included. Regarding gestational diabetes, the overall pooled prevalence was 14% (95% confidence interval [CI], 11%-18%; I2, 97%), reaching the highest level when polycystic ovarian morphology on ultrasound and 1 of the remaining 2 Rotterdam criteria (1/2 Rotterdam criteria) were used (18%; 95% CI, 13%-24%; I2, 20%) and the lowest when polycystic morphology on ultrasound and hyperandrogenism were used (3%; 95% CI, 0%-19%; I2, not applicable). Regarding PE, the overall pooled prevalence was 5% (95% CI, 4%-7%; I2, 82%). The highest PE prevalence was reported when the National Institutes of Health criteria were used (14%; 95% CI, 5%-33%; I2, 90%) and the lowest when menstrual irregularities and 1 of the 2 Rotterdam criteria were used (2%; 95% CI, 1%-3%; I2, not applicable). The prevalence of gestational diabetes mellitus in pregnant women with PCOS does not differ according to the criteria used; however, women diagnosed with PCOS per the National Institutes of Health criteria are at higher risk of PE.

Is anti-Mullerian hormone a useful biomarker in the diagnosis of polycystic ovary syndrome in Chinese adolescents?

Objective (1) To investigate anti-Mullerian-hormone (AMH) in adolescents with polycystic ovary syndrome (PCOS) compared to age-matched girls without PCOS; (2) to determine whether AMH is a valuable marker for diagnosing PCOS and to explore the best cutoff value in adolescents; (3) using a multivariate predictive model for the diagnosis of PCOS. Methods Ninety girls (aged 10–20 years) recruited during two years for the PCOS-group (n = 45) or control-group (n = 45). PCOS diagnostic criteria according guidelines of the Endocrinology Expert Group, Obstetrics/Gynecology Branch of the Chinese Medical Association. Serum AMH and other sex hormones were measured. Logistic regression analysis to estimate the odds ratio of AMH and other variables for the diagnosis of PCOS. Receiver operator characteristics (ROC) curve analysis was performed to reveal the diagnostic potential. Results (A) AMH was significantly higher in PCOS patients than in controls (10.21 ± 5.85 ng/ml vs. 4.31 ± 2.84 ng/ml, p < .001). In PCOS-group, total testosterone (TT), free testosterone (FT) and biologically active testosterone (BioT) were significantly higher than in controls (p < .001). (B) Logistic regression suggests that AMH and TT are correlated with the diagnosis of PCOS (p < .05). (C) ROC curve analyses demonstrated that the optimal value of AMH for predicting PCOS was 6.32 ng/mL, with 69.8% sensitivity and 80.5% specificity. Furthermore, AMH combined with TT can provide 83.7% sensitivity and 80.5% specificity for diagnosing PCOS in adolescents. Conclusions AMH may be a useful biomarker for the diagnosis of PCOS in Chinese adolescent girls. A cutoff value of 6.32 ng/mL best discriminated between PCOS patients and controls. Besides AMH a multivariate predictive model should include TT.

Substituting serum anti-Müllerian hormone for polycystic ovary morphology increases the number of women diagnosed with polycystic ovary syndrome: a community-based cross-sectional study.

Can serum anti-Müllerian hormone (AMH) replace polycystic ovary morphology (PCOM) determined by ultrasound as a diagnostic component of polycystic ovary syndrome (PCOS)? Despite good correlations between serum AMH and PCOM, the use of a high serum AMH as a proxy for PCOM resulted in the reclassification of PCOS in 5% of study participants, with the main effect being more women identified, although some women previously classified as having PCOS were no longer classified as such. AMH has been proposed as an alternative to PCOM as a diagnostic component of PCOS. Previous studies are limited by poorly defining PCOS, use of infertile women as comparators, measurement of hormones by immunoassay that lack precision in the female range, low-resolution ovarian ultrasound and inconsistent handling and storage of serum samples. This is an Australian cross-sectional study of 163 non-healthcare-seeking women. Serum AMH was measured by both the Ansh picoAMH assay and the Beckman Coulter Access 2 (BA2) assay, in parallel with androgens measured by liquid chromatography-tandem mass spectrometry, in blood samples of women, not pregnant, breast feeding or using systemic steroids, who also underwent high-resolution ovarian ultrasound. PCOS was determined by the Rotterdam criteria with PCOM defined by the Androgen Excess-PCOS Taskforce recommendation of ≥25 follicles in at least one ovary. Cut-off serum concentrations that best identified women as having PCOM were identified by receiver operator characteristic (ROC) curves. A total of 163 women, mean (SD) age 32.5 (5.5) years, who provided a blood sample and had both ovaries visualized on ultrasound were included in the analysis. Women with isolated PCOM had higher median (range) Ansh AMH and BA2 AMH concentrations than those with no PCOS characteristics [56.9 pmol/l (34.6, 104.2) versus 18.7 (3.2, 50.9), P = 0.002 and 38.5 pmol/l (22.2, 100.2) versus 16.7 (3.5, 38.9), P = 0.002, respectively]. An AMH ≥ 44.0 pmol/l, suggested by the ROC curve, identified 80.6% of women with PCOM, falsely identified 15.2% of women without PCOM as having PCOS and had a positive predictive value of 55.6%. The negative predictive value was 94.9%. An AMH BA2 assay cut-off of ≥33.2 pmol/l provided a sensitivity of 80.6%, a specificity of 79.5% and a positive predictive value for PCOM of 48.1%. The negative predictive value was 94.6% for PCOM. When serum AMH was used in the place of PCOM as a diagnostic criterion for PCOS, the Ansh assay resulted in an additional seven women classified as having PCOS and no longer classified one woman as having PCOS. For the BA2 assay, eight additional and two fewer women were classified as having PCOS. Overall, both assays resulted in six more women being classified as having PCOS. Women with functional hypogonadotrophic hypogonadism were not excluded and may have been misclassified as having an oligo-amenorrhoea-PCOM phenotype. As study participants were predominantly Caucasian/White, our findings cannot be generalized to women of other ethnicities. Although serum AMH reflects the number of developing ovarian follicles, the absolute values vary between assays and specific reference ranges for individual assays are required. Irrespective of the assay used, replacing PCOM with serum AMH to diagnose PCOS in a community-based sample altered the number of women classified as having or not having PCOS. Consequently, although overall the risk of women being identified as having PCOS would be increased, some women would no longer be classified as having this condition. The study was supported by the Norman Beischer Research Foundation and the Grollo-Ruzzene Foundation. S.R.D. is an NHMRC Senior Principal Research Fellow (Grant No. 1135843). S.R.D. reports unrelated support that includes grants from the NHMRC Australia, personal fees for educational activities from Besins Healthcare, Abbott Chile, BioFemme and Pfizer Australia, personal Advisory Board/consultancy fees from Theramex, Abbott Laboratories, Astellas, Mayne Pharmaceuticals, Roche Diagnostics, Lawley Pharmaceuticals and Que Oncology and has received institutional grant funding from Que Oncology and Ovoca research. The other authors declare no conflicts of interest. N/A.

Promotion of reproductive and metabolic health - current trends in the treatment and prevention of polycystic ovary syndrome in different periods of life

Polycystic ovary syndrome (PCOS) is one of the most common hormonal disorders and causes of infertility in women in reproductive age. Diagnostic criteria of PCOS in adult women include: ovulation disorders, hyperandrogenism and polycystic ovaries. According to most recommendations, 2 out of these 3 criteria are confirm the diagnosis of PCOS. In girls during puberty and in the first years after menarche, different diagnostic criteria of menstrual disorders should be taken into account (variable length of menstrual cycles, monophasic cycles) and the limited usefulness of ultrasound examination for PCOS diagnosis within 8 years after menarche. Fairly extensive differential diagnosis is also necessary, especially – exclusion of adrenal hyperandrogenism. Moreover, the diagnostic criteria of PCOS do not take into account the metabolic disorders found in most patients (obesity, insulin resistance, type 2 diabetes), which should be diagnosed as early as possible and treated appropriately. This is especially true for teenagers, in whom the unequivocal diagnosis of PCOS or its exclusion may be very difficult. Current recommendations regard hormonal contraception as the first-line therapy in PCOS, in both adult women and adolescents. Together with its beneficial effect on the reduction of hyperandrogenism and obtaining regular bleeding (which in fact are not menstruations), the unfavorable metabolic effects of hormonal contraception are emphasized, as well as the inadequacy of its use if it is expected to achieve or restore ovulation and fertility. The latest reports indicate the legitimacy of treatment aimed at correcting disorders of carbohydrate metabolism and its greater effectiveness compared to the use of oral contraceptives in both adult women and girls with PCOS. In the pharmacotherapy of insulin resistance, metformin is of fundamental importance, the use of pioglitazone, GLP-1 receptor agonists or inositols is also proposed. Adequate lifestyle and dietary modification are of major importance in the treatment and prevention of PCOS. The mechanisms of "inheritance" of PCOS and insulin resistance with the participation of epigenetic modifications are still better understood, taking into account the effects of exposure to androgen excess in utero, intrauterine growth retardation, and maternal obesity and hyperalimentation. This creates new possibilities for PCOS prophylaxis.