Modified Ferriman Gallwey Research Articles

How Frequently Is Ultrasound Required to Diagnose Polycystic Ovary Syndrome in a Clinical Population?

Background: Polycystic ovary syndrome (PCOS) is a common endocrine condition, affecting up to 20% of reproductive aged women worldwide. Polycystic ovarian morphology (PCOM) may be present, but is not required for diagnosis. Our study seeks to evaluate the utility of ultrasound in diagnosing or excluding PCOS by 2023 International Guidelines Criteria. Materials and Methods: Subjects were patients seen in a tertiary care referral clinic in whom other causes of hyperandrogenism (HA) were ruled out. All underwent complete history, physical, modified Ferriman Gallwey scoring, and serum androgen testing; followed by transvaginal ultrasound (TVUS) to assess ovarian morphology if indicated. PCOM was identified as antral follicle count ≥20 and/or ovarian volume >10 mL in at least one ovary. After clinical classification, PCOS was diagnosed by at least two of three: biochemical/clinical HA, ovulatory dysfunction (OD), and PCOM. Statistics were calculated using Fisher's exact test and chi-square. Results: In total, 454 subjects were included. 299 were classified as group A/B and did not require TVUS for diagnosis. Of 82 subjects with HA alone, 50 (61.0%) were classified as group C after demonstrating PCOM. Fifty-five subjects had OD alone, 37 (67.3%) of which were classified as group D based on PCOM. In total, 137/454, or 30.2% of subjects required TVUS for diagnosis or exclusion of PCOS. Conclusions: TVUS was necessary in less than one-third of subjects, primarily identifying PCOS groups C or D. Selective use of ovarian ultrasonography may reduce the costs and complexity of epidemiological and clinical studies for PCOS.

Physician and Adolescent Hirsutism Score Ratings and Their Concordance to Androgen Levels [ID 2683618

INTRODUCTION: Hirsutism affects 5–15% of reproductive-aged women. The gold standard for quantifying hirsutism is the modified Ferriman–Gallwey (mFG) score. This study explores whether adolescent and physician ratings of hirsutism using the mFG score, correlate with androgen levels in the setting of confounders like depilation. METHODS: Hispanic adolescent females with irregular menstruation and suspected polycystic ovary syndrome (PCOS) were recruited from obstetrics and gynecology clinics at TTUHSC El Paso between September 2021 and May 2023. Patients completed an intake questionnaire, completed PCOS laboratory testing, and rated their hair growth using the mFG visual scoring method. Providers used same the methods for rating hirsutism during the same visit. We estimated Lin’s concordance correlation and Bland–Altman agreement between patient and provider mFG ratings. Linear regression explored factors affecting score changes. Statistical analysis was done by STATA 17.0. RESULTS: Forty females participated in this study. The average age at enrollment was 16.19 with a mean (SD) mFG score of 10.55 (5.95) (physicians) and 18.29 (5.78) (adolescents). Adolescents reported higher mean mFG scores than physicians. There is a low level of agreement between the two groups (−7.95; 95% CI: −23.02, 7.12). Specifically, physicians underrated hirsutism scores for arm hair. Using unadjusted linear regression, DHEAS and 17-hydroxyprogesterone levels demonstrate the hormonal influence on hirsutism. CONCLUSION: Preliminary findings indicate discordance between physicians’ and patients’ mFG scores, possibly influenced by examination precision and patient perception. Physician-scored mFG, and evaluation of androgen levels, may serve as precise hirsutism markers for Hispanic adolescents.

Clinical assessment of the efficacy of Ayurvedic management in PCOS: Study protocol for a randomized open-label standard control trial

Abstract INTRODUCTION: Polycystic ovary syndrome (PCOS) is a heterogeneous disorder, typically characterized by anovulation, hormonal imbalances, obesity, infertility, and associated features, with a significant impact on the physiological and psychological wellbeing of females belonging to the reproductive age group. Due to the multifactorial etiology, treatment is often personalized with specific targets, and monotherapy is rarely used. In the present study, the efficacy of an Ayurveda regimen, comprising the Ayush-SSM tablet (a coded Ayurvedic formulation) administered after Virechana therapy (purgation), is being explored against conventional standard care. MATERIALS AND METHODS: This study is an open-label, randomized, controlled clinical trial consisting of 180 participants diagnosed with PCOS. The participants in the trial group will receive Ayurvedic treatment consisting of Virechana therapy followed by administration of Ayush-SSM (500 mg), two tablets twice a day for 6 months. The participants in the control group will receive metformin tablet 500 mg once a day in the first week, 500 mg twice a day in the second week, 500 mg thrice a day in the third week, and 850 mg twice a day from the fourth week till 6 months. The primary outcome is the proportion of study participants who attain normal menstrual cycle length (21–35 days) or ovulation and change in hirsutism as per the modified Ferriman–Gallwey (FG) Score. The secondary outcomes are change in acne score and acanthosis nigricans; change in abdominal girth, waist circumference, and BMI; and clinical safety of the trial interventions. CONCLUSION: The findings of the study could potentially demonstrate that the Ayurveda regimen, including Virechana therapy followed by administration of the Ayush-SSM tablet, may be as effective as conventional standard care. Trial registration: Clinical Trial Registry of India (CTRI/2022/09/045478, dated August 4, 2022).

O-03 Adrenalectomy for Cushing's syndrome during pregnancy

Abstract Introduction Cushing's syndrome (CS) is rare in pregnancy because CS itself is a cause of anovulatory infertility due to excess cortisol secretion. Moreover it is also difficult to diagnose CS in pregnancy because placental production of corticotropin releasing and adrenocorticotropic hormone (ACTH), increased maternal production of estrogen induced corticosteroid binding globulin leads to physiological hypercortisolism during pregnancy. So physicians face a clinical overlap in many features of CS such as weight gain, fatigue, edema, hypertension, hyperglycemia, stretch marks, mood changes that can also be attributed to pregnancy. Thus their coexistence represents a diagnostic challenge. Herein we report a case of CS that was diagnosed and successfully treated during pregnancy. Clinical Case A 43-year-old gravida 3 female was consulted at the 21st week of gestation with persistent high blood pressure and hyperglycemia for a month. She had an obstetric history of 2 spontaneous first term abortion, 2 healthy labor 18 years ago and she was healthy after. She was in such a depressive mood that she was consulted with psychiatry many times. On physical examination edema, proximal weakness of lower extremities and hirsutism (modified Ferriman–Gallwey score of 9) was detected. Initial laboratory tests were all within normal range except potassium level (2.7 mmol/L), the results were not consistent with preeclampsia and there was a suspicious adrenal mass detected on ultrasound. She was currently receiving high dose antihypertensive treatment with methyldopa, calcium channel blockers, rapid acting and detemir insulin for diabetes and i.v. potassium replacement. We ruled out conns syndrome with normal plasma aldosterone renin ratio and found catecholamine levels normal. Hormonal analyses revealed with high plasma cortisol levels, increased nocturnal cortisolemia, a suppressed plasma ACTH and dehydroepiandrosterone sulfate level and distinctly elevated 24-hour urinary cortisol greater than 3-fold the upper normal reference range. Non contrast magnetic resonance imaging demonstrated a 47×32 mm left adrenal mass. Laparoscopic adrenalectomy was performed in the 26th week of gestation and the following histopathology revealed an adrenocortical adenoma. Antihypertensive medication was progressively reduced, glycemic control and hypokalemia reversal were achieved. She was followed up with appropriate glucocorticoid replacement. At 34 weeks of gestation, after sudden labor pain and regular uterine contractions a 2586 g male infant with Apgar scores of 8 was born by cesarean section. They were discharged in good health. Conclusion CS should be kept in mind especially in the case of hypertension and diabetes that started before the 20th gestational age. Analysis of the urinary free cortisol level and circadian rhythm of cortisol is necessary to diagnose. Despite the diagnostic challenge we can achieve better maternal and fetal outcomes with proper management.Figure 1.Non-contrast magnetic resonance imaging of the patient Table 1.Patient's laboratuary test results Table 2.Patient's laboratory test results

Clinical and Biochemical Evaluation of Hirsutism in Young, Lean Girls from Kirkuk City, Iraq: A Cross-Sectional Study

Background: An increase in terminal hair in androgen-dependent regions is known as hirsutism. It is not solely caused by hyperandrogenemia; idiopathic forms are also frequently seen. Objective: To examine the modified Ferriman Gallwey (mFG) cut-off score in female Iraqis as well as the etiological, biochemical, and clinical characteristics of hirsutism. Methods: This prospective cross-sectional study included one thousand young girls with a normal BMI. The features associated with clinical hirsutism were identified using the mFG scoring system. We eliminated eighty-eight young girls who were diagnosed with PCOS. Samples of blood were drawn for biochemical analyses. Results: 53.1%, 19.6%, and 1.2% of females had mild, moderate, or severe hirsutism, respectively. For the young females who participated in the study, their mean mFG scores were 7.07, 11.26, 16.26, and 29, respectively. Only 5% of girls with mild hirsutism had high serum free testosterone levels, despite a considerable difference in free testosterone levels between them and the normal girls. The chin, upper lip, and lower abdomen were the sites that contributed the most to mFGs. Of the girls who were moderately hirsute, 55% had a positive family history of hirsutism. Conclusion: Iraqi women do not need to consider the mFG score system's cut-off number of 8. The endocrine society's guidelines for hirsutism estimation should be adhered to by the examiner.

Pre-polycystic ovary syndrome and polymenorrhoea as new facets of polycystic ovary syndrome (PCOS): Evidences from a single centre data set.

Polycystic ovary syndrome (PCOS) is a complex disorder with diverse metabolic implications. Diagnosis typically relies on oligo-amenorrhoea (OA), hyperandrogenism (HA), and polycystic ovarian morphology (PCOM). However, the role of polymenorrhoea in PCOS remains understudied. Additionally, limited information exists regarding metabolic disturbances in women with partial PCOS phenotypes that do not meet diagnostic criteria. This extensive database aims to provide substantial evidence on the metabolic implications of polymenorrhoea and partial PCOS phenotypes. Prospective observational study. In this single-centre study, 6463 women with PCOS-like characteristics and 3142 age-matched healthy women were included. The study compared clinical (anthropometry, modified Ferriman Gallwey [mFG] score), hormonal (serum testosterone), and metabolic (plasma glucose, serum lipids, insulin) characteristics between women diagnosed with PCOS, those with partial PCOS phenotypes, and the healthy control group RESULTS: In all, 5174 women met Rotterdam criteria for PCOS diagnosis, while 737 were classified as Pre-PCOS, including HA (n = 538), OA (n = 121), or PCOM (n = 78). Common clinical features included oligomenorrhoea (75.5%), hirsutism (82.9%), obesity (27.2%), hypertension (1.6%), metabolic syndrome (19.6%), and diabetes mellitus (5.6%). Women diagnosed with PCOS, HA only, and OA only exhibited higher average body mass index, plasma glucose levels (both fasting and 2 h after the oral glucose tolerance test), and lipid fractions in comparison to those with PCOM and the healthy controls. However, indices of insulin resistance were similar among women with PCOS, HA, PCOM, and OA, albeit higher than in the healthy controls. The polymenorrhoea subgroup (5.9%) had lower BMI and serum testosterone, but similar mFG score, plasma glucose, insulin, and lipid levels as the oligomenorrhoea subgroup. The metabolic disturbances observed in Pre-PCOS women highlight the need to reassess diagnostic criteria. Including the polymenorrhoea subcategory in PCOS criteria is recommended due to similar metabolic dysfunctions as the oligomenorrhoea group.

A randomized controlled trial comparing myoinositol with metformin versus metformin monotherapy in polycystic ovary syndrome.

Insulin resistance and hyperinsulinemia plays an important role in pathogenesis of polycystic ovary syndrome (PCOS). Metformin, Myoinositol and d-chiro-inositol acts as insulin sensitizers and exerts a beneficial effects in PCOS. The objective is to compare the effect of metformin monotherapy versus a combination of metformin with Myoinositol and d-chiro-inositol in PCOS. This study is a randomized controlled trial conducted over a period of 6 months. All overweight and obese women with PCOS with the age group between 18 and 35 were included and randomized into two groups, 27 in the metformin monotherapy arm and 26 in the myoinositol combination arm. The variables assessed were duration of menstrual cycle, anthropometric parameters, modified Ferriman Gallwey score, global acne score, Fasting insulin, HOMA-IR, fasting lipid profile, serum testosterone, sex hormone binding globulin, luteinizing hormone, follicle stimulating hormone, anti-Mullerian hormone, and pelvic ultrasound to assess ovarian volume, PCOS Questionnaire score. Changes in the parameters from baseline at the end of 6 months of treatment were assessed and compared between the groups. Menstrual cycle regularity improved in both groups with significantly greater improvement in the group receiving myoinositol-based therapy (p < .001). Pregnancy rate was equal in both the arms. There was a significant improvement in PCOSQ score in myoinositol-based therapy group (p < .001). However, there was no statistically significant difference in other hormonal, metabolic parameters between two groups in spite of symptomatic benefits. The addition of myoinositol to metformin exerts additional benefits in improving menstrual cycle regularity, and quality of life in women with PCOS.

Sexual Dysfunction in Infertile Patients with Polycystic Ovarian Syndrome

Introduction: Polycystic ovarian syndrome is one of the most common causes of infertility in women of reproductive age. It is a combination of chronic anovulation, obesity, and hyperandrogenism that may affect sexual function in women of reproductive age. Objectives: The study aimed to assess the sexual dysfunction, its frequency, and predisposing factors in infertile polycystic ovary syndrome (PCOS) patients. Methods: This descriptive cross-sectional study was conducted among 240 infertile women with a definite diagnosis of PCOS. The study duration was 1 year, from August 2019 to August 2020. Data was collected chronologically by interview, physical examination, and laboratory investigations using a structured questionnaire. The presence of hirsutism was assessed using the modified Ferriman–Gallwey (mFG) scoring system. Sexual function was assessed in the domains of desire, arousal, lubrication, orgasm, satisfaction, and pain using the female sexual function index (FSFI). Patients were also assessed for mental health by the depression, anxiety, and stress scale-21 (DASS-21). Results: Sexual dysfunction was present in 65.4% of patients with the domains of orgasm and arousal were particularly affected (92.9% and 90.0%, respectively). In this study, age and BMI had a significant negative correlation ([Formula: see text] = − 0.55 and [Formula: see text] = − 0.42, respectively) with sexual function. Increasing age and BMI resulted in a significant reduction in sexual function ( [Formula: see text] 0.001 each), including all domains. Patients with symptoms of depression and anxiety were significantly more likely to suffer from sexual dysfunction than those without these symptoms ([Formula: see text] = 0.041 and [Formula: see text] = 0.001, respectively). Hirsutism, serum testosterone (total) level, and stress were found to have no significant effect on sexual function. Conclusions: Infertile patients with PCOS markedly suffer from sexual dysfunction. Improvement of sexual dysfunction not only improves sexuality and quality of life, but also may improve fertility outcomes in infertile PCOS patients.

Impact of Insulin Resistance in Acne Vulgaris and Hirsutism Patients: An Analytical Cross-Sectional Study

Objective: The study's goals are to identify a causal connection between insulin resistance (IR) and hirsutism and acne vulgaris, as well as to evaluate the severity of the two conditions in relation to rising IR. Study design: An analytical cross-sectional study Place and Duration: This study was conducted at Primary Health Care Corporation, Qatar from August 2021 to August 2022. Methodology: In a predetermined proforma, a patient's entire clinical history as well as required variables, such as height, weight, body mass index (BMI), etc., were recorded in order to establish a link between IR and acne with/without hirsutism and only hirsutism.A HOMA-IR value of more than 2.5 was regarded as important and indicative of IR. Global Acne Grading System (GAGS) was used to determine the degree of acne, and the Modified Ferriman Gallwey Score was used to determine the severity of hirsutism (mFG). Results: The 354 participants in our study were divided into three groups: There was a statistically significant connection between IR and the severity and recurrence of acne in the Acne-only (N = 310) group. The homeostatic model assessment for insulin resistance (HOMA-IR), the modified Ferriman-Gallwey score, and recurrence were substantially correlated in the hirsutism-only (N = 26) group, demonstrating that insulin resistance increased with hirsutism severity and recurrence. In the sample of 18 people with acne and hirsutism (N = 18), higher BMI was positively linked with IR but not with the severity of both disorders. Conclusion: Causing serious, resistant acne and hirsutism, IR has come to be recognized as a significant contributory, if not causal, event. The mental stress affected by these conditions is greatly impacted, requiring a different approach to case management. Keywords: Acne, Hirsutism, Dermatology practice, Psoriasis, PCOS, Insulin resistance

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.&#x0D; 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). &#x0D; 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.

Role of Insulin Resistance in Patients of Acne Vulgaris and Hirsutism in the Western Part of India- A Cross-Sectional Study.

Despite being common and easy to treat conditions, acne and hirsutism may have a striking consequence on one's perception of self. Though understanding the pathogenesis of acne and hirsutism has undergone a major paradigm shift, one of them being insulin resistance (IR), extensive research is still underway. The purpose of the study is to establish causal relationship linking IR with acne vulgaris and hirsutism, as well as to assess severity of the two with increasing IR. A cross-sectional observational study was conducted in the dermatology department. Patient's detailed clinical history and necessary parameters like height, weight, body mass index (BMI), etc., were recorded in predefined proforma, noting signs and symptoms of underlying IR, along with acne severity calculated by global acne grading system (GAGS) and hirsutism severity by modified Ferriman Gallwey score (mFG), then analyzing using Pearson's correlation test to establish correlation between IR and acne with/without hirsutism and hirsutism alone. A total of 349 patients included in our study were divided into three groups, (i) Acne-only (N = 308) group showed statistically significant correlation of IR with acne severity (P < 0.0001) and recurrence (P < 0.0001). (ii) In hirsutism-only (N = 24) group, homeostatic model assessment for insulin resistance (HOMA-IR) was strongly associated with modified Ferriman-Gallwey score and recurrence suggesting raised insulin resistance with increased severity of hirsutism (P < 0.0001) and recurrence (P < 0.007). (iii) In acne + hirsutism (N = 17) group, raised BMI was found to be positively associated with IR but not with severity of both conditions. IR has emerged as an important contributory, if not, causative event in pathogenesis of severe, resistant acne, and hirsutism. These conditions have great deal of impact on the psychological health of those affected necessitating different approach to manage such cases.

Effect of Saleekha and Majeeth in Polycystic Ovarian Disease: An Open Observational Study

Pharmacognosy Research,2023,15,1,168-175.DOI:10.5530/097484900240Published:December 2022Type:Original ArticleAuthors:Shabnam Bano, Wajeeha Begum, and Syeda Sumaiya Author(s) affiliations:Shabnam Bano*, Wajeeha Begum, Syeda Sumaiya Department of Ilmul Qabalat of Amraze Niswan, National Institute of Unani Medicine, Kottigepalya, Bengaluru, Karnataka, INDIA. Abstract:Introduction: PCOD is a common, complex reproductive endocrinopathy characterized by menstrual irregularities, hyperandrogenism, polycystic ovaries, metabolic and psychological disorders and affects up to 18% of reproductive-aged women. Objectives: To evaluate the effect of Saleekha and Majeeth in PCOD. Materials and Methods: Clinically diagnosed Patients (n=30) with PCOD in age 18-35 years with oligomenorrhea or amenorrhoea were included in the study. Patients with thyroid dysfunction, systemic diseases, endometrial tuberculosis, malignancies on hormonal treatment in the last 3 months, pregnancy, and lactation were excluded. The research drug was administered orally in a dose of 3.5 gm B.D safūf (powder) of Saleekha with Joshānda (decoction) of Majeeth 7 gm BD for 14 days/ cycle for three consecutive cycles. Outcome measures were changes in subjective parameters (nature of bleeding, duration of cycles, duration of flow, amount of flow, weight reduction) and objective parameters, pictorial blood loss assessment chart (PBAC) score, basal metabolic index (BMI), modified Ferriman Gallwey (mFG) score, acanthosis nigricans scale and pelvic ultrasonography. Data were analyzed using the paired Student t-test. Results: Marked improvement was observed in menstrual irregularity and PBAC score with p<0.001 which is highly significant after the intervention. Significant change is seen in BMI, Ovarian volume, and SF-12 with p<0.001 after treatment. Safety parameters were within the normal range. Interpretation and Conclusion: Research drugs (Saleekha and Majeeth) can be used as an alternate remedy in PCOD patients, as it significant effect to regularize menstruation by reduction of BMI and probably by improving insulin resistance in PCOD. No adverse effect of the research drug was noted during the trial. Keywords:BMI, Majeeth, mFG, PBAC score, PCOD, SaleekhaView:PDF (272.5 KB)

The effect of hyperandrogenism and obesity on mindfulness and metacognition in adolescents with polycystic ovary syndrome

The aim of this study was to determine whether serum androgen levels have an effect on mindfulness and metacognition in adolescents with polycystic ovary syndrome (PCOS). Adolescents diagnosed with PCOS were asked to answer a questionnaire that included socio-demographic information and two scales: the Mindful Attention Awareness Scale (MAAS) and the Metacognition Scale Child and Adolescent form (MCQ-C). The patients were divided into two groups, the hyperandrogenism group and the non-hyperandrogenism group, according to serum androgen levels. The scores of MAAS and MCQ-C were compared between the groups. The study sample consisted of 70 adolescents. Of these, 44 had hyperandrogenism according to a blood test. No statistically significant difference was found in MAAS scores between the hyperandrogenism and the non-hyperandrogenism groups (p = 0.79). However, the level of mindfulness was found to be lower in participants with a higher modified Ferriman-Gallwey score (mFGS) (r = 0.26, p = 0.02). Mindfulness levels were also lower for obese patients with PCOS compared to non-obese patients with PCOS (p = 0.02). Cognitive monitoring (MCQ-C-CM), one of the MCQ-C sub-scales, was significantly higher in the non-hyperandrogenism group (p = 0.03), and similarly, a positive correlation was detected between higher androgen levels and the positive meta-worry (MCQ-C-PM) sub-scale of the MCQ-C (for total testosterone; r = 0.348, p = 0.03, and for androstenedione; r = 0.35, p = 0.03). High serum androgen levels in PCOS had no effect on mindfulness, but as the modified Ferriman Gallwey score increased, mindfulness levels decreased. For the sub-scales of MCQ-C,MCQ-C-CM, and MCQ-C-PM, the scores increased as androgen levels increased. In line with the results of the present study, evaluating mindfulness in PCOS patients with increased hair growth and metacognition in PCOS patients with serum hyperandrogenism may contribute well-being in adulthood by reducing the psychological burden caused by the disease.

New approaches to early detection of polycystic ovary syndrome in obese women

Objectives: development of an algorithm for the early detection of comorbid pathology polycystic ovary syndrome (PCOS) in obese women.Materials and methods. The study included 56 women aged 28.02 ± 2.25 years with a diagnosis of obesity who had no history of PCOS. The examination was carried out by a multidisciplinary group of doctors consisting of a family doctor, a gynecologist and an endocrinologist.The patient’s history of life and diseases was studied, an anthropometric еxamination and a survey according to the modified Ferriman–Gallwey scale were performed with a further ultrasound examination and a gynecologist consultation.Results. The majority of patients (55.36%) had acne, hirsutism and seborrhea occurred in 41.07 and 26.76% of women, respectively, and 14.29% of patients had alopecia. Often, the patient had not one, but several symptoms at the same time.According to the modified Ferriman–Gallwey scale, the majority of women (58.92%) had no manifestations of hirsutism along with obesity, 17.8% had moderate manifestations of hirsutism, 16.07 and 7.14% had mild and moderate hirsutism, respectively.The patients had no complaints and did not know whether they had PCOS. PCOS were diagnosed in 31 (55.36%) women after ultrasound examination and gynecologist consultation. It was also found that patients with longer obesity and a higher body mass index were more likely to have a diagnosis of PCOS (ρ = 0.77). The largest number of PCOS patients was among women with a body mass index over 40 kg/m2, i.e. with the III degree of obesity.Conclusions. The algorithm we developed for the diagnosis of PCOS in obese patients allowed us to detect this disease early in 55.36% of cases. We consider it appropriate to recommend screening for PCOS to all obese patients of reproductive age. This tactic will help maintain the fertility of this category of patients.

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.

The Degree of Menstrual Disturbance Is Associated With the Severity of Insulin Resistance in PCOS.

ObjectiveInsulin resistance (IR) is an important determinant of the phenotype and morbidity of the polycystic ovary syndrome (PCOS). In this study, we aimed to figure out the association between the degree of menstrual disturbance and the severity of IR in women with PCOS.DesignIt is a cross-sectional study conducted in an academic tertiary setting.PatientsThe patients comprised five hundred twenty-seven women diagnosed with PCOS by the 2003 Rotterdam criteria and 565 controls with regular vaginal bleeding.InterventionsThe interventions done for this study are medical history collection, physical examination, and blood sampling.Main outcome measuresThe main outcome measures are body mass index (BMI), fasting glucose, fasting insulin, homeostatic model assessment for IR (HOMA-IR), and hormonal parameters.ResultsWomen with PCOS had a higher level of BMI, HOMA-IR, and HOMA-β than controls, with a decreased level of sex hormone-binding globulin and QUICK I index. The luteinizing hormone (LH)/follicle-stimulating hormone (FSH), testosterone (T), antral follicle count (AFC), dehydroepiandrosterone sulfate, free androgen index, modified Ferriman–Gallwey score, and the incidence of delayed insulin peak increased with the degree of menstrual disturbance, although there was no significance for the latter four parameters. Women with vaginal bleeding intervals of 45–90 days had a relatively higher level of HOMA-IR and HOMA-β, although it was adjusted with age and BMI than the other two groups. Similar results were observed in AUCI (area under the curve of insulin) and I/G [the ratio of AUCI and AUCG (area under the curve of glucose)]. Anovulatory women with vaginal bleeding episodes of less than 45 days tended to have higher glucose and insulin levels, area under the curve of glucose (AUCG), area under the curve of insulin (AUCI), HOMA-IR, and HOMA-β but decreased QUICK I and Matsuda index than those who were ovulatory. Women with vaginal bleeding intervals of longer than 45 days who had hyperandrogenism (HA) showed a higher level of glucose, insulin, HOMA-IR, and HOMA-β but lower QUICK I and Matsuda Index.ConclusionsIn women with PCOS, the severity of IR, the LH/FSH ratio, and androgen level increased with a higher degree of disturbance in menstrual cyclicity (i.e., the vaginal bleeding intervals). Subgroup analysis indicated that the situation of HA may aggravate the disorder of glucose metabolism in women with PCOS. Overall, the interval between episodes of vaginal bleeding may be useful as a ready measure for predicting the severity of IR in PCOS.

Practical approaches to the use of markers of biochemical hyperandrogenism in women

Hyperandrogenism (HA) remains an actual problem that raises a large number of questions, in particular, in cases of discrepancy between the clinical signs of HA and biochemical parameters. This review includes an analysis of recent studies of androgen synthesis and metabolism in healthy women of reproductive age; management of pathologies accompanied by HA; as well as contemporary approaches to the principles of prescribing and evaluating the results of the main available markers of biochemical HA. There are сoncepts of clinical and biochemical HA. Biochemical HA is an increase in the levels of various circulating androgens. The concept of clinical HA includes hirsutism as assessed by the modified Ferriman–Gallwey scale. The most common causes of HA include polycystic ovary syndrome, non-classical forms of congenital adrenal hyperplasia, other endocrine disorders. It is necessary to carry out a differential diagnosis of these conditions with more rare causes as a primarily tumor pathology. The choice and evaluation of laboratory markers of biochemical HA should be made taking into account clinical data such as puberty history, anovulation, polycystic ovarian morphotype, obesity; presence and degree of hirsutism and/or other androgen-associated dermatopathies, the characteristics of the course of clinical HA (sudden onset, rapid progression), presence of other endocrinopathies, liver and kidney dysfunction; diabetes mellitus. The objectives of the laboratory assessment of HA are determination of HA severity; determination of the source of excess androgen synthesis (ovaries, adrenal glands); assessment of the free fraction of circulating active androgens; in some cases, assessment of the formation of active androgens in the skin. The following indicators are used to solve the tasks in laboratory diagnostics: total testosterone, free testosterone, free androgen index, androstenedione, dehydroepiandrosterone sulfate, 17-hydroxyprogesterone, dihydrotestosterone. A comprehensive assessment of these indicators allows not only assessing the presence of HA and its severity, but also the nature of its leading and secondary components, which determine the presence and prognosis of metabolic risks and allow individualizing therapeutic approaches.

Correlation between serum bisphenol A and testosterone levels in women with polycystic ovary syndrome

The aim was to estimate the levels serum bisphenol A and testosterone levels in women with polycystic ovary syndrome. This prospective case-control study was done from January to June 2021 and included 40 women PCOS (17-38 years), fulfilling the Rotterdam PCOS diagnostic criteria. Among women, 31 patients belonged to the PCOS group. Women with diabetes mellitus, Cushing’s syndrome, infectious diseases, hypertension, thyroid dysfunction, hyperprolactinemia, oral contraceptives, antiandrogens, and infertility treatment during the period in the last 6 months. Presence of hirsutism and/or acne was taken as basis of patients Hirsutism scores were determined using the Modified Ferriman Gallwey scoring system. The diagnosis of PCOS is in accordance with the Rotterdam 2003 Criteria, such as oligomenorrhea. Serum bisphenol A and testosterone levels were measured in all patients. The relationship between the variables was examined using the Pearson correlation method. The conformity of the variables to the normal distribution was investigated. Belonging to continuous variables; median, minimum and maximum values are presented. If the P value was less than 0.05, the difference between the groups was considered statistically significant. The study showed that bisphenol A level was elevated significantly (P&lt;0.01) in PCOS women (45.3 ± 9.24 ng/dl) as compared with control group, The study showed that testosterone level was elevated significantly (P&lt;0.01) in PCOS women (0.18 ± 0.03 ng/dl) as compared with control group (1.53 ± 0.29 ng/ml). The study showed that the highest mean of prolactin was in PCOS women (25.86 ± 7.31 ng/dl) as compared with control group (18.11 ± 3.14 ng/dl), with highly significant difference (P&lt;0.01).

Characterizing Dermatological Conditions in the Transgender Population: A Cross-Sectional Study.

This study aimed to demonstrate the effects of gender-affirming hormone therapy (GAHT) and gender-affirming procedures on the skin in transgender individuals. We conducted a cross-sectional study among transgender people. Skin conditions related to GAHT were assessed, including acne (using the Investigator's Global Assessment, IGA), postacne sequelae, melasma, hypertrichosis in androgen-sensitive areas (HAAs) in transgender men (TM) and hirsutism in transgender women (TW) (using the modified Ferriman-Gallwey score, mFG score), and hair loss (using the Hamilton-Norwood and Ludwig scale) at baseline, 6 months after GAHT, and the day on which the questionnaire was completed. Dermatological problems after gender-affirming procedures were evaluated. A total of 159 patients, including 134 TM and 25 TW, were eligible to participate. The median duration of GAHT was 23 and 36 months in TM and TW, respectively. In TM, the median IGA score of facial acne increased from 1 at baseline to 3 after 6 months and decreased to 2 after 2 years of GAHT. The mFG score indicated HAA in all TMs after testosterone treatment. A total of 88.1% of TM had no hair loss before hormone therapy. However, after 2 years of GAHT, 76.1% of TM developed male pattern hair loss (MPHL), and 26.1% of them had moderate-to-severe MPHL. In TW, the median IGA and mFG scores decreased after 3 years of hormone therapy, and the proportion of female pattern hair loss (FPHL) in TW increased to 16% after GAHT. In both groups, the most common skin complication after gender-affirming surgery was hypertrophic scarring. GAHT in TM resulted in acne and MPHL, whereas GAHT in TW caused melasma and FPHL.

PCOS Phenotype in Unselected Populations Study (P-PUP): Protocol for a Systematic Review and Defining PCOS Diagnostic Features with Pooled Individual Participant Data.

The diagnosis of polycystic ovary syndrome (PCOS) remains challenging due to limited data regarding normative cut-offs for the diagnostic features in different subpopulations. We aim to conduct a systematic review, build a comprehensive repository of de-identified individual participant data (IPD), and define normative ranges and diagnostic cut-offs for all PCOS diagnostic features. We will conduct a systematic search of MEDLINE and EMBASE databases for studies that assessed PCOS diagnostic features in unselected women. Two reviewers will assess eligibility and perform quality appraisal. Authors of included studies will be invited to contribute IPD. Primary variables include directly assessed modified Ferriman Gallwey (mFG) scores; menstrual cycle lengths; follicle number per ovary (FNPO), ovarian volume (OV), anti-Müllerian hormone (AMH); circulating androgens, including total testosterone (TT), free testosterone, bioavailable testosterone, free androgen index (FAI), androstenedione (A4), and dehydroepiandrosterone sulphate (DHEAS). Normative ranges and cut-offs will be defined using cluster analysis. Monash University Human Research Ethics Committee granted ethical approval (26938/0 1/12/2020), all IPD will be de-identified and primary studies have ethical approval from their institutional ethics committees. Findings will clarify distinction between PCOS and non-PCOS populations, and inform the update of the international evidence-based guidelines for the assessment and management of PCOS.