Presence Of Polycystic Ovarian Syndrome Research Articles

Endometrial Cancer in Reproductive-Aged Females: Etiology and Pathogenesis.

Endometrial cancer is the most common gynecologic malignancy in developed countries, and the incidence is rising in premenopausal females. Type I EC is more common than Type II EC (80% vs. 20%) and is associated with a hyperestrogenic state. Estrogen unopposed by progesterone is considered to be the main driving factor in the pathogenesis of EC. Studies show that BMI > 30 kg/m2, prolonged duration of menses, nulliparity, presence of polycystic ovarian syndrome, and Lynch syndrome are the most common causes of EC in premenopausal women. Currently, there are no guidelines established to indicate premenopausal patients who should be screened. This review aims to synthesize current data on the etiology, risk factors, presentation, evaluation, and prognosis of endometrial cancer in this population.

Role of Stress in Onset of Polycystic Ovarian Syndrome (PCOS)

Background: Polycystic ovarian syndrome (PCOS) is a prevalent endocrine disorder in women of reproductive age, characterized by a variety of symptoms that impact their physical and psychological health. Recent studies have suggested a potential link between stress and the onset of PCOS, but this relationship remains underexplored. Objective: The objective of this study was to investigate the correlation between stress and the development of PCOS in a young female population, specifically focusing on university students. Methods: This cross-sectional study involved 105 female university students aged between 15 and 25 years from major universities in Rawalpindi and Islamabad. Participants were divided into two groups: those diagnosed with PCOS and those without. Stress levels were measured using the Perceived Stress Scale (PSS), a 10-item questionnaire scored on a 5-point Likert scale. Data were analyzed using t-test and regression analysis to explore the correlation between stress levels and the presence of PCOS. Results: The study found that women with PCOS had significantly higher stress levels (M = 22.93, SD = 6.46) compared to those without PCOS (M = 19.56, SD = 4.45), with a t-value of 3.07 (p = .003). Regression analysis showed a positive correlation (r = .60, p < .001) between stress and PCOS. The majority of the PCOS-diagnosed group were single and within the 15-20 age range. Conclusion: The findings indicate a significant association between high stress levels and the presence of PCOS in young women. This suggests the need for incorporating stress management strategies in the prevention and treatment of PCOS. Further research with a more diverse and larger population is recommended to generalize these findings.

FRI402 “An Unusual Presentation Of Polycystic Ovary Syndrome” - Isolated DHEA-S Elevation In A Patient With Difficulty Conceiving And Recent Onset of Hirsutism

Abstract Disclosure: C. Musurakis: None. J.L. Gilden: None. Background: Isolated DHEA-S levels and worsening hirsutism often prompt the clinician to investigate more serious causes for the elevation, such as an adrenal mass. Clinical Case: A 29-year-old female G0P0 with Norwegian and English heritage and familial hypertriglyceridemia, was referred for elevated DHEA-S levels, and difficulty conceiving for past three years. She had hirsutism of face, chest, and abdomen, worsening over the last two years. Acne had also progressively worsened to cystic type. Menarche was at age 12, and menses were regular. She had never used contraception. Medications: docosahexanoic acid, eicosapentanoic acid, topical azelaic acid, benzoyl peroxide, clindamycin, pantoprazole, prenatal vitamins, and cholecalciferol. There was a family history of acne, but not for hirsutism or menstrual irregularities. Vitals: BP 137/73, HR 81, Ht 165.10 cm, Wt 86.18 Kg, BMI 31.68. Ferriman-Gallwey score was 10 with normal genitalia. Labs (luteal phase): DHEA-S 756 mcg/dL with repeat of 596 mcg/dl(n=35-430), total testosterone 25 ng/dL(n=2-45), free testosterone 4.3 pg/mL(n=0.1-6.4), prolactin 6.6 ng/mL(n=2.2-30.3), LH 5.1 mIU/mL(n=0.6-16.6), FSH 4.7 mIU/mL(n=1.7-12.9), 17-OH progesterone 74 ng/dL(n=139-431), androstenedione 163 ng/dL(n=73-184), estradiol 59.79 pg/mL(n=55.8-214.2), AMH 1.38 ng/mL(n=0.69-13.39), midnight salivary cortisol <0.03 and 0.05 mcg/dL(n<5), IGF-1 258 ng/mL(n=63-373), ACTH 31 pg/mL(n=0-47), AM cortisol 12.58 ug/dL(n=5.3-22.5), TSH 1.27 uIU/mL(n=0.358-3.74), Free T4 0.88 ng/dL (n=0.76-1.46), peroxidase antibodies 49.8 U/m (n=0-60), thyroglobulin antibodies <15(n=0-60), HbA1c 5.5% (n<=5.6%), 25-OH vitamin D 42.7 ng/mL(n=30-100) and negative pregnancy urine test. US pelvis: small follicles in ovaries and normal size. MRI abdomen w/wo contrast: normal bilateral adrenal glands. Cosyntropin stimulation test: baseline cortisol 15.03 ug/dL,17-OH progesterone 168 ng/dL. 30 mins: Cortisol 30.39ug/dL(n>18),17-OH progesterone 130ng/dL(n<200). 60 mins: cortisol 38.95ug/dL(n>18), 17-OH progesterone 153ng/dL(n<200). Non-Classical Congenital Adrenal Hyperplasia was excluded. Polycystic Ovary Syndrome (PCOS) was diagnosed based on clinical and biochemical hyperandrogenism, lack of adrenal mass, and clinical signs of anovulation. Conclusion: As reported by Carmina et al, few patients with PCOS exhibit isolated increase of serum DHEA-S. It is important to recognize that non-classic forms of PCOS (normal ovaries or normal ovulatory cycles) can present with a higher prevalence of adrenal hyperandrogenism than the common classical forms of PCOS. Reference: Carmina E, Longo RA. Increased Prevalence of Elevated DHEAS in PCOS Women with Non-Classic (B or C) Phenotypes: A Retrospective Analysis in Patients Aged 20 to 29 Years. Cells. 2022 Oct 17;11(20):3255. doi: 10.3390/cells11203255. PMID: 36291122; PMCID: PMC9601254. Presentation: Friday, June 16, 2023

Diagnostic Role of Anti-Mullerian hormone in Polycystic Ovarian Syndrome

Objective: To evaluate if the elevated levels of Anti-Mullerian hormone (AMH) could serve as an indicator of polycystic ovarian syndrome (PCOS) in patients presenting with infertility. Method: The present study was conducted at Institute of Molecular Biology and Biotechnology, The University ofLahore andAustralianConceptInfertilityMedicalCenter(ACIMC),Lahore. It was a case control study. Atotal of 101 females aged between 20-40 years presenting with infertility were included in this study. Among study participants, 51 infertile females had PCOS and 50 were non-PCOS infertile subjects. After taking informed consent, medical history and anthropometric indices were recorded on standardized proforma.Transvaginal ultrasound was done to assess ovarian morphology. Serum AMH, follicle stimulating hormone (FSH), luteinizing hormone (LH), thyroid stimulating hormone (TSH) and prolactin levels were measured by commercially available ELISAkits. Serum AMH levels were measured in 10 healthy, fertile females having normal menstrual cycle as normal reference values in our population. Results: Mean AMH levels were significantly higher (9.9±1.1ng/ml) in females with polycystic ovarian syndrome as compared to subjects without this syndrome (1.0± 0.3ng/ml). Mean FSH levels were significantly lower in females with PCOS (p value 0.001) but LH: FSH ratio, serum luteinizing hormone and prolactin level were not significantly different in two groups. Conclusion: The study provides evidence that raised serum levels of AMH are associated with the presence of PCOS and therefore can serve as useful marker in diagnosis of PCOS

Risk factors associated with preterm birth in singletons born after IVF: a national cohort study

Research questionWhat are the risk factors for prematurity other than intrauterine growth restriction in singletons after IVF? DesignData were collected from a national registry, based on an observational prospective cohort of 30,737 live births after assisted reproductive technology (fresh embryo transfers: n = 20,932 and frozen embryo transfer [FET] n = 9805) between 2014 and 2015. A population of not-small for gestational age singletons conceived after fresh embryo transfers and FET, and their parents, was selected. Data on a number of variables were collected, including type of infertility, number of oocytes retrieved and vanishing twins. ResultsPreterm birth occurred in 7.7% (n = 1607) of fresh embryo transfers and 6.2% (n = 611) of frozen–thawed embryo transfers (P < 0.0001; adjusted odds ratio [aOR] = 1.34 [1.21–1.49]). Endometriosis and vanishing twin increased the risk of preterm birth after fresh embryo transfer (P < 0.001; aOR 1.32 and 1.78, respectively). Polycystic ovaries or more than 20 oocytes retrieved also increased preterm birth risk (aOR 1.31 and 1.30; P = 0.003 and P = 0.02, respectively); large oocyte cohort (>20) was no longer associated with the risk of prematurity in FET. ConclusionEndometriosis remains a risk for prematurity even in the absence of intrauterine growth retardation, which suggests a dysimmune effect. Large oocyte cohorts obtained by stimulation, without clinical polycystic ovary syndrome diagnosed before attempts, do not affect FET outcomes, reinforcing the idea of a phenotypic difference in the clinical presentation of polycystic ovary syndrome.

Prediction of risk factors for first trimester pregnancy loss in frozen-thawed good-quality embryo transfer cycles using machine learning algorithms.

Can the risk factors that cause first trimester pregnancy loss in good-quality frozen-thawed embryo transfer (FET) cycles be predicted using machine learning algorithms? This is a retrospective cohort study conducted at Sisli Memorial Hospital, ART and Reproductive Genetics Center, between January 2011 and May 2021. A total of 3805 good-quality FET cycles were included in the study. First trimester pregnancy loss rates were evaluated according to female age, paternal age, body mass index (BMI), diagnosis of infertility, endometrial preparation protocols (natural/artificial), embryo quality (top/good), presence of polycystic ovarian syndrome (PCOS), history of recurrent pregnancy loss (RPL), recurrent implantation failure (RIF), severe male infertility, adenomyosis and endometriosis. The first trimester pregnancy loss rate was 18.2% (693/ 3805). The presence of RPL increased first trimester pregnancy loss (OR = 7.729, 95%CI = 5.908-10.142, P = 0.000). BMI, which is > 30, increased first trimester pregnancy loss compared to < 25 (OR = 1.418, 95%CI = 1.025-1.950, P = 0.033). Endometrial preparation with artificial cycle increased first trimester pregnancy loss compared to natural cycle (OR = 2.101, 95%CI = 1.630-2.723, P = 0.000). Female age, which is 35-37, increased first trimester pregnancy loss compared to < 30 (OR = 1.617, 95%CI = 1.120-2.316, P = 0.018), and female age, which is > 37, increased first trimester pregnancy loss compared to < 30 (OR = 2.286, 95%CI = 1.146-4,38, P = 0.016). The presence of PCOS increased first trimester pregnancy loss (OR = 1.693, 95%CI = 1.198-2.390, P = 0.002). The number of previous IVF cycles, which is > 3, increased first trimester pregnancy loss compared to < 3 (OR = 2.182, 95%CI = 1.708-2.790, P = 0.000). History of RPL, RIF, advanced female age, presence of PCOS, and high BMI (> 30kg/m2) were the factors that increased first trimester pregnancy loss.

Assessment of Pattern, Determinants and Treatment Practices of Menstrual Disorders Among Medical Undergraduate Students

Background: Menstruation-related symptoms (MRSs) have been observed to result in absenteeism from either work or education, more commonly among women below 21 years than women of any other age group. Despite its high prevalence and associated ill effects, it is generally ignored even by medical students. Objectives: This study was conducted to assess the pattern, determinants, and treatment practices of menstrual disorders among undergraduate medical students. Methods: This was a cross-sectional study conducted among 215 female medical students from first to final year. Data were collected by using a self-administered questionnaire. The height and weight of participants were measured using standard procedures. Results: The most common menstrual disorders reported by participants over the past six months were dysmenorrhoea (191(88.8%)) followed by irregular cycles (43(20.0%)). In multivariable analysis, the presence of polycystic ovarian syndrome (PCOS) and excessive consumption of coffee was associated with irregular menstrual cycles; the presence of anaemia was associated with menorrhagia, the presence of fibroids and age of participants were associated with polymenorrhoea, excessive chocolate consumption was related to intermenstrual bleeding, excessive chocolate consumption, presence of anaemia, and low body mass index (BMI) were associated with premenstrual syndrome. Self-medication was reported by 15 (42.9%) out of the 35 participants on treatment. Conclusion: Dysmenorrhoea and menstrual irregularities were common among participants. They need to limit potential risk factors like excessive consumption of coffee and chocolates. Additionally, screening for anaemia, PCOS, fibroids and low BMI needs to be done. Self-medication practices need to be also dissuaded in the setting.

Frequency and Risk Factors for Depression and Anxiety in Patients with Polycystic Ovary Syndrome Presenting in a Tertiary Care Hospital Karachi, Pakistan

Objective: To determine the frequency and risk factors for depression and anxiety in patients with Poly cystic ovary syndrome (PCOS). Study design: Comparative Analytic Study. Setting and duration: Department of Obstetrics and Gynaecology at a tertiary care hospital in Karachi, Paki- stan from July 2020-December 2020. Materials and methods: All females with diagnosed PCOS aged between 15-45yrs were included in the study .A total of 270 females (n=135) formed the study group. Group A (n=135) constituted females diagnosed to have PCOS and group B (n=135) without PCOS. Both groups were compared for anxiety and depression according to Hospital anxiety and Depression Scale (HADS).Demographic features were compared as well (age, qualification, BMI and parity). Results: A total of 270 females were part of this research (n=135).Most 170 (62.9%) of study population was aged between 21-35years.112 (41.5%) were undergraduate. Most 160 (59.2%) of participants had normal BMI <25kg/m .In group A, 38 (28.1%) had depression along with 43(31.9%) having borderline depression versus 12 (8.9%) had borderline depression in group B, p-value 0.000, which is statistically significant .The overall incidence of anxiety in Group A was 116 (85.9%) versus 50 (37%), p value 0.00 which is statistically significant. Conclusion: Depression and anxiety are common in PCOS. There is strong association of depression with young age (21-35), among graduate women and with no children that is subfertility.

Risk Factors in Young Female Patient with Polycystic Ovary Syndrome presenting with Acute Myocardial Infarction

Abstract Polycystic ovary syndrome (PCOS) is known to cause weight gain, nonspecific inflammation, dyslipidemia, and coronary artery disease (CAD). Oral contraceptives (OCs) also cause venous and arterial thromboembolism, cerebrovascular accidents (CVA), and acute coronary syndrome (ACS). Myocardial infarction (MI) is comparatively less common in patients taking newer generation OCs, particularly if risk factors for CAD are absent, but the risk for venous thromboembolism is still high. Therefore, OCs should be considered in properly selected patients after weighing risks and benefits.

Comparison of Vitamin D Status for Hirsutism, Biochemical Hyperandrogenism, Glycemia and Dyslipidemia among Subjects with Polycystic Ovarian Syndrome (PCOS)

Background: Data indicates that Vitamin-D (VD) insufficiency (low level of serum VD) has a close association with many metabolic disorders. Polycystic Ovary Syndrome (PCOS) is considered to be a metabolic disorder and VD administration has been attempted to ameliorate PCOS. VD insufficiency has been reported to be present in women with PCOS. However, coexisting conditions with PCOS (hyperandrogenism, insulin resistance, obesity, glucose intolerance, and dyslipidemia) have prevented to confirm this association. Methods: We measured and compared serum VD level in patients with PCOS (n=169) vs. those without PCOS (n=164), who visited PNS HAFEEZ Hospital Islamabad between Jan 2018-July 2019. We also compared VD level in relation to the following: BMI (using General Linear Model (GLM)), glucose levels and lipid parameters for patients with vs. without PCOS. Free Androgen Index (FAI) and modified Ferriman Gallwey (mFG) scores were compared between VD groups using one-way ANOVA. GLM was used to compare the effects of VD status and presence or absence of PCOS on insulin resistance. Results: Patients with PCOS, compared with those without it, showed lower VD levels regardless of BMI. Similarly, Lower level of Vitamin-D was observed in hyper-androgenism (Free Androgen Index (FAI)) and hirsutism (modified FG scores). Using univariate GLM with insulin resistance as dependent (confirmed) variable and PCOS and VD defined groups as independent factors, an increase in insulin resistance was observed with lower VD and the presence of PCOS. Conclusion: Patients with PCOS had lower VD levels than those with non-PCOS.

The Overlap Between Binge Eating Behaviors and Polycystic Ovarian Syndrome: An Etiological Integrative Model.

Studies indicate that Polycystic Ovarian Syndrome (PCOS) features (e.g. insulin instability, food cravings, overproduction of androgens and menstrual irregularities) are associated with increased appetite, impaired impulse control and feelings of body dissatisfaction. Counter intuitively, binge eating behaviors have been shown to reinforce PCOS symptomatology, precipitating concurrently body dissatisfaction, weight gain, insulin instability and overproduction of androgens. The present systematic literature review aspires to investigate the relationship between binge eating, in the broader context of eating disorder behaviors, and Polycystic Ovarian Syndrome (PCOS), taking into account shared characteristics between EDs (Eating Disorders) and PCOS. To address this aim, the PRISMA guidelines are adopted. A total of 21 studies, which investigated the presence of binge eating in PCOS population and the presence of PCOS in EDs population, were synthesized. Findings suggested that an increased prevalence of binge eating has been reported in women with Polycystic Ovarian Syndrome (PCOS); and that women suffering from BN (Bulimia Nervosa) and BED (Binge Eating Disorder) are more likely to display polycystic ovaries. Further research on their shared liability is required in order to inform more efficient prevention and treatment initiatives for populations presenting with comorbid features.

The effect of hirsutism on the quality of life of Indian women

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Quality of life is an individual perception of physical, psychological and social functioning. Hirsutism is excess male pattern hair growth in females. In women, hirsutism causes significant psychological and social problems. It impacts quality of life negatively. So, this study was undertaken to determine the quality of life of women with hirsutism using dermatology life quality index (DLQI).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Hirsutism was assessed quantitatively by Ferriman-Gallwey score (F-G score) and qualitatively by self-administered questionnaires of DLQI. Other parameters such as age, occupation, co- morbidities, socio-economic status, marriage status, religion, educational status were assessed.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; DLQI of 100 hirsute women, 12% had no effect, 34% had small effect, moderate effect in 37%, had very large effect in 17% and no patients had extremely large affect. Daily activity had highest mean DLQI followed by symptoms and feelings. The mean DLQI score of 100 hirsute women was 6.67±4.57. Mean DLQI score of hirsute women with polycystic ovarian syndrome (PCOS) was 9.96±5.62 which was greater than the patients without PCOS and it was statistically significant (p=0.03). DLQI score was not affected by severity of hirsutism, age, occupation, socio-economic status, marriage status, religion and educational status.&lt;/p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Hirsutism had a moderate effect on the quality of life of Indian women. Impairment of quality of life was greater with the presence of PCOS. Daily activity of the Indian women was affected the most due to the presence of hirsutism.

A cross sectional study of polycystic ovarian syndrome among young women in Bhopal, Central India

Background: Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder among women of reproductive age groups. It is one of the leading causes of poor fertility. Risk factors include obesity, not enough physical exercise, and a family history. Most studies in India report prevalence of PCOS as 9.13% to 36%. Behaviour and life style modifications are important part of treatment for PCOS. A number of cases in the community due to lack of awareness and proper guidance, it remains undiagnosed. Aim of this study was to find the prevalence of PCOS among the young females of Bhopal city. Thus, risk assessment in the form of a survey would be one of the strategies to identify this syndrome early so as to encourage young women to seek timely treatment and prevent its long term complications. Methods: Non comparative cross sectional study for duration of 8 month. Results: The prevalence of PCOS in this study was 8.20%. Among all the risk factors, BMI ≥25 (P value &lt; 0.0001) and waist hip ratio ≥0.85 (&lt;0.0001) were strongly associated with the presence of PCOS and Lack of awareness, there were in girls (78.4%). Conclusions: Women who were having BMI ≥25 and waist hip ratio ≥0.85 should be educated about its complications and should be advised weight loss. Girls who had irregularity of menses and signs of hyperandrogenism should be investigated and must be managed accordingly. Early diagnosis of PCOS and its prompt treatment will help the girls to improve quality of life.

Psychological burden among women with polycystic ovarian syndrome in Oman: a case-control study.

PurposePrevious studies in Euro-American populations have shown that women with polycystic ovarian syndrome (PCOS) have increased levels of “psychological burden”. While PCOS has been reported in Arab countries such as Oman, there is a dearth of studies of the occurrence of psychological burden among PCOS women in the Arab region. This study aimed to compare sociodemographic and clinical characteristics of PCOS women diagnosed with non-PCOS women and prevalence of severity of depression, anxiety and stress and to explore the association between PCOS and indices of psychological disturbances after adjusting for potential confounding factors.Patients and methodsThis hospital-based case–control study was conducted among women aged 16–49 years. The study included 52 women diagnosed with PCOS (as per Rotterdam 2003 criteria) and 60 control who were PCOS-free. The presence of psychological burden – depression, anxiety and stress – was quantified using Depression, Anxiety and Stress Scale-21 (DASS-21).ResultsThe crude odds ratios (ORs) generated by logistic regression models indicated an increased risk of depression, anxiety and stress among women with PCOS compared to controls. The adjusted OR also indicated an increased risk of depression (OR =1.10; 95% confidence interval [CI] 0.50, 2.43), anxiety (OR =1.09; 95% CI 0.47, 2.52) and stress (OR =1.45; 95% CI 0.68, 3.12), However, no statistical differences were observed along the three psychological distresses (p>0.05) between the two study groups.ConclusionThe study indicates that the presence of PCOS is associated with an increased risk of psychological burden. If this study will withstand further scrutiny, meeting psychological needs of such population would need to be contemplated.

Clinical Presentation of Polycystic Ovary Syndrome among Saudi Arabian Women - Jeddah, Saudi Arabia

Background: Polycystic ovary (PCO) is a highly variable condition with a wide array of presentations. The Polycystic ovary syndrome should meet at least two of the following three criteria: oligo- or anovulation; clinical and/or biochemical signs of hyperandrogenism; polycystic ovaries on ultrasound. The prevalence of PCO is largely unknown in Saudi Arabia. Objectives: The aim of this study was to investigate the reproductive hormones levels in patients with polycystic ovary syndrome (PCOS) in addition to the effect of age and body mass index (BMI) on the hormonal findings ,ultrasound and to determine the clinical, biochemical, and etiologic features of hirsutism in Saudi females. Methodology: A cross sectional study has been conducted among total of 183 patients diagnosed with PCOS had been assessed clinically along with measuring the level of reproductive hormones in Obstetrics and Gynecology Clinic at King Abdul-Aziz hospital and oncology center in Jeddah, Saudi Arabia, between June 2015 and June 2016. Conclusion: Elevated levels of luteinizing hormone / Follicle stimulating hormone LH/FSH and testosterone and reduced FSH, hormone-binding globulin (SHBG), and progesterone were predictors of PCOS. This was independent of BMI or age. Future studies with larger sample size and data on insulin levels are needed for greater understanding of the manifestations of PCOS in the Saudi population.

Prevalence of metabolic syndrome in relation to body mass index and polycystic ovarian syndrome in Indian women.

OBJECTIVE:To study the prevalence of metabolic syndrome (MBS) in Indian women and to see how does it correlate to body mass index (BMI) and polycystic ovarian syndrome (PCOS) in this population.STUDY DESIGN:Prospective cross-sectional observational study.SETTING:Infertility clinic of a tertiary center.MATERIALS AND METHODS:Two hundred women, 120 with PCOs and 80 age-matched controls were enrolled. The prevalence of MBS was studied in the women with and without and was co related to BMI by further subgrouping as team (BMI <23 kg/m3) and obese (BMI >23 kg/m2). The sample size was: team controls-40, obese controls-40, team PCOS-80. Each subject underwent a physical examination and laboratory evaluation for the diagnosis of MBS, which was defined according to the guidelines of National Cholesterol Education Program Adult Treatment Pamel (NCEP ATP III) 2005.INTERVENTION:None.MAIN OUTCOME MEASURES:Main Outcome Measures: Subjects with and without PCOs were compared with each other for the prevalence of MBS, and similarly team subjects were compared with obese subjects. Receiver operator characteristic (ROC) curves were obtained for both the PCOS and non PCOS population separately, co-relating the prevalence of MBS with BMI. These ROC curves were used to establish the cut off values of BMI, which could best predict the risk of MBS.RESULTS:The prevalence of MBS was significantly higher in the women with PCOS, as compared to age-matched controls. Similarly, when BMI was considered, MBS was more prevalent in overweight subjects than in lean subjects with or without PCOS. In subgroup analysis, the presence of PCOS had a lesser impact on the prevalence of MBS as compared to non-PCOS controls with higher BMI. The relative risk of MBS increased as follows: lean controls-1, lean PCOS-2.66, obese controls-5.33, and obese PCOS-6.5. The most appropriate cut-off level of BMI for predicting the risk of MBS in Indian women without PCOS seems to be 23 kg/m2, whereas, with PCOS, it was 22.5 kg/m2.CONCLUSION:MBS is more prevalent in women with PCOS. However, obesity is an independent and stronger risk factor for developing MBS. To reduce the risk of MBS and its related long-term health consequences, lifestyle modification is advisable above BMI of 23 kg/m2 in the normal population and 22.5 kg/m2 in women with PCOS.

Clinical and biochemical presentation of polycystic ovary syndrome in women between the ages of 20 and 40

The clinical features and metabolic complications of polycystic ovary syndrome (PCOS) may change with age. This study was designed to investigate the clinical and biochemical characteristics of PCOS patients between the ages of 20 and 40. The study included 781 Taiwanese women, of whom 453 were diagnosed with PCOS and 328 were non-PCOS controls. Anthropometric components, androgens, endocrine, insulin resistance, and metabolic components were measured and correlated with age. Above parameters were compared between younger and elder women with PCOS. Age had significant negative correlations with androgens (total testosterone and dehydroepiandrosterone sulfate), the modified Ferriman-Gallwey score and the prevalence of acne and hirsutism. Age had significant positive correlations with fasting glucose, cholesterol, triglycerides and low-density lipoprotein. The 453 women who fulfilled diagnostic criteria for PCOS were classified by age into two groups: Group A (20-29 years old, n= 294) and Group B (30-40 years old, n= 159). Group A had significantly higher total testosterone levels than Group B. Group B had higher fasting insulin and glucose levels, triglycerides, body mass index and waist measurements and a higher incidence of obesity than Group A. The average ovarian volume was not significantly different among the two groups. Increased age is accompanied by a decrease in the prevalence of both clinical and biochemical hyperandrogenism in women. Hyperandrogenism is the important factor for young women with PCOS; however, abdominal obesity and certain metabolic disturbances became major concerns for older women with PCOS.

Independent predictors of cardiovascular risk in polycystic ovarian syndrome

We aimed to determine the independent predictors of cardiovascular risk in polycystic ovarian syndrome (PCOS). Ninety-one PCOS and 51 control patients were enrolled to our prospective cross sectional case–control study. In early follicular phase hormonal and lipid profile, fasting insulin and CRP (hs-CRP) levels and glucose levels on fasting and 2 h after the 75 g glucose intake were determined. Insulin resistance (IR) was evaluated with homeostasis model assessment and free testosterone was determined with free androgen index. PCOS was found to be associated with dyslipidemia, hyperandrogenism, IR and sub-clinical inflammation. The prevalence of overweight–obesity (41.8% vs. 25.5%, p = 0.038), IR (42.9% vs. 23.5%, p = 0.035) and glucose intolerance (15.38% vs. 1.96%, p = 0.043) were significantly higher in PCOS compared to control group. Independent predictors of the risk of elevated hs-CRP level were PCOS status (OR = 5, 95% CI: 1.55–16.14, p = 0.007) and high BMI (OR = 4.2, 95% CI: 1.2−14.2, p = 0.022) and high BMI (OR = 1.2, 95% CI: 1.05−1.4, p = 0.007) and of TC/HDL ratio was high BMI (OR = 1.21, 95% CI: 1.05–1.4, p = 0.009) and increasing age (OR = 1.11, 95% CI: 1.01–1.2, p = 0.04). The presence of PCOS, independent from obesity and IR, is the strongest predictor of elevated hs-CRP level. Obesity and advanced age further increases the cardiovascular risk in PCOS.

Understanding the presentation of polycystic ovary syndrome (PCOS) in the adolescent population: results from a multispecialty adolescent PCOS program

OBJECTIVE: PCOS is increasingly appreciated in adolescents. The diagnostic criteria for this group are unclear, including the utility of transabdominal pelvic ultrasonography (TAS). We examined how TAS findings correlate with endocrine and metabolic parameters in adolescents with PCOS.

Inherited lipodystrophies and the metabolic syndrome

Lipodystrophies represent a heterogeneous group of diseases characterized by an abnormal subcutaneous fat distribution, the extent of which can vary from localized, to partial, to generalized lipoatrophy. Whereas partial and generalized lipodystrophies are each associated with metabolic abnormalities, the localized form is not. These metabolic changes include insulin resistance with type 2 diabetes, acanthosis nigricans, dyslipidaemia predominantly consisting of hypertriglyceridaemia (associated with the onset of pancreatitis) and depressed HDL cholesterol, liver steatosis and hypertension. Affected women are often hirsute and this can be associated with the presence of polycystic ovarian syndrome (PCOS). Most of these clinical features are present to some extent in patients with the common metabolic syndrome. As the prevalence of metabolic syndrome far outweighs that of lipodystrophy, the diagnosis of this rare disorder may often be overlooked with the affected patient diagnosed as merely being 'yet' another case of metabolic syndrome. In this article, we draw attention to the importance of recognizing patients with lipodystrophy who present with metabolic abnormalities, as both the diagnostic as well as the therapeutic approach of these patients differ profoundly from patients with the metabolic syndrome.