Abstract
Context
Premature adrenarche (PA) may increase the risk for polycystic ovary syndrome (PCOS).
Objective
To study features of PCOS in young adult women with a history of PA.
Methods
Thirty PA ...and 42 control females were followed from prepuberty to young adulthood (median age 18.1 years). The main outcome measures were ovarian function, the use of contraceptives, and clinical and biochemical indicators of hyperandrogenism.
Results
We found no differences in the use of hormonal contraceptives (50 vs 50%, PA vs controls, respectively; P > .999), indication for using contraceptives (P = .193), or in the history of oligo- (17 vs 26%, P = .392) and amenorrhea (0 vs 0%, P > .999). Among women not using hormonal contraceptives, those with a history of PA had a higher prevalence of hirsutism (27 vs 0%, P = .023) but not acne (87 vs 67%, P = .252). Steroid profiles were broadly comparable between the groups, but PA women had lower sex hormone–binding globulin (SHBG) concentrations (30.1 vs 62.4 nmol/L, P < .001) resulting in higher free androgen index (3.94 vs 2.14, P < .001). The difference in SHBG levels persisted through body mass index adjustment. SHBG correlated negatively with the homeostasis model assessment for insulin resistance (r –0.498, P = .003). Anti-Müllerian hormone concentrations were comparable between the groups (39.3 vs 32.1 pmol/L, P = .619).
Conclusion
PA was not associated with evident ovarian dysfunction in young adult women. However, women with a history of PA had decreased SHBG levels and thus, increased bioavailability of circulating androgens.
Abstract
Context
Despite the gut microbiome being widely studied in metabolic diseases, its role in polycystic ovary syndrome (PCOS) has been scarcely investigated.
Objective
Compare the gut ...microbiome in late fertile age women with and without PCOS and investigate whether changes in the gut microbiome correlate with PCOS-related metabolic parameters.
Design
Prospective, case–control study using the Northern Finland Birth Cohort 1966.
Setting
General community.
Participants
A total of 102 PCOS women and 201 age- and body mass index (BMI)-matched non-PCOS control women. Clinical and biochemical characteristics of the participants were assessed at ages 31 and 46 and analyzed in the context of gut microbiome data at the age of 46.
Intervention
(s): None
Main outcome measure(s)
Bacterial diversity, relative abundance, and correlations with PCOS-related metabolic measures.
Results
Bacterial diversity indices did not differ significantly between PCOS and controls (Shannon diversity P = .979, unweighted UniFrac P = .175). Four genera whose balance helps to differentiate between PCOS and non-PCOS were identified. In the whole cohort, the abundance of 2 genera from Clostridiales, Ruminococcaceae UCG-002, and Clostridiales Family XIII AD3011 group, were correlated with several PCOS-related markers. Prediabetic PCOS women had significantly lower alpha diversity (Shannon diversity P = .018) and markedly increased abundance of genus Dorea (false discovery rate = 0.03) compared with women with normal glucose tolerance.
Conclusion
PCOS and non-PCOS women at late fertile age with similar BMI do not significantly differ in their gut microbial profiles. However, there are significant microbial changes in PCOS individuals depending on their metabolic health.
To investigate plasma antimüllerian hormone (AMH) concentration and its relation to steroid hormone levels in pregnant women with polycystic ovary syndrome (PCOS) and controls at term.
Case–control ...study.
University-affiliated hospital.
A total of 74 pregnant women at term: 25 women with PCOS (aged 31.6 ± 3.9 years mean ± standard deviation, body mass index 24.0 ± 3.9 kg/m2, mean gestational length 279 ± 9 days) and 49 controls (aged 31.7 ± 3.3 years, body mass index 24.0 ± 3.3 kg/m2, mean gestational length 281 ± 9 days).
None.
Plasma AMH and steroid hormone levels.
Antimüllerian hormone, T, and androstenedione levels were higher in women with PCOS at term compared with controls, whereas estrogen and P levels were similar. The differences were pronounced in women carrying a female fetus. Testosterone and AMH levels correlated positively in both groups, but E2 levels only in women with PCOS.
Pregnant women with PCOS present with elevated AMH and androgen levels even at term, suggesting a hormonal imbalance during PCOS pregnancy. Differences were detected especially in pregnancies with a female fetus, raising the question of whether female pregnancies are more susceptible to AMH and steroid hormone actions.
Los niveles de hormona antimülleriana y esteroidea circulantes se mantienen altos en mujeres embarazadas a término con síndrome de ovario poliquístico
Investigar la concentración plasmática de hormona antimulleriana (AMH) y su relación con los niveles de hormonas esteroides en mujeres embarazadas a término con síndrome de ovario poliquístico (PCOS) y controles.
Estudio de casos y controles.
Hospital afiliado a la universidad.
Un total de 74 mujeres embarazadas a término: 25 mujeres con PCOS (edad 31,6 ± 3,9 años media ± desviación estándar, índice de masa corporal 24,0 ± 3,9 kg/m2, duración media de la gestación 279 ± 9 días) y 49 controles (edad 31,7 ± 3,3 años, índice de masa corporal 24,0 ± 3,3 kg/m2, duración media de la gestación 281 ± 9 días).
Ninguna.
Niveles plasmáticos de AMH y de hormonas esteroides.
Los niveles de hormona antimülleriana, T, y androstenediona fueron mayores en mujeres con SOP a término comparados con los controles, mientras que los niveles de estrógeno y P fueron similares. Las diferencias fueron pronunciadas en mujeres portadoras de un feto femenino. Los niveles de testosterona y AMH se correlacionaron positivamente en ambos grupos, pero los niveles de E2 sólo en mujeres con PCOS.
Las mujeres embarazadas con PCOS presentan niveles elevados de AMH y andrógenos incluso a término, sugiriendo un desequilibrio hormonal durante el embarazo con PCOS. Las diferencias fueron detectadas especialmente en los embarazos con un feto femenino, lo que plantea la cuestión de si los embarazos femeninos son más susceptibles a los efectos de la AMH y de las hormonas esteroides.
Abstract
Context
Polycystic ovary syndrome (PCOS) is associated with decreased health-related quality of life (HRQoL), but longitudinal data beyond the reproductive years are lacking, and the impact ...of isolated PCOS symptoms is unclear.
Objective
To study generic HRQoL using the 15D questionnaire, life satisfaction, and self-reported health status in women with PCOS symptoms at ages 31 and 46 years.
Design
A longitudinal assessment using the Northern Finland Birth Cohort 1966.
Setting
General community.
Participants
The 15D data were available for women reporting isolated oligo-amenorrhea (OA; at age 31 years, 214; and 46 years, 211), isolated hirsutism (H; 31 years, 211; and 46 years, 216), OA + H (PCOS; 31 years, 74; and 46 years, 75), or no PCOS symptoms (controls; 31 years, 1382; and 46 years, 1412). Data for life satisfaction and current health status were available for OA (31 years, 329; and 46 years, 247), H (31 years, 323; and 46 years, 238), PCOS (31 years, 125; and 46 years, 86), control (31 years, 2182; and 46 years, 1613) groups.
Intervention(s)
None.
Main Outcome Measure(s)
15D HRQoL, questionnaires on life satisfaction, and self-reported health status.
Results
HRQoL was lower at ages 31 and 46 in women with PCOS or H than in the controls. PCOS was an independent risk factor for low HRQoL, and the decrease in HRQoL in PCOS was similar to that of women with other chronic conditions, such as asthma, migraine, rheumatoid arthritis, and depression. The risk for low HRQoL in PCOS remained significant after adjusting for body mass index, hyperandrogenism, and socioeconomic status. Mental distress was the strongest contributing factor to HRQoL. PCOS was also associated with a risk for low life satisfaction and a 4-fold risk for reporting a poor health status.
Conclusions
Women with PCOS present with low HRQoL, decreased life satisfaction, and a poorer self-reported health status up to their late reproductive years. Assessments and interventions aiming to improve HRQoL in PCOS should be targeted beyond the fertile age.
Context:
Statins have been shown to improve hyperandrogenism in women with polycystic ovary syndrome (PCOS). However, their use has also been associated with impairment of glucose metabolism and an ...increased risk of type 2 diabetes mellitus. Because women with PCOS are prone to disturbances in glucose metabolism, statin therapy could also have negative effects.
Objective:
Our objective was to explore the effects of atorvastatin therapy on hormonal and metabolic parameters in women with PCOS.
Design and Setting:
We conducted a randomized, double-blind, placebo-controlled 6-month follow-up study conducted at Oulu University Hospital, Finland.
Patients:
Women with PCOS (Rotterdam criteria) were treated with atorvastatin (20 mg/d, n = 15) or placebo (n = 13) for 6 months.
Interventions:
Fasting serum samples were collected at baseline and at 3 and 6 months. Oral and iv glucose tolerance tests were performed at 0 and 6 months.
Main Outcome Measures:
Androgen secretion and glucose metabolism were measured.
Results:
Fasting levels and area under the curve of insulin increased significantly and insulin sensitivity (insulinogenic and Matsuda indexes) decreased during 6 months of atorvastatin therapy. Serum levels of dehydroepiandrosterone sulfate decreased in the atorvastatin group, whereas no change was observed in serum testosterone levels. Levels of C-reactive protein, total and low-density lipoprotein-cholesterol, and triglycerides decreased significantly during statin therapy.
Conclusions:
Atorvastatin therapy improves chronic inflammation and lipid profile, but it impairs insulin sensitivity in women with PCOS. Because women with PCOS have an increased risk of developing type 2 diabetes mellitus, the results suggest that statin therapy should be initiated on the basis of generally accepted criteria and individual risk assessment of cardiovascular disease, and not only because of PCOS.
Background
Polycystic ovary syndrome (PCOS) is the most common gynaecological endocrinopathy in women of fertile age and represents a major health issue among women affecting not only reproductive ...function, but also emergence of the most frequent causes of morbidity and mortality in women of postmenopausal age – type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVDs). The current epidemic of obesity suggests that the prevalence of PCOS and its adverse health effects may rise even further in the future.
Objectives
The ability to predict development of PCOS early in life would be essential to decrease and prevent late morbidity linked to PCOS, although, on the other hand, over-diagnosis should be avoided as it can lead to unnecessary labelling and can impact on an adolescent’s quality of life.
Materials and methods
Systematic search in the Medline literature database through PubMed using the search terms “Polycystic ovary syndrome”, “PCOS”, “Adolescents”, “Polycystic ovary morphology”, “PCOM”, “Menstrual disorders in adolescence”, “Hirsutism”, “Hyperandrogenaemia”, “Anti-Müllerian hormone”, “Obesity and adolescents” and “Prediction of PCOS”.
Results and conclusions
Follow-up and re-evaluation are warranted in all adolescents with features suggestive of PCOS, such as menstrual irregularities two or more years after menarche, or a menstrual interval >90 days, moderate to severe hirsutism and moderate to severe inflammatory acne vulgaris unresponsive to topical medication. Because of the strong association between obesity, weight gain through life, hyperandrogenism and development of PCOS, screening for PCOS and overweight/obesity as early as in adolescence is important in order to tailor treatment and intervention protocols and reduce future risks of infertility, CVDs and T2DM.
Objective was to evaluate serum anti-Müllerian hormone (AMH) levels in polycystic ovary syndrome (PCOS) and in its different phenotypes in relation to clinical, endocrine and metabolic parameters ...using a new automated VIDAS
®
method and to compare it with the Gen II method. Study design was multi-center study including 319 PCOS women and 109 healthy controls. Serum AMH levels measured using VIDAS
®
were significantly higher in PCOS women than controls (p < .001), and they correlated with those measured using the AMH Gen II method. An AMH cutoff value of 42.1 pmol/L distinguished PCOS women from controls with 67% sensitivity and 83% specificity. The PCOS women with three Rotterdam criteria or hyperandrogenism displayed significantly higher AMH levels compared with those with two Rotterdam criteria or normoandrogenism. In PCOS, AMH levels correlated positively with luteinizing hormone (LH), androgen and sex hormone-binding globulin (SHBG) levels and negatively with BMI, abdominal obesity, follicle-stimulating hormone (FSH), fasting glucose and insulin, and insulin resistance. In conclusion, AMH evaluated using the VIDAS
®
method distinguished PCOS patients from healthy controls relatively well, especially in those with more severe phenotypes. Further studies are needed to establish whether AMH measurements can distinguish PCOS patients with different metabolic risk factors.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
This population-based follow-up study investigated register-based disease diagnoses and medication use up till age of 50 years among women with polycystic ovary syndrome (PCOS) that were identified ...from a population-based birth cohort.
Population-based longitudinal cohort study.
Women reporting oligo/amenorrhea and hirsutism at age 31 and/or who were diagnosed with PCOS by a physician by age 46 (n = 244) and women without PCOS symptoms or diagnosis (n = 1 556) in the Northern Finland Birth Cohort 1966.
National register data on diagnosed diseases (ICD-8-10) and medication use (ATC) until the age of 50.
Women with PCOS had a 26% higher risk for any registered diagnosis (RR: 1.26 1.09-1.46) and a 24% higher risk for medication use (RR: 1.24 1.05-1.46) compared to non-PCOS women, even after adjusting for several confounders. Several main ICD categories were more prevalent among women with PCOS versus non-PCOS controls, e.g., endocrine, metabolic, nervous system, musculoskeletal and genitourinary diseases in addition with different symptoms and injuries. Surprisingly, even though the overall morbidity was only increased in women with PCOS with a BMI ≥ 25gk/m2, there were several ICD main categories that showed higher comorbidity risk especially in women with PCOS with a BMI <25 kg/m2. Several medications were prescribed more often to women with PCOS versus non-PCOS controls, e.g., medications related to the alimentary tract and metabolism, the cardiovascular system, genito-urinary system drugs and sex hormones, dermatologic and hormonal preparations, and medications to treat the musculoskeletal, nervous, and respiratory systems.
Women with PCOS are burdened with multimorbidity and higher medication use, independent of BMI and other confounders. Accordingly, preventive strategies are needed to alleviate the disease burden and improve the health outcomes of women with PCOS.
The role of androgen excess as a contributing factor to abnormal glucose metabolism (AGM) and insulin resistance in women remains controversial.
To investigate whether hyperandrogenemia (HA) ...estimated by serum testosterone (T) level and free androgen index (FAI) at ages 31 and 46 years is associated with insulin resistance, insulin secretion and AGM by age 46.
Prospective study including 5889 females followed at ages 31 and 46 years.
General community.
Women with HA were compared with normoandrogenic women at ages 31 and 46 years.
None.
AGM, including prediabetes and type 2 diabetes mellitus, homeostatic model assessments of insulin resistance (HOMA-IR) and of pancreatic β-cell function (HOMA-B).
At age 31 years, HA women displayed increased HOMA-IR (P = 0.002), HOMA-B (P = 0.007), and higher fasting insulin (P = 0.03) than normoandrogenic women after adjusting for body mass index (BMI). At age 46 years, there was a nonsignificant trend toward higher fasting glucose (P = 0.07) and glycated hemoglobin A1 (P = 0.07) levels in HA women. Women in the highest T quartile (odds ratio OR = 1.80; 95%CI, 1.15-2.82) at age 31 years and in the 2 highest FAI quartiles at ages 31 (Q4: OR = 3.76; 95% CI, 2.24-6.32) and 46 (Q4: OR = 2.79; 95% CI, 1.74-4.46) years had increased risk for AGM, independently of BMI, when compared with women in Q1. SHBG was inversely associated with AGM (at age 31 years: Q4: OR = 0.37; 95% CI, 0.23-0.60, at age 46 years: Q4: OR = 0.28; 95% CI, 0.17-0.44).
Hyperandrogenemia and low SHBG in early and middle age associates with AGM independently of BMI.
Objective Polycystic ovary syndrome (PCOS) presents with multiple comorbidities potentially affecting function. This was the first general population-based study to evaluate work ability, ...participation in working life, and disability retirement in middle-aged women with and without PCOS. Design This is a cohort study. Methods Women with PCOS (n = 280) and women without PCOS symptoms or diagnosis (n = 1573) were identified in the Northern Finland Birth Cohort in 1966 and were evaluated for self-rated work ability and potential confounders at age 46. Next, incidence rate ratios (IRRs) for disability and unemployment days were extracted from national registers during a prospective 2-year follow-up. Lastly, we assessed hazard ratios (HRs) for disability retirement between 16 and 52 years of age from national registers. Results The women with PCOS reported poorer ability to work at age 46, especially due to poorer health. During the 2-year follow-up period, the affected women gained on average an additional month of disability and unemployment days, corresponding to an approximately 25% higher risk for both disability (IRR (95% CI): 1.25 (1.22–1.27)) and unemployment days (IRR (95% CI): 1.26 (1.23–1.28)) in models adjusted for health and socioeconomic factors. Lastly, we found a two-fold higher cumulative risk for disability retirement by age 52 compared to non-PCOS women (HR (95% CI): 1.98 (1.40–2.80)), which remained after adjusting for confounding factors (aHR (95% CI): 1.55 (1.01–2.38)). Conclusions PCOS is associated with lower participation in working life already in midlife. Acknowledging PCOS-related multimorbidity, concerted efforts are needed to support sustainable careers for women with PCOS.
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