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PubMed2001

Diabetes prevalence and risk factors in polycystic ovary syndrome.

Polycystic ovary syndrome is a reproductive disorder with a significant impact on fertility. It is secondarily, and perhaps for the individual primarily, a disorder with a marked increase risk for diabetes and glucose intolerance. Physicians need to be aware that women who have PCOS are at high risk for impaired glucose tolerance and type 2 diabetes. In the author's opinion, they should be screened for these abnormalities. Minority women with PCOS may have higher prevalence rates of glucose intolerance, and further study of minority groups is indicated. The author's data indicate that fasting glucose levels are inadequate for such screenings. Fasting glucose levels are relatively poor predictors of type 2 diabetes as determined by glucose challenge testing in PCOS. These findings may have substantial clinical relevance. They strongly suggest that all PCOS women should be screened for glucose intolerance, and that basal and 2-hour, glucose-stimulated levels rather than fasting glucose levels alone are required for such screening. Further study is necessary to document conversion rates to worsening glucose tolerance over time, as well as the cardiovascular risk associated with glucose intolerance in PCOS.

Diabetes Mellitus↗

PubMed2000

Polycystic ovary syndrome in patients with focal epilepsy: a study in 93 women.

A prospective cohort analysis of premenopausal women with focal epilepsy was conducted in order to determine whether polycystic ovary syndrome (PCOS) is a common finding in women treated with antiepileptic drugs (AED). This study was carried out in 93 of 150 women (aged between 20 and 53 years; mean, 34.3 years) with chronic focal epilepsy consecutively cared for at the Department of Epileptology, University of Bonn: 38 were receiving one AED (18 valproate, 20 carbamazepine), 36 more than one drug, and 19 were without medication. Patients were followed-up for 6 months. PCOS was defined as hyperandrogenism (testosterone concentration, > 0.7 ng/ml) combined with oligomenorrhoea (cycle length, > 35 days) or amenorrhoea. PCOS was identified in two out of 19 (10.5%) patients receiving no medication; in four of 38 (10.5%) of patients receiving monotherapy, and in none of the patients receiving more than one AED. The incidence of PCOS in patients treated with valproate monotherapy (11.1%) was similar to that in patients treated with carbamazepine (10%) and also to that in patients not treated with AEDs. The results of this study suggest that the manifestation of PCOS in women with focal epilepsy is not related to the administration of valproate or carbamazepine.

Adult↗

PubMed1996

Hypersecretion of androgens by polycystic ovaries: the role of genetic factors in the regulation of cytochrome P450c17 alpha.

A single base change has been found in the promoter region of CYP17, the gene encoding P450c17 alpha, which appears to be a significant factor in the expression of hyperandrogenism in PCO but which can be excluded as the primary genetic defect. These findings are consistent with the biochemical data from the studies of patients with PCOS reported above, in which the production of ovarian 17 hydroxyprogesterone and androstenedione were observed to be greatly increased but the generation of progesterone was also exaggerated in PCO theca. Thus, genetic factors may well be involved in the observed dysregulation of 17 hydroxylase/17,20 lyase, but this does not appear to be the whole story. It remains a tenable hypothesis that a single-gene effect is the major cause of PCOS and that a gene involved in the expression of androgen production will be implicated. On the other hand, increased androgen production may be a reflection of an 'upstream' abnormality in the ovary, perhaps involving the fundamental processes of proliferation, differentiation and atresia in ovarian follicles. It is also possible that PCOS is truly polygenic and that CYP17 is one of several genes-including those related to insulin secretion and action-that contribute to the PCOS phenotype. Further candidate genes will need to be investigated using well-characterized, large families, but if several predisposing genes are involved, other approaches may be applicable, for example analysis of shared alleles by affected sibling pairs, which has proved valuable in understanding the genetics of type 1 diabetes (Davies et al, 1994). In conclusion, PCOS--one of the most common endocrinopathies--remains an enigmatic condition but one which may prove to be an important model for understanding the interaction of genetic and environmental factors in the aetiology of endocrine disorders.

Alleles↗

PubMed1997

Definition and significance of polycystic ovaries.

Defining the polycystic ovarian syndrome (PCOS) has challenged clinicians for many years. The clinical, hormonal and morphological definitions of PCOS have their own limitations and do not correspond exactly. Clinically, PCOS can be schematically divided into three components, i.e. hyperandrogenic, anovulatory and dysmetabolic. No one is specific for the syndrome. Hormonally, PCOS has recently been defined by the GnRH agonist test as a functional abnormality in ovarian androgen synthesis. This functional ovarian hyperandrogenism seems closely linked to hyperinsulinism secondary to an insulin resistance. Morphologically, ovarian ultrasonography has emerged in the last decade or so as a new diagnostic tool. However, the sonographic definition of the polycystic ovary (PCO) is controversial, mainly because of a lack of consensus about normative data. The aim of this review is to present the diagnostic dilemma in the diagnosis of PCOS and to discuss the prognostic significance of the PCO.

Androgens↗

PubMed2003

Developing integrated CAM services in Primary Care Organisations.

OBJECTIVES: To explore policy development and the provision of integrated NHS CAM therapy services following the reorganisation of UK primary care services in 1999. DESIGN: Structured survey interviews with Chairpersons in a stratified random sample of 72 Primary Care Organisations (PCOs) in England in 1999 and 2000; semi-structured telephone interviews with purposive samples of (i) providers of primary care CAM services (mostly General Practitioners), and (ii) Commissioners of primary care services in two purposive sub-samples of PCOs involved in positive policy formation in relation to CAM. RESULTS: By the end of 2000, it is estimated that 85% of PCOs in England (95% CI 78-91%) had discussed CAM at board level, and 37% (95% CI 26-48%) had at least one CAM policy in place. The dominant strategy that emerged was a policy of "provide and review", particularly in practices that had managed their own budgets under the previous fundholding system. We found that a small number of PCOs were developing area-wide services. Positive influences or "drivers" for CAM policy formation were identified as: existing services, local enthusiasm and expertise, patient demand, a willingness to consider the wider evidence-base for CAM, and a perception that complementary therapies could help the PCOs to meet national NHS targets. Negative influences included: the cost of ensuring equitable access to services, a perception that CAM lacks the credibility required for public funding, the need to prioritize services and the need to direct funding towards meeting national and local health objectives. CONCLUSIONS: Opportunities for development of integrated NHS services are most likely to occur where CAM provision is seen as a potential solution to an NHS problem. Locality-based, integrated CAM services that are responsive to NHS priorities may offer a model for the future development of CAMs in primary care.

Complementary Therapies↗

PubMed1997

Clinical, endocrinologic, and ultrasonographic features of polycystic ovary syndrome in Singaporean adolescents.

The study sought to evaluate the clinical, endocrinologic, and ultrasonographic features in 150 Singaporean adolescent girls with polycystic ovary syndrome (PCOS) before and after treatment, which was composed primarily of a combined hormone therapy of estrogen and cyproterone acetate. The patients' ages ranged from 12 to 22 years with the majority between 15 and 18 years of age. Most of these girls were seen between their third and fifth gynecologic year. A considerable proportion of them had matured early, experiencing menarche between 9 and 12 years of age. Tanner staging was normal except for a greater proportion at higher stages for pubic and axillary hair, most likely a reflection of the substantial degree of androgenization commonly found in subjects with PCOS. All 150 patients presented with menstrual disorders including secondary amenorrhea, menarche only, anovulatory uterine bleeding, oligomenorrhea, and primary amenorrhea. The majority had normal body weight; 10% to 27% were either underweight or overweight, respectively. On ultrasound, patients presented with enlarged ovaries; enlargement was more pronounced in the right ovary with dense stroma and multiple subcapsular cysts. Many subjects had elevated androgen, luteinizing hormone (LH), and LH/ follicle-stimulating hormone (FSH) levels. Although characteristic of PCOS, FSH levels were either low or normal. Prolactin, estradiol, dehydroepiandrosterone sulfate (DHEAS), and androstenedione were generally normal. A substantial proportion of the study group had elevated cortisol levels. It was noted that adolescent girls with PCOS responded well to treatment; more than 60% showed improvement in cycle profiles following at least 1 year of treatment. Our current opinion is that adolescents with PCOS should be managed early, and that treatment should include medical correction of any hormonal or body-weight imbalance and include psychologic intervention when necessary.

Adolescent↗

PubMed2005

Influence of oral contraceptive pills on phenotype expression in women with polycystic ovary syndrome.

Polycystic ovarian syndrome (PCOS) is characterized by a heterogeneous phenotype including chronic anovulation, hyperandrogenism and polycystic ovaries. The use of oral contraceptive pills (OCP) alters features characteristic for the syndrome. In the present study, PCOS features were compared between women using or not using OCP at the time of the study. One hundred and one women diagnosed with normogonadotrophic anovulatory infertility were included. A total of 81 (80%) women were diagnosed with PCOS (revised 2003 criteria). From these women, a total of 54 did not use OCP, whereas 27 women did. Corrected for age, women taking OCP had increased serum concentrations of sex hormone-binding globulin (P < 0.001). Serum concentrations of testosterone (P = 0.04) and androstenedione (P = 0.01) were decreased. These differences resulted in a decreased free androgen index for women currently taking OCP compared with women without (P < 0.001). The mean ovarian volume/ovary and the mean follicle number/ovary were not different. Use of OCP influences phenotype expression (the observable trait) of individual women known to suffer from PCOS by reducing hyperandrogenism. Despite taking OCP, women still fulfilled the revised 2003 criteria for the syndrome, as PCO morphology was still present. Hence, OCP use does not appreciably affect the PCOS phenotype.

Adult↗

PubMed2003

A comment on the European Society of Human Reproduction and Embryology/American Society for Reproductive Medicine consensus of the polycystic ovarian syndrome.

This commentary on the European Society of Human Reproduction and Embryology/American Society for Reproductive Medicine (ESHRE/ASRM) consensus on diagnosis, nomenclature and long-term health risks of the polycystic ovarian syndrome (PCOS) (conference in Rotterdam, Netherlands, March 2003) questions whether the preservation of the term PCOS sufficiently considers the modern aspects of the aetiology and pathogenesis of this complex syndrome. The misleading and simplified term PCOS, which comprises a variety of different entities, carries with it the risk of misinterpretation and under- and overestimation of symptoms, as well as of overlooking contraindications. Additionally, bias in future studies is pre-programmed. In this commentary, it is proposed that the term polycystic should be substituted with polyfollicular, and the term PCOS with functional hyperandrogenism, which is further subdivided into five additional groups. By using this new classification, most of the patients' dysfunctions belonging to the unspecifically termed PCOS are clearly defined, which leads on to the assumption that the diagnostic and therapeutic approaches required will improve, and the amount of bias in both basic and clinical studies will be reduced, respectively.

Embryo, Mammalian↗

PubMed2004

Genetic contributions to glucose intolerance in polycystic ovary syndrome.

Women with polycystic ovary syndrome (PCOS) are predisposed to develop impaired glucose tolerance and type-2 diabetes mellitus. Genetic factors appear to contribute to the insulin resistance that is characteristic of PCOS as well as to the failure of the pancreatic beta-cell to compensate adequately for this insulin resistance. The cumulative results of studies examining the genetic contribution to both the reproductive and metabolic phenotypes of PCOS are consistent with PCOS as a complex, polygenic disorder. This article reviews the background and recent studies examining the genetic contributions to glucose intolerance in PCOS.

Diabetes Mellitus, Type 2↗

PubMed2006

Use of metformin for ovulation induction in women who have polycystic ovary syndrome with or without evidence of insulin resistance.

OBJECTIVE: To determine whether women with polycystic ovary syndrome (PCOS) and abnormal insulin levels treated with metformin had different rates of ovulation and pregnancy from women with PCOS and normal insulin levels. METHODS: The outcomes of treatment with metformin in 146 infertile women with PCOS were analyzed using a retrospective cohort study design. Baseline characteristics and initial blood work results were recorded. The follow-up period was three months, and the primary outcome was ovulation. RESULTS: Of the 146 women with PCOS, one third had elevated fasting insulin levels. After treatment with metformin, cumulative rates of ovulation were similar in women with elevated fasting serum insulin levels (48.8%) and those with normal levels (44.7%). Rates of ovulation were also similar in women with normal and abnormal glucose to insulin ratios. There was no difference in cumulative pregnancy rates based on fasting insulin levels. A fasting insulin level above 20 mU/L correlated with an abnormal glucose to insulin ratio (98%). CONCLUSION: In anovulatory women with PCOS, fasting insulin levels and glucose to insulin ratios do not predict the ovulatory response to metformin.

Adult↗

PubMed2026

Genomic analyses implicate hormonal and metabolic dysregulation in polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) and its underlying features remain poorly understood. In this genetic study (n = 544,513), we expand the number of genetic loci from 16 to 29, and additionally identify 31 associated plasma proteins. Many risk-increasing loci were associated with later age at menopause, underscoring the reproductive longevity related to an increased oocyte number and/or availability across the lifespan. Hormonal regulation in the etiology of this condition, through metabolic and reproductive features, was emphasized. The proteomic analysis highlighted metabolic biology known to be related to PCOS. A polygenic risk score (PRS) was associated with adverse cardiometabolic outcomes, with differing relevance of testosterone and body mass index in women and men. Finally, while oligo-anovulation and anovulatory infertility are features of PCOS, we observed no impact of PCOS susceptibility on childlessness. We suggest that PCOS susceptibility confers balanced pleiotropic influences on fertility in women, and life-long adverse metabolic consequences in both sexes.

Humans↗

PubMed1997

Increased number of IGF-I receptors on erythrocytes of women with polycystic ovarian syndrome.

OBJECTIVE: To test the hypothesis that insulin acts though ovarian IGF-I receptors to produce excessive amounts of androgens in polycystic ovarian syndrome (PCOS), by measuring the binding capacity of IGF-I receptors on erythrocytes and relating the findings to the degree of hyperandrogenism and hyperinsulinaemia. DESIGN: A case-control study of IGF-I receptors on erythrocytes of women with PCOS and age- and weight-matched controls. PATIENTS AND METHODS: IGF-I receptors on erythrocytes, serum levels of androgens, IGF-I, GH, basal insulin and insulin response during oral glucose tolerance test (oGTT) were measured after induced or spontaneous withdrawal bleeding in 10 women with PCOS and eight normo-ovulatory women. RESULTS: An increased number of IGF-I receptors was found on erythrocytes of patients with PCOS compared with the controls (P < 0.01), irrespective of their body mass index. Serum IGF-I levels were similar in both groups. The degree of hyperinsulinaemia, provoked by oGTT, correlated positively with basal insulin (r = 0.69; P = 0.003), but not with the number of IGF-I receptors. However, the number of IGF-I receptors correlated positively with androstenedione (r = 0.54, P = 0.0018). CONCLUSIONS: The findings in the present study that the number of IGF-I receptors and not the insulin levels correlate with serum androstenedione support the theory that the hyperandrogenism in PCOS is not a direct effect of the hyperinsulinaemia, but IGF-I mediated.

Adolescent↗

PubMed1997

Evidence for a primary abnormality of thecal cell steroidogenesis in the polycystic ovary syndrome.

OBJECTIVE: Polycystic ovary syndrome (PCOS) is a common endocrinopathy of unknown aetiology. The aims of this study were to identify whether ovarian thecal cell steroidogenesis is abnormally regulated in PCOS by measuring steroid responses to a single dose of hCG before, and during, suppression of endogenous LH levels by GnRH analogue (GnRHa). DESIGN: Serum levels of LH, FSH, 17 alpha hydroxyprogesterone (17OHP), androstenedione, testosterone and dehydroepiandrosterone sulphate were measured before, and 48 hours after, a single intramuscular injection of 10,000 IU hCG. The test was repeated 4 weeks after suppression of endogenous LH levels by GnRHa. PATIENTS: The ovarian responses to hCG were compared in three groups of women. Eleven women had normal ovaries and regular cycles, eight had polycystic ovaries but not clinical features of the syndrome (PCO group) and eight had polycystic ovaries, anovulation and either severe hirsutism or alopecia (PCOS group). RESULTS: Before GnRHa treatment, LH levels were significantly higher in the PCOS group but hCG stimulated a similar rise in 17OHP in all three groups. Following analogue, LH levels were suppressed in all three groups but the 17OHP responses to hCG were significantly higher in both the PCO and PCOS groups compared with normal controls. CONCLUSIONS: These findings provide further evidence in favour of an intrinsic abnormality of thecal cell steroidogenesis in the polycystic ovary.

17-alpha-Hydroxyprogesterone↗

PubMed1999

The natural history of the metabolic syndrome in young women with the polycystic ovary syndrome and the effect of long-term oestrogen-progestagen treatment.

OBJECTIVE: Little is known about the natural history of polycystic ovary syndrome (PCOS), although preliminary data indicate that affected women are more susceptible than the general population to diabetes and cardiovascular diseases at post-menopausal ages. The aim of this study was to follow-up all main features of the metabolic syndrome in a group of young women with PCOS and to investigate the long-term effects on metabolism and body composition of oestrogen-progestagen (OP) compounds, which are frequently used in these women to treat hyperandrogenism and related clinical features. DESIGN: Long-term follow-up study. SUBJECTS AND METHODS: Thirty-seven women with PCOS were re-evaluated 10.3 +/- 0.8 years (range 6-18 years) after their first assessments (age: before 19.8 +/- 4.9 years; after 29.9 +/- 4.4 years). When first examined, women were instructed to follow a hypocaloric diet if they were obese plus OP, if they agreed to such treatment. Main anthropometric parameters, basal sex hormones and lipids, fasting and glucose-stimulated glucose and insulin levels and several clinical data were recorded before and after follow-up. RESULTS: In the whole group of women with PCOS we found no changes in body weight and fat mass, whereas both the waist-to-hip ratio and the waist-to-thigh ratio were significantly reduced. No significant changes occurred in mean fasting and glucose-stimulated glucose and insulin concentrations, whereas a significant increase in high-density lipoprotein-cholesterol was found. No significant changes occurred in testosterone levels. During the follow-up period 16 women took OP for an average of 97 +/- 18 months (range 12-180 months) (OP-users) whereas 21 women never took OP (non-OP-users). All OP-users were still taking OP when re-evaluated at the follow-up examination. With respect to baseline values, body mass index was higher in non-OP-users than in their counterparts. Waist circumference (P < 0.025), the waist-to-hip (P < 0.05) and the waist-to-thigh (P < 0.01) ratios decreased significantly only in the OP-users. In addition, percentage changes in waist circumference (P < 0.05) and waist-to-hip ratio (P < 0.05) during the follow-up period were significantly different between the groups. Glucose tolerance (as area under the curve (AUC)) improved (P < 0.05) in OP-users but not in non-OP-users. Moreover, compared to baseline values, basal insulin levels were significantly (P < 0.01) reduced in OP-users but not in non-OP-users. On the contrary, no significant change was found in insulinAUC in the former, whereas it significantly increased (P < 0.05) in the latter. Accordingly, fasting C-peptide decreased (P < 0.05) in OP-users, whereas both fasting (P < 0.01) and stimulated (P < 0.01) C-peptide significantly increased in non-OP-users. Changes in fasting or stimulated insulin and C-peptide in non-OP-users were not associated with parallel changes in testosterone levels. Total cholesterol and triglycerides did not change in either group, but HDL-cholesterol increased (P < 0.05) only in OP-users. Sex hormone-binding globulin concentrations increased significantly (P < 0.01) in OP-users, without any significant change in non-OP-users. Testosterone concentrations did not change significantly in either group, but the testosterone: SHBG ratio significantly decreased in OP-users (P < 0.05) but not in the non-OP-users. Among the clinical features, acanthosis nigricans significantly (P < 0.01) worsened in non-OP-users but not in the OP-users, without any significant change in the hirsutism and acne scores. Pregnancy rates during the follow-up were similar in both groups. CONCLUSIONS: These data indicate that hyperinsulinaemia and insulin resistance tended to worsen spontaneously in women with PCOS, without any worsening of the hyperandrogenism. Long-term oestrogen-progestagen treatment countered this tendency, probably because it improved the pattern of body fat distribution, by reducing abdominal fat depots.

Adolescent↗

PubMed1999

Polycystic ovaries and associated clinical and biochemical features in young women.

OBJECTIVE: To determine the prevalence of polycystic ovaries as identified by ultrasound in a group of young, postmenarcheal women in the normal population, and to investigate how polycystic ovaries are related to the spectrum of clinical and biochemical symptoms associated with the polycystic ovary syndrome (PCOS). DESIGN: Cross-sectional observational study. SUBJECTS AND METHODS: Volunteers were recruited from two universities and two general practice surgeries in Oxford. 230 women aged 18-25 years participated. Information collected and measurements performed included: a menstrual history, anthropometric measurements, clinical observation of acne and hirsutism, transabdominal pelvic ultrasound, and biochemical analysis of a fasting blood sample. MAIN OUTCOME MEASURES: Prevalence of polycystic ovaries and their association with symptoms of the polycystic ovary syndrome. RESULTS: Polycystic ovarian morphology was identified in 74 (33%, 95% CI = 27-39%) of the 224 women who attended for an ultrasound scan. In the non-users of hormonal contraception, irregular menstrual cycles were 20% more common in women with polycystic ovaries than in women with normal ovaries (P = 0.07). There were no significant differences in acne, hirsutism, body mass index or body fat percentage between women with polycystic and normal ovaries. Analysis of biochemical data showed that women with polycystic ovaries had higher total serum testosterone concentrations (P = 0.03). The prevalence of PCOS in this age group was as low as 8% or as high as 26% depending on which criteria were applied to define the syndrome. Sub-group analyses of women according to ovarian morphology and features of PCOS revealed greater mean BMI in women with PCOS, and also indicated lower fasting insulin concentrations and greater insulin sensitivity in polycystic ovary and PCOS groups when compared to women with normal ovaries. CONCLUSIONS: Polycystic ovaries are very common in this age group but are not necessarily associated with other symptomatology. The prevalence of polycystic ovary syndrome varies widely according to the definition applied. Sub-group analysis of women with polycystic ovaries according to the presence or absence of features of polycystic ovary syndrome does not reveal an increasing trend for progression of endocrine abnormalities usually associated with polycystic ovary syndrome.

Adult↗

PubMed2001

Smaller LDL particle size in women with polycystic ovary syndrome compared to controls.

OBJECTIVE: Women with polycystic ovary syndrome (PCOS) have an increased risk of cardiovascular disease. The contribution of lipid abnormalities to this higher risk, in particular atherogenic modifications of low density lipoprotein (LDL) such as a shift towards smaller LDL, has not been properly explored. We aimed to examine LDL size variation in relation to androgens and other risk factors in women with PCOS. DESIGN: Comparison of clinical and biochemical measurements in women with PCOS and women with normal ovarian function, of similar age and body mass index (BMI). PATIENTS: Thirty-one women with PCOS and 27 controls were studied. Patients were recruited from the outpatient endocrine clinic. MEASUREMENTS: Fasting total cholesterol, triglycerides (TG), high density lipoprotein (HDL), LDL, glucose, insulin, gonadotrophins, androgens, oestradiol, 17 OH progesterone and SHBG were measured. LDL particle diameter was calculated based on distance travelled in polyacrylamide native gels. Recumbent blood pressure was measured automatically. RESULTS: LDL particle size appeared to be significantly smaller in hyperandrogenic PCOS as compared to regularly cycling women (P = 0006), independent of variations in lipid levels. SHBG was the only independent predictor of LDL size in this population, with a strong correlation, which persisted after adjustment for all confounding variables. CONCLUSIONS: Our results suggest that androgen excess and mild insulin-resistance (both responsible for lower SHBG) may have an early modifying effect on low density lipoprotein size in polycystic ovary syndrome women. The denser pattern observed in polycystic ovary syndrome women could by itself constitute a higher cardiovascular risk, even in the absence of overt dyslipidaemia, and contribute to the excess risk of cardiovascular disease reported in this syndrome.

Adult↗

PubMed2001

On the association between valproate and polycystic ovary syndrome.

Recent studies by Isojärvi et al. have raised the issue of an increased incidence of polycystic ovary syndrome (PCOS) in women with epilepsy treated with valproate (VPA) and have proposed replacement with lamotrigine (LTG). Polycystic ovaries (PCO) are a common finding, with a prevalence >20% in the general population, and are easily detected by pelvic or vaginal ultrasonography, whereas PCOS is comparatively rare: few women with PCO have fully developed PCOS, which includes hirsutism, acne, obesity, hypofertility. hyperandrogenemia, and menstrual disorders. From an extensive review of the current literature, it appears that there are no reliable data on the actual prevalence of PCOS in normal women and in women with epilepsy. The pathogenesis of PCO is multifactorial, including genetic predisposition and the intervention of environmental factors, among which weight gain and hyperinsulinism with insulin resistance may play a part. The roles of central (hypothalamic/pituitary), peripheral, and local ovarian factors are still debated. PCO and PCOS appear to be more frequent in women with epilepsy, but there are no reliable data showing a greater prevalence after VPA. The recent studies by Isojärvi et al. may have been biased by the retrospective selection of patients. To date, there is no reason to contraindicate the use of VPA in women with epilepsy. However, patients should be informed about the risk of weight gain and its consequences.

Adolescent↗

PubMed2003

Clinical, metabolic and endocrine parameters in response to metformin in obese women with polycystic ovary syndrome: a randomized, double-blind and placebo-controlled trial.

There is still some controversy concerning the effects of metformin in the treatment of Polycystic Ovary Syndrome (PCOS). The aim of this study was to asses the effect of metformin on clinical, metabolic and hormone parameters in obese women with PCOS. Thirty obese, non-diabetic women with PCOS received 500 mg of metformin or placebo, TID, over 90 days. Assessed parameters included body mass index, waist-to-hip ratio, blood pressure, FSH, LH, total testosterone, SHBG, fasting insulinemia, insulin-to-glucose ratio, total, HDL and LDL cholesterol, triglycerides, and menstrual cycles before and after the use of the drugs. Before treatment, patients did not differ in the two groups. After 90 days of metformin use, PCOS women presented significantly lower levels of total testosterone (p = 0.030) and total cholesterol (p = 0.023) compared to the women that used placebo. The other parameters did not differ between the groups. In conclusion, obese women with PCOS may benefit from the use of metformin through the reduction of hyperandrogenemia, total cholesterol, and possibly by restoration of regular menstrual cycles. Further studies with longer follow-ups are necessary to determine cardiovascular and endometrial metformin benefits and insulin-resistance decrease in women with polycystic ovary syndrome.

Adolescent↗