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PubMed2002

Body fat distribution, insulin sensitivity, ovarian dysfunction and serum lipoproteins in patients with polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is characterized by various endocrine and metabolic abnormalities, whose mutual associations and symptoms are still not clear. In the present study, fifteen PCOS patients and fifteen controls, matched for age and body weight, were investigated. Endocrine profiles were evaluated by the nafarelin and the adrenocorticotropin (ACTH) test. Insulin sensitivity was determined by an intravenous insulin tolerance test. Patients showed a significant predominance of abdominal adiposity [waist-to-hip ratio (WHR), 0.86 +/- 0.05 vs. 0.79 +/- 0.04] with markedly higher fasting insulin levels (+75%) and reduced insulin sensitivity (-37%). Fasting insulin, testosterone and free androgen index were positively correlated with the body mass index (BMI). In contrast, insulin sensitivity and BMI were inversely correlated in patients only. In the nafarelin test increases of 17-OH-progesterone and androstenedione were higher in patients and positively correlated with fasting insulin levels. Lipoprotein profiles showed trends towards higher triglycerides, lower HDL-cholesterol and a preponderance of small, dense LDL in patients. In PCOS higher triglycerides and lower HDL cholesterol were correlated with insulin sensitivity. It is concluded that PCOS patients show metabolic abnormalities combined with a more adroid type of adiposity when compared to cyclic controls of similar BMI.

17-alpha-Hydroxyprogesterone↗

PubMed2002

Independent practice associations in New Zealand: a study of governance structures and process.

AIMS: To describe the governance structures and processes of four primary care organisations (PCOs) and to evaluate member general practitioners' (GPs) perceptions of the effectiveness of these structures and processes. METHODS: A sample of four PCOs was chosen in 1999, including three independent practitioner associations (IPAs), and a member organisation of CareNet. The chief executive officer of each PCO was interviewed, and the 245 member practitioners were surveyed with a written questionnaire. RESULTS: The response rate to the GP survey was 78.4%. A two tier governance structure was identifiable for all four PCOs: policy board or steering committee, and working committees. In addition each utilised a peer group review process to provide input to some administrative functions. The CareNet PCO emphasised reduced bureaucracy and a loose administrative structure and process. There was a high level of respondent satisfaction (>90%) with their PCO governance processes. CONCLUSIONS: Governance structures and processes have developed within the four PCOs that reflect the needs of member practitioners and according to the requirements of each district and PCO membership. A high level of member satisfaction with their PCO, its governance and processes, was evident.

Attitude of Health Personnel↗

PubMed2002

Clinical and endocrinological effects of 6 months of metformin treatment in young hyperinsulinemic patients affected by polycystic ovary syndrome.

Most patients with polycystic ovary syndrome (PCOS) have hyperinsulinemia; thus it has been postulated that insulin-lowering drugs, such as metformin, might be a useful long-term choice. We evaluated the effects of 6 months' administration of metformin on clinical and endocrine indices in PCOS patients. Forty-two hyperinsulinemic women with PCOS were continuously treated with metformin for 6 months. Gonadotropins, androgens (testosterone and androstenedione), insulin, sex hormone binding globulin (SHBG), lipid profile and clinical indices (menstrual length, body mass index (BMI), Ferriman-Gallwey score and waist/hip ratio (WHR)) were studied before and after metformin treatment. All women experienced a normalization of menstrual cycle length (reduction rate, 36.9%), a significant decrease in luteinizing hormone, insulin and androgen levels and an increase in SHBG plasma concentrations, with a concomitant decrease in cycle length and WHR. Significant changes were observed in the lipid profile. According to baseline androgen levels, patients were divided into two groups: 20 normoandrogenic and 17 hyperandrogenic women. The greatest decline of androgens, BMI and Ferriman-Gallwey score was observed in hyperandrogenic patients. Lowering of androgenicity was independent of BMI. Significant changes in lipid profile were observed in both groups after metformin treatment. These results suggest that metformin is effective in decreasing hyperandrogenism, mainly by reducing insulin levels. This leads to an improvement of clinical manifestations of PCOS and, in particular, of hyperandrogenism.

Adolescent↗

PubMed2002

Advances in polycystic ovary syndrome treatment: metformin and ovarian diathermy.

Polycystic ovary syndrome (PCOS) affects approximately 6% of women in their reproductive years. The symptoms of the syndrome are chronic anovulation and androgen excess. Infertility due to ovulatory dysfunction is a common problem for women with PCOS. Metformin, an antihyperglycemic agent, can correct the metabolic dysfunction that occurs with PCOS, and also stimulate folliculogenesis. The drug is effective alone and in combination with clomiphene citrate. An alternative option, ovarian diathermy, also promotes ovulation through changes in the intraovarian hormonal environment. Both techniques provide promising and effective alternatives for women with PCOS who do not respond to traditional oral ovulation induction agents.

Algorithms↗

PubMed2002

Detection of insulin resistance and its treatment in adolescents with polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) appears to be a lifelong disorder. The stigmata of insulin resistance, including obesity and premature adrenarche, may be early forms of its presentation. Girls with premature pubarche, characterized by elevated dehydroepiandrosterone levels and hyperinsulinemia, are at high risk for developing the full PCOS phenotype, including ovarian hyperandrogenism and chronic anovulation. Because PCOS is associated with a 40% prevalence of abnormal glucose tolerance, every adolescent patient should be evaluated regularly for glucose intolerance with a 2-hour oral glucose tolerance test and for lipid abnormalities with a fasting lipid profile. The role of insulin-sensitizing medications such as metformin in adolescents with PCOS is unclear; short-term studies suggest that these agents improve circulating androgens and ovulatory frequency. Primary prevention of diabetes mellitus and cardiovascular disease by lifestyle modification, including regular exercise and a balanced diet, is particularly important in adolescents, who have the opportunity to establish healthy habits before entering adulthood. The findings of diabetes prevention trials suggest that these interventions may be more efficacious than pharmacological therapy.

Adolescent↗

PubMedDate not supplied

A prospective, double-blind, randomized, placebo-controlled clinical trial of bromocriptine in clomiphene-resistant patients with polycystic ovary syndrome and normal prolactin level.

OBJECTIVE: To evaluate the effects of administration of bromocriptine combined with clomiphene citrate (CC) in CC-resistant patients with polycystic ovary syndrome (PCOS) and normal prolactin (PRL) level. DESIGN: Prospective double-blind, placebo-controlled, randomized. SETTING: Referral university hospitals. PATIENTS: One hundred women with PCOS and normal PRL who failed to ovulate with a routine protocol of CC. INTERVENTIONS: Treatment group received 150 mg of CC from day 5 to 9 and 7.5 mg bromocriptine continuously, with hCG 10,000 units on day 16 or 17. Control group received the same protocol of CC combined with placebo. MAIN OUTCOME MEASURES: Follicular development, hormonal changes, ovulation rate, pregnancy rate. RESULTS: Follicular development (follicular size greater than 15 mm) was observed in 12 (25.5%) and 8 (15.1%) women in the treatment and placebo group, respectively (p = 0.29). The serum prolactin level was within normal limits in all patients before treatment. After 3 and 6 months of treatment with bromocriptine, there was a significant decrease in serum level of prolactin (p = 0.000001). No significant differences were seen in ovulation, pregnancy rate, or serum levels of FSH, LH, DHEAS, and progesterone between treatment and placebo groups after treatment. CONCLUSIONS: The only significant effect of long-term bromocriptine therapy in CC-resistant women with PCOS was to lower the serum PRL concentration. It is also concluded that 10%-15% of patients with PCOS experienced occasional ovulatory cycles and pregnancy whether or not they were on treatment.

Adult↗

PubMed2002

Preliminary indication of a high prevalence of polycystic ovary syndrome in indigenous Australian women.

We aimed to estimate the likely prevalence of polycystic ovary syndrome (PCOS) in indigenous Australian women in a cross-sectional survey based on structured interviews. In the Kimberley region of Western Australia and south-western Victoria, between February and June 1999, women over the age of 18 available for interview and willing to participate were included. Menstrual status, anthropometric measures, fasting blood biochemistry and hirsutism were assessed. A total of 38 premenopausal women completed the survey. Of these, 50% had regular menstrual cycles of normal duration and no hirsutism; seven had oligomenorrhea and hirsutism/hyperandrogenemia; and of the nine women with hirsutism and regular menses, three had hyperandrogenemia. Thus, possibly ten women fulfilled the criteria of PCOS. This unique data set suggests a high prevalence of PCOS in indigenous Australian women. Further research to document this formally is warranted, in view of the potential adverse effects of PCOS on reproduction and metabolism.

Adult↗

PubMedDate not supplied

Ovarian pregnancy in polycystic ovary syndrome: a case report.

A case is reported of ectopic pregnancy occurring within an ovary with the morphologic appearance of polycystic ovary syndrome (PCOS). The hyperandrogenism and elevated LH/FSH ratio characteristic of PCOS were noted 2 months after removal of the ovarian gestation. The thickened ovarian cortex of the PCOS ovary and a defect in oocyte-cumulus complex detachment within the follicle are suggested as possible factors contributing to intraovarian fertilization in PCOS.

Adult↗

PubMed2003

Could the theory of chaos contribute to the interpretation of pathogenesis of polycystic ovary syndrome?

Polycystic ovary syndrome (PCOS) is a syndrome involving defects in primary cellular control mechanisms that result in the expression of chronic anovulation and hyperandrogenism. In this syndrome the relation between the various parameters is of particular interest. These relations constitute the cornerstone of the pathogenesis of PCOS. The fact that the pathogenesis of the PCOS has not yet been clarified, despite the plethora of relative information, may be the result of a general way of thinking in the interpretation of several scientific data, and especially those that refer to biochemical phenomena. The use of the various models of the theory of chaos, that permits a concrete approach for the interpretation of data, may constitute an optional procedure for the future understanding of the association of different parameters and their disturbances in the pathogenesis of PCOS.

Female↗

PubMed2003

[Endocrine and metabolic effects of metformin in combination with compound cyproterone acetate in women with polycystic ovarian syndrome].

OBJECTIVE: To study the endocrinologic and metabolic effects of metformin in combination with compound cyproterone acetate (CPA) on patients with polycystic ovarian syndrome (PCOS). METHODS: A prospective study involved total 45 PCOS patients as group A and 20 non-PCOS infertility patients as control (group B). Complete baseline work-up including body mass index (BMI), waist/hip ratio (WHR), ferriman-Gallwey score (FGS), gonadotrophin, testosterone (T), sex hormone-binding globulin (SHBG), dehydroepiandrosterone sulfate (Ds), insulin (FI) and glucose tolerance test, were performed in all patients. Patients in group A were treated with CPA alone (group A1), metformin alone (group A2) or combination of CPA with metformin (group A3), respectively by randomization. At the end of 12-week therapy, subjects were re-evaluated and above parameters were measured. RESULTS: Women in group A had significant increases in BMI, WHR, FGS, luteinizing hormone (LH), T, FI, insulin resistance, and significantly decrease in high-density lipoprotein (HDL)-C comparing with the control group (P < 0.01). No significant difference among A1, A2 and A3 was found at baseline. LH, T, free testosterone (FT) were significant decreased from (13.9 +/- 5.9) IU/L, (2.1 +/- 0.8) nmol/L and (2.8 +/- 2.3) nmol/L respectively to (5.8 +/- 2.2) IU/L, (1.2 +/- 0.4) nmol/L and (0.8 +/- 0.5) nmol/L respectively and SHBG was significant increased from (99 +/- 42) nmol/L to (187 +/- 64) nmol/L in group A3, when compared with LH, T and FT from (13.8 +/- 7.6) IU/L, (2.2 +/- 1.1) nmol/L and (2.5 +/- 1.9) nmol/L respectively to (11.8 +/- 6.5) IU/L, (1.8 +/- 0.8) nmol/L and (1.7 +/- 1.0) nmol/L respectively and SHBG from (99 +/- 40) nmol/L to (120 +/- 51) nmol/L in group A2 (P < 0.05 approximately 0.001). HDL-C were significantly increased from (1.5 +/- 0.3) mmol/L to (1.8 +/- 0.3) mmol/L in group A3 comparing with HDL-C from (1.5 +/- 0.4) mmol/L to (1.6 +/- 0.4) mmol/L in group A1 (P < 0.001). CONCLUSIONS: The PCOS patients treated with metformin in combination with compound cyproterone acetate may be more effective in inhibiting hyperandrogen and hypersecretion of LH than metformin alone and more obvious in improving lipid profiles than CPA alone.

Adult↗

PubMed2004

Diagnosis of polycystic ovary syndrome: from NIH criteria to ESHRE-ASRM guidelines.

In the past, the diagnosis of polycystic ovary syndrome (PCOS) was based on National Institute of Health (NIH) criteria (hyperandrogenism and chronic anovulation) or on sonographic findings of polycystic ovaries. Diffe-rences in diagnosis criteria made it difficult to compare the data of studies coming from different countries. Moreover, there was criticism of both the methods used. In 2003, at a joint meeting of the European Society for Human Reproduction (ESHRE) and the American Society of Reproductive Medicine (ASRM), new guidelines for the diagnosis of PCOS were suggested. According to these guidelines, it is possible to reach a diagnosis of PCOS when at least 2 of these 3 elements are present: hyperandrogenism, chronic anovulation and polycystic ovaries. New criteria for the echographic diagnosis of polycystic ovaries have been suggested, too. These diagnostic guidelines represent important progress because they are more flexible and permit us to make the diagnosis in patients who were previously excluded by the syndrome (such as ovulatory hyperandrogenic women with polycystic ovaries or anovulatory normoandrogenic women with polycystic ovaries). However, doubts still exist and regard some borderline group of patients such as hirsute ovulatory normoandrogenic women with polycystic ovaries. A new classification of PCOS syndrome is suggested on the basis of new guidelines.

Anovulation↗

PubMed2004

Do women with polycystic ovary syndrome have an increased risk of cardiovascular disease? Review of the evidence.

Polycystic ovary syndrome (PCOS) is a reproductive endocrine disorder found in ~5% of the general population and is characterized by chronic anovulation, hyperandrogenism, and insulin resistance. Women with PCOS are at increased risk for the development of Type II diabetes and may represent a unique group of women at high risk for the development of coronary heart disease (CHD). More adverse CHD risk profiles of women with PCOS have been demonstrated in several studies, yet actual health outcome studies have been inconclusive as to whether this translates into increased rates of cardiovascular disease in PCOS cases when compared to controls. This review focuses on the controversy surrounding the potential relationship between cardiovascular disease outcomes and polycystic ovary syndrome.

Adult↗

PubMed2004

Effects of metformin on clinical and biochemical parameters in polycystic ovary syndrome.

OBJECTIVE: To assess the effects of 6 months of metformin therapy on clinical and biochemical parameters in polycystic ovary syndrome (PCOS) and to evaluate those parameters in responders and nonresponders to identify the subjects who respond to an insulin sensitizer in PCOS. STUDY DESIGN: Sixty-six diagnosed PCOS patients were recruited. Baseline characteristics (menstrual history, hirsutism scoring, acne grading, body mass index [BMI], serum luteinizing hormone and follicule-stimulating hormone [LH/FSH] ratio, testosterone,fasting insulin and glucose/insulin index) were assessed initially and 6 months after metformin therapy. Three groups were constructed on the basis of menstrual symptoms: oligomenorrhea (group I), amenorrhea (group II) and hypomenorrhea (group III). Responders were those who had improvements in menstrual pattern or conceived. Response was compared in 3 groups, and biochemical parameters were compared in responders and nonresponders. RESULTS: There were 44 (66.6%) oligomenorrheic, 17 (25.7%) amenorrheic and 5 (7.5%) hypomenorrheic cases and 31 (46.5%) infertile women. In total, 85.7% responded to treatment; the rest (14.3%) were nonresponders. Among responders, 62.29% achieved regular periods, 22.95% experienced improvements in their menstrual abnormalities, and 13% conceived. Overall, a significant reduction occurred in BMI (P =.04), mean testosterone (P = .03) and mean fasting insulin levels (P = .01), but no significant improvement was observed in hirsutism, acne, LH/FSH ratio or glucose/insulin index. A total of 9.75%, 18.75% and 30% did not respond in the oligomenorrheic, amenorrheic and hypomenorrheic groups, respectively (P = .04). Testosterone and insulin were reduced significantly in responders (P = .05 and .01, respectively) but not in nonresponders (P = .26 and .73). An initial high LH/FSH ratio and lower testosterone levels were associated with a better response. CONCLUSION: Six months of metformin therapy improved menstrual cyclicity and fertility in women with PCOS. It resulted in a decline in testosterone and insulin levels. Oligomenorrheic patients with an increased LH/FSH ratio and lower testosterone levels responded better.

Adolescent↗

PubMed2004

Polycystic ovary (Stein-Leventhal) syndrome: etiology, complications, and treatment.

Polycystic ovary syndrome (PCOS) occurs in approximately 3% to 5% of the female population and may be the leading cause of infertility in those of reproductive age. PCOS presents clinically with a variety of signs and symptoms; the most common being menstrual irregularities, hyperandrogenism, infertility, and obesity. The true pathophysiology has not been clearly elucidated; however, there is growing agreement that gonadotropin dynamic dysfunction, hyperandrogenism, and insulin resistance are key features. The diagnosing of PCOS involves radiologic and laboratory studies. Radiologic studies typically include pelvic ultrasound; laboratory data should be obtained regarding pertinent gonadotropins and other hormone levels. PCOS is not a benign condition. It may lead to complications involving glucose metabolism, dyslipidemias, cardiovascular disease, and cancer. The goals of treatment should focus on restoring menstrual regularity, decreasing androgen excesses, and decreasing insulin resistance.

Acne Vulgaris↗

PubMed2004

[Sibutramine administration in polycystic ovary syndrome treatment].

Obesity is considered important factor contributing development of PCOS. Insulin resistance, low level of serum SHBG and activation of pituitary-adrenal axis plays a major role in pathogenesis and symptoms of PCOS. The achievement of weight loss is an important factor in treatment of PCOS, but difficulties with adherences to the dietary regiment discourage physicians to use this method. In our paper we would like to show the effectiveness of such treatment and pay attention to possibilities of drug facilities in dietary approach in treatment of PCOS coexisting with obesity.

Adolescent↗

PubMed2005

Polycystic ovary syndrome--a management update.

BACKGROUND: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women and is associated with both reproductive and metabolic disorders. OBJECTIVE: This article discusses the health risks, clinical assessment and investigations consistent with the new internationally agreed definition of PCOS, available treatments, and the long-term monitoring of women with PCOS. DISCUSSION: Women with PCOS have an increased risk of endometrial carcinoma, type 2 diabetes mellitus, and possibly cardiovascular disease. Polycystic ovary syndrome is a diagnosis of exclusion of other causes of hyperandrogenism. Screening for diabetes is important. Treatment is directed at the presenting symptom as the primary cause is unknown. Long-term medical treatment may include the oral contraceptive pill or metformin. Long-term surveillance is recommended for the early detection and treatment of potential metabolic complications.

Contraceptives, Oral↗

PubMed2005

[Treatment of polycystic ovarian syndrome with anovulatory infertility by ultrasound-guided immature follicle aspiration].

OBJECTIVE: To investigate the effect of ultrasound-guided immature follicle aspiration (IMFA) on polycystic ovarian syndrome (PCOS) in women with anovulatory infertility, such as the endocrinology of the patients and the basic follicles number in the ovaries, and to observe the ovarian response to human menopausal gonadotropin (hMG) stimulation and pregnancy after the therapy. METHODS: Seventy-one PCOS patients were involved in this trial, and divided into 2 groups. Thirty-seven patients of group I were primed with slight amount of hMG, the other 34 patients did not use hMG. Ultrasound-guided IMFA was performed 36 hour after human chorionic gonadotropin (hCG) administration. In the next cycle, the basal endocrinology and the basic number of follicles were checked, then IMFA were performed continuously until the basic number of follicles were under 10 per ovary. Afterwards, hMG were used to stimulate ovulation and the pregnant results were followed up. RESULTS: There were 37 cases (88 cycles) of PCOS patients in group I and 34 cases (87 cycles) in group II. After 2 to 3 treatment cycles, the testosterone level became normal in all of patients. The basic follicle number decreased to less than 10 per ovary in 33 cases (89%) in group I and 28 cases (82%) in group II. After hCG stimulation, all of them ovulated. Only 2 patients developed slight ovarian hyperstimulation syndrome (OHSS). Within 3 months after the procedure, 36 patients (51%) became pregnant by controlled ovarian hyperstimulation (COH) protocol after IMFA. CONCLUSIONS: Immature follicle aspiration treatment can improve the abnormal endocrinology, decrease the basic follicle number of the ovary, and achieve pregnancy in following COH cycles, meanwhile, avoid OHSS in PCOS patients.

Adult↗

PubMedDate not supplied

Presentation of polycystic ovary syndrome and its management with clomiphene alone and in combination with metformin.

BACKGROUND: This study was carried out to determine the pattern of presentation of Polycystic ovary syndrome (PCOS) in patients presenting at our unit and to compare effects of clomiphene alone and in combination with metformin in management of PCOS. METHODS: This study was conducted from Jan 2001-2003 at Military Hospital, Rawalpindi. All patients presenting with infertility were evaluated with a view to select 100 patients of PCOS with the help of history of oligomenorrhoea, hirsuitism and acne. Diagnosis was confirmed by ultrasonography and hormone analysis (LH, FSH, prolactin, testosterone along with LH:FSH>2). The 100 selected patients were divided into two equal groups. One was given combined clomiphene citrate (CC) and metformin for ovulation induction and the other CC alone. These patients were followed for six cycles for ovulation and conception. Follicle tracking on ultrasonography and day-21 serum progesterone level were used to detect ovulation while conception was confirmed by urine pregnancy test, serum B-HCG level and ultrasonography for gestational sac. RESULTS: Hirsuitism and oligomenorrhoea were the two most common clinical features of PCOS. In the first group 34 patients (68%) ovulated as compared with 18 (36%) in the second group. In the first group 18 out of 34 women (52.9%) conceived as compared with only 8 out of 18 (44%) in the second group. The difference was significant at >0.05 when ovulatory and pregnancy responses were compared among two groups. All patients tolerated metformin well and no teratogenic effects were observed in patients who conceived after treatment with metformin. CONCLUSION: A combination of metformin and clomiphene citrate significantly increases the ovulation and conception rates in these patients.

Adult↗