PCOS

7 Subtle Signs You Could Have PCOS

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Experts believe that more than half of women with polycystic ovary syndrome don’t even realize they have it.
PCOS_Feature

If you’ve skipped a period or two (and know you’re not pregnant) and have been breaking out like you’re a teenager again, it’s easy to chalk it all up to stress. But something more serious may be going on, such as polycystic ovary syndrome (PCOS), a stealth health issue caused by a hormonal imbalance and marked by a series of small cysts on the ovaries.

Five to 10 percent of women of childbearing age are affected by the condition, but less than half of women are diagnosed, according to the PCOS Foundation. That means millions of women have PCOS and don’t even know it. To shed some light on this silent disease, here are the most common not-so-obvious signs of the hormonal disorder. If you’re experiencing any of these symptoms, bring them up with your gynecologist or general practitioner and get them evaluated.

1. Your cycle is all over the place.

Unpredictable menstrual cycles or skipping several periods are one of the hallmarks of PCOS. “Our menstrual cycle is like a vital sign,” says Maryam Siddiqui, MD, assistant professor of obstetrics-gynecology at the University of Chicago Medicine. “It tells us if our metabolism is in a good state; if you’re too thin, overweight, or stressed, that can throw your cycles off. Having irregular periods or more likely, skipping multiple periods could be a sign of a hormonal imbalance like PCOS.” Menstrual irregularities like these should raise a red flag and warrant a doctor’s attention.

2. You’re growing hair in unexpected places.

With PCOS, the ovaries produce excessive amounts of a type of hormones called androgens, which stimulate hair growth. We’re not talking about the hairs on your head. “You’ll get hair growth in funny places—around the nipples, on your chest, the inside of your thighs, and your belly,” says Siddiqui. “Places were women don’t typically have a lot of hair growth.”

3. You’re breaking out.

Those same high levels of androgens also trigger acne. The hormones boost sebum production, and the combo of excess oil and old skin tissue plugs pores. To add insult to injury, bacteria that flourish on sebum increase, triggering inflammation.

4. There’s a dark “ring” around your neck.

You might blame it on a cheap necklace leaving a ring of residue on your skin at first, but PCOS can cause a stubborn darkening of the skin around the back of your neck. “It’s a velvety, dark discoloration that doesn’t wash off,” explains Siddiqui. The pigmentation and skin texture changes can also appear under your arms and around the vulva.

5. Your belly is getting bigger and you don’t know why.

Unexplained, persistent weight gain, particularly around the abdomen, is a sign of the hormonal disorder. Although it’s not fully understood why weight gain is a symptom, insulin resistance appears to play a role. “With PCOS, you can have trouble metabolizing blood sugar, known as insulin resistance,” explains Siddiqui. “When you have insulin resistance, your pancreas has to work really hard and make a lot of insulin just to lower your blood sugar. That is linked to weight gain and central obesity.” (Women with PCOS are at higher risk for developing diabetes.)

6. Those annoying skin tags keep popping up.

Although it’s not fully understood why, those flesh-colored nubs of excess skin tend to crop up around the neck area and under the arms of women with PCOS, according to the U.S. Department of Health and Human Services. It’s worth noting, though, that skin tags, which are benign and can be triggered by friction, are also common in people who don’t have PCOS, so don’t automatically freak out if you have them.

7. You’re having trouble getting pregnant.

The hormonal imbalance interferes with the body’s ability to ovulate normally, which is essential for pregnancy to occur. So it’s no surprise that PCOS is one of the most common causes of infertility. In fact, it’s responsible for 70 percent of infertility problems in women who have trouble ovulating, according to the PCOS Foundation.

Polycystic Ovary Syndrome Might Start in the Brain, Not the Ovaries

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Finally, some answers.

A new study has found evidence that the common and debilitating reproductive condition, polycystic ovary syndrome, could start in the brain, not the ovaries, as researchers have long assumed.

If verified, the research could change the way we think about the painful and severely misunderstood condition, which affects at least one in 10 women worldwide.

Anyone who has polycystic ovary syndrome (PCOS) – or knows someone with the condition – will be aware of how incredibly frustrating it can be.

Thanks to the variety of symptoms it can cause – from weight gain, large ovarian cysts, difficulty ovulating, acne, facial hair, depression, and agonising and heavy periods – it can take women years to get diagnosed.

Even then, there’s very little in the way of treatment options. Most women are simply told to go on the pill or take other hormonal medications to manage their individual symptoms, but not the underlying cause.

In the long-term, PCOS can lead to metabolic disorders, such as type 2 diabetes, cardiovascular disease, and hormonal dysfunction, including infertility. In fact, PCOS is the cause of more than 75 percent of anovulatory infertility, which is infertility caused by a woman not ovulating.

And yet, despite the severity of the condition, researchers still don’t understand how PCOS arises and how we can treat it.

Now, researchers led by the University of New South Wales in Australia have shown that mice without receptors for androgens – a group of steroid hormones commonly associated with males, such as testosterone – in their brains can’t develop PCOS. But if the androgen receptors in the ovaries are removed, the condition can still arise

 Seeing as mouse and human reproductive systems share many similarities, it’s compelling early evidence that doctors and scientists might have been focussing on the wrong piece of the puzzle all along.

“For the first time we have a new direction of where we should be looking to try and develop treatments that will treat the cause of PCOS, the androgen excess in the ovary but also in the brain,” said lead researcher Kirsty Walters in an emailed press release.

Before this, researchers knew that an increase in androgens, known as hyperandrogenism, was linked to the onset of PCOS. But exactly how and where these androgens act in the body was poorly understood.

“Hyperandrogenism is the most consistent PCOS characteristic; however, it is unclear whether androgen excess, which is treatable, is a cause or a consequence of PCOS,” the researchers write in their paper.

To get a better idea, the researchers took four groups of mice:

  • a control group of normal mice
  • a group of mice genetically engineered to have no androgen receptors (ARs) anywhere in their bodies
  • a group that had been engineered to have no ARs in just their brains
  • a final group that only had ARs missing from their ovaries.

The team then used a high dose of androgen to attempt to trigger PCOS in all four groups of mice.

While the control group developed PCOS as they expected, the mice missing ARs entirely, or just missing them from their brains, didn’t get the condition.

Interestingly, the mice that were only missing ARs from their ovaries still went on to develop PCOS, although at a lower rate than the control group. That means androgens acting on the ovaries can’t be the sole cause of PCOS.

The result suggests two important things: researchers were right about an excess of androgens triggering the condition; and the action of androgens on the brain is important to the development of PCOS.

That means if we can find a way to stop those excess androgens in the brain, it could signal a new way to treat PCOS.

“These data highlight the previously overlooked importance of extraovarian [outside the ovary] neuroendocrine androgen action in the origins of PCOS,” the researchers explain.

To be clear, this study has only looked at mice so far, and the results need to be replicated in humans before we can get an idea of whether the same thing is happening in our own reproductive systems.

But this is a big deal because, until now, the focus when looking for effective treatments and preventions has been on the ovaries – and we haven’t had much luck.

The new study, though it’s still early days, gives researchers a new target to look into, and it could hopefully lead to new, more effective treatments for people with the condition.

Source:http://www.sciencealert.com

For half her life, doctors told her to lose weight. But something else was going on.

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To Deborah E. Savage, a trip to the doctor was frequently an exercise in humiliation.

For more than 15 years, Savage’s doctors doled out the same advice: You need to stop gaining weight. When Savage replied that she had tried watching her diet and exercising, only to pack on more pounds, it was clear they simply didn’t believe her. Her family was equally skeptical.

“I would eat like my sister, and I would gain weight but she wouldn’t,” recalled Savage, a civil engineer who lives in Montgomery County and turns 31 next month.

Savage’s inexorable weight gain, which began in middle school and resulted in obesity, was not her only problem: For years, she also struggled with eruptions of painful acne and facial hair. “These things made me feel ugly,” she said.

For years, Debbie Savage kept gaining weight. She was plagued by horrific acne and apathetic doctors.

Last year, after Savage had trouble getting pregnant, an inability she suspected was linked to her irregular periods, she consulted a new obstetrician/gynecologist. The doctor suggested that Savage’s constellation of problems might have a single cause. But it took a second OB/GYN to conduct the proper tests, which led to a definitive diagnosis of a common — and consequential — disorder.

“It’s frustrating to me that so many doctors” didn’t think of this, she said. “If I’d known, I would have made changes years ago.”

Comparisons rankled

From the time she was 12, Savage recalled, her inability to lose weight became one of the defining elements of her life. And because she is short — 5-foot-3 — extra pounds were particularly noticeable. Her family’s comparisons with her older, thinner sister rankled.

At her mother’s suggestion, Savage joined a gym, but that didn’t help her lose more than a few pounds.

Savage said she was too intimidated to ask her doctors why her weight didn’t budge much, even when she faithfully followed a diet and worked out.

Nor did she mention the other problems that plagued her. “The facial hair thing was embarrassing, so I didn’t want to talk about it,” she recalled. “Same with the acne. I felt so sensitive about it.”

Savage wasn’t sure what to make of her irregular menstrual periods, but doctors did not seem concerned. At times she went three months without a period; at other times they lasted for two weeks. She managed to lose a little weight in college, but her acne and other problems persisted.

In her early 20s, Savage said, her gynecologist chided her about how heavy she was; every year, she seemed to gain 10 pounds. “I explained that I had tried diet and exercise, but he said I was not trying hard enough,” Savage recalled.

To regulate her menstrual cycle and tame her acne, the doctor prescribed oral contraceptives, which helped clear her skin and made her periods somewhat less irregular.

When she got married in 2010, Savage and her husband joined a popular weight-loss program to see whether they could motivate each other.

Savage said she lost only about eight pounds after several months, while her husband, who followed the same diet, had no trouble shedding much more weight.

“It was very frustrating,” she recalled. “I was serious about following the rules, but it didn’t pay off. I kind of gave up.”

By early 2015, she was desperate. She had stopped taking the pill nearly a year earlier, in hopes of getting pregnant; without it, her acne had roared back and her facial-hair problem had worsened. Savage was at her heaviest weight — about 240 pounds — and her family doctor warned that her cholesterol, at 210 mg/dL, was too high.

In March, sheswitched gynecologists. Her new doctor zeroed in on her irregular periods and her weight and asked Savage whether she had heard of a metabolic disorder called polycystic ovarian (or ovary) syndrome.

What is polycystic ovarian syndrome?

Polycystic ovarian (or ovary) syndrome is a condition that affects up to five million American women, but it often goes undiagnosed. Here are the basics. (Gillian Brockell/The Washington Post)

Savage replied that a friend in college had been diagnosed with PCOS. She was surprised when the doctor responded that she suspected Savage might have it, too.

An explanation at last

PCOS is a common hormonal imbalance that often begins in puberty and affects as many as 10 percent of women. Its cause is unknown, but heredity appears to play a role: Women whose mothers or sisters have the disorder are at higher risk. Many women with PCOS have enlarged ovaries containing fluid-filled cysts that produce excess androgens — male sex hormones, which interfere with ovulation. Other signs of PCOS include irregular, absent or prolonged periods, acne and excess facial and body hair, a condition known ashirsutism.

Because it also disrupts the regulation of insulin, many women with PCOS are overweight or obese. The disorder, which can be controlled but not cured, also increases the risk of Type 2 diabetes, high blood pressure and heart attack.

The gynecologist told Savage that she also suffered from PCOS. When Savage asked whether it was possible to test for the disorder, she said that the gynecologist told her, erroneously, that there were no tests. The best way to treat the problem was to lose weight, the doctor advised. And, the gynecologist added, she held weight-loss seminars in her office and urged Savage to sign up.

Savage declined. Two weeks later, she consulted a third OB/GYN, Neil Horlick, who practices in Montgomery and Frederick counties.

Horlick, after taking her history and performing an exam, said he suspected she had PCOS. When Savage told him she had been told there was no test for it, he assured her that testing was available and that he would order it.

Because abnormalities of the thyroid or adrenal glands can cause similar symptoms, those must be ruled out first. PCOS is essentially a diagnosis of exclusion, made on the basis of blood tests, a patient’s symptoms and an ultrasound of the ovaries.

“We generally look for two out of three criteria for PCOS,” Horlick said. These include a history of irregular or absent periods, elevated levels of male hormones, particularly testosterone, and the presence of ovarian cysts. In Savage’s case, an ultrasound showed no cysts, but she did have an elevated testosterone level.

Horlick said he was surprised that Savage’s condition went undiagnosed for so long. “PCOS is always on our radar” when a patient with irregular periods complains of weight gain and hirsutism, Horlick said.

He told Savage that her best chance of getting pregnant involved losing weight. Horlick prescribed metformin, a diabetes drug that can promote weight loss. Metformin is commonly given to PCOS patients and may help promote ovulation as well.

Savage decided to take a new approach to food. She began following a paleo diet, which emphasizes meat, vegetables, nuts and fruit, and drastically reduces the intake of carbohydrates, sugar and processed foods.

The first month, she said, she was elated to discover that she had lost 15 pounds; between April and September, she shed 50 pounds and her cholesterol dropped 20 points. Her acne also improved, her level of testosterone dropped, and her menstrual cycle became more regular.

Savage said she asked relatives whether anyone else had been diagnosed with PCOS. “My parents had never heard of it,” she said.

In October 2015, she and her husband were elated to learn that she was pregnant with identical twin boys. Savage spent six weeks hospitalized at Maryland’s Shady Grove Medical Center under close observation, because her twins have a rare condition in which they share a single amniotic sac and placenta, a condition unrelated to PCOS. The babies were born April 22.

Savage said she hopes that her experience will spare other women from “struggling for years the way I did.”

“This isn’t a bizarre disorder,” she said. “It shouldn’t take [this many] doctors to find out, when I have a textbook case.”

 

Reproductive success linked to 25-(OH)D concentrations in PCOS

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Measures of reproductive success in women with polycystic ovary syndrome after ovulation induction may be independently predicted by serum 25-hydroxyvitamin D levels, according to study data.

“Our current study reaffirms a relevance of adequate 25-(OH)D for procreative success in women with PCOS undergoing [ovulation induction],” the researchers wrote. “Beyond reaffirming a consistency in directionality of the previously observed associations, we have additionally noted that this association becomes apparent at serum 25-(OH)D levels that are well beyond the threshold of 30 ng/mL that is currently deemed as a target ‘normal’ level.”

Lubna Pal, MBBS, F RCOG, FACOG, associate chair of education in the department of gynecology and reproductive sciences at Yale School of Medicine, and colleagues evaluated data from the Pregnancy in Polycystic Ovary Syndrome (PPOS I) randomized controlled trial on 540 women (mean age, 28 years) with PCOS to determine whether any links exist between vitamin D status and ovulation induction outcomes.

Primary outcome was live birth, and secondary outcomes included ovulation and pregnancy loss after ovulation induction. Vitamin D status was defined as sufficient ( 30 ng/mL), inadequate (20-29.9 ng/mL), deficient (< 20 ng/mL) or severely deficient (< 10 ng/mL).

During the 6-month trial duration, 74% of participants had evidence of ovulation. Compared with participants with 25-(OH)D levels of at least 20 ng/mL, those with 25-(OH)D deficiency were less likely to achieve ovulation (P = .006).

Live birth rate was nearly 19% overall. Compared with participants who did not deliver a live birth, serum 25-(OH)D was higher in those who did (P = .046). The likelihood of live birth was increased by 2% with each 1 ng/mL increase in 25-(OH)D (OR = 1.02; 95% CI, 1-1.04). Participants who were vitamin D sufficient had a 26% live birth rate, whereas the likelihood of live birth decreased in participants with vitamin D insufficiency (OR = 0.74; 95% CI, 0.57-0.96), vitamin D deficiency (OR = 0.61; 95% CI, 0.35-1.08) and vitamin D severe deficiency (OR = 0.48; 95% CI, 0.19-1.23).

Participants with vitamin D levels greater than 45 ng/mL had a fourfold increased likelihood of live birth (OR = 4.5; 95% CI, 1.27-15.72), whereas there was a 44% reduction in likelihood of live birth among participants with 25-(OH)D levels less than 30 ng/mL (OR = 0.58; 95% CI, 0.35-0.92). There were progressive improvements in the odds for live birth at 25-(OH)D thresholds of at least 38 ng/mL (OR = 1.42; 95% CI, 1.08-1.8) and at least 40 ng/mL (OR = 1.51; 95% CI, 1.05-2.17).

Twenty-nine percent of positive pregnancy tests were followed by pregnancy loss, and there was an 82% reduced likelihood of pregnancy loss with serum 25-(OH)D levels of at least 38 ng/mL compared with lower levels (OR = 0.18; 95% CI, 0.02-0.9).

“Our data suggest that for infertile women with PCOS, [vitamin D] status, as reflected by serum levels of 25-(OH)D, is relevant for procreative success,” the researchers wrote. “We hypothesize that decline in circulating 25-(OH)D below the [lower reproductive threshold] may be contributory to ovulatory dysfunction, whereas at levels at and above an [upper reproductive threshold], achieved through supplementation, may result in improved endometrial receptivity, as has been previously suggested, thus yielding improved treatment [live birth] rates and reduce risk of [pregnancy loss] in women with PCOS, a population that is already an enhanced risk for pregnancy wastage.” – by Amber Cox

Metabolic syndrome rate, severity in PCOS reduced following bariatric surgery

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Bariatric surgery can improve cardiometabolic health in women with polycystic ovary syndrome and obesity, according to findings of a retrospective cohort study presented here.

McAnto Antony, MBBS, a second-year resident at Medstar Washington Hospital Center in Washington, D.C., and colleagues evaluated data from Medstar facilities on 19 women with PCOS (mean age, 18.4 years; 53% black; 41% white; 6% Asian) who had undergone a bariatric surgical procedure. The most common procedure was gastric sleeve, followed by lap band with fewer Roux-en-Y gastric bypass, according to Antony. Researchers compared BMI, blood pressure, HbA1c, and triglyceride and HDL levels before and at least 6 months after surgery (mean time between surgery and follow-up, 7.9 months).

McAnto Antony

McAnto Antony

Compared with presurgical values, postsurgical reductions were observed in body weight (mean, 271 kg vs. 205.4 kg; P < .0001), BMI (mean, 45.9 kg/m2 vs. 35 kg/m2; P < .0001), systolic BP (mean, 133.4 mm Hg vs. 119.5 mm Hg; P = .0002), diastolic BP (mean, 81.9 mm Hg vs. 73.1 mm Hg; P= .007), triglycerides (mean, 143.2 mg/dL vs. 111.5 mg/dL; P = .04) and HbA1c (mean 6.6% vs. 5.8%; P = .03); mean HDL level increased (44.8 mg/dL vs. 52.5 mg/dL; P = 0.04). Before surgery, participants had a mean 2.7 components of metabolic syndrome on average, which decreased to 1.9 after their procedure (P < .01). Forty-seven percent of participants had at least three of the five components of metabolic syndrome, meeting criteria for the condition, before surgery. Following surgery, prevalence dropped to 21%.

“Bariatric surgery is definitely an option in the obese woman with PCOS to reduce her risk of developing cardiovascular disease in the future,” Antony told Endocrine Today. “ – by Jill Rollet

CVD risk higher for women aged at least 30 years with PCOS

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Among women with polycystic ovary syndrome, those aged 30 years or older are potentially at higher risk for developing early atherosclerosis, based on elevated lipid levels, lipid ratios and hypertension rates, compared with younger women with or without polycystic ovary syndrome, according to research in the International Journal of Endocrinology.

Subclinical cardiovascular disease was more prevalent in women aged at least 30 years with PCOS regardless of BMI, according to researchers.

“If we consider that women with PCOS are exposed to risk factors for CVD early in life, the diagnosis of subclinical atherosclerosis in this population would be of importance,” the researchers wrote.

Djuro Macut, MD, of the University of Belgrade, Serbia, and colleagues compared data from 100 women with PCOS (26.32 ± 5.26 years; BMI, 24.98 ± 6.38 kg/m²) with 50 healthy women (27.96 ± 5.6 years; BMI, 24.66 ± 6.74 kg/m²). Baseline blood samples collected after 12 hours of fasting during the follicular phase of the menstrual cycle, or randomly in the case of amenorrhea, were analyzed for levels of total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, apolipoprotein A, ApoB, glucose, insulin, total testosterone, sex hormone-binding globulin, androstenedione and dehydroepiandrosterone sulfate.

Patients aged at least 30 years with PCOS (n = 24) had higher BMI (P < .001) waist-to-hip ratio (P = .008), systolic blood pressure (P < .001), diastolic BP (P < .001), all lipids and their ratios, and ApoB (P = .014) than younger women with PCOS (n = 76), according to researchers. After adjustment for BMI, significant differences remained for systolic BP (P = .003), diastolic BP (P = .003), triglycerides (P = .05), insulin (P = .028) and free androgen index (P = .043).

In the older subgroups, women with PCOS had a significantly higher prevalence of hypertension than women without PCOS (n = 18; 61% vs. 17%, P = .003).

“A more proper assessment of the clinical phenotypes and use of specific metabolic indicators could be a valuable tool for the evaluation of [CV] potential and outcomes in future randomized studies on women with PCOS,” the researchers wrote. – by Regina Schaffer

High testosterone, dihydrotestosterone linked to adverse metabolic phenotype in patients with PCOS

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Patients with polycystic ovary syndrome who have a high testosterone to dihydrotestosterone ratio appear to be more likely to have an adverse metabolic phenotype, according to recent findings.

In the study, researchers evaluated 275 premenopausal women aged 16 to 48 years with PCOS and 35 BMI-matched, premenopausal, health women aged 21 to 50 years as controls. The researchers recorded anthropometric data for all participants, including height, weight, waist circumference and hip circumference.

Researchers recorded systolic and diastolic blood pressure measurements and calculated BMI. Fasting blood samples were taken to evaluate basal hormone serum levels. Additionally, an oral glucose tolerance test was performed, and blood samples were collected at 30, 60 and 120 minutes to determine glucose and insulin concentrations.

A routine method for liquid chromatography/mass spectrometry was used to determine total testosterone (T), total dihydrotestosterone (DHT), androstenedione and dehydroepiandrosterone (DHEA).

The researchers found that patients with PCOS had significantly higher levels of total T (P<.001), free testosterone (P<.001) and free DHT (P<.001) vs. healthy controls. Additionally, patients with PCOS had a significantly higher total T/DHT ratio (P<.001). No difference was found between PCOS and control participants in terms of total DHT levels (P=.072).

An analysis of just patients with PCOS revealed a significantly higher total T/DHT ratio in patients with obesity (P<.001) as well as those with metabolic syndrome (P<.001), impaired glucose tolerance (P<.001) or insulin resistance (P<.001).

The researchers also found significant association between total T/DHT ratio and various adverse anthropometric, hormonal, lipid and liver measures, and measures of glucose tolerance.

“This correlation was only found in PCOS patients, suggesting the [total] T/DHT ratio is a new biomarker for an adverse metabolic phenotype in PCOS patients,” the researchers wrote. “Nevertheless, future studies and larger trials are needed for the evaluation of results.”

PCOS increased risk for CVD, obesity.

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In a case-control study, researchers found that young women with polycystic ovary syndrome have a higher prevalence of cardiovascular disease risk factors, including hypertension, obesity and metabolic syndrome, compared with controls. The researchers also found significantly lower levels of lipoprotein apolipoprotein A-I and observed a significant reduction in efflux capacity.

  • “Given the available data, there is evidence to suggest that women with PCOS are at an increased risk for developing CV-related outcomes,” Andrea Roe, MD, of the department of obstetrics and gynecology in the division of reproductive endocrinology at the University of Pennsylvania, and colleagues wrote. “These data strongly support educating all PCOS patients about the associated risk of dyslipidemia and need for frequent lipid screening.”

The researchers evaluated women aged 18 to 50 years with PCOS (n=124) and geographically matched controls (n=67). The patients with PCOSdemonstrated higher BMI and blood pressure, but similar HDL and LDL levels compared with controls, according to data.

The mean ApoA-I levels were lower and ApoB to ApoA-I ratio was greater among patients with PCOS compared with controls (P<.01), researchers wrote.

In addition, women with PCOS displayed an 11% decrease in normalized cholesterol efflux capacity compared with controls (P<.05). The cholesterolefflux capacity was correlated with BMI, ApoA-I, HDL and presence of metabolic syndrome, researchers wrote.

Multivariable regression model data indicated that PCOS was significantly associated with less cholesterol efflux (beta level, –0.05; 95% CI, –0.1 to –0.009).

After adjustments for age and BMI, PCOS was also significantly associated with an atherogenic profile, including an increase in large VLDL particles, size and small LDL particles (P<.01).

BMI may be most vital determinant of basal metabolic rate in PCOS.

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The BMI of patients with polycystic ovary syndrome appeared to be the most important factor in basal metabolic rate, independent of the polycystic ovary syndrome phenotype and insulin resistance, according to Margareta D. Pisarska, MD, who presented the data at the conjoint meeting of the International Federation of Fertility Societies and the American Society for Reproductive Medicine.

“Based on our study — since we do think obesity does play a significant role — we believe it is important for endocrinologists to help counsel these women in a fashion similar to those who are obese by emphasizing that weight loss and lowering BMI are important,” Pisarska, director of the division of reproductive endocrinology and infertility; director of the Fertility and Reproductive Medicine Center at Cedars-Sinai Medical Center; associate professor at Cedars-Sinai Medical Center and the David Geffen School of Medicine at UCLA, told Endocrine Today.

 

The researchers conducted the case-control study examining the metabolic changes (ie, lean body mass, body fat mass, body fat percentage, skeletal muscle mass, BMI and basal metabolic rate) in 128 patients with PCOS (mean age, 28.1 years) and 72 eumenorrheic, non-hirsute controls (mean age, 32.9 years).

In terms of hormonal profile, patients with PCOS had greater testosterone, dehydroepiandrosterone sulfate (DHEA-sulfate), fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR) levels compared with controls.

After controlling for age and BMI differences, there was no difference in body composition parameters between patients with PCOS and controls. There were no significant results regarding changes to the basal metabolic rate (P=.0162), lean body mass (P=.0153) or skeletal muscle mass (P=.0169), she said.

However, differences in fasting insulin and HOMA-IR remained significant. When looking at insulin resistance in women with PCOS as a potential factor affecting body composition and metabolic rates, there was also no difference between these groups.

“It is not necessarily PCOS; BMI and age are probably the more important determinants of basal metabolic rate, regardless of PCOS phenotype and insulin resistance,” Pisarska said.

Two-state solution’ proposed for renaming PCOS.

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New terminology is warranted for improved diagnosis and treatment of polycystic ovary syndrome phenotypes, according to researchers.

 “We would like to propose a nosological ‘two-state solution’ to the conflict. The endocrine syndrome of hyperandrogenism and chronic anovulation, eg, the National Institutes of Health (NIH) phenotype, should have a new name that acknowledges both its reproductive features as well as its long-term metabolic risks. The phenotypes diagnosed by ovarian morphology, eg, the remaining Rotterdam phenotypes, should continue to be known as PCOS,” wroteAndrea Dunaif, MD, vice chair for research in the department of medicine at Northwestern University Feinberg School of Medicine, and Bart Fauser, MD, of the department of reproductive medicine and gynecology at the University Medical Center in Utrecht, the Netherlands.

 

The researchers cited recommendations from the NIH Office for Disease Prevention’s Evidence-based Methodology Workshop on PCOS held last year, which suggested clarifying benefits and drawbacks from diagnostic criteria; causes, predictors and long-term consequences; and treatment and prevention strategies. They added that the syndrome is often overlooked outside of obstetrics and gynecology visits.

Currently, the diagnostic criteria for PCOS by the NIH include hyperandrogenism and chronic anovulation; Rotterdam includes two of the following: hyperandrogenism, chronic anovulation and polycystic ovaries. Finally, the Androgen Excess Society criteria state that PCOS is marked by hyperandrogenism plus ovarian dysfunction indicated by oligo/amenorrhea and/or polycystic ovaries, according to the researchers.

“Specifically, we want to ensure that this recommendation does not lead to Balkanization of the field, which will clearly undermine the broad interdisciplinary efforts required for meaningful scientific advances in our understanding of PCOS,” they wrote.

Source: Endocrine Today