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D Guzick - One of the best experts on this subject based on the ideXlab platform.
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Polycystic Ovary Syndrome symptomatology pathophysiology and epidemiology
American Journal of Obstetrics and Gynecology, 1998Co-Authors: D GuzickAbstract:Abstract Women with Polycystic Ovary Syndrome seek health care for 3 major reasons: infertility, menstrual irregularity, and androgen excess. The infertility is associated with anovulation. The menstrual irregularity is typically chronic, beginning with menarche. Although amenorrhea may sometimes occur, the more common presentation is irregular bleeding characteristic of anovulation. Androgen excess may be manifested by varying degrees of hirsutism. Patients may also report acne. The rapid development of virilizing signs, such as deepening of the voice, increased muscle mass, and temporal balding, should prompt a search for a tumor and lead one away from a diagnosis of Polycystic Ovary Syndrome. Typically treatment is directed at alleviating the symptoms: ovulation induction for infertility, oral contraceptives or a progestin for menstrual irregularity, and oral contraceptives or spironolactone for hirsutism. On the basis of recent epidemiologic data suggestive of increased cardiovascular risk among women with Polycystic Ovary Syndrome, such treatment might be complemented by a long-term approach that addresses the underlying pathophysiology of insulin resistance. (Am J Obstet Gynecol 1998;179:S89-93.)
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Polycystic Ovary Syndrome: Symptomatology, pathophysiology, and epidemiology ☆ ☆☆
American Journal of Obstetrics and Gynecology, 1998Co-Authors: D GuzickAbstract:Abstract Women with Polycystic Ovary Syndrome seek health care for 3 major reasons: infertility, menstrual irregularity, and androgen excess. The infertility is associated with anovulation. The menstrual irregularity is typically chronic, beginning with menarche. Although amenorrhea may sometimes occur, the more common presentation is irregular bleeding characteristic of anovulation. Androgen excess may be manifested by varying degrees of hirsutism. Patients may also report acne. The rapid development of virilizing signs, such as deepening of the voice, increased muscle mass, and temporal balding, should prompt a search for a tumor and lead one away from a diagnosis of Polycystic Ovary Syndrome. Typically treatment is directed at alleviating the symptoms: ovulation induction for infertility, oral contraceptives or a progestin for menstrual irregularity, and oral contraceptives or spironolactone for hirsutism. On the basis of recent epidemiologic data suggestive of increased cardiovascular risk among women with Polycystic Ovary Syndrome, such treatment might be complemented by a long-term approach that addresses the underlying pathophysiology of insulin resistance. (Am J Obstet Gynecol 1998;179:S89-93.)
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Polycystic Ovary Syndrome: symptomatology, pathophysiology, and epidemiology.
American journal of obstetrics and gynecology, 1998Co-Authors: D GuzickAbstract:Women with Polycystic Ovary Syndrome seek health care for 3 major reasons: infertility, menstrual irregularity, and androgen excess. The infertility is associated with anovulation. The menstrual irregularity is typically chronic, beginning with menarche. Although amenorrhea may sometimes occur, the more common presentation is irregular bleeding characteristic of anovulation. Androgen excess may be manifested by varying degrees of hirsutism. Patients may also report acne. The rapid development of virilizing signs, such as deepening of the voice, increased muscle mass, and temporal balding, should prompt a search for a tumor and lead one away from a diagnosis of Polycystic Ovary Syndrome. Typically treatment is directed at alleviating the symptoms: ovulation induction for infertility, oral contraceptives or a progestin for menstrual irregularity, and oral contraceptives or spironolactone for hirsutism. On the basis of recent epidemiologic data suggestive of increased cardiovascular risk among women with Polycystic Ovary Syndrome, such treatment might be complemented by a long-term approach that addresses the underlying pathophysiology of insulin resistance.
Gordana M. Prelevic - One of the best experts on this subject based on the ideXlab platform.
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The role of metformin in the management of Polycystic Ovary Syndrome.
Current Opinion in Obstetrics and Gynecology, 2003Co-Authors: Tasoula Tsilchorozidou, Gordana M. PrelevicAbstract:Purpose of review The purpose of this review is to provide a critical summary of recent studies on the clinical effects of metformin in Polycystic Ovary Syndrome. Recent findings After the recognition that hyperinsulinaemia is a fundamental disturbance in Polycystic Ovary Syndrome, a novel and promising form of therapy in the form of insulin-sensitizing drugs has been introduced. Among these, metformin is the most widely used. This therapeutic intervention has been shown to exert beneficial effects on the endocrine and metabolic disturbances that characterize the Syndrome and, more recently, to improve the reproductive outcome in women with Polycystic Ovary Syndrome. With rapid progress in this area, metformin use has also been extended to the management of lean Polycystic Ovary Syndrome patients. Summary Although most studies are nonrandomized trials, current data provide a rationale for metformin as first-line management for women with Polycystic Ovary Syndrome, alone or in combination with conventional treatments. Controversy still exists, however, regarding the mechanisms by which metformin exerts its beneficial effects in Polycystic Ovary Syndrome.
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INSULIN RESISTANCE IN Polycystic Ovary Syndrome
Current Opinion in Obstetrics and Gynecology, 1997Co-Authors: Gordana M. PrelevicAbstract:Hyperinsulinaemia is found in 30% of slim and 75% of obese women with Polycystic Ovary Syndrome. Despite resistance to insulin action in terms of glucose transport, increased insulin levels may cause hyperandrogenaemia by enhancement of androgen production in the ovaries where insulin acts as co-gonadotrophin. Recent interest in insulin resistance results from the recognition that it predisposes to various metabolic abnormalities, and could be involved in the pathogenesis of atherosclerosis. Women with Polycystic Ovary Syndrome frequently have metabolic disturbances associated with insulin resistance, and recent long-term follow-up studies have indicated that they also have a higher incidence of diabetes and hypertension later in life compared with control populations. This review describes the association of hyperinsulinaemia with hyperandrogenism, metabolic and circulatory changes in women with Polycystic Ovary Syndrome. Special emphasis is placed on recent studies of molecular mechanisms of insulin resistance in Polycystic Ovary Syndrome and clinical implications of hyperinsulinaemia in these women.
John E. Nestler - One of the best experts on this subject based on the ideXlab platform.
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Polycystic Ovary Syndrome.
New England Journal of Medicine, 2016Co-Authors: John E. NestlerAbstract:Key Clinical PointsPolycystic Ovary Syndrome The Polycystic Ovary Syndrome is diagnosed in women with at least two of the following otherwise unexplained abnormalities: hyperandrogenism (clinical, biochemical, or both), ovulatory dysfunction, and Polycystic ovarian morphologic features. Women with the Polycystic Ovary Syndrome are at increased risk for infertility, endometrial hyperplasia and cancer, abnormal glucose metabolism, dyslipidemia, obstructive sleep apnea, depression, and anxiety. Nonpharmacologic therapies play key roles in the treatment of the Polycystic Ovary Syndrome. Lifestyle modification is important for patients who are (or are at risk for being) overweight or obese and in those with other coexisting metabolic conditions. Mechanical hair removal (e.g., shaving) is an important treatment strategy in patients with hirsutism. Combined (estrogen–progestin) oral contraceptives are considered to be the first-line pharmacologic therapy for the classic symptoms of the Polycystic Ovary Syndrome....
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Metformin for the treatment of the Polycystic Ovary Syndrome.
New England Journal of Medicine, 2008Co-Authors: John E. NestlerAbstract:A 23-year-old woman with known Polycystic Ovary Syndrome visits her family physician. She has taken oral contraceptive pills in the past but did not tolerate them and is not currently receiving any treatment. She has three or four menstrual periods per year and is not interested in becoming pregnant now, but she will be getting married in a year. She has heard that the Polycystic Ovary Syndrome is associated with diabetes and is concerned because both her mother and father have type 2 diabetes. Her bodymass index (the weight in kilograms divided by the square of the height in meters) is 32, her waist circumference is 38 in. (96.5 cm), her serum total testosterone level is elevated at 0.9 ng per milliliter (90 ng per deciliter, or 2.9 nmol per liter), her plasma high-density lipoprotein cholesterol level is 35 mg per deciliter (0.9 mmol per liter), and her triglyceride level is 190 mg per deciliter (2.1 mmol per liter). Her serum glucose level 2 hours after the ingestion of 75 g of dextrose is 138 mg per deciliter (7.7 mmol per liter). The physician wonders whether treatment with metformin would be beneficial and refers the patient to an endocrinologist. T h e C l i nic a l Probl e m The Polycystic Ovary Syndrome is a clinical diagnosis characterized by the presence of two or more of the following features: chronic oligo-ovulation or anovulation, androgen excess, and Polycystic ovaries. 1 It affects 5 to 10% of women of childbearing age 2,3 and is the most common cause of anovulatory infertility in developed countries. Common clinical manifestations include menstrual irregularities and signs of androgen excess such as hirsutism, acne, and alopecia. The Polycystic Ovary Syndrome is associated with important metabolic derangements. The prevalence of type 2 diabetes in the United States is 10 times as high among young women with the Polycystic Ovary Syndrome as among normal women, 4,5 and impaired glucose tolerance or overt type 2 diabetes develops by the age of 30 years in 30 to 50% of obese women with the Polycystic Ovary Syndrome. 4‑6 The prevalence of the metabolic Syndrome is two to three times as high among women with the Polycystic Ovary Syndrome as among normal women matched for age and body-mass index, and 20% of women with the Polycystic Ovary Syndrome who are younger than 20 years of age have the metabolic Syndrome. 7 Although outcome data specifically for women with the Polycystic Ovary Syndrome are lacking, the risk of fatal myocardial infarction is twice as high among women with severe oligomenorrhea, most of whom would be expected to have the Polycystic Ovary Syndrome, as among women with eumenorrhea. 8 This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are reviewed. Relevant formal guidelines, if they exist, are presented. The article ends with the author’s clinical recommendations.
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Insulin resistance and the Polycystic Ovary Syndrome: recent advances
Current Opinion in Endocrinology & Diabetes, 2000Co-Authors: John E. NestlerAbstract:The Polycystic Ovary Syndrome is a prevalent disorder characterized by chronic anovulation and hyperandrogenism. It has recently been appreciated that insulin resistance with a compensatory hyperinsulinemia is also a prominent feature of the disorder and plays a key role in its development in many affected women. The purpose of this review is to highlight clinical studies in this area that were published during the past year. Areas discussed include the use of insulin-sensitizing drugs for treatment, D-chiro-inositol and insulin resistance, Syndrome X (ie, the dysmetabolic Syndrome), genetics of Polycystic Ovary Syndrome, precocious puberty and adrenarche as early manifestations of Polycystic Ovary Syndrome, and early pregnancy loss in Polycystic Ovary Syndrome.
Richard S. Legro - One of the best experts on this subject based on the ideXlab platform.
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Current perspectives of insulin resistance and Polycystic Ovary Syndrome
Diabetic Medicine, 2011Co-Authors: Jaimey G. Pauli, Nazia Raja-khan, Richard S. LegroAbstract:Diabet. Med. 28, 1445–1454 (2011) Abstract Aims To review the relationship between insulin resistance and Polycystic Ovary Syndrome. Methods A literature review. Results Insulin resistance likely plays a central pathogenic role in Polycystic Ovary Syndrome and may explain the pleiotropic presentation and involvement of multiple organ systems. Insulin resistance in the skeletal muscle of women with Polycystic Ovary Syndrome involves both intrinsic and acquired defects in insulin signalling. The cellular insulin resistance in Polycystic Ovary Syndrome has been further shown to involve a novel post-binding defect in insulin signal transduction. Treatment of insulin resistance through lifestyle therapy or with a diabetes drug has become mainstream therapy in women with Polycystic Ovary Syndrome. However, effects with current pharmacologic treatment with metformin tend to be modest, with limited benefit as an agent to treat infertility. Insulin resistance contributes to increased risk for pregnancy complications, diabetes and cardiovascular disease risk profile in Polycystic Ovary Syndrome, which is further exacerbated by obesity. While numerous studies demonstrate increased prevalence of cardiovascular disease risk factors in women with Polycystic Ovary Syndrome, there are limited data showing that women with Polycystic Ovary Syndrome are at increased risk for cardiovascular disease events. Conclusions Insulin resistance is linked to Polycystic Ovary Syndrome. Further study of lifestyle and pharmacologic interventions that reduce insulin resistance, such as metformin, are needed to demonstrate that they are effective in reducing the risk of diabetes, endometrial abnormalities and cardiovascular disease events in women with Polycystic Ovary Syndrome.
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Polycystic Ovary Syndrome.
The Lancet, 2007Co-Authors: Robert J Norman, Didier Dewailly, Richard S. Legro, Theresa E HickeyAbstract:Polycystic Ovary Syndrome is a heterogeneous endocrine disorder that affects about one in 15 women worldwide. The major endocrine disruption is excessive androgen secretion or activity, and a large proportion of women also have abnormal insulin activity. Many body systems are affected in Polycystic Ovary Syndrome, resulting in several health complications, including menstrual dysfunction, infertility, hirsutism, acne, obesity, and metabolic Syndrome. Women with this disorder have an established increased risk of developing type 2 diabetes and a still debated increased risk of cardiovascular disease. The diagnostic traits of Polycystic Ovary Syndrome are hyperandrogenism, chronic anovulation, and Polycystic ovaries, after exclusion of other conditions that cause these same features. A conclusive definition of the disorder and the importance of the three diagnostic criteria relative to each other remain controversial. The cause of Polycystic Ovary Syndrome is unknown, but studies suggest a strong genetic component that is affected by gestational environment, lifestyle factors, or both.
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Polycystic Ovary Syndrome: A Guide to Clinical Management - Polycystic Ovary Syndrome : a guide to clinical management
2005Co-Authors: Adam H Balen, Gerard S. Conway, Roy Homburg, Richard S. LegroAbstract:1. Introduction and Overview 2. Defining the Polycystic Ovary Syndrome 3. Epidemiology of PCOS 4. The Pathophysiology of Polycystic Ovary Syndrome 5. The Genetics of Polycystic Ovary Syndrome 6. Body Image and Quality of Life with Polycystic Ovary Syndrome 7. The Effects of Obesity and a Diet 8. Long Term Sequelae of Polycystic Ovary Syndrome: Diabetes and Cardiovascular Disease 9. Long Term Sequelae of Polycystic Ovary Syndrome: Gynaecological Cancer 10. Disorders of the Pilosebaceous Unit: Hirsutism and Androgenic Alopecia 11. Acne 12. Menstrual Disturbances 13. The Management of Infertility Associated with Polycystic Ovary Syndrome 14. PCOS, Pregnancy and Miscarriage 15. Menopause
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prevalence and predictors of dyslipidemia in women with Polycystic Ovary Syndrome
The American Journal of Medicine, 2001Co-Authors: Richard S. Legro, Allen R Kunselman, Andrea DunaifAbstract:Abstract Purpose Women with Polycystic Ovary Syndrome are hyperandrogenemic and insulin resistant, which are associated with alterations in circulating lipid and lipoprotein levels. We sought to determine the prevalence of, and risk factors for, lipid abnormalities in these women. Subjects and methods Non-Hispanic white women with Polycystic Ovary Syndrome (n = 195) and ethnically matched control women (n = 62) had fasting blood obtained for hormone and lipid levels. Subjects were categorized by body mass index (nonobese 2 , obese ≥27 kg/m 2 ), and analyses were adjusted for age. Results Total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels increased significantly in obese women with Polycystic Ovary Syndrome (n = 153) compared with obese control women (n = 35; mean difference in total cholesterol level=29 mg/dL; 95% confidence interval [CI]: 14 to 45 mg/dL; P P = 0.006). Similarly, total cholesterol and LDL-C levels increased significantly in nonobese women with Polycystic Ovary Syndrome (n = 42) compared with nonobese control women (n = 27; mean difference in total cholesterol=32 mg/dL; 95% CI: 13 to 52 mg/dL; P P P = 0.002; mean difference in triglyceride level=34 mg/dL; 95% CI: 1 to 77 mg/dL; P = 0.04). Differences in LDL-C and HDL-C levels, but not triglyceride levels, remained significant after adjusting for alcohol intake, smoking, and exercise. Although age, body mass index, and Polycystic Ovary Syndrome status were significant predictors of lipid levels, these factors accounted for no more than 25% of the variance. Conclusions In this large study of non-Hispanic white women, elevations in LDL-C levels were the predominant lipid abnormality in women with Polycystic Ovary Syndrome, independent of obesity. The characteristic dyslipidemia of insulin resistance was absent. Indeed, obese women with Polycystic Ovary Syndrome had relatively elevated HDL-C levels, which may confer some protection against cardiovascular disease.
Elisabeth R. Mathiesen - One of the best experts on this subject based on the ideXlab platform.
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Polycystic Ovary Syndrome and metformin in pregnancy.
Acta Obstetricia et Gynecologica Scandinavica, 2006Co-Authors: Anna E. Lilja, Elisabeth R. MathiesenAbstract:The diagnostic criteria of Polycystic Ovary Syndrome incorporate hyperandrogenism, Polycystic ovaries, anovulation and irregular menstrual bleeding and the Syndrome is a recognized reason behind infertility. The biguanide metformin has encouraging effects on several metabolic aspects of the Syndrome, including insulin sensitivity, plasma glucose concentration and lipid profile. Moreover, metformin improves the ovarian function in women diagnosed with Polycystic Ovary Syndrome. Hence, metformin is considered an agent for ovulation induction among these patients. However, even higher ovulation frequencies have been observed when metformin has been adjuvant to clomifene therapy. Metformin-induced ovulation presumably brings about resumption of regular menstrual cycles and improved conception rates. Polycystic Ovary Syndrome patients are presumably more likely than healthy women to suffer from pregnancy-related problems like early pregnancy loss, gestational diabetes mellitus and hypertensive states in pregna...