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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.
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.
S L Berga - One of the best experts on this subject based on the ideXlab platform.
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Polycystic Ovary Syndrome
Clinical Reproductive Medicine and Surgery, 2013Co-Authors: E.b. Johnston-macananny, John Kyun Park, S L BergaAbstract:Polycystic Ovary syndrome (PCOS) is characterized by a constellation of clinical symptoms that include irregular menses due to chronic oligo-ovulation, phenotypic features of hyperandrogenism, and obesity. The term “Polycystic Ovary” refers to ovarian morphology with increased ovarian stroma and a ring of cortical follicles. Core biochemical features include hyperandrogenism and insulin resistance. The pathogenesis of PCOS remains a topic of debate. Treatment of PCOS typically focuses on mitigating the impact of hyperandrogenism, insulin resistance, and chronic oligo-ovulation and restoring fertility when desired.
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The obstetrician-gynecologist's role in the practical management of Polycystic Ovary syndrome
American Journal of Obstetrics and Gynecology, 1998Co-Authors: S L BergaAbstract:Women with Polycystic Ovary syndrome come to the gynecologist with a variety of symptoms, including menstrual irregularities, hirsutism, acne, weight gain, obesity, and infertility. An accurate diagnosis requires both confirmation of signs and symptoms of Polycystic Ovary syndrome and exclusion of other disorders. Once the diagnosis of Polycystic Ovary syndrome has been established, the presence of concomitant conditions, such as hypertension, dyslipidemia, and diabetes, must be assessed. Because the cause of Polycystic Ovary syndrome is not clear, treatment options have focused on symptom management. Such treatment options include oral contraceptives, gonadotropin-releasing hormone analogs with “add-back” hormone regimens, antiandrogens, ovulation-inducing agents, electrolysis, nutritional and weight loss counseling, exercise, laparoscopic ovarian drilling, and glucocorticoids. Pathogenic considerations, risk factor assessments, and treatment objectives combine to determine the choice of therapies. It is not clear whether insulin resistance is clinically important or causal in Polycystic Ovary syndrome symptom complex in all affected women. Polycystic Ovary syndrome may be the final common expression of a variety of metabolic or neuroendocrine perturbations. If insulin resistance is a universal feature, it would make sense to treat with an insulin-sensitizing agent in the expectation that symptoms would resolve or improve. If insulin resistance is not the main etiologic factor, however, then insulin-sensitizing agents would be useful as adjunctive agents only for women with clinically important insulin resistance (eg, patients with Polycystic Ovary syndrome in whom insulin resistance causes hyperglycemia). In such cases an insulin-sensitizing agent could be instituted along with a program of weight loss and exercise. (Am J Obstet Gynecol 1998;179:S109-13.)
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The obstetrician-gynecologist's role in the practical management of Polycystic Ovary syndrome.
American journal of obstetrics and gynecology, 1998Co-Authors: S L BergaAbstract:Women with Polycystic Ovary syndrome come to the gynecologist with a variety of symptoms, including menstrual irregularities, hirsutism, acne, weight gain, obesity, and infertility. An accurate diagnosis requires both confirmation of signs and symptoms of Polycystic Ovary syndrome and exclusion of other disorders. Once the diagnosis of Polycystic Ovary syndrome has been established, the presence of concomitant conditions, such as hypertension, dyslipidemia, and diabetes, must be assessed. Because the cause of Polycystic Ovary syndrome is not clear, treatment options have focused on symptom management. Such treatment options include oral contraceptives, gonadotropin-releasing hormone analogs with "add-back" hormone regimens, antiandrogens, ovulation-inducing agents, electrolysis, nutritional and weight loss counseling, exercise, laparoscopic ovarian drilling, and glucocorticoids. Pathogenic considerations, risk factor assessments, and treatment objectives combine to determine the choice of therapies. It is not clear whether insulin resistance is clinically important or causal in Polycystic Ovary syndrome symptom complex in all affected women. Polycystic Ovary syndrome may be the final common expression of a variety of metabolic or neuroendocrine perturbations. If insulin resistance is a universal feature, it would make sense to treat with an insulin-sensitizing agent in the expectation that symptoms would resolve or improve. If insulin resistance is not the main etiologic factor, however, then insulin-sensitizing agents would be useful as adjunctive agents only for women with clinically important insulin resistance (eg, patients with Polycystic Ovary syndrome in whom insulin resistance causes hyperglycemia). In such cases an insulin-sensitizing agent could be instituted along with a program of weight loss and exercise.
Adam H Balen - One of the best experts on this subject based on the ideXlab platform.
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Polycystic Ovary syndrome
InnovAiT: Education and inspiration for general practice, 2016Co-Authors: Adam H BalenAbstract:Polycystic Ovary syndrome is the most common endocrine disturbance to affect women, with approximately 10–15% of women experiencing this problem. It involves a spectrum of signs and symptoms, which...
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Polycystic Ovary Versus Polycystic Ovary Syndrome
Polycystic Ovary Syndrome, 2008Co-Authors: Adam H BalenAbstract:The Polycystic Ovary syndrome (PCOS) is a heterogeneous condition. Polycystic ovaries are detected in 19–33% of the “general population,” of whom approximately 80% have symptoms of PCOS, albeit for many such symptoms are usually mild. Thus, about 20% of women with Polycystic ovaries are symptom free. It appears that ovarian dysfunction is expressed when the ovaries of women with Polycystic ovaries alone are stressed, by either a gain in weight, a rise in circulating insulin levels, or stimulation with follicle-stimulating hormone (FSH) for assisted conception treatments. Longitudinal studies are required to better explore the evolution of signs and symptoms of the syndrome over time in women with Polycystic ovaries and by comparison with those with normal ovaries.
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Is metformin the treatment of choice for anovulation in Polycystic Ovary syndrome
Nature Clinical Practice Endocrinology & Metabolism, 2007Co-Authors: Adam H BalenAbstract:The insulin-sensitizing agent metformin has been heralded as a novel therapy for women with Polycystic Ovary syndrome-associated anovulatory infertility. The author of this Viewpoint reviews the evidence from clinical trials and asks whether metformin will become the first-line therapy for ovulation induction in Polycystic Ovary syndrome.
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Management of Polycystic Ovary Syndrome
Women's Health, 2007Co-Authors: Ephia Yasmin, Adam H BalenAbstract:Polycystic Ovary syndrome is a common endocrinological problem in women of reproductive age. Polycystic Ovary syndrome is a heterogenous disorder and patients may attend different clinics depending on the main complaint. The exact pathophysiology of Polycystic Ovary syndrome remains obscure, although there have been insights that have thrown light on this condition. Consensus on the definition of the syndrome has only been recently achieved. The management of Polycystic Ovary syndrome poses a challenge to the physician as responses to the different treatment regimes have proved to be inconsistent. Diet and lifestyle advice, restoration of menstrual cycle regularity, treatment of hyperandrogenism, treatment of infertility and prevention of long-term consequences form the basis of Polycystic Ovary syndrome management. This review aims to provide the reader with the latest evidence in the treatment of Polycystic Ovary syndrome, as well as focus on some of the controversies surrounding its management.
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Up-to-date Definition of the Polycystic Ovary and Polycystic Ovary Syndrome
Ultrasound, 2006Co-Authors: R. Hamzeh, Adam H BalenAbstract:Abstract Polycystic Ovary syndrome (PCOS) is common in the general population. In this paper the author presents the up to date definition of PCOS and PCO. At a joint ASRM/ESHRE consensus meeting, a refined definition of the PCOS was agreed, in which two out of the following are required: (1) oligomenorrhoea or amenorrhoea; (2) clinical and/or biochemical signs of hyperandrogenism; (3) Polycystic ovaries, once appropriate tests have been performed to exclude other causes of androgen excess and menstrual disturbance. The definition of a Polycystic Ovary (PCO) should have at least one of the following: either 12 or more follicles measuring 2–9 mm in diameter or increased ovarian volume (>10 cm3). If there is a follicle >10 mm in diameter, the scan should be repeated at a time of ovarian quiescence in order to calculate volume and area. The presence of a single PCO is sufficient to provide the diagnosis. The distribution of follicles and a description of the stroma are not required in the diagnosis.
Kathleen M. Hoeger - One of the best experts on this subject based on the ideXlab platform.
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Obesity in Polycystic Ovary Syndrome: Insulin Sensitizing Therapy
Current Obesity Reports, 2012Co-Authors: Kathleen M. HoegerAbstract:Polycystic Ovary Syndrome (PCOS) is a common reproductive endocrine disorder in women that is highly associated with obesity. Whether obesity is intrinsic to the disorder or is a result of different lifestyle and environmental concerns is unclear, however obesity influences the risks of PCOS with respect to fertility complications, pregnancy complications and cardiovascular risk. Polycystic Ovary syndrome is known to be associated with insulin resistance in both lean and obese individuals. Insulin resistance in fact is felt to be a key feature in the reproductive and metabolic dysfunction of PCOS. There are numerous studies reporting the benefits of insulin sensitizing therapy, specifically metformin and thiazolidinediones, on the features of PCOS and emerging evidence on the impact of these agents on the risk and management of obesity. Weight loss and maintenance of weight reduction has been seen in women and adolescents treated with metformin therapy. Most studies indicate a synergy of metformin with lifestyle therapy in the general population but there are limited data in PCOS.
