Efficacy and safety of acupuncture for polycystic ovary syndrome: An overview of systematic reviews / 中西医结合学报

BACKGROUND@#Polycystic ovary syndrome (PCOS) is the primary cause of anovulatory infertility, bringing serious harm to women's physical and mental health. Acupuncture may be an effective treatment for PCOS. However, systematic reviews (SRs) on the efficacy and safety of acupuncture for PCOS have reported inconsistent results, and the quality of these studies has not been adequately assessed.@*OBJECTIVE@#To summarize and evaluate the current evidence on the efficacy and safety of acupuncture for PCOS, as well as to assess the quality and risks of bias of the available SRs.@*SEARCH STRATEGY@#Nine electronic databases (Cochrane Library, MEDLINE, Embase, PsycINFO, CINAHL, Chinese National Knowledge Infrastructure, Wanfang Data, Chongqing VIP Chinese Science and Technology Periodical Database, and China Biology Medicine disc) were searched from their establishment to July 27, 2022. Based on the principle of combining subject words with text words, the search strategy was constructed around search terms for "acupuncture," "polycystic ovary syndrome," and "systematic review."@*INCLUSION CRITERIA@#SRs of randomized controlled trials that explored the efficacy and (or) safety of acupuncture for treating patients with PCOS were included.@*DATA EXTRACTION AND ANALYSIS@#Two authors independently extracted study data according to a predesigned form. Tools for evaluating the methodological quality, risk of bias, reporting quality, and confidence in study outcomes, including A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2), Risk of Bias in Systematic Reviews (ROBIS), Preferred Reporting Items for Systematic Reviews and Meta-analyses for Acupuncture (PRISMA-A), and the Grading of Recommendations Assessment, Development and Evaluation (GRADE), were used to score the included SRs.@*RESULTS@#A total of 885 studies were retrieved, and 11 eligible SRs were finally included in this review. The methodological quality of 2 SRs (18.18%) was low, while the other 9 SRs (81.82%) were scored as extremely low. Four SRs (36.36%) were considered to be of low risk of bias. As for reporting quality, the reporting completeness of 9 SRs (81.82%) was more than 70%. Concerning the confidence in study results, 2 study results were considered to have a high quality of evidence (3.13%), 14 (21.88%) a "moderate" quality, 28 (43.75%) a "low" quality, and 20 (31.24%) considered a "very low" quality. Descriptive analyses suggested that combining acupuncture with other medicines can effectively improve the clinical pregnancy rate (CPR) and ovulation rate, and reduce luteinizing hormone/follicle-stimulating hormone ratio, homeostasis model assessment of insulin resistance, and body mass index (BMI). When compared with medicine alone, acupuncture alone also can improve CPR. Further, when compared with no intervention, acupuncture had a better effect in promoting the recovery of menstrual cycle and reducing BMI. Acupuncture was reported to cause no adverse events or some adverse events without serious harm.@*CONCLUSION@#The efficacy and safety of acupuncture for PCOS remains uncertain due to the limitations and inconsistencies of current evidence. More high-quality studies are needed to support the use of acupuncture in PCOS.

Ansiedad y depresión en mujeres con el síndrome de ovario poliquístico / Anxiety and depression in women with polycystic ovary syndrome

Introducción: El síndrome de ovario poliquístico es una condición muy frecuente en la mujer durante la etapa fértil y tiene implicaciones en la esfera reproductiva y cardiometabólica. Sin embargo, se ha observado que estas mujeres también pueden ver afectada su esfera psicoafectiva. Objetivo: Demostrar que las mujeres con síndrome de ovario poliquístico tienen mayor frecuencia de padecer alteraciones del ánimo (ansiedad y depresión). Métodos: Con la metodología de la investigación documental se analizaron 54 artículos publicados desde 2002, procedentes de las bases de PubMed/MEDLINE, Embase, PsycINFO and Web. Se usaron como palabras clave: síndrome de ovario poliquístico, ansiedad, depresión, alteraciones psicológicas y alteraciones psicoafectivas. Conclusiones: Los resultados de las investigaciones revisadas coinciden en que las mujeres con síndrome de ovario poliquístico tienen niveles más latos de depresión y ansiedad que las mujeres sin el síndrome, lo cual se basa en mecanismos biológicos y socioculturales(AU)

Introduction: Polycystic ovary syndrome is a very frequent condition in women during the fertile stage and has reproductive and cardiometabolic implications. However, it has been observed that these women may also be affected in their psychoaffective sphere. Objective: To demonstrate that women with polycystic ovary syndrome have a higher frequency of mood disorders (anxiety and depression). Methods: Using documentary research methodology, 54 articles published since 2002 were analyzed from PubMed/MEDLINE, Embase, PsycINFO and Web databases. Polycystic ovary syndrome, anxiety, depression, psychological alterations and psychoaffective alterations were used as keywords. Conclusions: The results of the reviewed research coincide in demonstrating that women with PCOS have lower levels of depression and anxiety than women without the syndrome which is based on biological and sociocultural mechanisms(AU)

La metformina durante el embarazo en mujeres con síndrome de ovario poliquístico / Metformin during pregnancy in women with polycystic ovary syndrome

Introducción: La resistencia a la insulina tiene gran relevancia en la patogenia del síndrome de ovario poliquístico, por lo que es común que se empleen los sensibilizadores a la insulina. La metformina tiene diversos fines terapéuticos y es la más recomendada. Durante el embarazo desempeña un rol en la reducción del riesgo de aborto, la hipertensión inducida por el embarazo, la macrosomía, la cesárea y la hipoglucemia neonatal. Con resultados menos consistentes también participa en la reducción del riesgo de diabetes gestacional. No obstante, existen preocupaciones sobre su seguridad a largo plazo. Objetivo: Realizar una actualización del estado del arte sobre el empleo de la metformina durante el embarazo en mujeres con síndrome de ovario poliquístico. Métodos: Se realizó una revisión bibliográfica donde se consultaron 57 artículos obtenidos de las bases de datos Google Académico, Medline, Pubmed, SciELO. Conclusiones: El tratamiento con metformina es más fácil, más económico y menos "inquietante" que la insulina. La prescripción y adherencia son más simples, lo que ha contribuido a que en la práctica clínica se emplee la metformina durante el embarazo con una frecuencia cada vez mayor. El posicionamiento actual de la comunidad científica acepta la metformina como una alternativa válida de tratamiento en las mujeres con síndrome de ovario poliquístico durante el embarazo pero recomienda poner cuidado en la observación de su seguridad a largo plazo e incrementar la evidencia(AU)

Introduction: Insulin resistance is highly relevant in the pathogenesis of polycystic ovary syndrome, which is why it is common to use insulin sensitizers. Metformin has various therapeutic purposes and is the most recommended. During pregnancy, it plays a role in reducing the risk of miscarriage, pregnancy-induced hypertension, macrosomia, cesarean section, and neonatal hypoglycemia. With less consistent results, it also participates in reducing the risk of gestational diabetes. However, there are concerns about its long-term safety. Objective: To update the state of the art on the use of metformin during pregnancy in women with polycystic ovary syndrome. Methods: A bibliographic review was carried out where 57 articles obtained from the Google Scholar, Medline, Pubmed, SciELO databases were consulted. Conclusions: Treatment with metformin is easier, cheaper and less "disturbing" than insulin. Prescription and adherence are simpler, which has contributed to the fact that metformin is used in clinical practice during pregnancy with increasing frequency. The current position of the scientific community accepts metformin as a valid treatment alternative in women with polycystic ovary syndrome during pregnancy, but recommends careful observation of its long-term safety and increasing evidence(AU)

Factores de riesgo cardiovascular en familiares de primer grado de mujeres con síndrome de ovario poliquístico / Cardiovascular Risk Factors in First-Degree Relatives of Women with Polycystic Ovary Syndrome

Introducción: El síndrome de ovario poliquístico es una entidad que, más allá de las afectaciones reproductivas que lo caracterizan, constituye un factor de riesgo de enfermedad cardiovascular. Esto último, adquiere mayor relevancia debido a que ha aumentado en la mujer que padece el síndrome y también en sus familiares. Objetivo: Demostrar que los familiares de primer grado de las mujeres con el síndrome de ovario poliquístico tienen mayor frecuencia de trastornos del metabolismo hidrocarbonado, dislipidemia y resistencia a la insulina. Métodos: Se realizó un estudio descriptivo transversal con 36 familiares de primer grado de mujeres con y sin síndrome de ovario poliquístico. Se les realizó un examen físico para comprobar el peso, la talla y la tensión arterial para descartar hipertensión en el momento de la inclusión. Resultados: La media del índice HOMA-IR en el grupo de estudio fue de 3,3 y en el de control 2,4. La prueba de tolerancia a la glucosa de 2 horas diagnosticó una glucosa alterada en ayunas a 9 familiares, 5 (55,6 por ciento) del grupo de estudio y 4 (44,4 por ciento), del grupo control. Hubo 7 familiares a los que se les detectó una tolerancia a la glucosa alterada, 6 (85,7 por ciento) familiares de mujeres con el síndrome y 1 (14,3 por ciento), del grupo control. Conclusiones: Los factores de riesgo cardiovasculares clásicos estudiados son más frecuentes en los familiares de mujeres con síndrome de ovario poliquístico que en los familiares de mujeres sin dicha enfermedad(AU)

Introduction: Polycystic ovary syndrome is an entity that, beyond the reproductive affectations that characterize it, constitutes a risk factor for cardiovascular disease. This aspect acquires greater relevance because the associated entity is not only increasing among the women who suffers from the syndrome, but also among their family members. Objective: To show that first-degree relatives of women with polycystic ovary syndrome present a higher frequency of carbohydrate metabolism disorders, dyslipidemia and insulin resistance. Methods: A cross-sectional and descriptive study was carried out with 36 first-degree relatives of women with and without polycystic ovary syndrome. They underwent physical examination to check their weight, height and blood pressure, in order to rule out hypertension at the time of inclusion. Results: The mean HOMA-IR index was 3.3 in the study group and 2.4 in the control group. The two-hour glucose tolerance test permitted to diagnose impaired fasting glucose in nine relatives, five (55.6 percent) from the study group and four (44.4 percent) from the control group. Seven relatives were reported with impaired glucose tolerance, six (85.7 percent) relatives of women with the syndrome and one (14.3 percent) from the control group. Conclusions: The classic cardiovascular risk factors studied are more frequent in the relatives of women with polycystic ovary syndrome than in the relatives of women without this disease(AU)

Enfermedad cardiovascular subclínica en familiares de mujeres con síndrome de ovario poliquístico y su asociación con la resistencia a la insulina / Subclinical Cardiovascular Disease in Relatives of Women with Polycystic Ovary Syndrome and its Association with Insulin Resistance

Introducción: Se ha demostrado que los familiares de mujeres con síndrome de ovario poliquístico tienen mayor frecuencia de factores de riesgo cardiovascular, tales como la resistencia a la insulina, la diabetes mellitus tipo 2, la dislipidemia y la hipertensión arterial. Por ende, estas personas presentan un mayor riesgo de desarrollar enfermedad cardiovascular. Objetivo: Determinar la frecuencia de enfermedad cardiovascular subclínica en familiares de primer grado de mujeres con y sin síndrome de ovario poliquístico y su relación con la resistencia a la insulina. Métodos: Se realizó un estudio descriptivo transversal en 36 familiares de primer grado de mujeres con el síndrome de ovario poliquístico e igual cantidad en familiares de mujeres sin la enfermedad. Ninguno de los miembros de ambos grupos tenía antecedentes de diabetes mellitus, prediabetes, dislipidemia e hipertensión arterial, ni obesidad. Para llevar a cabo la comparación de los resultados de las pruebas realizadas fueron pareados a razón de 1:1, por edad ± 5 años, parentesco, sexo e índice de masa corporal. Resultados: Con enfermedad cardiovascular subclínica hubo 21 familiares, 15 del grupo de estudio (71,4 por ciento) y del grupo control el 28,6 por ciento, (p < 0,05). De la totalidad de familiares del grupo de estudio, con resistencia a la insulina el 65,0 por ciento presentó enfermedad cardiovascular subclínica. En el grupo control, ninguno de los pacientes con insulinemia en ayunas normal tuvo enfermedad cardiovascular subclínica. Conclusiones: La enfermedad cardiovascular subclínica es más frecuente en los familiares de mujeres con síndrome de ovario poliquístico y la resistencia a la insulina se asocia de forma significativa a este padecimiento en ambos grupos(AU)

Introduction: Relatives of women with polycystic ovary syndrome have been show to present a higher frequency of cardiovascular risk factors, such as insulin resistance, type 2 diabetes mellitus, dyslipidemia and arterial hypertension. Therefore, these people have a higher risk for developing cardiovascular disease. Objective: To determine the frequency of subclinical cardiovascular disease in first-degree relatives of women with and without polycystic ovary syndrome and its relationship with insulin resistance. Methods: A cross-sectional and descriptive study was carried out with 36 first-degree relatives of women with polycystic ovary syndrome and with the same number of relatives of women without the disease. None of the members of both groups had a history of diabetes mellitus, prediabetes, dyslipidemia, high blood pressure, or obesity. To carry out the comparison of the results of the tests carried out, they were matched at a 1: 1 ratio, by age ± 5 years, relationship, sex and body mass index. Results: There were 21 relatives with subclinical cardiovascular disease, 71.4 percent of which belonged to the study group, why 28.6 percent belonged to the control group (P < 0.05). Of the total family members of the study group, with insulin resistance, 65.0 percent had subclinical cardiovascular disease. In the control group, with normal fasting insulinemia, none has subclinical cardiovascular disease. Conclusions: Subclinical cardiovascular disease is more frequent in the relatives of women with polycystic ovary syndrome, while insulin resistance is significantly associated with this condition in both groups(AU)

Síndrome dos ovários policísticos: conceito, epidemiologia e fisiopatologia aplicada à prática clínica / Polycystic ovary syndrome: concept, epidemiology and pathophysiology applied to clinical practice

Desde 1935, quando Stein e Leventhal descreveram o quadro dos "ovários policísticos", muitos estudos foram desenvolvidos no sentido de aprimorar os conhecimentos sobre esse tema. Contínuas discussões relativas a fisiopatologia, associações clínicas, repercussões sobre a saúde reprodutiva e conduta terapêutica foram realizadas ao longo desse intervalo de tempo. Do ponto de vista clínico, a síndrome dos ovários policísticos (SOP) tem se destacado como uma das desordens endócrinas mais comuns na idade reprodutiva, e sua prevalência varia de 6% a 10% em mulheres na menacme. A sua etiologia ainda permanece uma incógnita, tendo em vista que vários fatores devem estar envolvidos na sua gênese. A sua relação com os desvios do metabolismo lipídico e glicídico tem sido alvo de muitos estudos, pois hoje a SOP é vista como uma doença metabólica, com todas as suas implicações. O foco deixou de ser exclusivamente o sistema reprodutor, mas sim o organismo como um todo, o que tem gerado o interesse e a preocupação de outros profissionais da saúde sobre essas pacientes. Nesta matéria de capa, são abordados todos os aspectos dessa intrigante doença, como a etiologia, a fisiopatologia, a terapia e, especialmente, os desequilíbrios metabólicos que elevam os riscos de doenças cardiovasculares e diabetes nessas pacientes, sobretudo nas obesas. Com tantos recursos científicos disponíveis nos dias de hoje, não é mais possível ao ginecologista, isoladamente, abordar com competência todos os passos dessa terapia complexa das pacientes com SOP. Há necessidade do apoio de outros profissionais da área da saúde, como psicólogo, nutricionista, educador físico, entre outros. Não há dúvidas de que os fenômenos biológicos, psicológicos, sociais e ambientais são todos interdependentes e de que a abordagem das pacientes com SOP deve ser holística e multiprofissional.(AU)

Síndrome de ovarios poliquísticos. Entidad que demanda diagnóstico temprano / Polycystic ovary syndrome, an entity demanding an early diagnosis

RESUMEN El síndrome de ovario poliquístico se ha convertido en un problema de salud pública, siendo el más común de los desórdenes endocrinos en mujeres en edad reproductiva con estudios que reportan una prevalencia de hasta un 21%. El diagnóstico de esta entidad es importante debido a que representa riesgos metabólicos, cardiovasculares y afecta la capacidad reproductiva de estas pacientes. Se realizó una revisión bibliográfica de los principales artículos relacionados sobre el tema, resumiendo los aspectos fundamentales de este problema de salud.

ABSTRACT Polycystic ovary syndrome has become a public health problem, being the most common of the endocrine disorders in reproductive-age women, with studies reporting prevalence by 21 %. The diagnosis of this entity is important because it represents metabolic and cardiovascular risk, and affects the reproductive capacity of these patients. The authors carried out bibliographic review of the main articles related with the theme, summarizing the basic aspects of this health problem.

Metabolic and hormonal assessment of adolescent and young adult women with prior premature adrenarche

OBJECTIVE: Follow-up studies of girls with premature adrenarche have reported the development of polycystic ovary syndrome, insulin resistance, and dyslipidemia and a propensity to cardiovascular disease. The aim of this study was to analyze the presence of these conditions in patients previously treated at the Universidade Federal do Triângulo Mineiro. METHODS: A total of 130 medical records reported premature adrenarche. One hundred and twenty-two patients were invited to participate, of whom 54 accepted; 34 patients were selected, as they had reached their final height. Anthropometric, blood glucose, insulin, and lipid and hormonal profile (LH, FSH, estradiol, 17α-OH-progesterone, androstenedione, dehydroepiandrosterone sulfate, testosterone) data were obtained, the HOMA-IR index was calculated, and pelvic ultrasonography was performed. To characterize polycystic ovary syndrome and metabolic syndrome, the Rotterdam and International Diabetes Federation criteria, respectively, were used. Data were analyzed according to measures of dispersion, frequency and correlations of interest. RESULTS: The age of the participants ranged from 15.2 to 28.2 years/months; 23.5% of the patients were overweight, 11.8% were obese, 29.4% had a large waist circumference, and 8.8% were hypertensive. None of the patients had altered glucose levels, and insulin levels and HOMA-IR were elevated in 29.4% and 38.2% of the participants, respectively; 14.7% of the patients exhibited acanthosis nigricans. The lipid profiles of the participants were variable, and one patient (2.9%) had metabolic syndrome. Polycystic ovary syndrome was found in 41.2% of patients. CONCLUSION: The percentage of patients with polycystic ovary syndrome who also had overweight, obesity and insulin resistance corroborates the literature data about the need for follow-up aiming at interventions, especially for conditions associated with cardiometabolic risk.

Estudios de laboratorio de diversos parámetros orientados a tratar de dilucidar la fisiopatología del síndrome de ovarios poliquísticos. Parte 1 / Laboratory studies of various parameters aimed at trying to elucidate the pathophysiology of polycystic ovary syndrome. Part 1

Esta revisión fue realizada con el fin de evaluar nuestros resultados de laboratorio así como aquellos de la literatura que constituyen, a nuestro entender, aportes significativos en el síndrome de ovarios poliquísticos (SOP). Nuestro especial énfasis será presentar las limitaciones de las metodologías empleadas por nuestro grupo, comparativamente a las reportadas por otros investigadores. La determinación de andrógenos, en particular de Testosterona (TT), es quizá la de mayor complejidad dado que los resultados con los diferentes inmunoensayos empleados en nuestro medio producen resultados muy variables por los diferentes métodos y aún entre laboratorios que usan la misma metodología. La técnica de referencia es la cromatografía líquida en tándem con espectrometría de masa (LC-MSMS), de difícil aplicación en laboratorios de análisis clínicos debido a su alto costo y la imposibilidad de resolver numerosas muestras. En estudios previos demostramos que de los métodos habitualmente usados para evaluar la TT circulante, solo en 2 inmunoensayos los resultados obtenidos fueron satisfactoriamente validados indirectamente según el criterio del Consenso de los Centros para el Control y Prevención de Enfermedades (CDC, USA) contra LC-MSMS, los cuales fueron comparables a dicha metodología con niveles superiores a 0,5 ng/ml. El SOP puede presentar factores de riesgo aumentados para la enfermedad cardiovascular y la diabetes II. Estos factores no están debidamente categorizados en función de los distintos fenotipos del SOP. Se evaluarán los principales analitos empleados con este objetivo y los nuevos que aporten elementos de mayor especificidad en este sentido

This review was performed in order to evaluate our laboratory results as well as those of the literature that constitute, in our opinion, significant contributions in these pathophysiologies. Our special emphasis will be on presenting the limitations of the methodologies used by our group, compared to those reported by other researchers. The determination of androgens, in particular Testosterone (TT), is perhaps the most complex since the results with the different immunoassays used in our environment produce very variable results by the different methods and even between laboratories that use the same methodology. The reference technique is LC-MSMS, difficult to apply in clinical analysis laboratories because of its high cost and the inability to solve numerous samples. In previous studies, we demonstrated that, in comparison to LC-MSMS with the usual methods for evaluating circulating TT, the results obtained in only 2 immunoassays were satisfactorily validated indirectly according to the criteria of CDC against LC-MSMS, which were comparable to that methodology with levels higher than 0.5 ng/ml. PCOS may have increased risk factors for cardiovascular disease and diabetes II. These factors are not properly categorized according to the different phenotypes of PCOS. The main analytes used for this purpose will be evaluated and new ones that contribute elements of greater specificity in this sense

Current aspects of polycystic ovary syndrome: A literature review / Aspectos atuais da síndrome do ovário policístico: uma revisão da literatura

SUMMARY Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disorder with variable prevalence, affecting about one in every 15 women worldwide. The diagnosis of polycystic ovary syndrome requires at least two of the following criteria: oligoovulation and/or anovulation, clinical and/or biochemical evidence of hyperandrogenism and morphology of polycystic ovaries. Women with PCOS appear to have a higher risk of developing metabolic disorders, hypertension and cardiovascular disorders. The aim of this article was to present a review of the literature by searching the databases Pubmed and Scielo, focusing on publications related to polycystic ovaries, including its pathogenesis, clinical manifestations, diagnosis and therapeutic aspects, as well as its association with cardiovascular and arterial hypertensive disorders.

RESUMO A síndrome dos ovários policísticos (SOP) é uma desordem endócrina heterogênea com prevalência variável, que afeta cerca de uma em cada 15 mulheres no mundo. O diagnóstico da SOP requer, pelo menos, dois dos seguintes critérios: oligo-ovulação e/ou anovulação, evidência clínica e/ou bioquímica de hiperandrogenemia e morfologia dos ovários policísticos. As mulheres com SOP parecem ter um risco mais elevado de desenvolver distúrbios metabólicos, hipertensão e doenças cardiovasculares. O objetivo deste artigo foi apresentar uma revisão da literatura por meio de pesquisa nas bases de dados PubMed e Scielo, focada em publicações relacionadas com ovários policísticos, incluindo patogênese, manifestações clínicas, diagnóstico e aspectos terapêuticos, bem como associação com doenças cardiovasculares e hipertensão arterial.

Epidemiología del síndrome de ovario poliquístico en Chillán-Chile / Epidemiology of polycystic ovary syndrome in Chillan-Chile

Introducción: El síndrome de ovario poliquístico (SOP) es una disfunción endocrino metabólica de alta prevalencia, definida por alteraciones menstruales, hirsutismo, y ováricos morfológicamente poliquístico. Objetivos: Describir las características clínicas de las pacientes con SOP atendidas en el consultorio adosado de especialidades (CAE) del Hospital clínico Herminda Martin (HCHM) de Chillán. Materiales y método: Estudio transversal de 116 pacientes con diagnóstico de SOP (CIE-10 E28.2), en edad fértil, con diagnóstico realizado en CAE del HCHM durante 2010 y 2014. Se obtuvieron datos demográficos y clínicos, luego fueron tabulados en Excel para su análisis. Resultados: El grupo etario más frecuente fueron las pacientes entre 15 y 19 años. En la mayoría de los casos, la consulta se debió a alteraciones menstruales e hirsutismo. Un 33,6% de las pacientes correspondieron a SOP clásico. Un 72,4% presentó insulinoresistencia (IR) y un 40% sobrepeso. Discusión: Su fuerte relación con síndrome metabólico, nos lleva a plantear la posibilidad de aplicar medidas de prevención primaria, en los grupos poblacionales que han sido caracterizados enfrentando esta patología como una enfermedad endocrino-metabólica y tratarla de forma integral por un grupo multidisciplinario. Se sugiere realizar una pesquisa sistemática en pacientes de riesgo, incluyendo el SOP en programas de pesquisa específicos para enfermedades no transmisibles (examen médico preventivo del adolecente y del adulto).

Introduction: Polycystic ovary syndrome (PCOS) is an endocrine-metabolic dysfunction highly prevalence, defined by menstrual alterations, hirsutism, and polycystic ovarian morphologically. Objetive: To describe the clinical characteristics of patients with PCOS treated at the "Consultorio adosado de especialidades" (CAE) of the Hospital Clínico Herminda Martin (HCHM) of Chillán. Materials and methods: A cross-sectional study of 116 patients with a diagnosis of PCOS (ICD-10 E28.2), of childbearing age, with a diagnosis made at the HCHM CAE during 2010 and 2014. Demographic and clinical data were obtained and then tabulated in Excel for your analysis. Results: The most frequent age groups were patients aged 15 to 19 years. In most cases, the consultation was due to menstrual alterations and hirsutism. A total of 33.6% of the patients were classical PCOS. 72.4% had insulin resistance (IR) and 40% were overweight. Discussion: Its strong relationship with metabolic syndrome leads us to consider the possibility of applying primary prevention measures in the population groups that have been characterized as endocrine-metabolic disease and treated in an integral way by a multidisciplinary group. It is suggested to conduct a systematic study in patients at risk, including PCOS in specific programs for noncommunicable diseases (preventive medical examination of adolescents and adults).

Relación entre la insulinorresistencia y el síndrome de ovario poliquístico y sus comorbilidades metabólicas / Relationship between Insulin Resistance and Polycystic Ovary Syndrome and Its Metabolic Comorbidities

Introducción: el síndrome de ovario poliquístico es un desorden de etiología multifactorial, caracterizado por un cuadro clínico heterogéneo y a veces subclínico que dificulta su manejo y diagnóstico. Se vincula a varias comorbilidades sobre todo de tipo metabólicas, donde la insulinorresistencia puede jugar un papel relevante. Objetivo: describir la relación que existe entre la insulinorresistencia y la génesis del síndrome de ovario poliquístico y de algunas de sus comorbilidades metabólicas. Conclusiones: la insulinorresistencia guarda una estrecha relación con la génesis del síndrome de ovario poliquístico, así como en el desarrollo de algunas de sus comorbilidades metabólicas (diabetes mellitus tipo 2, dislipidemia, hígado graso no alcohólico y síndrome metabólico), las que deben ser identificadas y tratadas precoz y adecuadamente(AU)

Introduction: Polycystic ovary syndrome is a disorder of multifactorial etiology, characterized by a heterogeneous clinical and subclinical, which sometimes makes handling and diagnosis difficult, and it is linked to several metabolic comorbidities especially those insulin resistant that may play a significant role. Objective: Describe the relationship between insulin resistance and the genesis of polycystic ovarian syndrome and some of its metabolic comorbidities. Conclusions: Insulin resistance is closely related to the genesis of polycystic ovary syndrome, as well as the development of some of its metabolic comorbidities (diabetes mellitus Type 2, dyslipidemia, nonalcoholic fatty liver disease and metabolic syndrome), which must be identified and timely and properly treated(AU)

Síndrome de ovario poliquístico: revisión de su fisiopatogenia / [Polycystic ovary syndrome: physiopathology review].

Polycystic ovary syndrome (PCOS), the most common gynecological endocrinopathy in women of reproductive age, is characterized by hyperandrogenism, chronic anovulation and /or polycystic ovaries. Although the cause of PCOS is still unknown, there are several hypotheses attempting to explain the primary defect; the most commonly accepted is insulin resistance. Due to its high prevalence, the patients have increased risk of developing metabolic and cardiovascular alterations. The compensatory hyperinsulinemia contributes to hyperandrogenism in different ways: by stimulating ovarian androgen synthesis and inhibiting hepatic production of sex hormone binding globulin. From the study of the intrauterine environment in recent years it has been suggested that PCOS may have an origin in utero associated with prenatal exposure to androgens. The aim of this paper is to review the main mechanisms proposed to cause the syndrome.

Hiperandrogenización prenatal en ratas y el metabolismo lipídico en la vida adulta / The role of prenatal hyperandrogenism on lipid metabolism during adult life in a rat model

El síndrome del ovario poliquístico (PCOS) es una afección de alta incidencia en mujeres en edad fértil. Si bien la etiología de la enfermedad se desconoce, se cree que la exposición a andrógenos durante la vida intrauterina generaría reprogramación fetal afectando vías endocrinas y metabólicas que, junto a alteraciones génicas y ambientales, inducirían la aparición de PCOS en etapas muy tempranas de la vida. Es por ello que se buscan marcadores tempranos del desarrollo de PCOS. Utilizando un modelo murino de hiperandrogenización prenatal (HA) recreamos dos fenotipos de PCOS: ovulatorio y anovulatorio. La HA no alteró el colesterol circulante pero disminuyó el colesterol HDL y aumentó el LDL y los triglicéridos (TG) con respecto a los controles. La relación colesterol total/HDL como marcador de riesgo cardiovascular y la relación TG/HDL se vieron incrementadas con respecto a los controles, resultando mayor en el grupo PCOS anovulatorio. El presente trabajo demuestra la importancia de la determinación del perfil lipídico a edades tempranas en poblaciones de riesgo (como es el caso de hijas de madres con PCOS).

Polycystic ovary syndrome (PCOS) is one of the commonest endocrine diseases that affect women in their reproductive ages; however, the etiology of the syndrome remains unknown. A hypothesis proposes that during gestation increased exposure of androgen would induce fetal programming that may increase the risk of PCOS development during the adult life. By means of a prenatally hyperandrogenized (HA) rat model we demonstrated the importance of determining the lipid profile at early ages. HA induced two different phenotypes: ovulatory and anovulatory PCOS. HA did not modify total cholesterol but decreased HDL cholesterol and increased both LDL and tryglicerides (TG) when compared with controls. Both, the ratio total cholesterol: HDL (marker of cardiovascular risk) and TG:HDL (marker of metabolic syndrome) were increased in the HA group with respect to controls. In addition, these abnormalities were stronger in the anovulatory than ovulatory phenotype. Our results point out the need to find early markers of PCOS in girls or adolescents with increased risk to develop PCOS (as in daughters of women with PCOS).

Effect of thyroid hormone replacement therapy on ovarian volume and androgen hormones in patients with untreated primary hypothyroidism

Primary hypothyroidism may be associated with ovarian enlargement and/ or cyst formation. We evaluated the effect of thyroid hormone replacement therapy on hormonal changes, ovarian volume and sonographic appearance. Open, prospective study of women admitted to university gynecology clinic. The study included 26 patients with untreated hypothyroidism who had polycystic [n=10] or normal-appearing [n=16] ovaries and 20 euthyroidic controls. Basal serum total testosterone, free testosterone, androstenedione, dehydroepiandosterone-sulfate, prolactin, estradiol, luteinizing hormone, follicle-stimulating hormone, free T3, free T4 and thyroid-stimulating horone, together with ovarian volumes, were determined and repeated after euthyroidism was achieved. Ovarian volumes of patients with hypothyroidism were significantly greater compared with controls, and their magnitudes diminished significantly during thyroid hormone replacement therapy. Hypothyroidic patients with polycystic ovaries had significantly higher serum free testosterone and dehydroepiandosterone-sulfate, but lower androstenodione levels compared with those who had normal-appearing ovaries. Serum total testosterone concentrations were significantly higher in hypothyroidic patients without polycystic ovaries, and thyroid hormone replacement therapy achieved a significant reduction in total as well as free testosterone. Severe longstanding hypothyroidism leads to increased ovarian volume and/or cyst formation. A decrease in ovarian volume, resolution of ovarian cysts and reversal of the polycystic ovary syndrome-like appearance, together with improvement in serum hormone levels, occurred after euthyroidism was achieved

Cirugía de mínimo acceso en la infertilidad femenina / Minimum access surgery in the female sterility

La infertilidad es la incapacidad de lograr el embarazo con relaciones sexuales mantenidas durante un año. Entre el 10 y el 20 por ciento de las parejas presentan esta dificultad. La cirugía de mínimo acceso se ha convertido en piedra angular en el tratamiento de la infertilidad femenina. OBJETIVO: Describir los resultados de la cirugía de mínimo acceso en el tratamiento de los factores tubo-peritoneal, ovárico y la endometriosis entre agosto del año 2000 y abril de 2007. Se evaluaron 205 pacientes procedentes de la consulta de infertilidad. MÉTODOS: Investigación descriptiva, longitudinal, prospectiva. Bioética: Consentimiento in formado. Los datos fueron procesados con el paquete estadístico SPSS. RESULTADOS: Se obtuvieron 76 embarazos (37,07 por ciento) distribuidos en: 44 partos, 18 cesáreas, 9 ectópicos y 5 abortos. El rango de edades más frecuente fue de 26 a 30 años, predominó la infertilidad secundaria y el factor tubo-peritoneal (p<0,05). Las técnicas más aplicadas fueron: fimbrioplastia (78 por ciento), salpingoneostomÍa (32,2 por ciento) y salpingoovariolisis (29,3 por ciento). Con la punción múltiple de ovario y la salpingolisis se alcanzó un 50 por ciento de embarazos. La mayorÍa de las pacientes consiguieron embarazarse en menos de 6 meses. Se reportó un 4,3 por ciento de complicaciones. Estos resultados son comparables con los de otros autores. CONCLUSIONES: La cirugÍa de mínimo acceso constituye una opción asequible en el tratamiento de la infertilidad en casos seleccionados con satisfactorios resultados

Infertility is the inability or diminished ability to produce offspring with maintained intercourses for one year. Between the 10 percent and the 20 percent of couples has this difficulty. The minimum access surgery becomes in the cornerstone in treatment of female infertility. OBJECTIVE: To describe results of the minimum access surgery in the treatment of tuboperitoneal factors and ovarian as well as endometriosis between August, 2000 and April, 2007. A total of 205 patients were assessed from the infertility consultation. METHODS: A prospective, longitudinal and descriptive research. Bioethics: written informed consent. Data were processed with the SPSS statistical package. RESULTS: It was possible to achieve 76 pregnancies (37.07 percent) distributed in: 44 deliveries, 18 cesarean sections, 9 ectopic pregnancies and 5 abortions. The more frequent age rank was from 26 to 30 years with predominance of secondary infertility and the tuboperitoneal factor (p < 0.05). The more used techniques were: the fimbrioplasty (78 percent), salpingoneostomy (32.2 percent) and salpingoovariolysis (29.3 percent). With the multiple ovary puncture and the salpingolysis it was possible to achieve the 50 percent of pregnancies. Most of patients made pregnant in less than 6 months. There was a 4.3 percent of complications. Theses results are comparable with those of other authors. CONCLUSIONS: The minimum-access surgery is a feasible option in the treatment of infertility in selected cases with satisfactory results

Molecular & genetic factors contributing to insulin resistance in polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of unknown etiology. Insulin resistance is very common and plays a central pathogenic role in PCOS. During last decade several studies have been conducted to understand the mechanisms contributing to the state of insulin resistance and insulin-induced hyperandrogenemia in PCOS. Insulin signaling pathways have been dissected in different insulin responsive tissues such as skeletal muscles, adipose tissues, fibroblasts as well as ovaries to elucidate the mechanism. These studies suggest a post receptor signaling defect where metabolic action of insulin is affected but not the steroidogenic and mitogenic actions. Despite advancement in these studies gaps exist in our understanding of the mechanism of insulin resistance as well as insulin-induced steroidogenesis in PCOS. The syndrome is now considered as a complex multigenic disorder. Efforts are ongoing to dissect the variants of genes from multiple logical pathways which are involved in pathophysiology of the syndrome. But still today no gene has been emerged as universally accepted susceptibility gene for PCOS. This review briefly describes the lacunae along with the current status of molecular events underlying insulin resistance and the contribution of insulin signaling pathway genes in pathogenesis of PCOS along with future researchable areas.

Genética del síndrome de poliquistosis ovárica / The genetic of polycystic ovary syndrome

El síndrome de poliquistosis ovárica (PCOs) es un desorden multisistémico heterogéneo de etiología aun no totalmente definida y comúnmente asociado a obesidad e insulino-resistencia. La insulino-resistencia y la consecuente hiperinsulinemia juegan un rol clave en la patogénesis de PCOs. La importancia de este rol clave en PCOs ha sido recientemente confirmada por estudios con drogas insulino-sensibilizantes que restauran la función ovárica y disminuyen la biosíntesis y secreción de andrógenos en ovario, estableciendo una relación causalidad desde la insulino-resistencia hacia el desorden en el eje hipotálamo-hipófisi-gonadal. PCOs desde el punto de vista genético, es considerado un síndrome poligénico de herencia no mendeliana como lo son la diabetes tipo 2, la obesidad, la hipertensión arterial, etc. La segregación familiar tanto del rasgo metabólico como del hiperandrogenismo funcional sugiere una base hereditaria. Este desorden, se desarrolla por la combinación de factores de riesgo genéticos y factores ambientales desencadenantes. En PCOs se considera que las vías metabólicas principalmente afectadas serían: la síntesis de hormonas esteroideas, la síntesis y acción de la insulina y otros caminos metabólicos involucrados en diferentes mecanismos de regulación. Teniendo en cuenta las vías metabólicas afectadas, se postulan como genes candidatos a aquellos involucrados en los mecanismos de síntesis o regulación mencionados...

Metformina pode ser utilizada em mulheres grávidas com síndrome dos ovários policísticos? / Can metformin be used in pregnant women with polycystic ovary syndrome?

A síndrome dos ovários policísticos é a endocrinopatia mais comum presente no consultório do ginecologista. No passado, representava apenas um problema estético e de irregularidade menstrual. Atualmente, está intimamente ligada à resistência insulínica, que pode acometer gravemente a saúde dessas mulheres, com repercussões metabólicas e cardiovasculares. O tratamento da SOP com a metformina melhora o hiperandrogenismo e regulariza os ciclos menstruais, facilitando a gravidez. Nesse momento surge a dúvida da continuidade do tratamento durante a gestação. Vários autores são favoráveis, devido aos efeitos benéficos da metformina, como a diminuição nas taxas de abortamentos precoces e de diabetes gestacional. As conclusões são obtidas em grande parte de estudos retrospectivos e ainda não são definitivas.

Polycystic ovary syndrome is the most common endocrine disorder found in a Gynecologists office. In the past, it represented only an aesthetic problem and menstrual irregularity. Nowadays, it is closely related to insulin resistance, which can severely affect the health of these women with metabolic and cardiovascular effects. The treatment of PCOS with metformin improves hyperandrogenism and regulates menstrual cycles facilitating conception. It is not known if the treatment should be extended through pregnancy. Many authors are favorable, due to the beneficial effects of metformin, such as lower first-trimester abortion and gestational diabetes rates. The conclusions are mostly obtained from retrospective studies and are not yet definitive.