Diagnosis and management of polycystic ovary syndrome: Perspectives of clinicians in Singapore

INTRODUCTION@#To harmonise the diagnostic processes of polycystic ovary syndrome (PCOS) and enable clinicians to provide better patient care, it is critical to understand the knowledge gaps in PCOS diagnosis. We evaluated how clinicians in endocrinology, family medicine, general practice and gynaecology diagnose PCOS.@*METHODS@#This cross-sectional survey involved 208 clinicians from specific subspecialties across various healthcare settings in Singapore.@*RESULTS@#A total of 160 responses were included in the final analysis. Among all the diagnostic criteria, the Rotterdam 2003 criteria was most frequently used (66.3%). More than half of the gynaecologists reported having a standardised workplace protocol while the majority from other specialties reported otherwise. A large percentage of respondents (60.5%) were unable to identify the correct PCOS clinical features, which is concerning. Only 8.8% of respondents used clinical and biochemical hyperandrogenism, menstrual disturbances and pelvic ultrasound to diagnose PCOS without performing unnecessary and incorrect investigations. Most clinicians recognised insulin resistance/type 2 diabetes mellitus and fertility problems as complications while only a few recognised psychological complications. Many clinicians (37.3%) sought standardisation of PCOS diagnosis and management guidelines for improvement in PCOS care and 81.9% of respondents would appreciate standardised educational materials.@*CONCLUSION@#This is the first study to the best of our knowledge that gives an insight into the diagnostic and management processes of PCOS among various healthcare institutions in Singapore. This study calls for greater harmonisation of diagnostic processes and holistic evidence-based management of patients with PCOS through standardised workplace protocols and patient education resources.

Effect of acupuncture on vascular endothelial function in patients of polycystic ovary syndrome with different glucose tolerance status / 中国针灸

OBJECTIVE@#To observe the effect of acupuncture on vascular endothelial function in patients of polycystic ovary syndrome (PCOS) with impaired glucose tolerance (IGT) and normal glucose tolerance (NGT).@*METHODS@#A total of 140 patients with PCOS were divided into an IGT group (70 cases, 11 dropped off) and a NGT group (70 cases, 9 cases dropped off). The patients in the two groups were treated with full-cycle acupuncture at Zhongwan (CV 12), Guanyuan (CV 4), Qihai (CV 6), Tianshu (ST 25), etc. once every other day, 3 times a week, for 3 months. Before and after treatment, TCM symptom score, insulin resistance index [including fasting plasma glucose (FPG), 2-hour blood glucose (2hPG), fasting serum insulin (FINS), homeostasis model assessment of insulin resistance (HOMA-IR)] and vascular endothelial related factors [including asymmetric dimethylarginine (ADMD), endothelin-1 (ET-1), malondialdehyde (MDA), nitric oxide (NO)] were compared between the two groups; in addition, the obese subgroup and non-obese subgroup of the two groups were further compared.@*RESULTS@#Compared before treatment, the TCM symptom scores, ADMD, ET-1 and MDA after treatment were decreased (@*CONCLUSION@#Acupuncture could improve vascular endothelial function in PCOS patients, IGT patients have better efficacy than NGT patients, and obese patients have better efficacy than non-obese patients.

Impact of Low Frequency Electro-acupuncture on Glucose and Lipid Metabolism in Unmarried PCOS Women: A Randomized Controlled Trial / 中国结合医学杂志

OBJECTIVE@#To explore the effect of electro-acupuncture (EA) on glucose and lipid metabolism in unmarried patients with polycystic ovary syndrome (PCOS).@*METHODS@#Fifty-four PCOS patients were equally randomized into true acupuncture group and sham acupuncture group (control) for totally 16 weeks of treatment by random method with a computerized randomization program. Patients in true acupuncture group accepted traditional acupuncture methods with EA and two sets of acupoint groups were used alternatively. The first set consisted of Zhongji (CV 3), Qihai (CV 6), Guilai (ST 29), Sanyinjiao (SP 6), Yinlingquan (SP 9), Hegu (LI4) and Baihui (GV 20), and the second set consisted of Tianshu (ST 25), ST 29, CV 3, CV 6, SP 6, Taichong (LR 3), Neiguan (PC) 6 and GV 20. Patients in the sham acupuncture group accepted shallow acupuncture methods through EA without electricity at 4 non-meridian points in each shoulder and upper arm. Outcome measures included body mass index (BMI), waist-hip-ratio (WHR), oral glucose tolerance test (OGTT), insulin release test, glucose and lipid metabolism indicators such as total cholesterol (TC), triglycerides, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, adiponectin, leptin, visfatin, resistin, and interleukin (IL-6).@*RESULTS@#Twenty-six subjects in the true acupuncture group and 20 subjects in the sham group completed the clinical trial. After 16 weeks of treatment, no significant difference in the outcome measures were observed between the two groups (P>0.05). However, as compared with baseline data, a reduction in weight, BMI, hipline, WHR, fasting glucose, homeostatic model assessment of insulin sensitivity, visfatin and HDL-C, and an increase in resistin and IL-6 were observed in the true acupuncture group (P<0.05). In addition, a reduction in visfatin and an increase in TC were also observed in the sham group (P<0.05).@*CONCLUSIONS@#Acupuncture may have a beneficial effect in the treatment of PCOS by improving glucose and lipid metabolism. Moreover, the sham acupuncture may be not completely ineffective. Sham acupuncture may improve some of the aspects of the glucose and lipid metabolism of PCOS patients through a placebo effect. (Registration Nos. ChiCTR-TRC-12002529 and NCT01812161).

Novel mechanisms underlying anti-polycystic ovary like syndrome effects of electroacupuncture in rats: suppressing SREBP1 to mitigate insulin resistance, mitochondrial dysfunction and oxidative stress

BACKGROUND: Acupuncture, a therapy of traditional Chinese medicine, is confirmed to exert the therapeutic action on polycystic ovary syndrome (PCOS). However, the detailed therapeutic mechanisms of acupuncture in PCOS remain ambiguous. In this study, we further investigated whether electroacupuncture (EA) alleviated PCOS-like symptoms in rats via regulating a metabolic regulator, sterol regulatory element binding protein-1 (SREBP1). Methods: The PCOS-like rat model was built by hypodermic injection with dehydroepiandrosterone (DHEA). The rats were subjected to EA intervention (ST29 and SP6 acupuncture points) for 5 weeks. Primary granulosa cells were isolated from control and PCOS-like rats for evaluating insulin resistance, mitochondrial dysfunction and oxidative stress in vitro. RESULTS: The expression of SREBP1 was increased in PCOS-like rats, which was suppressed by EA treatment. In addition, lentivirus-mediated overexpression of SREBP1 restrained EA treatment-induced improvement in pathological changes, serum hormone levels and insulin resistance in rats. In addition, overexpression of SREBP1 repressed insulin-stimulated phosphorylation of insulin receptor ß (IR) and AKT in primary granulosa cells. Moreover, upregulation of SREBP1 further exacerbated mitochondrial dysfunction and oxidative stress in granulosa cells isolated from PCOS-like rats. Mechanically, EA treatment suppressed SREBP1 expression through inducing the activation of AMP-activated protein kinase (AMPK) signaling pathway in PCOS-like rats. CONCLUSION: EA intervention alleviated PCOS-like symptoms in rats via improving IR, mitochondrial dysfunction and oxidative stress through regulating SREBP1, a lipid metabolism regulator. Our findings illuminate the novel protective mechanisms of EA in the treatment of PCOS.

Síndrome de ovario poliquístico / Polycystic ovary syndrome

El síndrome de ovario poliquísticos (SOP) representa una de las endocrinopatías más frecuentes en la mujer y es la principal causa de hiperandrogenismo (HA). Se trata de un trastorno complejo, multifactorial, poligénico con influencias ambientales. Aunque se han propuestos diferentes criterios para su diagnóstico, se prefiere el uso del más abarcativo (Criterio de Rotterdam) con la presencia de 2 de 3 de los siguientes: 1) HA clínico o bioquímico, 2) oligoanovulación crónica (OA), 3) poliquistosis ovárica por ecografía, excluyendo otras etiologías. Es frecuente su asociación con comorbilidades metabólicas (obesidad, diabetes 2, dislipidemia, apnea del sueño, etc.) y trastornos reproductivos (hiperplasia endometrial e infertilidad), sobre todo en los fenotipos clásicos, con HA y OA. El tratamiento estará orientado a las características clínicas de cada paciente y al deseo reproductivo. La pérdida de peso en aquellas con sobrepeso u obesidad o ambos factores puede restaurar los ciclos menstruales y disminuir el riesgo metabólico y representa la primera línea de tratamiento. Los anticonceptivos orales (ACO) son el tratamiento farmacológico de elección ya que atenúan las manifestaciones de HA y ofrecen protección endometrial. En las pacientes con oligoanovulación que buscan embarazo, el citrato de clomifeno es el tratamiento aconsejado en primera instancia. La metformina podría usarse en aquellas con intolerancia a la glucosa o diabetes 2 y también como segunda línea de tratamiento para restaurar los ciclos e inducir la ovulación. (AU)

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women, the main cause of hyperandrogenism (HA). It is a complex, multifactorial polygenic disorder with environmental influences. Although there have been proposed different criteria for diagnosis, using the most comprehensive (Criteria Rotterdam) with the presence of 2 of 3 of the following is preferred: 1) HA clinical or biochemical, 2) oligo-anovulation chronic (OA), 3) polycystic ovaries by ultrasound, excluding other etiologies. It is frequently associated with metabolic comorbidities (obesity, type 2 diabetes, dyslipidemia, sleep apnea, etc.) and reproductive disorders (endometrial hyperplasia and infertility), especially in the classical phenotypes, with HA and OA. The treatment will be oriented to the clinical characteristics of each patient and reproductive desire. Weight loss in those who are overweight and / or obesity can restore menstrual cycles and decrease metabolic risk and represents the first line of treatment. Oral contraceptives (OC) are the pharmacological treatment of choice as it attenuates the manifestations of HA and offer endometrial protection. In patients seeking pregnancy with oligo-anovulation, clomiphene citrate would be used at first instance. Metformin may be used in those with impaired glucose tolerance or type 2 diabetes and also as a second-line treatment to restore cycles and induce ovulation. (AU)

Comparing the effect of aqueous extract of green tea and catechin on gonadotropins, beta-estradiol, Progesterone, testosterone and ovarian follicle in polycystic ovarian syndrome rat model

Background and Aim: Polycystic ovary syndrome [PCOS] is a complex endocrine and metabolic disorder, which is characterized by ovulatory dysfunction and hyperandrogenism. Regarding to the antioxidant properties of green tea [Camellia sinensis] compounds, the present study was done to evaluate the effect of aqueous extract of green tea and catechin on the status of sex hormones and ovaries in polycystic ovarian syndrome rat model

Materials and Methods: In this experimental study, 42 Wistar female rats were divided into 7 equal groups of control, PCOS control, PCOS treated with aqueous extract of green tea [50 and 100 mg/kg, 24 days, ip], PCOS treated with catechin [50 and 100 mg/kg, 24 days, ip] and PCOS treated with clomiphene citrate [1.5 mg/kg, 24 days, ip]. Polycystic ovarian syndrome was induced by a single intramuscular injection of estradiol valerate [4 mg/kg]. At the end of administration period, serum level of LH, FSH, ?-estradiol, Progesterone, and testosterone was measured using ELISA. Also, the number of ovarian follicles was counted. The obtained data was analyzed using one-way ANOVA and Post Hoc Tukey statistical tests

Results: Compared to PCOS control group, serum level of LH, beta-estradiol, testosterone and number of cystic follicles in the groups treated with clomiphene citrate, treated with 100 mg/kg aqueous extract of green tea and treated with 50 and 100 mg/kg of catechin significantly decreased, but serum level of FSH, progesterone and number of preantral, antral, preovulatory follicles, and corpus luteum significantly increased [p<0.05]

Conclusion: Compared with green tea, catechin has a more favorable effect on improving hormonal parameters, especially FSH hormone and increasing the number of ovarian follicles in rats with polycystic ovary syndrome

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.

Quality of Life in Women with Polycystic Ovary Syndrome after a Program of Resistance Exercise Training / Qualidade de vida emmulheres com síndrome de ovários policísticos após um programa de treinamento de exercício resistido

Abstract Purpose Aerobic exercises may improve quality of life (QoL) in women with polycystic ovary syndrome (PCOS). However, there is no data on the effect of resistance exercise training (RET) programs on the QoL of women with PCOS. Thus, this study aimed to assess the effect of a 16-week RET program on QoL in PCOS women. Methods This 16-week case-control study enrolled 43 women with PCOS (PCOS group, PCOSG) and 51 healthy pre-menopausal controls aged 18 to 37 years (control group, CG). All women underwent a supervised RET program for 16 weeks, and were evaluated in two different occasions: week-0 (baseline), and week-16 (after RET). Quality of life was assessed using the 36-Item Short Form Health Survey (SF-36). Results Testosterone reduced significantly in both groups after RET (p < 0.01). The PCOSG had improvements in functional capacity at week-16 relative to week-0 (p = 0.02). The CG had significant improvements in vitality, social aspects, and mental health at week-16 relative to week-0 (p ≤ 0.01). There was a weak correlation between social aspects of the SF-36 domain and testosterone levels in PCOS women. Conclusion A 16-week RET program modestly improved QoL in women with PCOS.

Resumo Objetivos Exercícios aeróbicos podem melhorar a qualidade de vida (QV) de mulheres com síndrome dos ovários policísticos (SOP). No entanto, não há dados sobre o efeito de um programa de treinamento de exercício resistido (TER) sobre a QV destas mulheres. Assim, este estudo teve como objetivo avaliar o efeito de um programa de TER de 16 semanas na QV em mulheres com SOP. Métodos Estudo caso-controle com 16 semanas de duração, para o qual foram incluídas 43 mulheres com SOP (grupo com SOP, GSOP) e 51 controles saudáveis com received idade entre 18 a 37 anos (grupo de controle, GC). Todas as mulheres foramsubmetidas ao protocolo TER supervisionado por 16 semanas, e foram avaliadas em dois momentos: na semana 0 (linha de base), e na semana 16 (após TER). A qualidade de vida foi avaliada pelo 36-Item Short Form Health Survey (SF-36). Resultados Houve redução significativa da testosterona emambos os grupos após o TER (p < 0,01). O GSOP obteve significativa melhora na capacidade funcional na semana 16 em relação à semana 0 (p = 0,02). O GC apresentou significativa melhora no escore do domínio vitalidade, aspectos sociais e saúde mental na semana 16 em relação à semana 0 (p ≤ 0,01). Houve uma fraca correlação entre os aspectos sociais de domínio SF-36 e o nível de testosterona em mulheres com SOP. Conclusão a aplicação de um programa de treinamento físico resistido durante 16 semanas resultou em melhora modesta da QV de mulheres com SOP.

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).

El síndrome de ovario poliquístico: aspectos psicológicos / Polycystic ovary syndrome: psychological aspects

ANTECEDENTES: La gran mayoría de la literatura científica sobre el síndrome de ovario poliquístico (SOP) ha utilizado un enfoque bio-médico para analizar esta enfermedad. En América Latina, y específicamente en idioma español, hay escasa información sobre las relaciones del SOP con factores psicológicos. OBJETIVO: Analizar este trastorno ginecológico de origen endocrino y su asociación con diferentes factores psicológicos, así como su abordaje integral. MÉTODO: Se realizó una búsqueda en bases de datos en los últimos años con los términos "SOP", "calidad de vida", "ansiedad", "depresión", "imagen corporal" y "disfunción sexual". RESULTADOS: El SOP es una enfermedad multifactorial que se ha vinculado a la depresión, la ansiedad, el estrés, la insatisfacción de la imagen corporal, trastornos sexuales y de la alimentación, el funcionamiento cognitivo, calidad de vida y el bienestar psicológico; la co-ocurrencia de este tipo de situaciones psicológicas alimenta la condición somática en mención. CONCLUSION: El abordaje psicológico puede complementar las acciones preventivas y terapéuticas que influyen en la efectividad del tratamiento y el bienestar subjetivo informado por los pacientes.

BACKGROUND: The vast majority of the scientific literature on polycystic ovary syndrome (PCOS) have used a bio-medical approach to analyzing this disease. In Latin America, specifically in Spanish, little is known about the relationship of PCOS with psychological factors. AIM: To analyze this gynecological disorder of endocrine origin and their association with different psychological factors and their comprehensive approach. METHOD: A search was performed in databases in recent years with the terms "PCOS", "quality of life", "anxiety", "depression", "body image" and "sexual dysfunction." RESULTS: PCOS is a multifactorial disease that has been linked to depression, anxiety, stress, dissatisfaction with body image, sexual and eating disorders, cognitive functioning, quality of life and psychological well-being; the co-occurrence of such psychological situations feed the somatic condition analyzed. CONCLUSION: The psychological approach can complement the preventive and therapeutic actions that influence the effectiveness of treatment and subjective well-being reported by patients.

Polycystic ovary syndrome: reviewing diagnosis and management of metabolic disturbances / Síndrome dos ovários policísticos: revisando o diagnóstico e o manejo dos distúrbios metabólicos

Polycystic ovary syndrome (PCOS) is a common condition in women at reproductive age associated with reproductive and metabolic dysfunction. Proposed diagnosed criteria for PCOS include two out of three features: androgen excess, menstrual irregularity, and polycystic ovary appearance on ultrasound (PCO), after other causes of hyperandrogenism and dysovulation are excluded. Based on these diagnostic criteria, the most common phenotypes are the “classic PCOS” – hyperandrogenism and oligomenorrhea, with or without PCO; the “ovulatory phenotype” – hyperandrogenism and PCO in ovulatory women; and the “non-hyperandrogenic phenotype”, in which there is oligomenorrhea and PCO, without overt hyperandrogenism. The presence of obesity may exacerbate the metabolic and reproductive disorders associated with the syndrome. In addition, PCOS women present higher risk for type 2 diabetes and higher prevalence of cardiovascular risk factors that seems to be associated with the classic phenotype. The main interventions to minimize cardiovascular and metabolic risks in PCOS are lifestyle changes, pharmacological therapy, and bariatric surgery. Treatment with metformin has been shown to improve insulin sensitivity, lowering blood glucose and androgen levels. These effects are more potent when combined with lifestyle interventions. In conclusion, besides reproductive abnormalities, PCOS has been associated to metabolic comorbidities, most of them linked to obesity. Confounders, such as the lack of standard diagnostic criteria, heterogeneity of the clinical presentation, and presence of obesity, make management of PCOS difficult. Therefore, the approach to metabolic abnormalities should be tailored to the risks and treatment goals of each individual woman.

A síndrome dos ovários policísticos (PCOS) é um distúrbio frequente em mulheres em idade reprodutiva, associado com disfunção reprodutiva e metabólica. Os critérios diagnósticos atuais para PCOS incluem pelo menos dois dos três seguintes: hiperandrogenismo, irregularidade menstrual e aparência policística dos ovários à ultrassonografia (PCO), após exclusão de outras causas de hiperandrogenismo e anovulação. Com base nesses critérios diagnósticos, os fenótipos mais comuns são “PCOS clássico”– hiperandrogenismo e oligomenorreia, com ou sem PCO; o “fenótipo ovulatório” – hiperandrogenismo e PCO em mulheres ovulatórias; e o “fenótipo não hiperandrogênico”– no qual ocorrem oligomenorreia e PCO sem hiperandrogenismo evidente. A presença de obesidade pode exacerbar os distúrbios metabólicos e reprodutivos associados com a síndrome. Além disso, mulheres com PCOS apresentam maior risco para diabetes tipo 2 e maior prevalência de fatores de risco cardiovascular, que parecem estar associados com o fenótipo clássico. As principais intervenções para minimizar riscos metabólicos e cardiovasculares em PCOS são mudanças de estilo de vida, tratamento farmacológico e cirurgia bariátrica. O tratamento com metformina melhora a sensibilidade à insulina, reduz a glicemia e os níveis de androgênios. Esses efeitos são mais evidentes quando a metformina é associada às mudanças de estilo de vida. Em conclusão, além das anormalidades reprodutivas, a PCOS tem sido associada com comorbidades metabólicas ligadas à obesidade. Fatores confundidores, como a falta de critérios diagnósticos padronizados, heterogeneidade da apresentação clínica e presença de obesidade, tornam difícil o manejo clínico de PCOS. Assim, a abordagem das anormalidades metabólicas deve ser individualizada para os riscos e objetivos terapêuticos de cada mulher.

Polycystic ovarian syndrome.

Polycystic ovarian syndrome (PCOS) is a "multispeciality" disorder suspected in patients with irregular menses and clinical signs of hyperandrogenism such as acne, seborrhoea, hirsutism, irregular menses, infertility, and alopecia. Recently, PCOS has been associated with the metabolic syndrome. Patients may develop obesity, insulin resistance, acanthosis nigricans, Type 2 diabetes, dyslipidemias, hypertension, non-alcoholic liver disease, and obstructive sleep apnoea. Good clinical examination with hematological and radiological investigations is required for clinical evaluation. Management is a combined effort involving a dermatologist, endocrinologist, gynecologist, and nutritionist. Morbidity in addition includes a low "self image" and poor quality of life. Long term medications and lifestyle changes are essential for a successful outcome. This article focuses on understanding the normal and abnormal endocrine functions involved in the pathogenesis of PCOS. Proper diagnosis and management of the patient is discussed.

[ effects of an aerobic exercise program on LH, FSH, TST and DHEA levels in obese women with polycystic ovary syndrome]

Polycystic ovary syndrome [PCOS] is an endocrine disorder, characterized by anovulation, hirsutism, acne, hyperandrogenism, impaired glucose tolerance, insulin resistance and obesity. Life style modifications are recommended to prevent and treat obese and over weight women with PCOS. The purpose of this study was to determine the effects of aerobic exercise program on concentrations of LH, FSH, TST and DHEA in obese women with polycystic ovary syndrome. Seventeen obese female volunteers who were diagnosed with polycystic ovary syndrome [age: 15-30 y and BMI=29.35 +/- 2.88 Kg/m2] were selected. An aerobic exercise program was performed for 12-weeks, three sessions week]. Anthropometric characteristics, metabolic and hormonal profiles were measured at base line and after 12-week exercises or [36th session]. Data were analyzed by Paired-Samples T Test [t-student], P values <0.05 being considered significant. After the 12-week exercise program, subjects showed a significant reduction in body weight, body fat percent, waist circumference, luteinizing hormone and an increase in Vo2-peak[P<0/05]; changes however in body mass index, FSH, TST and DHEA were not significant. These results suggest that aerobic exercise training affects some of anthropometric characteristics and metabolic and hormonal profiles and also improves metabolic status and ovulation disorders, including polycystic ovary syndrome

Assessment of serum progesterone level on the day of hCG injection in infertile polycystic ovarian syndrome patients referred to women's hospital, Tehran, 2009

Background: Polycystic ovarian syndrome [PCOS] is one of the most common causes of endocrine disorders and main reasons for infertility due to unovulation and recurrent abortions. There is no consensus on effect of serum progesterone level on the day of human chorionic gonadotropin [hCG] injection. This study aims to evaluate the effect of plasma levels of progesterone on the day of hCG injection on the rate of pregnancy in in vitro fertilization [IVF] cycles of PCOS cases

Materials and Methods: A stratified cohort study was conducted over a period of one year [2009] on 38 infertile women with PCOS who were suitable candidates for the IVF program. Patients were evaluated for other causes of infertility with hysterosalpingography [HSG], laparoscopy and normal sperm analysis. Patients were placed on the long protocol, followed by oocyte pick up, and finally IVF-embryo transfer [ET]. Study patients were grouped according to progesterone levels of greater or less than 1.2 ng/ml on the day of hCG injection. Pregnancy rates were defined in each group. Levels on day of hCG day clinical pregnancy outcome were assessed. Experimental data were then compared against Fisher's exact test in SPSS version 18

Results: The overall pregnancy rate in this study was 26.3%. In the group with progesterone levels more than 1.2 ng/ml on the day of hCG injection, the clinical pregnancy rate was 4 [21.1%] and chemical pregnancy rate was 3[15.8%]. In the group with progesterone levels less than 1.2 ng/ml, the clinical pregnancy rate was 1[5.3%] and chemical pregnancy rate was 2[10. 5%]

Conclusion: This study showed that PCOS patients with progesterone levels more than 1.2 ng/ml on the day of hCG injection resulted in higher chemical and clinical pregnancy rates. However, no significant statistical differences were found between the two groups. For further verification, we recommend additional studies with larger numbers of subjects