Women with PCOS are at risk for emotional and uncontrolled eating at midlife: a population-based cohort study.

OBJECTIVE: To investigate eating behavior domains -emotional, uncontrolled, and cognitive restraint eating- in women with polycystic ovary syndrome (PCOS) with different PCOS phenotypes and women without PCOS at midlife. DESIGN: A prospective cohort study. Eating behavior domains were assessed at age 46. Predictors of eating behaviors were evaluated using variables collected at ages 31 and 46. SUBJECTS: Women identified as having PCOS (n=251) at age 31 using the updated Rotterdam criteria were compared to women without any PCOS criteria (n=935). The PCOS population comprised women with the classic A+B-phenotype (hyperandrogenism and oligomenorrhea, with or without elevated anti-Müllerian hormone, n=60), C-phenotype (hyperandrogenism and elevated anti-Müllerian hormone, n=84), and D-phenotype (oligomenorrhea and elevated anti-Müllerian hormone, n=86). EXPOSURE: The main explanatory variables for the eating behavior domains were PCOS, body mass index, a history of weight loss attempts, a perception of being overweight, and psychological distress. MAIN OUTCOME MEASURES: Revised Three-Factor Eating Questionnaire-18 scores for eating behavior domains. RESULTS: Compared to women without PCOS, women with PCOS exhibited higher scores for emotional (33.1±27.8 vs. 39.0±29.9, p=0.005) and uncontrolled eating (26.7±18.2 vs. 30.7±19.4, p=0.003) but no difference in cognitive restraint (46.6±18.6 vs. 45.9±18.5, p=0.563) at age 46. Emotional and uncontrolled eating scores were higher in the A+B-phenotype compared to women without PCOS, while uncontrolled eating scores in the C-phenotype were higher than in women without PCOS and the D-phenotype. At age 46, the perception of overweight was an independent predictor of emotional eating among women with PCOS (B=11.96 [95% confidence interval [CI]: 2.81-20.29], p=0.008), while a history of weight loss attempts was a predictor of uncontrolled eating (B=6.06 [95% CI: 1.05-10.83], p=0.015). Among women with PCOS, higher psychological distress at age 31 was a significant risk factor for scoring in the highest quartile of emotional (adjusted odds ratio [aOR]: 2.85 [95% CI: 1.19-6.85], p=0.019) and uncontrolled eating (aOR: 4.37 [95% CI: 1.77-10.80], p=0.001) at age 46. CONCLUSION: Women with PCOS at midlife showed a high tendency for unfavorable eating behaviors. Our findings emphasize the need for sensitivity in weight management counseling and addressing psychological distress to prevent unfavorable eating in this population.

Polycystic ovary syndrome is associated with weight-loss attempts and perception of overweight independent of BMI: a population-based cohort study.

OBJECTIVE: Up to 70% of women with polycystic ovary syndrome (PCOS) have pre-obesity or obesity. The aim of this study was to investigate whether women with PCOS have more weight-loss attempts than women without PCOS, regardless of BMI. Moreover, women's weight perceptions in relation to previous weight-loss attempts were evaluated. METHODS: A population-based birth cohort study included women with (n = 278) and without PCOS (control individuals, n = 1560) who were examined at ages 31 and 46 years with questionnaires and clinical examinations. RESULTS: Women with PCOS had more weight-loss attempts compared with control individuals at age 31 (47% vs. 34%, p < 0.001) and 46 years (63% vs. 47%, p < 0.001). At age 46 years, PCOS was associated with multiple weight-loss attempts in the adjusted model (odds ratio: 1.43 [95% CI: 1.00-2.03], p = 0.05). The perception of having overweight was more prevalent in those with PCOS, even among participants with normal weight, at age 31 (PCOS 47% vs. control 34%, p = 0.014) and 46 years (PCOS 60% vs. control 39%, p = 0.001). CONCLUSIONS: Women with PCOS were more likely to have experienced multiple weight-loss attempts and a perception of having overweight compared with control individuals, regardless of obesity status.

Associations of Sex Hormones and Hormonal Status With Arterial Stiffness in a Female Sample From Reproductive Years to Menopause.

Objective: Loss of sex hormones has been suggested to underlie menopause-associated increment in cardiovascular risk. We investigated associations of sex hormones with arterial stiffness in 19-58-years-old women. We also studied associations of specific hormonal stages, including natural menstrual cycle, cycle with combined oral contraceptives (COC) and menopausal status with or without hormone therapy (HT), with arterial stiffness. Methods: This study includes repeated measurements of 65 healthy women representing reproductive (n=16 natural, n=10 COC-users) and menopause (n=5 perimenopausal, n=26 postmenopausal, n=8 HT-users) stages. Arterial stiffness outcomes were aortic pulse wave velocity (PWVao) and augmentation index (AIx%) assessed using Arteriograph-device. Generalized estimating equation models were constructed to investigate associations of each hormone (wide age-range models) or hormonal stage (age-group focused models) with arterial stiffness. PWVao models with cross-sectional approach, were adjusted for age, relative fitness, fat mass and mean arterial pressure, while models with longitudinal approach were adjusted for mean arterial pressure. AIx% models used the same approach for adjustments and were also adjusted for heart rate. Results: Negative and positive associations with arterial stiffness variables were observed for estradiol and follicle-stimulating hormone, respectively, until adjustment for confounding effect of age. In naturally menstruating women, AIx% was higher at ovulation (B=3.63, p<0.001) compared to the early follicular phase. In COC-users, PWVao was lower during active (B=-0.33 - -0.57, p<0.05) than inactive pills. In menopausal women, HT-users had higher PWVao (B=1.43, p=0.03) than postmenopausal non-HT-users. Conclusions: When using wide age-range assessments covering reproductive to menopausal lifespan it is difficult to differentiate age- and hormone-mediated associations, because age-mediated influence on arterial stiffness seemed to overrule potential hormone-mediated influences. However, hormonal status associated differentially with arterial stiffness in age-group focused analyses. Thus, the role of sex hormones cannot be excluded. Further research is warranted to resolve potential hormone-mediated mechanisms affecting arterial elasticity.