Women's Health Research Institute, H214-4500 Oak St, Vancouver, British Columbia V6H 3N1, Canada; Department of Pathology & Laboratory Medicine, University of British Columbia, Rm. G227 - 2211 Wesb...ROR
Chronic inflammation predisposes to poor bone health. Women with polycystic ovary syndrome (PCOS) experience androgen excess, ovulatory disturbances, insulin resistance, abdominal adiposity and chronic inflammation. Our objective was to investigate the relationships among bone health parameters, chronic subclinical inflammation and anthropometric measures in premenopausal women with and without PCOS. In 61 premenopausal women, 22 women with PCOS and 39 controls, we assessed bone parameters (total hip bone mineral density [BMD] by dual-energy X-ray absorptiometry and radius strength-strain index [SSI] by peripheral quantitative computed tomography), inflammation (C-reactive protein/albumin), oxidative stress (leukocyte telomere length, urinary 8-hydroxydeoxyguanosine); hemoglobin A1c; anthropometric measures (body mass index, waist-to-height ratio, cross-sectional muscle area). A diagnosis of PCOS negatively predicted (beta = -0.251, p = 0.022) hip BMD in a regression model including weight. In women with PCOS, inflammation, which was predicted by increased waist-to-height ratio and current use of oral contraceptives, attenuated the positive influences of increased weight and muscle mass on bone strength and was inversely associated with radial SSI (R(2) = 0.25, p = 0.018). In conclusion, chronic subclinical inflammation may negatively impact bone physiology in women with PCOS. Strategies focused on reducing abdominal adiposity and avoiding medications that increase inflammation may counter this effect.
polycystic ovary syndrome bone health, PCOS chronic inflammation, bone mineral density PCOS, subclinical inflammation bone loss, C-reactive protein PCOS, trabecular bone score premenopausal, abdominal adiposity bone metabolism, oral contraceptives inflammation, PCOS androgen excess bone, insulin resistance skeletal health
PMID 28611442 28611442 DOI 10.1038/s41598-017-03685-x 10.1038/s41598-017-03685-x
Cite this article
Kalyan, S., Patel, M. S., Kingwell, E., Côté, H. C. F., Liu, D., & Prior, J. C. (2017). Competing Factors Link to Bone Health in Polycystic Ovary Syndrome: Chronic Low-Grade Inflammation Takes a Toll. Scientific reports, 7(1), 3432. https://doi.org/10.1038/s41598-017-03685-x
Kalyan S, Patel MS, Kingwell E, Côté HCF, Liu D, Prior JC. Competing Factors Link to Bone Health in Polycystic Ovary Syndrome: Chronic Low-Grade Inflammation Takes a Toll. Sci Rep. 2017;7(1):3432. doi:10.1038/s41598-017-03685-x
Kalyan, S., et al. "Competing Factors Link to Bone Health in Polycystic Ovary Syndrome: Chronic Low-Grade Inflammation Takes a Toll." Scientific reports, vol. 7, no. 1, 2017, pp. 3432.
This clinical trial aims to compare hormonal and metabolic changes after a 9-week continuous use of oral or vaginal combined hormonal contraceptives (CHCs) in women with polycystic ovary syndrome (PCOS). We recruited 24 women with PCOS and randomized them to use either combined oral (COC, n = 13) or vaginal (CVC, n = 11) contraception. At baseline and 9 weeks, blood samples were collected and a 2 h glucose tolerance test (OGTT) was performed to evaluate hormonal and metabolic outcomes. After treatment, serum sex hormone binding globulin (SHBG) levels increased (p < 0.001 for both groups) and the free androgen index (FAI) decreased in both study groups (COC p < 0.001; CVC p = 0.007). OGTT glucose levels at 60 min (p = 0.011) and AUCglucose (p = 0.018) increased in the CVC group. Fasting insulin levels (p = 0.037) increased in the COC group, and insulin levels at 120 min increased in both groups (COC p = 0.004; CVC p = 0.042). There was a significant increase in triglyceride (p < 0.001) and hs-CRP (p = 0.032) levels in the CVC group. Both oral and vaginal CHCs decreased androgenicity and tended to promote insulin resistance in PCOS women. Larger and longer studies are needed to compare the metabolic effects of different administration routes of CHCs on women with PCOS.
Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility. Absent, impaired, or rare ovulation induces progesterone deficiency in the luteal phase, which is a critical problem in PCOS. A usual pattern of progesterone administration from a fixed and arbitrary pre-determined day of a menstrual cycle may preserve infertility but can easily be avoided. We present the case of a 29-year-old infertile woman who had been ineffectively treated for over two years. We introduced a line of therapy that was suited to her individual menstrual cycle by implementing biomarker recording. Supplementation based on a standardized observation of the basal body temperature (BBT) and cervical mucus stopped the vicious circle of absent ovulation and hyperandrogenism, restoring regular bleeding, ovulation cycles, and fertility. The implementation of a reliable fertility awareness method (FAM), accompanied by a standardized teaching methodology and periodic review of the observations recorded by the patient, validated through an ultrasound examination and plasma gonadotropins, estrogens, and progesterone concentrations, is key to achieving therapeutic success. The presented case is an example of a clinical vignette for many patients who have successfully managed to improve their fertility and pregnancy outcomes by applying the principles of a personalized treatment approach together with gestagens by recording their fertility biomarkers.
Metformin is the gold standard insulin sensitizer, which is widely used to treat insulin resistance in polycystic ovary syndrome (PCOS). However, metformin may induce gastrointestinal side effects. Inositols have long been debated as a potential alternative for metformin in treating PCOS. Therefore, the present systematic review aimed to evaluate the efficacy and safety of inositols in treating PCOS. The present systematic search was performed in CENTRAL, MEDLINE, and Embase from the inception until October 20th, 2021. Eligible randomized controlled trials (RCTs) included women diagnosed with PCOS and compared any inositols with metformin or placebo. Our primary outcome was cycle normalization, whereas secondary outcomes were body mass index (BMI), parameters of carbohydrate metabolism and clinical and laboratory hyperandrogenism. Results are reported as risk ratios or mean differences (MDs) with 95% confidence intervals (CIs). Twenty-six RCTs were identified, including data of 1691 patients (806 inositol, 311 with placebo, and 509 metformin groups). In patients treated with inositols, the risk (CI: 1.13; 2.85) of having a regular menstrual cycle was found by 1.79 higher than in the case of placebo. Moreover, the inositols showed non-inferiority compared to metformin in this outcome. In the case of BMI (MD = -0.45; CI: -0.89; -0.02), free testosterone (MD = -0,41, CI: -0.69; -0.13), total testosterone (MD = -20.39, CI: -40.12; -0.66), androstenedione (MD = -0.69, CI: -1,16; -0.22), glucose (MD = -3.14; CI: -5.75; -0.54) levels and AUC insulin (MD = -2081.05, CI: -2745.32; -1416.78) inositol treatment induced greater decrease compared to placebo. Inositol increased sex-hormone-binding globulin significantly compared to placebo (MD = 32.06, CI:1.27; 62.85). Inositol is an effective and safe treatment in PCOS. Moreover, inositols showed non-inferiority in most outcomes compared to the gold standard treatment; metformin. PROSPERO CRD42021283275.
Women with polycystic ovary syndrome experience increased health complications during and after pregnancy, including a higher prevalence of postpartum depression. Although previous research has found that Hispanic women with polycystic ovary syndrome experience heightened hyperandrogenism and metabolic effects compared with non-Hispanic women, it is unknown whether they experience other polycystic ovary syndrome-related comorbidities, such as postpartum depression, to a greater degree than their non-Hispanic counterparts. This study aimed to determine the associations among a self-reported prepregnancy diagnosis of polycystic ovary syndrome, polycystic ovary syndrome symptoms (irregular menstruation, hirsutism, and acne), and postpartum depression among a national sample of at-risk women and evaluated the potential effect modification by Hispanic ethnicity. The study population included 52,267 postpartum (2-6 months) women who completed the US Pregnancy Risk Assessment Monitoring System Phase 8 questionnaire (2016-2018). Data from US states that captured self-reported polycystic ovary syndrome symptoms in the 3 months before pregnancy (n=17 states) were used. Moreover, we performed a subanalysis restricted to data from the Utah Pregnancy Risk Assessment Monitoring System Phase 8 questionnaire (2016-2019; n=5814), as it was the only state that considered self-reported polycystic ovary syndrome symptoms during this period. Postpartum depressed mood and anhedonia, the postpartum depression outcome measurements, were assessed via the following questions, (1) "Since your new baby was born, how often have you felt down, depressed, or hopeless?" and (2) "Since your new baby was born, how often have you had little interest or little pleasure in doing things you usually enjoyed?" In addition, postpartum depressed mood and anhedonia were assessed separately and as a combined variable. Here, weighted adjusted prevalence ratios and 95% confidence intervals were used to assess the association between polycystic ovary syndrome and postpartum depressed mood and anhedonia among Hispanic women and non-Hispanic women while taking into account preconception sociodemographics, lifestyle, and health history confounding factors. The national study population was composed of 16.8% of Hispanic ethnicity, with 11.4% Hispanic women and 17.1% non-Hispanic women reporting prepregnancy polycystic ovary syndrome symptoms. The study found no association between women reporting prepregnancy polycystic ovary syndrome vs women without polycystic ovary syndrome and the prevalence of postpartum depressed mood and/or anhedonia. Moreover, the results were null when we stratified by Hispanic ethnicity. The Utah study population was composed of 15.5% of women of Hispanic ethnicity, with 5.8% of Hispanic women and 7.4% of non-Hispanic women reporting prepregnancy polycystic ovary syndrome. Symptom-based polycystic ovary syndrome (having irregular menstruation with hirsutism or irregular menstruation with acne), compared with having regular menstruation in the Utah sample, was associated with a 1.54 higher adjusted prevalence ratio (95% confidence interval, 1.14-2.09) for postpartum depressed mood and anhedonia. Stratified analyses by ethnicity indicated a 2to 5-fold higher prevalence of postpartum depression with symptom-based polycystic ovary syndrome for Hispanic women and a 1.5-fold higher prevalence for non-Hispanic women. In this US population-based study, a self-reported prepregnancy diagnosis of polycystic ovary syndrome was not associated with postpartum depression. However, self-reported polycystic ovary syndrome symptoms, including irregular menstruation and acne and/or hirsutism, were associated with a higher probability of postpartum depression, most prominently for Hispanic women. Our findings suggested that capturing polycystic ovary syndrome symptoms among at-risk women may be important for identifying associations with postpartum depression and potentially other comorbidities.