Farrell, K., & Antoni, M. H. (2010). Insulin resistance, obesity, inflammation, and depression in polycystic ovary syndrome: biobehavioral mechanisms and interventions. Fertility and sterility, 94(5), 1565-1574. https://doi.org/10.1016/j.fertnstert.2010.03.081
Farrell K, Antoni MH. Insulin resistance, obesity, inflammation, and depression in polycystic ovary syndrome: biobehavioral mechanisms and interventions. Fertil Steril. 2010;94(5):1565-1574. doi:10.1016/j.fertnstert.2010.03.081
Farrell, Kristen, and Michael H. Antoni. "Insulin resistance, obesity, inflammation, and depression in polycystic ovary syndrome: biobehavioral mechanisms and interventions." Fertility and sterility, vol. 94, no. 5, 2010, pp. 1565-1574.
Insulin resistance, inflammation, and depression are linked in PCOS
Insulin resistance, inflammation, and depression are strongly linked in PCOS, a 2010 review concludes. The authors pulled together studies on body chemistry, mood, and treatment. They conclude that PCOS care would benefit from adding mental health and behavior support. PCOS is now also called polyendocrine metabolic ovarian syndrome (PMOS).
Key Findings
70% of women with PCOS are insulin resistant, the review reports.
In U.S. studies of women with PCOS, type 2 diabetes prevalence was 7.5% to 10%, against 0.7% in healthy young women.
Depression prevalence in women with PCOS has been reported as high as 40%. A German internet survey of 448 women with PCOS found clinical depression in 21%.
Obese women with PCOS had more depressive disorders than obese controls (44% versus 7%). Women with PCOS may be at greater risk of depression regardless of obesity.
In one study, a 6-month program of diet and exercise advice brought back normal periods in 60% of women with PCOS who were not ovulating.
Interpretation
The paper is a narrative review. The authors kept papers that fit the review's purpose, and they report no pooled analysis. Many links rest on correlational studies. Some mechanisms come from animal and general-population studies. Human studies testing whether chronic stress causes inflammation gave mixed results. The authors found one small pilot study of cognitive behavioral therapy in PCOS, in teens, and call for much more research. The advice to add mental health and behavior support is the authors' own conclusion.
RRM Context
The review describes PCOS as a linked condition of metabolism, hormones, and mood. That fits the root-cause, whole-person view of restorative reproductive medicine. The authors say insulin resistance appears to play a central role. In one lifestyle study they cite, insulin resistance did not improve in women who stayed without ovulation.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To summarize physiological and psychological characteristics that are common among women diagnosed with polycystic ovary syndrome (PCOS) and provide evidence suggesting that addressing psychological disturbances can reduce or alleviate physical symptoms of PCOS through behavioral pathways and physiological pathways.
Methods
Empirical studies and expert consensuses pertaining to physiological, psychological, and medical management aspects of PCOS were identified and presented in this review. Articles were identified by searching Pubmed, PsycInfo, Medline ISI, CINAHL, or a Web browser (i.e., Google) using numerous combinations of terms pertaining to physiological, psychological, and medical management aspects of PCOS. An article was chosen to be included in this review if it reported findings and/or provided information that related to and helped support the main purpose(s) of this review article.
Results
Available literature on the physiological (i.e., hyperandrogenism, central obesity, inflammation, insulin resistance) and psychological (i.e., depression, anxiety, eating disorders) factors among women with PCOS provides evidence that these various aspects of PCOS are strongly interrelated.
Conclusions
The existence of these relationships among physiological and psychological factors strongly suggests that medical management of PCOS would greatly benefit from inclusion of psychological and behavioral approaches.
Singh S et al., 2023·Journal of clinical medicine·Free full text on PubMed Central
Polycystic ovary syndrome (PCOS) is a complex endocrine and metabolic disorder, typically characterized by anovulation, infertility, obesity, insulin resistance, and polycystic ovaries. Lifestyle or diet, environmental pollutants, genetics, gut dysbiosis, neuroendocrine alterations, and obesity are among the risk factors that predispose females to PCOS. These factors might contribute to upsurging metabolic syndrome by causing hyperinsulinemia, oxidative stress, hyperandrogenism, impaired folliculogenesis, and irregular menstrual cycles. Dysbiosis of gut microbiota may play a pathogenic role in the development of PCOS. The restoration of gut microbiota by probiotics, prebiotics, or a fecal microbiota transplant (FMT) might serve as an innovative, efficient, and noninvasive way to prevent and mitigate PCOS. This review deliberates on the variety of risk factors potentially involved in the etiology, prevalence, and modulation of PCOS, in addition to plausible therapeutic interventions, including miRNA therapy and the eubiosis of gut microbiota, that may help treat and manage PCOS.
The incidence of polycystic ovarian disease (PCOD) varies from 0.6 to 92%, depending on the parameters analysed, PCOD has been reported to appear in association with Cushing's Syndrome, adrenal hyperplasia, hypothyroidism, adrenal and ovarian tumours and some genetic abnormalities. The controversy regarding the pathophysiological mechanism underlying the disease still persists. Critical evaluation of old data, assessment of new findings concerning the possible role of insulin, growth factors and their binding proteins, and extrapolation of neuroendocrinological experiments enabled the construction of a concise hypothesis of the pathophysiology of PCOD. According to this hypothesis, PCOD is a multifactorial disease. The sequence of events finally leading to clinical manifestation of the disease (hyperandrogenism, abnormal luteinizing hormone pulsatility pattern and ovulation disturbances) may originate in different organs or be triggered by different mechanisms. It may stem from the adrenals, the hypothalamus or higher central nervous system centres, or from the ovary itself; it may originate from excess of fat tissue usually combined with hyperinsulinism; or may be the result of a net increase in active growth factors. Each of the above disturbances probably appears early in life, much before the clinical signs of the disease are evident. Predisposing factors such as gestational diabetes of the mother, childhood obesity, borderline adrenal hyperplasia and late menarche have to be looked for as early as possible in order to prevent the late consequences of the disease, such as increased risk of infertility, endometrial and breast cancer and cardiovascular disease.
Aversa A et al., 2020·Frontiers in endocrinology·Free full text on PubMed Central
Polycystic ovary syndrome (PCOS) is a very common endocrine and metabolic disorder with the involvement of both genetic and environmental factors. Although much has been clarified on its pathogenesis, diagnosis, clinical manifestations, and therapy, there are still areas of uncertainty. To address fundamental concepts, novel aspects and hypotheses, and future perspectives, including the possible additional benefits of treatment with nutraceuticals, an expert consensus panel formed by endocrinologists and gynecologists was established. After an independent review of the literature, the panel convened electronically on February 3, 2020, and six resolutions were created, debated, and agreed upon discussion, and finally approved in their final form in a consensus livestream meeting held on April 15. The summary of the resolutions are: (1) PCOS is a well-established medical condition that negatively affects reproduction, general health, sexual health, and quality of life; (2) the symptoms and signs of PCOS appear early in life especially in female newborns from PCOS carriers; (3) women with PCOS have significantly increased risk of pregnancy-related complications including gestational diabetes mellitus; (4) a male PCOS equivalent exists, and it may impact on metabolic health and probably on reproduction; (5) the evidence supports that medical therapy for PCOS is effective, rational, and evidence-based; (6) the evidence supports a major research initiative to explore possible benefits of nutraceutical therapy for PCOS. The proposed resolutions may be regarded as points of agreement based on the current scientific evidence available.
Baptiste CG et al., 2010·The Journal of steroid biochemistry and molecular biology·Free full text on PubMed Central
Polycystic ovary syndrome (PCOS) is a very common endocrine disorder characterized by chronic anovulation, clinical and/or biochemical hyperandrogenism, and/or polycystic ovaries. But most experts consider that hyperandrogenism is the main characteristic of PCOS. Several theories propose different mechanisms to explain PCOS manifestations: (1) a primary enzymatic default in the ovarian and/or adrenal steroidogenesis; (2) an impairment in gonadotropin releasing hormone (GnRH) secretion that promotes luteal hormone (LH) secretion; or (3) alterations in insulin actions that lead to insulin resistance with compensatory hyperinsulinemia. However, in the past 20 years there has been growing evidence supporting that defects in insulin actions or in the insulin signalling pathways are central in the pathogenesis of the syndrome. Indeed, most women with PCOS are metabolically insulin resistant, in part due to genetic predisposition and in part secondary to obesity. But some women with typical PCOS do not display insulin resistance, which supports the hypothesis of a genetic predisposition specific to PCOS that would be revealed by the development of insulin resistance and compensatory hyperinsulinemia in most, but not all, women with PCOS. However, these hypotheses are not yet appropriately confirmed, and more research is still needed to unravel the true pathogenesis underlying this syndrome. The present review thus aims at discussing new concepts and findings regarding insulin actions in PCOS women and how it is related to hyperandrogenemia.
PMOS / PCOS › Pathophysiology › Insulin Resistance · Mental Health and Psychosocial Care › Psychosocial Support › Counseling and Therapy
Michael H Antoni
Mike Antoni, M Antoni
PMID 20471009 20471009 DOI 10.1016/j.fertnstert.2010.03.081 10.1016/j.fertnstert.2010.03.081 Farrell et al. 2010, Farrell 2010
Cite this article
Farrell, K., & Antoni, M. H. (2010). Insulin resistance, obesity, inflammation, and depression in polycystic ovary syndrome: biobehavioral mechanisms and interventions. Fertility and sterility, 94(5), 1565-1574. https://doi.org/10.1016/j.fertnstert.2010.03.081
Farrell K, Antoni MH. Insulin resistance, obesity, inflammation, and depression in polycystic ovary syndrome: biobehavioral mechanisms and interventions. Fertil Steril. 2010;94(5):1565-1574. doi:10.1016/j.fertnstert.2010.03.081
Farrell, Kristen, and Michael H. Antoni. "Insulin resistance, obesity, inflammation, and depression in polycystic ovary syndrome: biobehavioral mechanisms and interventions." Fertility and sterility, vol. 94, no. 5, 2010, pp. 1565-1574.
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