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.
PMID 37109164 37109164 DOI 10.3390/jcm12082827 10.3390/jcm12082827
Cite this article
Mosorin, M., Piltonen, T., Rantala, A. S., Kangasniemi, M. H., Korhonen, E., Bloigu, R., Tapanainen, J., & Morin-Papunen, L. (2023). Oral and Vaginal Hormonal Contraceptives Induce Similar Unfavorable Metabolic Effects in Women with PCOS: A Randomized Controlled Trial. Journal of clinical medicine, 12(8), 2827. https://doi.org/10.3390/jcm12082827
Mosorin M, Piltonen T, Rantala AS, Kangasniemi MH, Korhonen E, Bloigu R, et al. Oral and Vaginal Hormonal Contraceptives Induce Similar Unfavorable Metabolic Effects in Women with PCOS: A Randomized Controlled Trial. J Clin Med. 2023;12(8):2827. doi:10.3390/jcm12082827
Mosorin, Maria-Elina, et al. "Oral and Vaginal Hormonal Contraceptives Induce Similar Unfavorable Metabolic Effects in Women with PCOS: A Randomized Controlled Trial." Journal of clinical medicine, vol. 12, no. 8, 2023, pp. 2827.
Curcumin, a bioactive polyphenol derived from turmeric (Curcuma longa), has garnered substantial attention for its potent anti-inflammatory, antioxidant, and antineoplastic properties. This review explores the therapeutic potential of curcumin in gynecologic health, with a focus on its role in the management of ovarian, cervical, and endometrial cancers, as well as benign conditions such as endometriosis, polycystic ovary syndrome, premenstrual syndrome, and menopausal symptoms. A literature review was conducted on the health effects of gynecology. Relevant articles were identified through systematic searches in major biomedical databases, including PubMed, Scopus, Cochrane Library, Embase, and Web of Science databases for studies reporting the relationship between curcumin and some in gynecological diseasess as of 2025. Curcumin modulates key inflammatory signaling pathways, reduces oxidative stress, and exerts antiproliferative effects, making it a promising adjunct in the treatment of both neoplastic and inflammatory gynecologic disorders. Nevertheless, clinical translation remains limited by challenges such as poor bioavailability and a paucity of large-scale, randomized controlled trials. Emerging evidence supports the integration of curcumin into multimodal treatment strategies, particularly in oncology and chronic inflammatory conditions. In light of the need to improve treatment efficacy and enhance patients' quality of life, the exploration of novel adjuvant therapeutic strategies is highly warranted. Recent studies have demonstrated the beneficial effects of curcumin and its novel analogues across a range of gynecologic diseases, while advances in formulation technologies have led to improved pharmacokinetic profiles and therapeutic outcomes. Nevertheless, further robust clinical investigations are required to optimize curcumin formulations, enhance bioavailability, and establish evidence-based guidelines for its integration into gynecologic care. This review synthesizes current evidence and highlights the underlying molecular mechanisms responsible for the observed effects, aiming to support the rational development of curcumin-based strategies in gynecology.
The primary objective of polycystic ovarian syndrome (PCOS) treatment is to achieve mono-ovulatory cycles, thereby enabling pregnancy and childbirth. Laparoscopic ovarian drilling (LOD) and transvaginal ovarian drilling (TVOD) are widely used second-line treatments for ovulation induction in PCOS patients who do not respond to clomiphene citrate (CC). LOD involves the application of heat or laser energy to create small perforations in the ovary, whereas TVOD involves ultrasound-guided ovarian puncture. Both LOD and TVOD have been shown to be effective in promoting ovulation and enhancing fertility outcomes in PCOS patients. TVOD offers several potential advantages over LOD, including a lower risk of surgical complications, reduced cost, and the ability to be performed in an outpatient setting. Both LOD and TVOD are effective treatment options for PCOS-related infertility. The choice between the two procedures should be based on individual patient characteristics, including body mass index (BMI), hormonal profiles, and previous responses to treatment. Further research is needed to optimize these techniques and clarify their clinical applications. Patients with clomiphene-resistant PCOS should be carefully assessed for both LOD and TVOD. LOD may be more suitable for patients with elevated luteinizing hormone (LH) levels and shorter durations of infertility. In contrast, TVOD may be preferred for patients who would benefit from a less invasive approach with a lower risk of adhesion formation.
Is there a difference in live birth rates at 24 months between infertile women with polycystic ovary syndrome (PCOS) who have normal versus abnormal glucose metabolism? Abnormal glucose metabolism did not significantly reduce live birth rates but was associated with increased obstetric complications. Women with PCOS are often at increased risk of glucose metabolism disorders. However, evidence about the impact of these disorders on pregnancy outcomes remains limited, particularly in Asian populations. This prospective cohort study was conducted at a reproductive care centre in Vietnam from June 2020 to August 2024. A total of 1208 women were enrolled. PARTICIPANTS/MATERIALS Eligible participants were infertile women aged 18-40 years diagnosed with PCOS (Rotterdam criteria). Comprehensive assessments included medical history, anthropometric measurements, endocrine evaluations, fasting plasma glucose (FPG), glycosylated haemoglobin (HbAlc), and oral glucose tolerance tests (OGTT). Participants were categorized into normal or abnormal glucose metabolism groups and monitored for live birth outcomes at 24 months from the first visit. MAIN Live birth rates at 24 months were comparable between women with normal versus abnormal glucose metabolism (52.7% vs 48.2%, P = 0.12). However, obstetric complications, including gestational diabetes mellitus (15.2% vs 28.0%, P < 0.001) and hypertensive disorders of pregnancy (2.3% vs 9.0%, P < 0.001), were more common in the group with abnormal glucose metabolism. In women who conceived naturally, greater waist circumference and higher Homeostatic Model Assessment of Insulin Resistance index were significantly associated with lower odds of live birth, whereas the presence of hyperandrogenism was associated with higher odds of live birth. No factors were significantly associated with live birth in the group that conceived via ovulation induction plus IUI. In the group that conceived through IVF or IVM, a higher BMI was significantly associated with a lower live birth rate. LIMITATIONS This single-centre study was conducted exclusively on infertile women from South-East Asia who had PCOS, potentially limiting generalizability to other populations. Additionally, metabolic assessments were only performed at baseline, preventing evaluation of longitudinal changes and their dynamic effects on reproductive outcomes. While no significant difference in live birth rates was observed between PCOS women with normal and abnormal glucose metabolism, the abnormal glucose metabolism group experienced higher rates of gestational complications. These findings underscore the importance of preconception metabolic screening and tailored fertility strategies that include targeted interventions to optimize reproductive and maternal outcomes in women with PCOS. This study was supported by My Duc Hospital. Lan N. Vuong reports funding from the Vietnam National Foundation for Science and Technology Development (NAFOSTED; grant number FWO.108-2022.01); Speaker and conference fees; speaker and conference fees as well as a grant; speaker, conference, and scientific board fees outside the submitted work. All other authors declare no conflicts of interest. NCT04364087.
A tubo-ovarian abscess (TOA) is a complication of pelvic inflammatory disease (PID) resulting from an ascending infection of the upper genital tract. It is characterized by an inflammatory mass involving the fallopian tube, ovary, and sometimes adjacent pelvic organs. It is diagnosed through clinical evaluation and imaging, and initially treated with broad-spectrum antibiotics. Despite conservative management, surgical intervention may be necessary if there is a leak or rupture of the TOA or if the patient experiences chronic pain. Rarely, a TOA can cause septicemia. Insertion of an IUD in a patient with a history of PID is contraindicated. A 41-year-old, gravida 2, para 1011 (G2P1011) woman presented with a TOA complicated by Escherichia coli bacteremia. She experienced acute abdominal pain, fever, nausea, and vomiting. An intrauterine contraceptive device (IUD) had been inserted one year prior to her presentation. She had a history of PID 20 years earlier. Pelvic computed tomography (CT) and transvaginal ultrasound showed findings consistent with TOA. After multiple courses of inpatient and outpatient antibiotics, she eventually underwent diagnostic laparoscopy, bilateral salpingectomy, and lysis of adhesions. During surgery, she was found to have extensive adhesions, bilateral salpingitis, and a right pyosalpinx suspicious for rupture or leaking. The timing of her IUD insertion and the onset of active pelvic infection was likely not coincidental. TOA complicated by E. coli bacteremia and suspected rupture or leakage presents a rare but serious clinical scenario. This case highlights the importance of early recognition of systemic infection signs, careful use of imaging and culture data, and prompt surgical intervention when conservative management fails.