Sexual and relational satisfaction in couples where the woman has polycystic ovary syndrome: a dyadic analysis

STUDY QUESTION: How are objective characteristics of polycystic ovary syndrome (PCOS) and PCOS-related concerns associated with the sexual and relational satisfaction of PCOS women and their partners? SUMMARY ANSWER: Both objective PCOS characteristics (parity, women's body mass index (BMI) and current unfulfilled wish to conceive) and PCOS-related concerns (women's infertility-related and acne-related concerns) were associated with sexual and/or relational satisfaction, although some associations differed for PCOS women and their partners. WHAT IS KNOWN ALREADY: There is some evidence indicating an association between objective PCOS characteristics and sexual satisfaction of PCOS women, but this evidence is conflicting, scarce, and often validated questionnaires have not been used to evaluate sexual satisfaction. No evidence is available about the association of: (i) PCOS with relational satisfaction; (ii) PCOS-related concerns with sexual and relational satisfaction; and (iii) PCOS with sexual and relational satisfaction as experienced by partners of PCOS women. STUDY DESIGN, SIZE, DURATION: We set up a cross-sectional study from April 2007 until April 2009, including 31 overweight (BMI >= 25 kg/m(2)) women with PCOS and at a reproductive age as well as their partners with whom they had a committed intimate relationship at the time of recruitment. PARTICIPANTS/MATERIALS, SETTING, METHODS: The study was performed at the fertility center of the Ghent University Hospital. Objective PCOS characteristics were registered and PCOS-related concerns were evaluated by the PCOS Questionnaire. Sexual ((SS)) and relational ((RS)) satisfaction were measured by the Maudsley Marital Questionnaire (MMQ). Dyadic statistical analyses were performed using linear mixed models (alpha < 0.05). MAIN RESULTS AND THE ROLE OF CHANCE: A lower parity tended to be associated with higher levels of sexual and relational satisfaction, with a significantly stronger association in PCOS women than in their partners (p((SS)) = 0.015 and p((RS)) = 0.009). A higher BMI tended to be associated with lower and higher satisfaction levels (sexual and relational) in PCOS women and their partners, respectively, with a significantly stronger association in the partners (p((SS)) = 0.029 and p((RS)) = 0.021). The presence of a current unfulfilled wish to conceive and a higher level of infertility-related concerns was significantly more strongly associated with a higher level of relational satisfaction for PCOS women than for their partners (p((RS)) = 0.021 and p((RS)) = 0.011, respectively). Higher levels of acne-related concern were significantly associated with lower levels of sexual satisfaction in both PCOS women (p((SS)) = 0.025) and their partners (p((SS)) = 0.002). LIMITATIONS, REASONS FOR CAUTION: The fact that this study was performed in a sample of PCOS women who were all overweight and the small sample size are important limitations. Data were partially missing in some couples but this limitation was dealt with by using linear mixed models. WIDER IMPLICATIONS OF THE FINDINGS: Our results suggest a differential association of PCOS with sexual and relational satisfaction between PCOS women and their partners. This should be kept in mind during the psychological guidance of couples dealing with PCOS

Early impairment of endothelial structure and function in young normal-weight women with polycystic ovary syndrome

The aim of this study was to evaluate the presence of early vascular damage in young normal-weight women with polycystic ovary syndrome (PCOS).Thirty young normal-weight women with PCOS, who had no additional metabolic or cardiovascular diseases, and 30 healthy women (controls) matched for age and body mass index were studied. A complete hormonal assay was performed in each subject. Serum insulin and glucose levels were measured at baseline and after the oral glucose tolerance test. Plasma endothelin-1 levels and serum lipid profile were also assessed. The endothelial function was studied by flow-mediated dilation on the brachial artery, and arterial structure was evaluated by intima-media thickness measurement using Doppler ultrasound of both common carotid arteries.A significant (P &lt; 0.05) difference in flow-mediated dilation (14.3 +/- 1.9% vs. 18.1 +/- 2.0% for PCOS patients and controls, respectively) and in intima-media thickness (0.53 +/- 0.09 mm vs. 0.39 +/- 0.08 mm for PCOS patients and controls, respectively) was found between PCOS and control subjects. Serum endothelin-1 levels were also significantly (P &lt; 0.05) higher in PCOS patients compared with controls (1.1 +/- 0.4 pmol/liter vs. 0.5 +/- 0.2 pmol/liter for PCOS patients and controls, respectively).In conclusion, our data show that young, normal-weight, nondyslipidemic, nonhypertensive women with PCOS have an early impairment of endothelial structure and function

The cardiovascular risk of young women with polycystic ovary syndrome: an observational, analytical, prospective case-control study

To evaluate the cardiovascular risk of polycystic ovary syndrome (PCOS), we investigated lipid profile, metabolic pattern, and echocardiography in 30 young women with PCOS and 30 healthy age- and body mass index (BMI)-matched women. PCOS women had higher fasting glucose and insulin levels, homeostasis model assessment score of insulin sensitivity, total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) levels, and TC/high density lipoprotein cholesterol (HDL-C) ratio and lower HDL-C levels than controls. Additionally, PCOS women had higher left atrium size (32.0 +/- 4.9 vs. 27.4 +/- 2.1 mm; P &lt; 0.0001) and left ventricular mass index (80.5 +/- 18.1 vs. 56.1 +/- 5.4 g/m(2); P &lt; 0.0001) and lower left ventricular ejection fraction (64.4 +/- 4.1 vs. 67.1 +/- 2.6%; P = 0.003) and early to late mitral flow velocity ratio (1.6 +/- 0.4 vs. 2.1 +/- 0.2; P &lt; 0.0001) than controls. When patients and controls were grouped according to BMI [normal weight (BMI, &gt;18 and &lt;25 kg/m(2)), overweight (BMI, 25.1-30 kg/m(2)), and obese (BMI, &gt;30 kg/m(2))], the differences between PCOS women and controls were maintained in overweight and obese women. In normal weight PCOS women, a significant increase in left ventricular mass index and a decrease in diastolic filling were observed, notwithstanding no change in TC, LDL-C, HDL-C, TC/HDL-C ratio, and TG compared with controls. In conclusion, our data show the detrimental effect of PCOS on the cardiovascular system even in young women asymptomatic for cardiac disease

Impaired carotid viscoelastic properties in women with polycystic ovaries

Background-The purpose of this study was to assess the elastic properties of the carotid arteries in women with polycystic ovarian syndrome, asymptomatic women with polycystic ovaries. and healthy controls.Methods and Results-We recruited the following 60 subjects: 20 symptomatic women with polycystic ovaries attending the reproductive endocrinology clinics, 20 asymptomatic women with polycystic ovaries attending the family planning clinic, and 20 staff volunteers as healthy controls with normal ovaries on transvaginal scan. Compliance and stiffness index were assessed in the common and internal carotid arteries using duplex ultrasound equipped with an echo-locked arterial wall-tracking system. Compliance was significantly lower in the common carotid artery in symptomatic and asymptomatic women with polycystic ovaries than in the controls (10.7, 14.1, and 19.2%mm Hg-1 x 10(-2), respectively). The arterial stiffness index was correspondingly increased (12.3, 10.2, and 6.7, respectively). Similar results were obtained in the internal carotid artery for compliance (10.1. 11.0, and 16.9 %mm Hg-1 x 10(-2), respectively) and stiffness index (14.8, 16.2, and 8.7, respectively).Conclusions-The results of this study provide additional evidence of vascular dysfunction in women with polycystic ovaries and are compatible with the hypothesis that they are at increased risk from coronary artery disease and stroke

Salivary testosterone measurement in women with and without polycystic ovary syndrome

Clinical and/or biochemical hyperandrogenism is one of the diagnostic criteria for PCOS. An evaluation of the role of salivary testosterone (salT) and androstenedione (salA) for the diagnosis of PCOS was undertaken in a cross sectional study involving 65 women without PCOS and 110 women with PCOS fulfilling all 3 diagnostic Rotterdam criteria. Serum and salivary androgen measurements were determined by LC-MS/MS. salT and salA were significantly elevated in PCOS compared to controls (P&lt;001). No androgen marker was more predictive than another using ROC curves, but multiple logistic regression suggested salT was more predictive than free androgen index (FAI)(p&lt;0.01). The combination of salT or FAI identified 100% of PCOS women. PCOS women with both biochemical and clinical hyperandrogenism as opposed to clinical hyperandrogenism alone showed a metabolic phenotype (p&lt;0.05) and insulin resistance(p&lt;0.001). PCOS patients with an isolated elevated FAI showed increased insulin resistance compared to those with an isolated salT(P&lt;0.05). salT appeared to be at least as predictive as FAI for the diagnosis of the classical PCOS phenotype, and the combination of salT or FAI identified 100% of PCOS patients. This suggests that salT measurement by LC-MS/MS holds the promise of complementing existing laboratory tests as a means of assessing hyperandrogenemia

Divergences in insulin resistance between the different phenotypes of the polycystic ovary syndrome

Context/Objective: Current diagnostic criteria for polycystic ovary syndrome (PCOS) have generated distinct PCOS phenotypes, based on the different combinations of diagnostic features found in each patient. Our aim was to assess whether either each single diagnostic feature or their combinations into the PCOS phenotypes may predict insulin resistance in these women. Patients/Design: A total of 137 consecutive Caucasian women with PCOS, diagnosed by the Rotterdam criteria, underwent accurate assessment of diagnostic and metabolic features. Insulin sensitivity was measured by the glucose clamp technique. Results: Among women with PCOS, 84.7% had hyperandrogenism, 84.7% had chronic oligoanovulation, and 89% had polycystic ovaries. According to the individual combinations of these features, 69.4% of women had the classic phenotype, 15.3% had the ovulatory phenotype, and 15.3% had the normoandrogenic phenotype. Most subjects (71.4%) were insulin resistant. However, insulin resistance frequency differed among phenotypes, being 80.4%, 65.0%, and 38.1%, respectively, in the 3 subgroups (P < .001). Although none of the PCOS diagnostic features per se was associated with the impairment in insulin action, after adjustment for covariates, the classic phenotype and, to a lesser extent, the ovulatory phenotype were independently associated with insulin resistance, whereas the normoandrogenic phenotype was not. Metabolic syndrome frequency was also different among phenotypes (P = .030). Conclusions: There is a scale of metabolic risk among women with PCOS. Although no single diagnostic features of PCOS are independently associated with insulin resistance, their combinations, which define PCOS phenotypes, may allow physicians to establish which women should undergo metabolic screening. In metabolic terms, women belonging to the normoandrogenic phenotype behave as a separate group

Psychological Morbidity in patients with Idiopathic Hirsutism presenting for Laser Treatment at a Tertiary Care Hospital

Objective: The objective of our study was to determine the frequency of depression, anxiety, and stress in females presenting for laser treatment of hirsutism at a dermatology clinic. Materials and Methods: This was a cross-sectional descriptive study. 152 female participants of all ages presenting for laser treatment of hirsutism to the dermatology department –removed for blind review--from June 2019 to Dec 2019, were included using a consecutive convenient sampling technique. Patients having an FG (Ferriman and Gallwey) score of 8 or more, were included whereas those having any underlying cause (as assessed by history and examination and laboratory investigations where required) for both hirsutism and psychological disorder were excluded. The participants were given an Urdu version of the DASS 21 (depression, anxiety, and stress scale) to complete. Results: The participants had a mean age of 30.22 (SD = 9.17). The prevalence of depression, anxiety, and stress in the sample was found to be 13.2%, 23.7%, and 17.8%, respectively. Mean depression, anxiety, and stress scores on DASS 21 were 4.43(SD=4.87, Cut-off= 10), 4.34(SD=5.12, Cut-off= 8), and 8.21(SD=6.26, Cut-off=15), respectively, indicating that the scores were within the normal range. Anxiety was the most common illness in the sample and both depression and stress showed a decline with advancing age up till 45years of age. No statistically significant association was found between the severity of hirsutism and depression, stress, and anxiety scores. Conclusion: Psychological morbidity was found to be lower in patients of idiopathic hirsutism presenting for laser treatment. The long-term efficacy of laser treatment needs further evaluation in future research

Is metformin an effective adjunctive treatment in treating hirsutism in patients with PCOS?

Objective: The objective of this selective EBM review is to determine whether or not “Is metformin an effective adjunct treatment in treating hirsutism in patients with PCOS?” Study Design: A review of three randomized control trials (RCTs) published in English between 2011-2018. Data Sources: This paper evaluates three RCTs found via PubMed comparing the efficacy of simvastatin, clomiphene citrate and exercise as monotherapies versus each therapy in combination with metformin for the treatment of hirsutism in women with PCOS. Outcome(s) Measured: Hirsutism was measured using the Ferriman and Gallwey score. This score measures hirsutism based on the quantity and thickness of terminal hair growth in 9 androgen-sensitive areas, including upper lip, chin, chest, upper and lower abdomen, back and upper arm and thigh. Results: All three studies found that adjunctive metformin did not offer a statistically significant increase in the reduction of hirsutism when compared to monotherapy treatments. The RCT performed by Banaszewska et al. showed a 1.0 point Ferriman and Gallwey score decrease when treated with simvastatin and metformin combination, which is not a statistically significant reduction when compared to the simvastatin only group, a 1.1 point decrease (p=0.52). The RCT performed by Roth et al. similarly showed a 1.1 point decrease when treated with clomiphene citrate and metformin combination, which is not a statistically significant reduction when compared to the clomiphene citrate only group, a 0.6 point decrease (p=0.44). The RCT performed by Tiwari et al. showed a 1.63 point decrease when treated with exercise and metformin which is also not a statically significant reduction when compared to the exercise only group, a 0.67 point decrease (p=0.567). Conclusions: All three studies demonstrated that the adjunctive metformin accounted for a decrease from the Ferriman and Gallwey score baselines, however, the decrease from baseline was not significantly different from the monotherapy treatment. Future studies should include adolescent populations, incorporate patient self-assessment data and cover a duration of treatment greater than six months

Efficacy Of Cyproterone Acetate And Drosperinone Containing Cocps In Treatment Of Hirsutism In Patients With PCOS

Introduction: Hirsutism is a condition characterized by excess hair growth on the face, chest, and/or back in women and it is often caused by an imbalance of hormones, such as androgens. OCPs prove to be effective in reducing hirsutism in patients with PCOS by inhibiting the production of androgens and decreasing the activity of androgen receptors. OCPs may have additional benefits for patients with PCOS, such as regulating menstrual cycles, improving fertility, and reducing the risk of endometrial cancer. However, OCPs may not be suitable for all women with PCOS. Methods: The study was conducted to investigate the effectiveness of these OCPs in reducing hirsutism in PCOS patients. In the study, 80 participants were included, 40 in the intervention group and 40 in the control group. The intervention group received a combination oral contraceptive pill containing cyproterone acetate and drosperinone (COCP) for a period of 6 months, while the control group received a placebo. Hirsutism was assessed at baseline and at the end of the 6-month treatment period using the Ferriman-Gallwey score. The primary outcome measure was the change in Ferriman-Gallwey score from baseline to the end of the treatment period. Results: The study found that OCPs containing cyproterone acetate and drosperinone were more effective in reducing hirsutism in patients with PCOS compared to OCPs containing levonorgestrel. Conclusion: It is important to note that OCPs may not be appropriate for all women with PCOS, therefore it's crucial to explore the risks and advantages with a healthcare professional before beginning therapy