Pathogenesis of polycystic ovary syndrome: what is the role of obesity? (original) (raw)
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The Role of Obesity in the Development of Polycystic Ovary Syndrome
Current Pharmaceutical Design, 2012
Polycystic Ovary Syndrome (PCOS) is one of the common endocrine diseases that affects women in their reproductive age. PCOS has diverse clinical implications that include reproductive (infertility, hyperandrogenism, hirsutism), metabolic (insulin resistance, impaired glucose tolerance, type 2 diabetes mellitus, cardiovascular diseases) and psychological features (increased anxiety, depression and worsened quality of life). The exact patho-physiology of PCOS is complex and remains largely unclear. The prevalence of PCOS is estimated at 4-18%, depending on diverse factors discussed ahead. The phenotype varies widely depending on life stage, genotype, ethnicity and environmental factors including lifestyle and body weight. During the last decades, obesity and excess weight are major chronic diseases all around the word. Obesity increases some features of PCOS such as hyperandrogenism, hirsutism, infertility and pregnancy complications. Both obesity and insulin resistance increase diabetes mellitus type 2 and cardiovascular diseases. Moreover, obesity impairs insulin resistance and exacerbates reproductive and metabolic features of PCOS. It is well known that obesity is associated with anovulation, pregnancy loss and late pregnancy complications (pre-eclampsia, gestational diabetes). Obesity in PCOS is also linked to failure or delayed response to the various treatments including clomiphene citrate, gonadotropins and laparoscopic ovarian diathermy. It has been reported that, after losing as little as 5 % of initial body weight obese women with PCOS improved spontaneous ovulation rates and spontaneous pregnancy. Therefore, the weight loss prior to conception improves live birth rate in obese women with or without PCOS. The treatment of obesity may include lifestyle therapy (diet and exercise), pharmacological treatment and bariatric surgery. In summary, weight loss is considered the first-line therapy in obese women with PCOS. In the present review, the consequence and treatment of obesity in women with PCOS are discussed.
Obesity Differentially Affects Phenotypes of Polycystic Ovary Syndrome
International Journal of Endocrinology, 2012
Obesity or overweight affect most of patients with polycystic ovary syndrome (PCOS). Phenotypes are the clinical characteristics produced by the interaction of heredity and environment in a disease or syndrome. Phenotypes of PCOS have been described on the presence of clinical hyperandrogenism, oligoovulation and polycystic ovaries. The insulin resistance is present in the majority of patients with obesity and/or PCOS and it is more frequent and of greater magnitude in obese than in non obese PCOS patients. Levels of sexual hormone binding globulin are decreased, and levels of free androgens are increased in obese PCOS patients. Weight loss treatment is important for overweight or obese PCOS patients, but not necessary for normal weight PCOS patients, who only need to avoid increasing their body weight. Obesity decreases or delays several infertility treatments. The differences in the hormonal and metabolic profile, as well as the different focus and response to treatment between ob...
Obesity and Polycystic Ovary Syndrome
Annals of the New York Academy of Sciences, 1991
Over the last 40 years, the global prevalence of obesity in women has increased 2.5-fold from 6% to 15%. 1 Over a similar timeframe, the prevalence of obesity-related co-morbidities, of which there are >50 that collectively account for a substantial global health and socioeconomic burden, 2-4 has increased commensurately. The development of many obesity-related conditions is mediated through the deleterious effects of insulin resistance (a consequence of weight gain) or compensatory hyperinsulinaemia, and its associated metabolic dysfunction. 5 These include features of the metabolic syndrome (type 2 diabetes mellitus [T2D], dyslipidaemia and hypertension) and obesity-related malignancies such as endometrial carcinoma. 6 Polycystic ovary syndrome (PCOS) is an important and highly prevalent obesity-related comorbidity, 7 that develops in girls and women who are genetically predisposed to its development. 8-11 PCOS affects between 6%-10% of reproductive-age women 12-15 and often develops during adolescence. 3 PCOS manifests with the typical clinical features of hyperandrogenism (including acne, hirsutism | |
Role of obesity and adiposity in polycystic ovary syndrome
International Journal of Obesity, 2007
Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age. Obesity may have a marked impact on both the development and progression of the syndrome. A high proportion of women with PCOS are obese. Regardless of the degree of obesity, women with PCOS are more likely to have central (abdominal) distribution of body fat, which is associated with insulin resistance and hyperandrogenaemia. PCOS is not only a reproductive disorder, but is also associated with significant increase in metabolic aberrations and cardiovascular risk factors. It has been shown that weight loss improves the metabolic and reproductive abnormalities that characterise the syndrome.
Polycystic ovary syndrome and obesity: a modern paradigm
RUDN Journal of Medicine
Polycystic ovary syndrome is a heterogeneous endocrine disease that affects women of childbearing age. The pathogenesis of polycystic ovary syndrome has not been fully studied to date, its paradigm considers the genetic determinism of the manifestation of hormonal and metabolic disorders, which are considered to be criteria for the verification of the disease (hyperandrogenism, oligo/anovulation and/or polycystic ovarian transformation during ultrasound examination (ultrasound). This review discusses the main ways of interaction between hyperandrogenism, insulin resistance and obesity and their role in the pathogenesis of polycystic ovary syndrome, as well as possible methods of treatment for this category of patients. The review analyzes the role of hyperandrogenism and insulin resistance in the implementation of the genetic scenario of polycystic ovary syndrome and finds out the reasons why women with polycystic ovary syndrome often demonstrate the presence of a «metabolic trio» -...
POLYCYSTIC OVARIAN SYNDROME IN WOMEN WITH OBESITY
Introduction: Obesity becomes a recent worldwide epidemic and it is close associated with PCOS. Currently there are not enough researches which can let to understand the interplay between PCOS and its features including anovulation and infertility and androgen status and obesity. The aim of the study was to identify relations between PCOS and obesity. Methodology: Cross-sectional study was conducted for the period 2014-2016 and included 300 of patients with PCOS. The following categorical variables were studied: age, marital status, weight, BMI, family history, frequency of irregular periods, subfertility, hirsutism, acne, skin hyperpigmentation. The analyses were performed using the SPSS package version 17.0 (SPSS Inc., Chicago, IL, USA). Results and conclusion: Current research showed that non-obese women with PCOS more often had family history of PCOS and were significantly more likely to have such symptoms as irregular menses, hirsutism, acne vulgaris and recurrent miscarriages than women with obesity and PCOS. However there is a need for more researches regarding to risk factors, etiology and pathogenesis of PCOS in order to identify the underlying causes.
Clinical medicine (London, England), 2015
Polycystic ovary syndrome (PCOS) is a common condition that typically develops in reproductive-age women. The cardinal clinical and biochemical characteristics of PCOS include reproductive dysfunction and hyperandrogenic features. PCOS is also strongly associated with obesity based on data from epidemiological and genetic studies. Accordingly, PCOS often becomes manifest in those women who carry a genetic predisposition to its development, and who also gain weight. The role of weight gain and obesity in the development of PCOS is mediated at least in part, through worsening of insulin resistance. Compensatory hyperinsulinaemia that develops in this context disrupts ovarian function, with enhanced androgen production and arrest of ovarian follicular development. Insulin resistance also contributes to the strong association of PCOS with adverse metabolic risk, including dysglycaemia, dyslipidaemia and fatty liver. Conversely, modest weight loss of just 5% body weight with improvement ...
Polycystic ovary syndrome (PCOS) is a common problem among Arab women and is the main cause of infertility due to anovulation. This study investigates insulin resistance (IR) and obesity in different PCOS phenotypes among infertile women (n = 213), of whom 159 had PCOS and 54 women without PCOS, recruited as a control group. Biometric, hormonal and clinical parameters were studied. IR was observed in 133 (83.6%) women with PCOS and in 25 (46.3%) women without PCOS (p < 0.001). IR was significantly associated with PCOS only among women with central obesity (χ 2 = 35.0, p < 0.001) and not for the normal category (χ 2 = 4.04, p < 0.058). The LH/FSH ratio was not significantly different among the PCOS group (n = 37, 23.3%) compared to the control group (n = 9, 16.7%) (p = 0.308). Among women with PCOS, the most common phenotype was type I (50.3%), with type III (29.6%), type II (14.5%) and type IV (5.7%). Type I had the highest values of fasting insulin (median = 12.98 mU/ mL) and HOMA IR values (significant difference among the four phenotypes, p = 0.009 and 0.006, respectively) and is associated with severity of the disease. There was no difference in glucose levels. Polycystic ovary syndrome (PCOS) is a heterogeneous condition, the pathophysiology of which appears to be a multifactorial, polygenic and multisystem endocrine disorder affecting 5–10% of women of reproductive age, characterised by hyperandrogenism and chronic anovulation 1. The prevalence of PCOS varies with ethnicity 2 , appearing in 6.6% in the population of the southeastern United States 3 , 6.8% in Greece 4 , 6.5% in Spain 5 , 13% among Mexican American women 6 , and 52% among South Asian female immigrants of Britain 7. Clinical features of PCOS include hirsutism; androgenic alopecia 8 menstrual irregularity, usually from the time of menarche 9 ; acne 10 ; hyperinsulinemia 11 ; insulin resistance (IR); early onset of type 2 diabetes mellitus 12 ; and dyslipidemia 13. According to the 1990 NICHD definition, women with PCOS may present three phenotypes: (i) oligo-ovulation, hyperandrogenemia and hirsutism (Oligo+ HA+ Hirsutism); (ii) oligo-ovulation and hyper-androgenemia, without frank hirsutism (Oligo+ HA); and (iii) oligo-ovulation and hirsutism, without measurable hyperandrogenemia (Oligo+ Hirsutism) 14. According to ESHRE guidelines 15 , women with PCOS present with four phenotypes: type I: hyperandrogenism, chronic anovulation, and polycystic ovaries; type II: hyperan-drogenism and chronic anovulation but with normal ovaries; type III: hyperandrogenism and polycystic ovaries but ovulatory cycles; and type IV: chronic anovulation and polycystic ovaries but no clinical or biochemical hyperandrogenism. The association between PCOS and hyperinsulinemia was first reported by Burghen et al. 16 , as it became clear that women with the syndrome have major metabolic as well as reproductive morbidities. Recently, more attention was focused on the degree of IR (insulin resistance) in women with PCOS. One report even considered all women with PCOS to have some degree of IR 17. Recent evidence suggests that obesity appears to exert an additive synergistic impact on the manifestations of PCOS, including a modifying effect on insulin sensitivity and gonadotrophin secretion and independently and negatively affecting insulin sensitivity, risk of diabetes, and cardiovascular impact 18 .
Scientific Reports, 2017
Polycystic ovary syndrome (PCOS) is a common problem among Arab women and is the main cause of infertility due to anovulation. This study investigates insulin resistance (IR) and obesity in different PCOS phenotypes among infertile women (n = 213), of whom 159 had PCOS and 54 women without PCOS, recruited as a control group. Biometric, hormonal and clinical parameters were studied. IR was observed in 133 (83.6%) women with PCOS and in 25 (46.3%) women without PCOS (p < 0.001). IR was significantly associated with PCOS only among women with central obesity (χ 2 = 35.0, p < 0.001) and not for the normal category (χ 2 = 4.04, p < 0.058). The LH/FSH ratio was not significantly different among the PCOS group (n = 37, 23.3%) compared to the control group (n = 9, 16.7%) (p = 0.308). Among women with PCOS, the most common phenotype was type I (50.3%), with type III (29.6%), type II (14.5%) and type IV (5.7%). Type I had the highest values of fasting insulin (median = 12.98 mU/ mL) and HOMA IR values (significant difference among the four phenotypes, p = 0.009 and 0.006, respectively) and is associated with severity of the disease. There was no difference in glucose levels. Polycystic ovary syndrome (PCOS) is a heterogeneous condition, the pathophysiology of which appears to be a multifactorial, polygenic and multisystem endocrine disorder affecting 5-10% of women of reproductive age, characterised by hyperandrogenism and chronic anovulation 1. The prevalence of PCOS varies with ethnicity 2 , appearing in 6.6% in the population of the southeastern United States 3 , 6.8% in Greece 4 , 6.5% in Spain 5 , 13% among Mexican American women 6 , and 52% among South Asian female immigrants of Britain 7. Clinical features of PCOS include hirsutism; androgenic alopecia 8 menstrual irregularity, usually from the time of menarche 9 ; acne 10 ; hyperinsulinemia 11 ; insulin resistance (IR); early onset of type 2 diabetes mellitus 12 ; and dyslipidemia 13. According to the 1990 NICHD definition, women with PCOS may present three phenotypes: (i) oligo-ovulation, hyperandrogenemia and hirsutism (Oligo+ HA+ Hirsutism); (ii) oligo-ovulation and hyperandrogenemia, without frank hirsutism (Oligo+ HA); and (iii) oligo-ovulation and hirsutism, without measurable hyperandrogenemia (Oligo+ Hirsutism) 14. According to ESHRE guidelines 15 , women with PCOS present with four phenotypes: type I: hyperandrogenism, chronic anovulation, and polycystic ovaries; type II: hyperandrogenism and chronic anovulation but with normal ovaries; type III: hyperandrogenism and polycystic ovaries but ovulatory cycles; and type IV: chronic anovulation and polycystic ovaries but no clinical or biochemical hyperandrogenism. The association between PCOS and hyperinsulinemia was first reported by Burghen et al. 16 , as it became clear that women with the syndrome have major metabolic as well as reproductive morbidities. Recently, more attention was focused on the degree of IR (insulin resistance) in women with PCOS. One report even considered all women with PCOS to have some degree of IR 17. Recent evidence suggests that obesity appears to exert an additive synergistic impact on the manifestations of PCOS, including a modifying effect on insulin sensitivity and gonadotrophin secretion and independently and negatively affecting insulin sensitivity, risk of diabetes, and cardiovascular impact 18 .