By Suna Özdemira, Hüseyin Görkemlia, Kazim Gezginça, Mustafa Özdemirb, Aysel Kiyicic
International Journal of Gynecology & Obstetrics
Volume 103, Issue 1, Pages 44-49 (October 2008)
Abstract
Objectives: To investigate the effects of treatment with medroxyprogesterone acetate (MPA), 10 days per month for 6 months, on lipid and carbohydrate metabolism in women with polycystic ovary syndrome (PCOS). Methods: Sixty-three women with PCOS were randomized to receive MPA or ethinyl estradiol plus drospirenone. Results: There were no changes in lipid or carbohydrate metabolism in the MPA group, but serum levels of luteinizing hormone (P<0.001) and total testosterone (P<0.003) significantly decreased, as did the free androgen index (P<0.02) and acne (P<0.03) and seborrhea (P<0.04) scores. In the ethinyl estradiol plus drospirenone group lipid and hormone values significantly increased whereas acne, seborrhea, hair loss, and Ferriman-Gallwey scores decreased. There was no statistically significant change in the total cholesterol to high-density cholesterol ratio in either group. Conclusion: Treatment of PCOS patients with MPA provided good menstrual cycle control, beneficial changes in hormonal values associated with hyperandrogenism, and no significant changes in lipid or carbohydrate metabolism.
Kent, Sarah C.; Gnatuk, Carol L.; Kunselman, Allen R.; Demers, Laurence M.; Lee, Peter A.; Legro, Richard S. Obstetrical & Gynecological Survey. 63(10):646-647, October 2008.
Abstract:
Both hyperandrogenism and insulin resistance are heritable family traits that may cluster in children whose mothers have polycystic ovary syndrome (PCOS). This case control study compared reproductive and metabolic abnormalities in 32 healthy “PCOS children,” 17 girls and 15 boys, and 38 children whose mothers did not have PCOS. The children ranged in age from 4 to 14 years. There were no differences between PCOS and control children in the length of gestation or birth weight.
Urinary levels of luteinizing hormone were significantly lower in Tanner IV-V PCOS girls than in control subjects. Urinary testosterone levels were significantly greater in Tanner II-III PCOS boys than in controls. No significant differences in levels of dehydroepiandrosterone (DHEA) or DHEA sulfate were observed. Fasting insulin levels did not differ significantly between PCOS and control children of either gender, whether saliva or blood samples were analyzed. Nevertheless, mean area-under-the-curve salivary insulin levels were significantly higher in Tanner IV-V PCOS girls in the later stages of puberty than in control children. Five of 15 PCOS children met the de Ferranti criteria for metabolic syndrome, compared to only one of 12 control children. No children in either group met criteria for abnormal fasting blood glucose. Although ovaries tended to be larger in PCOS girls, none of the children examined by transabdominal ultrasonography had evidence of polycystic ovaries based on morphological criteria.
This study suggests that hyperinsulinism may be a familial feature of PCOS children - at least girls - but it does not emerge until the later stages of puberty. It is possible that reproductive abnormalities characteristic of PCOS will develop later in life.
C) 2008 Lippincott Williams & Wilkins, Inc.
http://www.obgynsurvey.com/pt/re/obgynsurv/currenttoc.htm
“Posh Spice” Victoria Beckham is reported to be suffering from a major source of female infertility called Polycystic Ovarian Syndrome (PCOS) while attempting to become pregnant again.
The latest issue of Now magazine claims the English pop singer and her soccer superstar husband David Beckham have been trying for a fourth child for the last three months. The magazine reports that they are now consulting specialists in both Los Angeles and London.
During a routine checkup at London’s exclusive Portman Hospital two weeks ago, the 34-year-old Spice Girl was warned by doctors that her fertility rate is lower than at the time of her first baby. The Beckhams have three sons - Brooklyn, nine, Romeo, five, and Cruz, three.
A Now magazine source said: “Victoria is suffering from PCOS and irregular periods, both of which can affect her chances of having a baby. She’s trying not to get too nervous as she knows this won’t help, but it’s becoming more and more of a concern.” PCOS is a heartbreaking but manageable disease caused by an imbalance of hormones. It can severely disrupt a woman’s menstrual cycle and is thought to affect 10-15% of females of child-bearing age worldwide. A classic symptom of the condition is non-existent ovulation, without which pregnancy is impossible.
In February, Victoria admitted: “I’m really feeling that pressure. Every time I go out, someone says to me: ‘Are you pregnant?”’Now magazine says the Beckhams’ baby dilemma is complicated by the possible retirement next year when he turns 60 of her trusted obstetrician, Dr. Malcolm Gillard, who delivered all her boys.
Fifty per cent of women with PCOS suffer from excess weight or obesity. But it can also strike adolescents and females of normal healthy weight and even lean women. Post-menopausal women are also vulnerable to PCOS. Other symptoms of the disease include skin conditions like acne and brown patches, excess facial and body hair, fatigue and mood swings, male pattern baldness in women and reduced sex drive.
A balanced, nutritious diet combined with nutraceuticals and regular exercise to achieve weight loss has, however, been shown to greatly improve the management of PCOS symptoms and, in many cases, even make them disappear.
To learn more about PCOS and how to reverse the symptoms, visit www.pcos.insulitelabs.com
Press release: July 28, 2008
Contact: Megan Manlove
mmanlove@hmc.psu.edu
717-531-8604
Penn State
Elevated levels of insulin could be an early sign that girls whose mothers suffer from polycystic ovary syndrome — or PCOS — may also be susceptible to the disease, according to gynecologists who have found evidence of insulin resistance in young children.
The findings could help determine whether daughters of women suffering from PCOS are at a higher risk of developing the disease, compared to girls whose mothers do not have the disease.
Polycystic ovary syndrome is a common hormonal disorder that affects women of reproductive age, and sometimes causes inability to become pregnant. Symptoms include hairiness due to excessive amounts of male hormones, irregular periods, and insulin resistance.
“We found insulin resistance in children who had entered puberty, and whose mothers had PCOS,” said Richard Legro, M.D., professor of obstetrics and gynecology, Penn State College of Medicine and lead author. “We did not find it in the youngest children, which suggests that the disease is triggered by puberty.”
Legro and his colleagues were interested in finding out whether metabolic and reproductive abnormalities associated with the inheritable disease, are more likely to show up in children whose mothers have PCOS, and how parents could find out whether their child was at risk.
The researchers designed a study to compare 38 children — boys and girls aged 4 to 14 — whose mothers had PCOS with 32 children in a control group. They specifically looked for the early onset of androgen — male hormones — production, and production of excess insulin.
“We collected samples of saliva and urine to analyze levels of insulin and sex steroids respectively,” explained Legro. “But we also looked for gonadotropins, hormones that stimulate sex steroids and provide the earliest sign of puberty.”
Results from the test indicate that older girls, but not boys, of PCOS mothers had significantly higher concentrations of salivary insulin. Compared to the control group, the girls also had lower levels of urinary hormones.
According to Legro, the key finding of the study is that insulin levels appear to be elevated in daughters of PCOS mothers, which becomes more pronounced as they pass through puberty. Since the androgen levels were comparatively normal throughout puberty, and insulin resistance was only found in girls who had undergone puberty, Legro argues that insulin is the primary problem, while male hormones are a secondary problem.
“Insulin is the real culprit in terms of stimulating the ovary, more so than gonadotropins, said Legro, whose findings appeared in a recent issue of The Journal of Clinical Endocrinology and Metabolism and was the subject of an editorial in the same issue.
“You could argue children of PCOS mothers build up excessive insulin during puberty, which in turn contributes to reproductive abnormality,” explained Legro.
However, Legro cautions that it may be too early to conclude that excessive insulin is the sole factor that makes daughters of PCOS mothers susceptible to the disease. He is also not fully sure whether hyperandrogenism — excess of male hormones — precedes or follows excessive levels of insulin.
Researchers say future longitudinal studies will focus only on girls and try to pin down whether an abnormal level of insulin is the sole factor that causes reproductive abnormalities.
“That is the tantalizing question,” the Penn State medical researcher said. “The ultimate goal would be to find the earliest sign that makes a child more susceptible to develop PCOS. Right now the earliest sign would be an elevation in insulin levels.”
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Legro’s work is funded by the National Institutes of Health.
Other researchers on the paper are Sarah C. Kent, family medicine physician; Allen R. Kunselman, senior research assistant; Laurence M. Demers, M.D., distinguished professor emeritus of medicine and pathology; Carol L. Gnatuk, M.D., professor of obstetrics and gynecology; Peter A. Lee, professor of pediatrics; and William C. Dodson, M.D., professor of obstetrics and gynecology, all at Penn State College of Medicine. Penn State College of Medicine is at http://www.pennstatehershey.org
The Department of Obstetrics and Gynecology is at http://www.hmc.psu.edu/womens/
