scholarly journals Association of LH/FSH ratio with menstrual cycle regularity and clinical features of patients with polycystic ovary syndrome

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Maja Mitrašinović-Brulić ◽  
Mihaela Buljan ◽  
Damir Suljević

Abstract Background Understanding the global prevalence and phenotypic features of polycystic ovary syndrome (PCOS) is important as geographic factors and ethnic variations can significantly alter the clinical syndrome. The aim of this study was to determine and evaluate the luteinizing hormone/follicle-stimulating hormone ratio (LH/FSH) in women with PCOS during therapy on selected endocrine and biochemical parameters. Results Women with PCOS were included in the study and were classified into two groups: women without therapy (de novo) and women with therapy for PCOS. ESHERE/ASRM criteria that require the presence of two out of three criteria: ovulatory dysfunction, hyperandrogenism, and morphological PCOS detected by ultrasound diagnostics. Electrochemiluminescence immunoassay (ECLIA) was used for FSH and insulin analysis. The enzymatic method was used to analyze the biochemical profile. There was a significant difference between the two groups in terms of the LH/FSH ratio (2.56 vs. 2.41, P=0.043), glucose (6.23 vs. 5.12, P=0.003), insulin (19.21 vs. 7.35, P=0.000), IR (3.22 vs. 1.42, P=0.000), cholesterol (5.97 vs. 4.92, P=0.002), and LDL (3.56 vs. 2.56, P=0.001). The data suggest that patients with PCOS therapy have reduced hyperinsulinemia and insulin resistance. There was a significant correlation between the LH and FSH in the de novo group, as well as the correlation between hormone levels and LH/FSH ratio in both groups. Patients with PCOS therapy have a tendency for normal body weight and reduction of severe obesity compared to patients without therapy. Clinical features such as regular menstrual cycle and the prevalence of acne and hirsutism are not significantly different between groups. Conclusion PCOS cause irregularities of the menstrual cycle, the appearance of clinical manifestations, especially changes of LH/FSH ratio. Therapy for PCOS contributes to better regulation of endocrine and biochemical parameters, especially in the reduction of hyperinsulinemia, insulin resistance, and reduced LH/FSH ratio.

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Haiqing Qian ◽  
Wenting Xu ◽  
Lijuan Cui ◽  
Rong Wang ◽  
Jiahui Wang ◽  
...  

Abstract Background Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disease in women. Insulin resistance (IR) has emerged as a central contributor to the pathogenesis of this disease. According to traditional Chinese medicine (TCM), kidney deficiency is the main syndrome of PCOS. The deficiency of the kidney cannot vaporize water-dampness, and the retention of water-dampness accumulates into phlegm dampness stagnation, resulting in visceral dysfunction and metabolic disorder. TCM involving syndrome differentiation and treatment is widely used to adjust women’s menstrual cycles. Our patented formula Bushen Huatan Decoction (BSHTD) has been proven to be effective in the clinical treatment of IR-PCOS. Baduanjin also plays an important role in improving metabolic syndrome through lifestyle intervention. This study investigates the clinical efficacy of Bushen Huatan Decoction combined with Baduanjin in IR-PCOS, to form a specific TCM-behaviour intervention plan in the treatment of IR-PCOS. Methods/design This is a randomized controlled trial involving 190 participants diagnosed with IR-PCOS. All participants will be randomly allocated into 5 groups: group A will receive metformin; group B, BSHTD; group C, Baduanjin; group D, BSHTD combined with metformin; and group E, BSHTD combined with Baduanjin. One course of treatment lasts 3 months, a total of two courses. The primary outcomes are changes in the homeostatic model assessment of insulin resistance (HOMA-IR) and improvements in the oral glucose tolerance test (OGTT) and insulin-releasing test (INS). The secondary outcomes are improvements in the menstrual cycle, ovulation rate, clinical pregnancy rate, basic serum sex hormone levels, free androgen index (FAI), Ferriman-Gallwey scores, body mass index (BMI) and TCM syndrome scores. The related observation indexes will be collected at baseline, during the process of treatment and at the 6-month follow-up. Simultaneously, close monitoring of possible adverse events will be performed throughout the trial process. Discussion This trial will investigate the efficacy of the comprehensive intervention program of Bushen Huatan Decoction combined with Baduanjin on the adjustment of the menstrual cycle, improvement of insulin resistance and correction of glucose metabolism disorder in IR-PCOS patients. It is expected to form an alternative treatment of TCM-behaviour intervention therapy for IR-PCOS and promote the Chinese fitness Qigong Baduanjin in the application of lifestyle diseases. Trial registration Chinese Clinical Trial Registry ChiCTR2100043415. Registered on 15 February 2021.


2019 ◽  
Vol 68 (3) ◽  
pp. 7-14
Author(s):  
Elena I. Abashova ◽  
Maria A. Shalina ◽  
Elena V. Misharina ◽  
Natalia N. Tkachenko ◽  
Olga L. Bulgakova

Hypothesis/aims of study. Polycystic ovary syndrome (PCOS) is a common disease, the frequency of which ranges from 8 to 13% in women of reproductive age. PCOS is a complex polygenic endocrine disorder with reproductive, metabolic, and psychological features. Currently, four PCOS phenotypes are identified that are associated with metabolic disorders, insulin resistance, impaired glucose tolerance (IGT), diabetes mellitus, and an increase in the number of risk factors for cardiovascular diseases. The aim of this study was to investigate the clinical features of PCOS phenotypes in women with normogonadotropic anovulation in reproductive age. Study design, materials, and methods. The study included 60 women of reproductive age from 24 to 37 years (mean age 28 ± 4 years) with PCOS and normogogonadotropic, normoprolactinemic anovulation. We studied the levels of anti-mullerian, follicle-stimulating, luteinizing hormone, prolactin, estradiol, and androgens from days 2 to 5 of the menstrual cycle. The serum progesterone level was studied by ELISA using test systems manufactured by Alkor Bio Ltd. (Russia) on days 20–23 of the menstrual cycle for three consecutive cycles. The average level of progesterone in the blood on days 20–23 of the menstrual cycle was 3.1 ± 1.5 nM. Echographic methods for diagnosing polycystic ovaries were used. All women included in the study underwent hysteroscopy on days 18–22 of the menstrual cycle, followed by a histological and immunohistochemical study of the endometrium. Results. In women with anovulatory PCOS phenotypes, phenotype A (classical) was detected in 32 (53.3%) women; phenotype B (anovulatory) in 18 (30%) women; phenotype D (non-androgenic) in 10 (16.7%) women with. In 32 (53.3%) patients, changes in carbohydrate metabolism (IGT) were found. Clinical and biochemical manifestations of androgen-dependent dermopathy (acne, oily seborrhea, and hirsutism) were significantly (p < 0.05) more often observed in PCOS patients with phenotypes A (84.4%) and B (88.9%) than in women with phenotype D (30%). In the majority (93.8%) of patients with IGT, the androgenic-anovulatory PCOS phenotypes were detected: phenotype A in 20 (62.5%) women and phenotype B in 10 (31.3%) women. Phenotype D (non-androgenic) was present only in two women with PCOS and IGT. As a result of complex histological and immunohistochemical studies of endometrial biopsy specimens, chronic endometritis was detected in 44 (73.3%) examined women with PCOS and simple glandular endometrial hyperplasia was diagnosed in 13 (21.7%) PCOS patients. The incidence of chronic endometritis and simple glandular endometrial hyperplasia in women with normogonadotropic anovulation and PCOS directly depended (r = 0.35; p < 0.05) on disorders of carbohydrate metabolism and was detected more often in patients with PCOS and IGT. Conclusion. The differential approach to the examination of patients with various PCOS phenotypes allows personalizing the therapy of this disease and determining the complex of preventive measures to improve the quality of life of women of reproductive age.


2021 ◽  
Vol 2021 (2) ◽  
Author(s):  
Ewelina Kolan′ska-Dams ◽  
Joanna Boinska ◽  
Maciej W. Socha

Introduction: Central obesity appears to play a major role in the pathogenesis of metabolic disorders in polycystic ovary syndrome. Insulin resistance and carbohydrate disorders are associated with dysfunctional secretion of various adipokines by the adipose tissue. Objectives: This study aimed to evaluate leptin, apelin, and visfatin against a background of carbohydrate metabolism parameters in patients diagnosed de novo with polycystic ovary syndrome (PCOS). Material and methods: The study group consisted of 40 patients with PCOS (mean age, 29 years) diagnosed in accordance with the American Society for Reproductive Medicine criteria from 2003. The control group consisted of 37 clinically healthy women (mean age, 26 years). All controls had regular menses and no clinical or biochemical signs of hyperandrogenism. Concentrations of leptin, apelin, visfatin, and insulin were measured by immunoenzymatic methods. Glucose concentrations were determined using spectrophotometry. Results: Significantly higher concentrations of leptin, insulin, homeostatic model assessment for insulin resistance (HOMA-IR) index, and the immunoreactive insulin (IRI)/glucose index were found in the PCOS group than in the control group. Notably, the concentration of apelin was over five times lower in the PCOS group than in the control group. In patients with PCOS, a positive correlation was found between the concentrations of insulin and leptin and concentrations of leptin and IRI/glucose. Patients of the PCOS group with body mass index (BMI) ≥  25 had significantly higher values of leptin, insulin, HOMA-IR index, and IRI/glucose index than patients of the PCOS group with normal BMI. In the PCOS group, a positive correlation was found between BMI and leptin concentration (r = 0.7176; p < 0.0001) and carbohydrate metabolism, such as insulin (r = 0.5524; p = 0.0003), glucose (r = 0.3843; p = 0.0157), HOMA-IR (r = 0.5895; p < 0.0001), and IRI/glucose (r = 0.3872; p = 0.0163). These findings were not observed in the control group. Conclusions: (1) Increased leptin concentration observed in women diagnosed de novo with PCOS as well as positive correlations between leptin and HOMA-IR, and IRI/glucose and BMI may indicate a potential role of leptin in the reduction of tissue sensitivity to insulin. (2) Significantly lower apelin concentration in the PCOS group (>5 fold) than in the control group, associated with a concomitant increase in leptin, may also contribute to carbohydrate metabolism disorders occurring in the course of PCOS.


2021 ◽  
pp. 46-50
Author(s):  
Е. А. Kyrylenko

Abstract. The purpose of this article was to convey information about polycystic ovary syndrome (PCOS), to reveal the information about the diagnosis of this syndrome and methods of treatment under various circumstances and reproductive plans. PCOS is now being diagnosed very often. However, frequently this is performed only on the basis of ultrasound diagnostics of the pelvic organs, which is not entirely correct. The picture of multi-follicular ovaries is just one of the symptoms of this syndrome, which may also indicate the presence of other disorders in the body. This is the main reason why the wrong treatment is prescribed. After all, the wrong diagnosis is the key to the wrong treatment. It is important to understand that even with true PCOS, the most important thing is a woman's reproductive plans. When a woman has reproductive plans, COC therapy is out of the question. The realities of today are such that everyone needs to understand at least a little bit about the anatomy and physiology of their own body. This helps a lot to avoid misdiagnosis and, as a result, incorrect treatment, and also speeds up the search for the true cause of the problem. If misdiagnosed, the underlying problem is ignored, which can serve as a trigger for its aggravation and, as a result, its symptoms. That is why everyone in our time needs to understand everything about it. So, for example, few people understand such things as: what is the menstrual cycle, how it should take place, what is its normal duration, what is the rate of discharge and in what periods of the menstrual cycle, is the pain normal at one time or another, and so on. Very often doctors of the old school prescribe, for example, COCs. Most importantly, this is often unnecessary. Also, in our society, after completing the COC course, the concept of "cancellation effect" was formed, which is not true. Evidence-based medicine believes that eggs have several stages of growth and development, and only one of them is regulated by hormones. The rest of the stages proceed continuously and without stopping, and no exogenous or endogenous hormones can stop this. That is, the eggs always die regardless of whether you take COCs or not - this is an axiom. No method is able to prolong the childbearing age, since the ovarian reserve ends, it stops. The only thing that can save eggs is cryo-freezing. This method can be a solution for those who want to have their own children, but at the moment, for one reason or another, fertilization does not occur. Yes, not all diseases can be cured, but even with those that are incurable, you need to learn to live and adapt, remove their manifestations and, if possible, reduce discomfort. Even in the absence of complete recovery from a particular disease, it is necessary to understand that there are methods of physical therapy, diet and conventional drug therapy that can partially improve the condition. Recently, diet therapy has been actively discussed, namely the presence of a complete, balanced and rational diet for all, without exception. In recent decades, fractional nutrition has shown its effectiveness. A balanced fractional nutrition allows you to provide the body with a sufficient amount of energy, to normalize the intestines, to ensure the normal functioning of the hormonal and nervous systems, etc. What is PCOS and the main health problems in women associated with this syndrome? Can true PCOS be completely cured? The correct and complete diagnosis of PCOS and the main nuances of its "treatment" are offered.  


2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Lu Lin ◽  
Cunren Chen ◽  
Tuanyu Fang ◽  
Daoxiong Chen ◽  
Kaining Chen ◽  
...  

Abstract Background Type A insulin resistance syndrome, one type of the hereditary insulin resistance syndromes, is a rare disorder. Patients with type A insulin resistance syndrome are nonobese and demonstrate severe hyperinsulinemia, hyperandrogenism, and acanthosis nigricans. The clinical features are more severe in affected females than in males, and they mostly become apparent at the age of puberty. In many cases, when severe insulin resistance is covered up by other signs or symptoms of type A insulin resistance syndrome, patients are often easily misdiagnosed with other diseases, such as polycystic ovary syndrome. Case presentation Our patient was a 27-year-old Han Chinese woman who sought treatment because of a menstrual disorder and hirsutism. Tests showed that her levels of insulin and testosterone were elevated, and gynecological color Doppler ultrasound suggested multiple cystic changes in the bilateral ovaries. After a diagnosis of polycystic ovary syndrome was made, pulsatile gonadotropin-releasing hormone therapy and metformin were administered, but the patient’s symptoms did not improve in 1 year of follow-up. Considering that the previous diagnosis might have been incorrect, venous blood samples were collected from the patient and her relatives for genetic analysis. Subsequently, using Illumina sequencing, it was found that the proband, her father, and two brothers all had the c.3601C>T heterozygous missense mutation in exon 20 of the insulin receptor gene. The diagnosis was corrected to type A insulin resistance syndrome, and the patient’s treatment was modified. Conclusion We report a case of a young woman with type A insulin resistance syndrome that was misdiagnosed as polycystic ovary syndrome. We discuss the causes, clinical features, diagnosis, and treatment of type A insulin resistance syndrome to improve the recognition of the disease and reduce its misdiagnosis. Female patients with high androgen levels and severe hyperinsulinemia should be considered for the possibility of hereditary insulin resistance syndromes (such as type A insulin resistance syndrome). Gene sequencing helps in making an early diagnosis and developing a targeted treatment strategy.


2005 ◽  
Vol 153 (6) ◽  
pp. 853-860 ◽  
Author(s):  
Susanne Hahn ◽  
Onno E Janssen ◽  
Susanne Tan ◽  
Katja Pleger ◽  
Klaus Mann ◽  
...  

Objective: Polycystic ovary syndrome (PCOS) has been shown to cause a reduction in quality of life. This study examines the extent of different PCOS symptoms on quality-of-life, psychosocial well-being and sexual satisfaction. Methods: Complete metabolic, hormonal, clinical and psychosocial data were obtained from a total of 120 women with PCOS. Patients were compared with 50 healthy women to establish reductions in quality-of-life and emotional well-being. In addition, the correlation between psychosocial variables and the major clinical PCOS features obesity (body mass index (BMI)), excessive body hair (hirsutism score), acne, hyperandrogenism (serum testosterone levels), disturbed insulin regulation (area under the insulin response curve and homeostasis model assessment of insulin resistance), menstrual cycle disturbances and infertility were analyzed. Results: PCOS patients showed significant reductions in quality-of-life, increased psychological disturbances, and decreased sexual satisfaction when compared with healthy controls. BMI and hirsutism scores, but not the presence of acne, were associated with physical aspects of quality-of-life and sexual satisfaction. No clear effect of androgens or insulin resistance on psychosocial variables was detected. Similarly, the type of menstrual cycle disturbances or infertility had no impact on psychological well-being. Conclusion: In PCOS, changes in appearance, particularly obesity and hirsutism, reduce physical dimensions of quality-of-life and decrease sexual satisfaction. The role of biochemical, endocrine and metabolic parameters as well as menstrual irregularities and infertility appeared to be less important. Clinicians should pay attention to the psychosocial dimensions of PCOS on an individual basis, regardless of symptom severity or treatment response.


2021 ◽  
Author(s):  
Haiqing Qian ◽  
Wenting Xu ◽  
Lijuan Cui ◽  
Rong Wang ◽  
Jiahui Wang ◽  
...  

Abstract Background: Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disease in women. Insulin resistance (IR) has emerged as a central contributor to the pathogenesis of this disease. Traditional Chinese medicine (TCM) involving syndrome differentiation and treatment is widely used to adjust women's menstrual cycles. Our patented formula Bushen Huatan Decoction (BSHTD) has been proven to be effective in the clinical treatment of IR-PCOS. Baduanjin also plays an important role in improving metabolic syndrome through lifestyle intervention. This study investigates the clinical efficacy of Bushen Huatan Decoction combined with Baduanjin in IR-PCOS, to form a specific TCM-behaviour intervention plan in the treatment of IR-PCOS.Methods/design: This is a randomized controlled trial involving 190 participants diagnosed with IR-PCOS. All participants will be randomly allocated into 5 groups: group A will receive metformin; group B, BSHTD; group C, Baduanjin; group D, BSHTD combined with metformin; and group E, BSHTD combined with Baduanjin. One course of treatment lasts three months, a total of two courses. The primary outcomes are changes in the homeostatic model assessment of insulin resistance (HOMA-IR) and improvements in the oral glucose tolerance test (OGTT) and insulin-releasing test (INS). The secondary outcomes are improvements in the menstrual cycle, ovulation rate, clinical pregnancy rate, basic serum sex hormone levels, free androgen index (FAI), Ferriman-Gallwey scores, body mass index (BMI) and TCM syndrome scores. The related observation indexes will be collected at baseline, during the process of treatment and at the 6-months follow-up. Simultaneously, close monitoring of possible adverse events will be performed throughout the trial process.Discussion: This trial will investigate the efficacy of the comprehensive intervention program of Bushen Huatan Decoction combined with Baduanjin on the adjustment of menstrual cycle, improvement of insulin resistance and correction of glucose metabolism disorder in IR-PCOS patients. It is expected to form an alternative treatment of TCM-behavior intervention therapy for IR-PCOS and promote the Chinese fitness Qigong Baduanjin in the application of lifestyle diseases.Trial registration: Chinese Clinical Trial Registry, ChiCTR2100043415. Registered on 15 February,2021.


2021 ◽  
Vol 69 (6) ◽  
pp. 7-16
Author(s):  
Elena I. Abashova ◽  
Maria I. Yarmolinskaya ◽  
Olga L. Bulgakova ◽  
Elena V. Misharina

Hypothesis/Aims of study. Dyslipidemia is a common metabolic disorder and is an atherogenic factor in the development of cardiovascular disease in women with polycystic ovary syndrome. Currently, four phenotypes of polycystic ovary syndrome are distinguished, associated in varying degrees of severity with dyslipidemia, insulin resistance, impaired glucose tolerance, and diabetes mellitus on one hand and chronic inflammation and oxidative stress on the other. Hyperandrogenic phenotypes (A, B, C) in polycystic ovary syndrome are associated with the development of adverse metabolic disorders and associated complications. The aim of this study was to evaluate the lipid profile in the serum of women of reproductive age with various polycystic ovary syndrome phenotypes. Study design, materials and methods. The study included 86 women of reproductive age from 22 to 37 years old (average age was 26.6 4.3 years), who, in accordance with polycystic ovary syndrome phenotypes (A, B, C, D), were divided into four groups. We studied the levels of anti-Mllerian hormone, follicle-stimulating and luteinizing hormones, prolactin, estradiol, and androgens from days 2 to 5 of the menstrual cycle. The levels of progesterone in the blood serum were determined by the enzyme immunoassay on days 20 to 23 of the menstrual cycle for three consecutive cycles. We also used echographic methods for diagnosing polycystic ovaries. All women underwent a biochemical blood test with an assessment of the lipid profile parameters (total cholesterol, triglycerides, high-density lipoproteins (HDL), and low-density lipoproteins, LDL). Besides, an oral glucose tolerance test was assessed with the study of plasma glucose and insulin levels on an empty stomach and two hours after ingestion of 75 g of glucose, the HOMA-IR index being used to assess insulin resistance. Results. Phenotype A was found in 40 (46.5%) women with polycystic ovary syndrome, phenotype B in 22 (25.6%), phenotype C in 10 (11.6%), and phenotype D (non-androgenic) in 14 (16.3%) patients with PCOS. Of those 42 (48.8%) individuals had changes in carbohydrate metabolism (impaired glucose tolerance), of whom 39 (92.8%) women had androgenic polycystic ovary syndrome phenotypes (A, B, C). Both non-androgenic phenotype D and impaired glucose tolerance were found in 7.2% of cases. In women with hyperandrogenic polycystic ovary syndrome phenotypes, both the fasting and stimulated insulin levels were increased significantly comparing to the non-androgenic anovulatory phenotype (p 0.05). The HOMA-IR index in women with phenotypes A, B and C was significantly (p 0.05) higher than in patients with non-androgenic phenotype D. When evaluating the lipid profile parameters, no significant differences in cholesterol level and atherogenic coefficient in women with various polycystic ovary syndrome phenotypes were found. The levels of triglycerides and LDL were significantly (p 0.05) higher in women with androgenic phenotype B compared to those in patients with non-androgenic phenotype D and they correlated significantly (p 0.05) with the serum levels of androgens and sex hormone-binding globulin (SHBG). Patients with androgenic polycystic ovary syndrome phenotypes (A and B) had significantly (p 0.05) decreased HDL levels that correlated negatively (r = 0.29; p 0.05) with the levels of free testosterone and SHBG, when compared to the same parameters in women with non-androgenic phenotype D. In women with androgenic polycystic ovary syndrome phenotypes (A, B, C), a significant correlation (r = 0.27; p 0.05) between the levels of stimulated insulin and SHBG were found, and a direct relation (r = 0.32; p 0.05) between those parameters and increased levels of triglycerides and LDL was also revealed. Conclusion. In women with hyperandrogenic and anovulatory polycystic ovary syndrome phenotypes A and B, atherogenic dyslipidemia and impaired carbohydrate metabolism were significantly more pronounced, when compared with patients with non-androgenic phenotype D. A differential and personalized approach to the examination of patients with various polycystic ovary syndrome phenotypes is an important step in the prevention of the risks of developing cardiovascular diseases in women of reproductive age.


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