scholarly journals Impact of hypocaloric dietary intervention on ovulation in obese women with PCOS

Reproduction ◽  
2017 ◽  
Vol 153 (1) ◽  
pp. R15-R27 ◽  
Author(s):  
Brittany Y Jarrett ◽  
Marla E Lujan
Keyword(s):  
Weight Loss ◽  
Dietary Intervention ◽  
Polycystic Ovary ◽  
Reproductive Function ◽  
Antral Follicle ◽  
Reproductive Age ◽  
Obese Women ◽  
Dietary Interventions ◽  
Wide Range ◽  
The Impact

Polycystic ovary syndrome (PCOS) is a common cause of ovulatory dysfunction affecting women of reproductive age. Obesity and insulin resistance are thought to potentiate disruptions in antral follicle development that result in chronic anovulation, and as such, have become important therapeutic targets of dietary interventions aimed at weight loss. Caloric restriction has been shown to promote sporadic ovulation in obese women with PCOS, but improvements have occurred across a wide range of patients and little has been garnered about the factors that distinguish responders from non-responders. Further, few studies have evaluated the likelihood for modest weight loss to restore normal ovulatory cyclicity in PCOS. Consensus regarding the impact of dietary intervention on ovulation has been limited by variability in the measures used to characterize and report ovulatory status across studies. In response, this review provides an assessment of the evidence surrounding the effectiveness of hypocaloric dietary intervention to normalize ovulatory function in PCOS. The impact of physiological vs methodological factors on the evaluation of ovulatory status is discussed, and recommendations to strengthen future studies in this area are provided. Ultimately, further research is needed to understand the optimal dietary or lifestyle approaches that promote ovulation and sustained improvements in reproductive function in PCOS.

scholarly journals A review of therapeutic options for managing the metabolic aspects of polycystic ovary syndrome

2020 ◽  
Vol 11 ◽  
pp. 204201882093830 ◽  
Author(s):  
Mohammed Altigani Abdalla ◽  
Harshal Deshmukh ◽  
Stephen Atkin ◽  
Thozhukat Sathyapalan
Keyword(s):  
Insulin Resistance ◽  
Weight Loss ◽  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Therapeutic Options ◽  
Reproductive Age ◽  
Obese Women ◽  
Cardiovascular Risk Reduction ◽  
Ovary Syndrome ◽  
Incretin Mimetics

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. Metabolic sequelae associated with PCOS range from insulin resistance to type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Insulin resistance plays a significant role in the pathophysiology of PCOS and it is a reliable marker for cardiometabolic risk. Although insulin sensitising agents such as metformin have been traditionally used for managing metabolic aspects of PCOS, their efficacy is low in terms of weight reduction and cardiovascular risk reduction compared with newer agents such as incretin mimetics and SGLT2 inhibitors. With current pharmaceutical advances, potential therapeutic options have increased, giving patients and clinicians more choices. Incretin mimetics are a promising therapy with a unique metabolic target that could be used widely in the management of PCOS. Likewise, bariatric procedures have become less invasive and result in effective weight loss and the reversal of metabolic morbidities in some patients. Therefore, surgical treatment targeting weight loss becomes increasingly common in the management of obese women with PCOS. Newer emerging therapies, including twincretins, triple GLP-1 agonists, glucagon receptor antagonists and imeglemin, are promising therapeutic options for treating T2DM. Given the similarity of metabolic and pathological features between PCOS and T2DM and the variety of therapeutic options, there is the potential to widen our strategy for treating metabolic disorders in PCOS in parallel with current therapeutic advances. The review was conducted in line with the recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018.

scholarly journals Update on polycystic ovary syndrome

2021 ◽  
Author(s):  
Jin Ju Kim
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Meta Analysis ◽  
Daily Practice ◽  
Antral Follicle ◽  
Reproductive Age ◽  
Lifestyle Modifications ◽  
First Line ◽  
Ovary Syndrome ◽  
Wide Range

Polycystic ovary syndrome (PCOS) is a common disorder in reproductive-age women. In 2018, an international evidence-based guideline announced recommendations spanning a wide range of issues on the assessment and management of PCOS. From the 166 recommendations, the present study reviews those that are of particular clinical relevance for daily practice and introduces other relevant studies that have been published since the global guideline. The 2018 guideline increased the antral follicle count cutoff for the diagnosis of PCOS from 12 to 20 when using a high-frequency probe. Hirsutism was defined as having a score of ≥4–6 based on a lower percentile of 85%–90% or cluster analysis, which was lower than the traditionally used 95th percentile-based cutoff. The diagnosis of PCOS in adolescents is challenging, and irregular menstruation was defined carefully according to years from menarche. The use of ultrasonography for the diagnosis of PCOS was restricted to those 8 years after menarche. As medication for non-fertility indications, combined oral contraceptives are the first-line drug. Metformin, in addition to lifestyle modifications, should be considered for adult patients with a body mass index ≥25 kg/m2 for the management of weight and metabolic outcomes. An aromatase inhibitor is the recommended first-line medication for ovulation induction, a subsequent individual patient data meta-analysis also reported the same conclusion. Whether the new global guideline will be fully adopted by many specialists and change clinical practice is open to question. Further studies are needed to better understand and manage PCOS patients well.

scholarly journals Impact of weight loss on plasma ghrelin level, clinical, and metabolic features of obese women with or without polycystic ovary syndrome

2019 ◽  
Vol 24 (1) ◽  
Author(s):  
Nearmeen M. Rashad ◽  
Yasser S. Saraya ◽  
Samir A. Afifi ◽  
Ayman E. Ali ◽  
Radwa M. Al-sayed
Keyword(s):  
Weight Loss ◽  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Ghrelin Level ◽  
Enzyme Linked Immunosorbent Assay ◽  
Obese Women ◽  
Ovary Syndrome ◽  
Plasma Ghrelin Level ◽  
Co Morbidity ◽  
The Impact

Abstract Background Polycystic ovary syndrome (PCOS) is a common reproductive endocrine co-morbidity of obesity. Ghrelin is a peptide which regulates food intake and body weight. The aim of this study was to measure ghrelin levels in obesity and PCOS and to evaluate the impact of weight loss on plasma ghrelin level, metabolic, and phenotypic features of PCOS. This prospective comparative study enrolled obese women without PCOS (N = 60) and obese PCOS women (n = 50) and 85 control groups. Body compositions including fat mass (FM) and fat-free mass (FFM) were measured by dual-energy X-ray absorptiometry (DEXA). Plasma ghrelin concentrations were measured using enzyme-linked immunosorbent assay (ELISA). Results Our results revealed that plasma ghrelin levels were lower in PCOS patients compared to obese (9.49 ± 5.59 ng/ml) and controls (48.21 ± 21.09 ng/ml). Moreover, it was negatively correlated to anthropometric measures, glycemic, lipid profile, and the phenotype characteristics of PCOS. Interestingly, after 12 weeks of following the Mediterranean diet (MD)-based weight loss program, ghrelin levels were increased in both obese groups. Conclusion Successful weight loss leads to increase ghrelin levels in both obese and PCOS groups.

scholarly journals Review Article: Obesity and Infertility

2021 ◽  
Vol 8 (2) ◽  
pp. 173-183
Author(s):  
Meena S. Farman ◽  
Marwa A. Akoul
Keyword(s):  
Weight Loss ◽  
Polycystic Ovary ◽  
Obese Woman ◽  
Critical Mass ◽  
Reproductive Function ◽  
Obese Patients ◽  
Obese Women ◽  
Fat Tissue ◽  
Perinatal Complications ◽  
Ovary Syndrome

Obesity is a main health problem, that affects people all over the world. According to recent articles, obese patients should be denied any therapy to aim improving ovulation rates and achieving pregnancy until their BMI is reduced. We believe that this approach does not solve the issue, but rather exacerbates the maternal and perinatal complications linked to fertility clinics. Obesity independent of polycystic ovary syndrome (PCOS) is related with anovulation, and a weight loss alone is an effective treatment for inducing ovulation in both obese women with or not PCOS. As a result, weight-loss lifestyle programs should be considered an ovulation induction therapy, with due consideration for a possible pregnancy in an obese woman. Obesity has been linked to menstrual irregularities and infertility, Despite the fact that a critical mass of adipose tissue is needed for development female reproductive function. The severity of fat tissue distribution and obesity are important factors that affect the female reproductive system. The mechanisms of pathogenetic that link them aren't well understood. Insulin resistance and hyperinsulinemia are common in obese, especially those women with upper obesity of body, as are hyperandrogenemia, increased peripheral aromatization of androgens to oestrogens, altered secretion of gonadotrophin, and reduced (SHBG), decreased growth hormone (GH) , insulin like growth factor binding proteins (IGFBPs), elevated level of leptin and changed neuroregulation of the hypothalamic‐pituitary‐gonadal axis.

scholarly journals Dietary Interventions: A Promising Treatment for Polycystic Ovary Syndrome

2021 ◽  
Vol 77 (6) ◽  
pp. 313-323
Author(s):  
Xuan Che ◽  
Zhuo Chen ◽  
Mingqi Liu ◽  
Zhongcheng Mo
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Dietary Patterns ◽  
Dietary Intervention ◽  
Dietary Habits ◽  
Polycystic Ovary ◽  
Early Stage ◽  
Reproductive Function ◽  
Dietary Interventions ◽  
Ovary Syndrome ◽  
The Status

<b><i>Background:</i></b> Dietary interventions as a first-line treatment for patients with polycystic ovary syndrome (PCOS) have been evaluated, but the optimal diet has not been determined. Proper diet and the maintenance of adequate nutritional status are of great importance in the prevention of this disorder, and therapeutics and dietary habits play an important role in the recovery of patients with PCOS. <b><i>Summary:</i></b> A range of dietary patterns have been shown to impact weight loss and insulin resistance (IR) and improve reproductive function, including the Mediterranean diet, the ketogenic diet, Dietary Approaches to Stop Hypertension, and other dietary patterns. <b><i>Key Messages:</i></b> Diets that can reduce rates of obesity and IR are beneficial to women with PCOS, the status of obesity and IR should be determined at the early stage of the disease, so as to develop individualized and sustainable dietary intervention. The long-term efficacy, safety, and health benefits of diet management in patients with PCOS need to be tested by further researches.

scholarly journals Heterogeneity in the responsiveness to long-term lifestyle intervention and predictability in obese women with polycystic ovary syndrome

2011 ◽  
Vol 164 (1) ◽  
pp. 53-60 ◽  
Author(s):  
Renato Pasquali ◽  
Alessandra Gambineri ◽  
Carla Cavazza ◽  
Daniela Ibarra Gasparini ◽  
Walter Ciampaglia ◽  
...  
Keyword(s):  
Weight Loss ◽  
Polycystic Ovary Syndrome ◽  
Lifestyle Intervention ◽  
Polycystic Ovary ◽  
Obese Women ◽  
Ovary Syndrome ◽  
Partial Group ◽  
The Impact

BackgroundTreatment of obesity improves all features of the polycystic ovary syndrome (PCOS). There is, however, a heterogeneous response to weight loss, and predictive factors are unknown.ObjectiveThis follow-up study aimed to investigate obese women with PCOS treated with a long-term lifestyle program to evaluate responsiveness and predictability.MethodsOne hundred PCOS women meeting the criteria for selection were invited to participate and 65 of them agreed. Lifestyle intervention had consisted of a 1200–1400 kcal/day diet for 6 months, followed by mild calorie restriction and physical activity. The protocol, which was similar at baseline and follow-up, included anthropometry, clinical evaluation, pelvic ultrasound, and laboratory investigations. The mean follow-up period was 20.4±12.5 months.ResultsAfter the follow-up period, women were reclassified into three groups according to the persistence (group 1, 15.4%), partial (group 2, 47.7%), or complete (group 3, 36.9%) disappearance of the categorical features of PCOS (hyperandrogenism, menses, and ovulatory dysfunctions). Duration of the follow-up and extent of weight loss were similar among the three groups, as were fasting and glucose-stimulated insulin and indices of insulin resistance. Baseline waist circumference, waist to hip ratio (WHR), and androstenedione blood levels were negatively correlated with a better outcome in the univariate analysis. However, only basal androstenedione values persisted to a highly significant extent (P<0.001) in the multivariate analysis.ConclusionsResponsiveness to weight loss in overweight/obese PCOS women varies considerably and more than one third of women may achieve full recovery. These findings add new perspectives to the impact of obesity on the pathophysiology of PCOS.

scholarly journals The Impact of Bariatric Surgery on Menstrual Abnormalities—a Cross-Sectional Study

2020 ◽  
Vol 30 (11) ◽  
pp. 4505-4509
Author(s):  
Anna Różańska-Walędziak ◽  
Paweł Bartnik ◽  
Joanna Kacperczyk-Bartnik ◽  
Krzysztof Czajkowski ◽  
Maciej Walędziak
Keyword(s):  
Bariatric Surgery ◽  
Menstrual Cycle ◽  
Cross Sectional Study ◽  
Reproductive Age ◽  
Obese Women ◽  
Sectional Study ◽  
Cross Sectional ◽  
Contraception Use ◽  
Before And After ◽  
The Impact

Abstract Introduction Obesity is associated with hyperestrogenism along with other hormonal abnormalities affecting the menstrual cycle. The most effective and decisive method of obesity treatment is bariatric surgery. The aim of this study was to analyze the impact of bariatric surgery on menstrual cycle, the incidence of menstrual abnormalities, hyperandrogenism manifestation, and contraception use. Materials and Methods It was a cross-sectional study of 515 pre-menopausal women who had undergone bariatric surgery between 1999 and 2017 in a bariatric center. Data was collected via anonymous questionnaire, and the questions covered a 1-year period before the surgery and the last year before questionnaire completion. Results Before the surgery, 38.6% of the patients reported irregular menstruations in comparison with 25.0% after bariatric surgery (RR = 0.65; 95%CI 0.53–0.79). The mean number of menstruations per year did not differ before and after surgery (10.2 ± 3.9 vs 10.4 ± 3.3; p < .45). There were no statistically significant differences in terms of prolonged menstruations, acne, and hirsutism prevalence. A total of 14.4% of patients before surgery reported estrogen-based contraception use in comparison with 15.0% after the surgery (p < .95). There were no significant differences in the frequency of OC use (11.0% before surgery vs 13.6% 12 months after the surgery vs 11.5% at the moment of survey administration; p < 0.46). Conclusion Bariatric surgery improves the regularity of the menstrual cycle in obese women in reproductive age. The lack of any changes in the combined hormonal contraception (CHC) use, especially OC, before and after bariatric surgery may be a result of a possibly low level of contraception counseling.

scholarly journals Effects of Weight Loss on FGF-21 in Human Subjects: An Exploratory Study

2019 ◽  
Vol 16 (23) ◽  
pp. 4877
Author(s):  
Headland ◽  
Clifton ◽  
Keogh
Keyword(s):  
Weight Loss ◽  
Exploratory Study ◽  
Wound Repair ◽  
Dietary Intervention ◽  
Human Subjects ◽  
Restriction Pattern ◽  
Energy Restriction ◽  
Fibroblast Growth Factor 21 ◽  
Continuous Energy ◽  
The Impact

Fibroblast growth factor-21 (FGF-21), is a protein involved in cell growth and differentiation, development, wound repair and metabolism. Research looking at the impact of weight loss on FGF-21 levels is limited. The objective of this exploratory study was to determine changes in serum FGF-21 levels following weight loss induced by either continuous energy restriction or intermittent energy restriction. A sub cohort of participants who completed a 12-month dietary intervention trial following continuous energy restriction, or a week-on week-off energy restriction pattern, were selected for analysis. FGF-21 levels were not altered by weight loss and were not correlated with body weight or BMI at baseline or 12 months. Weight loss after 12 months either through continuous energy restriction or intermittent energy restriction was −5.9 ± 4.5 and −4.9 ± 3.4 kg, respectively. There was no change in FGF-21 levels, 0.3 ± 0.9 and 0.04 ± 0.2 ng/mL (p = 0.2). In conclusion, weight loss in healthy overweight or obesity subjects did not affect FGF-21 levels.

scholarly journals Pesticides as endocrine distruptors of the reproductive system (literature review and own research)

2021 ◽  
pp. 49-62
Author(s):  
Ninel Shepelska ◽  
Mykola Prodanchuk ◽  
Yana Kolianchuk
Keyword(s):  
Reproductive Health ◽  
Endocrine Disruptors ◽  
Reproductive System ◽  
Reproductive Toxicity ◽  
Endocrine System ◽  
Reproductive Function ◽  
Dose Dependence ◽  
Animal Cells ◽  
Wide Range ◽  
The Impact

Currently, one of the main threats to human health is undoubtedly endocrine disruptors (ED), since they directly disrupt the processes of homeostasis maintenance, controlled by the endocrine system, the purpose of which is to maintain normal functions and development in a constantly changing environment. Pesticides can disrupt the physiological functioning of many endocrine axes, including the endocrine mechanisms that ensure reproductive health. It should be noted that research aimed at preventing chemically induced reproductive disorders in the human population is one of the central areas of preventive medicine, both in terms of their importance and the complexity of the tasks being solved. Analysis and generalization of the results of our own long-term studies have shown that the selective, and, therefore, the most dangerous toxicity of pesticides for the reproductive system is determined by endocrine-mediated mechanisms of etiopathogenesis. The low level of doses inducing pathological changes in reproductive function in our studies fully confirms one of the universal signs inherent in endocrine-distruptive compounds. The above examples demonstrate a wide range of possible endocrine-mediated mechanisms of reproductive toxicity of pesticides - endocrine disruptors. However, it is very important to note that low doses may be more effective in changing some endpoints compared to high (toxic) doses. Currently, several mechanisms have been identified and studied that demonstrate how hormones and ED induce non-monotonic reactions in animal cells, tissues and organs. The reproductive system, the functioning of which is ensured by a fine balancing of the action of androgens and estrogens, is one of the systems that presents a unique opportunity for modeling a non-monotonic dose dependence. All of the above indicates the extreme danger of the impact of hormonally active agents on the reproductive health of a person and his offspring. At the same time, the threat of endocrine-mediated disorders for subsequent generations can also be realized through the induction of mechanisms of development of epigenetic transgenerational effects. Taking into account the results of studies of the mechanisms of the ED destructive action, as well as their ability to induce non-monotonic dose dependence at an extremely low dose level, it should be admitted that, apparently, there is a need to revise the paradigm of methodological approaches to the regulation of pesticides with endocrine-disruptive properties. Key words: pesticides, endocrine disruptors, reproductive system

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