Study: polycystic ovarian spectrum
Study: polycystic ovarian spectrum
Reference
Sjaarda La, Mumford SL, Kissell K, et al. Increased androgen, anti-Müller hormone and sporadic annovulation in healthy, Eumenorrheic women: a mild PCOS-like phenotype? J clin endocrinol metab. 2014; 99 (6): 2208-2216.
Design
prospective cohort study
participant
between 2005 and 2007 259 Eumenorrheic women without a self-reported history of infertility, polycystic ovarian syndrome (PCOS) or other endocrine disorders (including diabetes, cushing syndrome or diseases of the thyroid gland, adrenal glands or hypothalamus) were recorded over a period of 1 year Menstrual cycles. The researchers demanded that the participants had to stop all hormonal medication (including Depo-Provera, Norplant and intrauterine pessary) before the study. The participants also had to drop oral contraceptives or other hormone preparations three months before the enrollment.
The participants provided information on health and lifestyle, including an assessment of hair growth and acne history as well as a physical assessment including weight, size and body composition.
A total of 509 cycles were monitored, with the time measurement of the menstrual cycle phase supported by fertility monitors. The women emitted blood samples up to 8 times per menstrual cycle and all of them emitted at least 5 samples per cycle. These samples corresponded to the early menstruation, the middle follicular phase, 3 samples of the period and rehearsals in the early, medium and late lutal phase. All samples were removed in the morning after fasting.
Serum Sea of Östradiol, progesterone, insulin, sex hormone-binding globulin, Leitinizing hormone (LH), follicle-stimulating hormone (FSH), albumin, glucose, blood greases, antiMüller hormone (AMH) and overall test allosterone (t). Sporadic anovulatory cycles were defined as an observed progesterone peak of less than or just 5 ng/ml and no detectable serum LH peak in the later cycle measurements.
most important knowledge
The participants were healthy, young women (age 18–44 years). Testosterone (t) concentration and age were in the opposite context. The lowest T-quartile had an average age of 32.7 ± 8.0 years, compared to 23.6 ± 6.1 years in the highest quartile ( p <0.001). The prehistory of medically treated acne or taking medication was significantly lower in the quartile with the lowest T concentration compared to the three higher higher, but the hirsutism did not differ between the quarters of these healthy women.
The total T concentrations during the cycle were between 3.0 and 135.6 ng/dl and at the beginning of the study (during menstruation) between 6.8 and 79.2 ng/dl. The T concentrations rose to their highest value around ovulation.
Compared to ovulation cycles (n = 467), sporadic anovulatory cycles (n = 42) had a slightly higher overall testosterone level and a significantly higher free testosterone level (on average 23.7 ng/dl). [95% Confidence interval (CI): 21.4-26.3] vs. 21.6 ng/dl [95% CI: 20.9-22.3], p = 0.08 and 0.36 ng/dl [95% CI: 0.33-0.40] Vs. 0.32 ng/dl [95% CI: 0.31-0.33], p = 0.02) during menstruation and throughout the entire lute phase ( p <0.01 for all participants). Women with higher T had increased AMH concentrations and reported more often about acne in the history that required medical treatment, but not about increased brainutism. The percentage of the anovulatory cycles was significantly higher in all quarters with increasing overall testosterone levels. The ratio of LH to FSH and AMH was also higher in the quarters with increasing overall testosterone level regardless of age. It is noteworthy that the AMH value in the highest T-quartile was about twice as high as in the lowest quartile.
effects on practice
Diagnostic criteria for PCOS, as defined in 2003 by the American College of Gynecologists and Obstricians 1 include chronic annovulation and hyperandrogenism, as is defined by hormone measurements or clinical findings such as acne and brainutism. About 4 to 6 % of women meet these diagnostic criteria and in these women there is a higher risk of loss of pregnancy in the first trimester, pregnancy complications, insulin resistance and obesity.
This study is important for the naturopathic clinical approach in menstrual disorders and PCOs, since the results show that the pattern of the hormone -like weight observed in PCOS can be observed in women that would not meet the diagnosis criteria. This finding suggests that the functional changes that occur in PCOS are not available as a discrete black and white-onset weight, but rather on a scale consisting of gray tones, which requires a name as "pre-PCOS" or "subclinical PCOS". "
From this study it can be seen that PCO syndrome is indeed a spectrum of polycystic ovaries whereby there is a pattern of hormonal equilibrium over a severity scale.
As expected, higher T-values were observed among younger subjects. In addition, it is nothing new that correlate higher T-values with a higher occurrence of acne in women. Although hirsutism was also associated with a higher serum testosterone level, this was not observed in this study, which indicates that the testosterone level, which is necessary to influence hair growth, exceeds the value that has been observed in order to influence the menstrual patterns in women, and that there may be no serious improvement in eumenorrhoic women to have enough. To observe symptoms of PCOS.
amh is a hormone that is produced by the original follicles while developing in the ovary. It has been reported earlier that higher AMH values can be observed in women with PCOS, since there are more follicles in development (hence the term). polycystic ) During the follicular phase. 2 Interestingly, this higher AMH mirror was observed in this study in healthy women without menstrual regulators, but with increased T compared to other healthy cohorts. Sporadic anovulatory cycles and an increased LH-to-FSH ratio were also observed more often in healthy subjects with higher T-values. Both results indicate that the hyperandrogenicity observed in women with PCOS in healthy women with only occasional menstrual discretion may be available to a lesser extent.
This finding has a significant impact on practice because it can change the approach of a doctor to the treatment of women with occasional hormone -like weight that cannot meet the conventional diagnostic criteria for PCOS. This study shows that PCO syndrome is indeed a spectrum of polycystic ovaries , whereby there is a pattern of hormonal equilibrium over a severe grade scale, whereby the most distal endpoint of anovulation, hiresutism and acne, insulin resistance and other characteristic criteria for diagnosis are being diagnosed. This could expand the treatment options for these Eumenorrheic women, be it because of their acne, infertility or menstrual disorders, to expand nutrients that are traditionally recommended for women with PCOS, including N-Acetylcystein and inositol.
All in all, these results indicate a possible underlying cause of occasional annovulations, for example a long -term, even subclinical dysfunction of the follicles, ovaries, the hypothalamus or the pituitary gland, even with otherwise healthy, menstruating women.
- Schroeder B. Acog publishes guidelines for the diagnosis and treatment of polycystic ovarian syndrome. I'm a family doctor. 2003; 67 (7): 1619-1622.
- cui y, shi y, cui l, han t, gao x, chen zj. Age-specific serum anti-meter hormone levels in women with and without polycystic ovarian syndrome. fertilize sterile. 2014; 102 (1): 230-236.E2.
- Mumford SL, Schistermann EF, Siega-Riz am, et al. Cholesterol, endocrine and metabolic disorders in sporadically anovulatory women with regular menstruation. hum reprod. 2011; 26 (2): 423-430.
- Hambridge HL, Mumford SL, Mattisone Dr, et al. The influence of sporadic annovulations on the hormone level in ovulation cycles. Hum Reprod. 2013; 28 (6): 1687-1694.
- Ahrens K, Mumford SL, Schliep KP, et al. Serum leptin level and reproductive function during the menstrual cycle. at J Obstet Gynecol. 2014; 210 (3): 248. E1-9.