Pregnancy outcomes after laparoscopic ovarian drilling in women with polycystic ovarian syndrome. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. Nonalcoholic fatty liver disease in women with polycystic ovary syndrome. Impact of obstructive sleep apnea on insulin resistance and glucose tolerance in women with polycystic ovary syndrome. Relative risk of conversion from normoglycaemia to impaired glucose tolerance or non-insulin dependent diabetes mellitus in polycystic ovarian syndrome. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. A pilot study of the long-term effects of acipimox in polycystic ovarian syndrome. The prevalence of polycystic ovary syndrome in a community sample of Iranian population: Iranian PCOS prevalence study The effect of ethinyl estradiol–cyproterone acetate treatment on homocysteine levels in women with polycystic ovary syndrome Optimized Probability Sampling of Study Sites to Improve Generalizability in a Multisite Intervention Trial Serum levels of insulin-like growth factor-1, IGF binding protein-1 and insulin and the response to human menopausal gonadotrophins in women with polycystic ovary syndrome. The relationship between circulating androgens, obesity, and hyperinsulinemia on serum insulin-like growth factor binding protein-1 in the polycystic ovarian syndrome. Serum uric acid concentration as non-classic cardiovascular risk factor in women with polycystic ovary syndrome: effect of treatment with ethinyl-estradiol plus cyproterone acetate versus metformin. Influence of body mass index on measured and calculated androgen parameters in adult women with Hirsutism and PCOS. Metformin to restore normal menses in oligo-amenorrheic teenage girls with polycystic ovary syndrome (PCOS). Prevention of gestational diabetes by metformin plus diet in patients with polycystic ovary syndrome. Polycystic ovary syndrome, the G1691A factor V Leiden mutation, and plasminogen activator inhibitor activity: associations with recurrent pregnancy loss. Testosterone and visceral fat in midlife women: the Study of Women's Health Across the Nation (SWAN) fat patterning study. Obesity, free testosterone, and cardiovascular risk factors in adolescents with polycystic ovary syndrome and regularly cycling adolescents. Metformin-Diet Ameliorates Coronary Heart Disease Risk Factors and Facilitates Resumption of Regular Menses in Adolescents with Polycystic Ovary Syndrome Hypothalamic-pituitary-adrenal axis sensitivity to opioids in women with polycystic ovary syndrome. Androgen excess in women: experience with over 1000 consecutive patients. Serum leptin levels in patients with polycystic ovary syndrome. Ethinylestradiol/cyproterone acetate in polycystic ovary syndrome: lipid and carbohydrate changes Ghrelin and measures of satiety are altered in polycystic ovary syndrome but not differentially affected by diet composition. Prevalence and characteristics of the polycystic ovary syndrome in overweight and obese women. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. Clinical, ultrasound and biochemical features of polycystic ovary syndrome in adolescents: implications for diagnosis. Metformin during pregnancy reduces insulin, insulin resistance, insulin secretion, weight, testosterone and development of gestational diabetes: prospective longitudinal assessment of women with polycystic ovary syndrome from preconception throughout pregnancy. Prevalence of Polycystic Ovary Syndrome in Girls Aged 14–18 Years in Isfahan, Iran The effects of spironolactone on testosterone fractions and sex-hormone binding globulin binding capacity in hirsute women Adolescent BMI trajectory and risk of diabetes versus coronary disease. Correlates of increased lean muscle mass in women with polycystic ovary syndrome.
OBJECTIVE To study whether there is an increased risk of glucose intolerance and hypertensive complications during pregnancy in women with polycystic ovarian syndrome ( PCOS ) who conceived after laparoscopic ovarian drilling  and to investigate if there is an adverse pregnancy outcome . METHODS This prospect i ve study took place at Salmaniya Medical Complex in Bahrain , between June 1996 and June 2003 . We compared the pregnancy and neonatal outcomes of 134 patients with PCOS who were treated with laparoscopic ovarian drilling with 479 pregnant women without PCOS ( controls ) . We used the multiple logistic regression analysis to assess the risk of PCOS on impaired glucose tolerance ( IGT ) , gestational diabetes mellitus ( GDM ) , hypertensive disorders in pregnancy ( HDP ) and premature delivery . RESULTS Subjects with PCOS had a significantly greater  prepregnancy body mass index , prevalence of obesity and nulliparity  as compared with controls . The incidence of IGT ( p=0.007 ) , GDM ( p=0.01 ) and HDP ( p=0.001 ) were significantly higher in pregnant PCOS compared with the control group . There were no significant differences in the neonatal outcomes and prevalence of premature delivery between the 2 study groups . When non-obese PCOS patients were compared with non-obese controls , the incidence of GDM ( p=0.04 ) and HDP ( p=0.004 ) were still significantly higher in the former . The prevalence of pregnancy complications were not significantly different when obese PCOS were compared with obese control patients . The PCOS was demonstrated as a risk factor for IGT ( p=0.05 ) , GDM ( p=0.03 ) and HDP ( p=0.03 ) , but not for premature delivery . CONCLUSION Women with PCOS who conceived after the drilling were at higher risk of IGT , GDM and HDP , and this risk seemed to be independent of maternal obesity We prospect ively estimated the prevalence of the polycystic ovary syndrome ( PCOS ) , as defined by the NIH/NICHHD 1990 endocrine criteria , in a population of 154 Caucasian women of reproductive age reporting spontaneously for blood donation .  Anthropometric data ; the presence of hirsutism , acne , and and rogenic alopecia ; and the menstrual history were recorded by a single investigator . In 145 women , blood sample s were also obtained for measurement of serum and rogen levels .  PCOS was defined by the presence of 1 ) oligomenorrhea , 2 ) clinical and /or biochemical hyper and rogenism , and 3 ) exclusion of hyperprolactinemia , thyroid disorders , and nonclassic 21-hydroxylase deficiency . Hirsutism was defined by a modified Ferriman-Gallwey score of 8 or more , acne was considered as a sign of hyper and rogenism when persistent after the second decade of life , and hyper and rogenemia was defined by an increase in circulating testosterone or dehydroepi and rosterone sulfate or an increase in the free and rogen index above the 95th percentile of the control values derived from the nonhirsute , nonacneic women having regular menses who were not receiving hormonal therapy . PCOS was present in 10(6.5 % ) , hirsutism was present in 11 ( 7.1 % ) , and acne was present in 19 ( 12.3 % ) of the 154 women . Our results demonstrate a 6.5 % prevalence of PCOS , as defined , in a minimally biased population of Caucasian women from Spain . The polycystic ovary syndrome , hirsutism , and acne are common endocrine disorders in women BACKGROUND / AIMS Insulin resistance is a common feature of both nonalcoholic fatty liver disease ( NAFLD ) and polycystic ovary syndrome ( PCOS ) , therefore , we hypothesize that PCOS and NAFLD may coexist . The aim of the present study was to determine the frequency and characteristics of NAFLD in women with PCOS . METHODS A prospect i ve study of patients with PCOS and no current pharmacological treatment was conducted . NAFLD was diagnosed by abdominal ultrasound following exclusion of alcohol consumption , viral , or autoimmune liver disease . Anthropometric variables , serum levels of glucose , insulin , lipids and aminotransferases , and HOMA index were determined . RESULTS Forty-one PCOS patients ( mean age : 24.6+/-7.2yr , mean body mass index [ BMI ] : 30.3+/-7.0kg/m(2 ) ) were included ; 26 of 41 PCOS patients ( 63.4 % ) had insulin resistance and 17 ( 41.5 % ) had NAFLD . Nine of the NAFLD patients ( 64 % ) also had abnormal aminotransferases .  Women with NAFLD and PCOS had a higher HOMA index and a higher waist-hip ratio than those with normal ultrasound . Patients with PCOS showed a higher frequency of NAFLD ( 41 % vs. 19 % ) and insulin resistance ( 63 % vs. 35.5 % ) than a control group . CONCLUSIONS NAFLD is frequent in patients with PCOS confirming a relevant clinical association between these two conditions . Women with PCOS should be screened for liver disease CONTEXT Insulin resistance , impaired glucose tolerance , and type 2 diabetes are common in women with polycystic ovary syndrome ( PCOS ) .  Obstructive sleep apnea ( OSA ) has been linked to metabolic dysfunction . We studied women with and without PCOS to determine the extent to which OSA is responsible for insulin resistance and glucose intolerance in PCOS . METHODS In a prospect i ve design , 52 women with PCOS and 21 women without PCOS of similar age and body mass index had an overnight polysomnogram and a 75-g oral glucose tolerance test . RESULTS Twenty-nine women ( 56 % ) with PCOS had OSA compared with four controls ( 19 % ) ( adjusted odds ratio 7.1 ; 95 % confidence interval , 1.7 - 45.7 ; P = 0.01 ) . PCOS women with OSA were more insulin resistant than those without OSA [ homeostasis model assessment ( HOMA ) index 5.7 + /- 0.4 vs. 3.5 + /- 0.4 ; P = 0.006 ] after controlling for age , body mass index , and ethnicity . Impaired glucose tolerance was found in 16 of 29 ( 55 % ) PCOS women with OSA and only six of 23 ( 26 % ) of those without OSA ( unadjusted P = 0.049 ) . Insulin resistance and glucose intolerance were highly correlated with the presence and severity of OSA . Among PCOS women with normal glucose tolerance , the presence of OSA was associated with a nearly 2-fold higher fasting insulin level and HOMA index . The severity of OSA was a highly significant predictor of the fasting concentrations of glucose and insulin as well as the 2-h glucose concentration and HOMA index . CONCLUSIONS OSA is a highly prevalent and important determinant of insulin resistance , glucose intolerance , and type 2 diabetes in PCOS BACKGROUND Cross-sectional studies have shown a high frequency of impaired glucose tolerance ( IGT ) and non-insulin dependent diabetes mellitus ( NIDDM ) in women with polycystic ovarian syndrome ( PCOS ) . However , little is known about the change in glucose tolerance that occurs over a period of several years in women with PCOS . METHODS Sixty-seven women with PCOS received a 75 g glucose tolerance test and measurement of lipids at baseline and at follow-up after an average time of 6.2 years . All women followed prospect ively had normal glucose tolerance ( n = 54 ) or IGT ( n = 13 ) at the start of the study . RESULTS Change in glycaemic control from baseline was frequent , with 5/54 ( 9 % ) of normoglycaemic women at baseline developing IGT and a further 4/54 ( 8 % ) moving directly from normoglycaemic to NIDDM . For women with IGT at baseline , 7/13 ( 54 % ) had NIDDM at follow-up . Body mass index ( BMI ) at baseline was an independent significant predictor of adverse change in glycaemic control . CONCLUSIONS Women with PCOS , particularly those with a high BMI , should be review ed regularly with respect to IGT or NIDDM , as the frequency of impaired glycaemic control is high , and that the rate of conversion from normal glucose tolerance to IGT or NIDDM , or from IGT to NIDDM is substantial Estimates of the prevalence of the polycystic ovary syndrome ( PCOS )  in the general population have ranged from 2 - 20 % . The vast majority of these reports have studied White population s in Europe , used limited definitions of the disorder , and /or used bias population s , such as those seeking medical care . To estimate the prevalence of this disorder in the United States and address these limitations , we prospect ively determined the prevalence of PCOS in a reproductive-aged population of 369 consecutive women ( 174 White and 195 Black ; aged 18 - 45 yr ) , examined at the time of their preemployment physical .  Body measures  were obtained , and body hair was quantified by a modified Ferriman-Gallwey ( F-G ) method . All exams were initially performed by 2 trained nurses , and any subject with an F-G score above 3 was reexamined by a physician , the same for all patients . Of the 369 women , 277 ( 75.1 % ) also agreed to complete a question naire and have additional blood drawn . Subjects were studied regardless of current estrogen/progestin hormonal use ( 28.5 % ) . PCOS was defined as 1 ) oligoovulation , 2 ) clinical hyper and rogenism ( i.e. hirsutism ) and /or hyper and rogenemia , and 3 ) exclusion of other related disorders , such as hyperprolactinemia , thyroid abnormalities , and non-classic adrenal hyperplasia . Hirsutism was defined by a F-G score of 6 or more , and hyper and rogenemia was defined as a total or free testosterone , and rostenedione , and /or dehydroepi and rosterone sulfate level above the 95th percentile of control values [ i.e. all eumenorrheic women in the study , who had no hirsutism ( F-G < or = 5 ) or acne and were receiving no hormonal therapy ; n = 98 ] . Considering all 369 women studied , White and Black women had similar mean ages ( 29.4 + /- 7.1 and 31.1 + /- 7.8 yr , respectively ) , although White women had a lesser body mass than Black women ( 24.9 + /- 6.1 vs. 29.2 + /- 8.1 kg/m2 , respectively ; P < 0.001 ) . Of these 7.6 % , 4.6 % , and 1.9 % demonstrated a F-G score of 6 or more , 8 or 10 , respectively , and there was no significant racial difference , with hirsutism prevalences of 8.0 % , 2.8 % , and 1.6 % in Whites , and 7.1 % , 6.1 % , and 2.1 % in Blacks , respectively . Of the 277 women consenting to a history and hormonal evaluation , 4.0 % had PCOS as defined , 4.7 % ( 6 of 129 ) of Whites and 3.4 % ( 5 of 148 ) of Blacks . In conclusion , in our consecutive population of unselected women the prevalence of hirsutism varied from 2 - 8 % depending on the chosen cut-off F-G score , with no significant difference between White and Black women . Using an F-G score of 6 or more as indicative of hirsutism , 3.4 % of Blacks and 4.7 % of Whites had PCOS as defined . These data suggest that PCOS may be one of most common reproductive endocrinological disorders of women BACKGROUND To evaluate the effects of long-term acipimox administration on glucose-induced insulin secretion and peripheral insulin sensitivity in polycystic ovarian syndrome ( PCOS ) , 20 PCOS subjects ( eight lean and 12 obese ) and 14 body mass index-matched controls ( seven lean and seven obese ) were investigated . METHODS Fasting blood sample s were collected for basal hormone and lipoprotein assays , after which patients underwent an oral glucose tolerance test ( OGTT ) . The following day a euglycaemic-hyperinsulinaemic clamp was performed . After 4 - 6 weeks of treatment with acipimox at a dose of 250 mg given orally three times a day , the patients repeated the study protocol . RESULTS No significant differences were found in the glucose , insulin or C-peptide responses to OGTT before and after anti-lipolytic drug administration in any group , nor was there any effect on insulin sensitivity . Concerning the lipid profile , acipimox administration led to a significant decrease of cholesterol and low-density lipoprotein levels in obese PCOS patients as well as in obese and lean controls . Lower triglycerides were found after the drug administration in both obese groups . Post-treatment free fatty acid levels were not significantly different when compared with basal values . CONCLUSIONS Acipimox does not appear to be an effective insulin-lowering drug in PCOS , even if it can be used in obese women with PCOS as an additional therapeutic agent to ameliorate the atherogenic lipid profile of the syndrome Background Despite the heavy burden and impact of the polycystic ovary syndrome ( PCOS ) in reproduction and public health , estimates regarding its prevalence at community levels are limited . We aim ed to ascertain prevalence of PCOS in a community based sample using the National Institute of Health ( NIH ) , the Rotterdam consensus ( Rott . ) and the And rogen Excess Society ( AES ) criteria . Methods Using the stratified , multistage probability cluster sampling method , 1126 women were r and omly selected from among reproductive aged women of different geographic regions of Iran . PCOS were diagnosed using universal assessment of ultrasonographic parameters , hormonal profiles and clinical histories . Results The mean + /- SD of age of study population was 34.4 + /- 7.6 years . Estimated prevalence of idiopathic hirsutism was 10.9 % ( 95 % CI : 8.9 - 12.9 % ) ; 8.3 % of women had only oligo/anovulation and 8.0 % had only polycystic ovaries . The prevalence of PCOS was 7.1 % ( 95 % CI : 5.4 - 8.8 % ) using the NIH definition , 11.7 % ( 95 % CI : 9.5 - 13.7 % ) by AES criteria and 14.6 % ( 95 % CI : 12.3 - 16.9 % ) using the Rott definition . Conclusions At community level , widespread screening of Rotterdam criteria will increase the estimated prevalence of PCOS over twofold . Establishing an explicit and contemporaneous method for definition and screening of each PCOS criteria has important investigational implication s and increase the comparability of published research Objective Women with polycystic ovary syndrome ( PCOS ) have multiple risk factors for cardiovascular disease . The cardiovascular risk marker homocysteine ( Hcy ) is elevated in women with PCOS . This prospect i ve study investigated the effect of oral contraceptives containing ethinyl estradiol – cyproterone acetate ( EE – CA ) on serum Hcy levels in women with PCOS . Study design A total of 30 women with PCOS were enrolled in this prospect i ve study . The diagnosis of PCOS was made according to the criteria of the Rotterdam PCOS consensus workshop group . All women  took oral contraceptives containing EE/CA ( 35 μg/2 mg ) for 3 months . Serum sample s for Hcy , lipid profile and hormones were obtained during the early follicular phase ( days 3–5 ) of the spontaneous or progestin-induced bleeding at baseline , and after the third treatment cycle . Results Three months of EE – CA therapy significantly decreased the Hcy levels from 55.97 ± 16.04 to 54.03 ± 16.15 ( P = 0.01 ) . A significant correlation was observed between the Hcy and total and free testosterone levels ( r = 0.44 , P = 0.015 and r = 0.46 , P = 0.001 respectively ) . Conclusions Although the decrease in Hcy levels with EE – CA therapy was statistically significant , further studies are necessary to determine the clinical benefit of this treatment Introduction Studies of type 2 translation , the adaption of evidence -based interventions to real-world setting s , should include representative study sites and staff to improve external validity . Sites for such studies are , however , often selected by convenience sampling , which limits generalizability . We used an optimized probability sampling protocol to select an unbiased , representative sample of study sites to prepare for a r and omized trial of a weight loss intervention . Methods We invited North Carolina health departments within 200 miles of the research center to participate ( N = 81 ) . Of the 43 health departments that were eligible , 30 were interested in participating . To select a representative and feasible sample of 6 health departments that met inclusion criteria , we generated all combinations of 6 from the 30 health departments that were eligible and interested . From the subset of combinations that met inclusion criteria , we selected 1 at r and om . Results Of 593,775 possible combinations of 6 counties , 15,177 ( 3 % ) met inclusion criteria . Sites in the selected subset were similar to all eligible sites in terms of health department characteristics and county demographics . Conclusion Optimized probability sampling improved generalizability by ensuring an unbiased and representative sample of study sites In order to determine which factors influence the large variations in sensitivity to gonadotrophins  witnessed in women with polycystic ovary syndrome ( PCOS ) , a prospect i ve study was conducted of the correlation between basal clinical and endocrinological features and gonadotrophin requirements of 20 women with clomiphene-resistant PCOS undergoing ovulation induction . Baseline evaluation of  serum concentrations of luteinizing hormone ( LH ) , follicle stimulating hormone ( FSH ) , testosterone , fasting insulin , insulin-like growth factor-1 ( IGF-1 ) , IGF binding protein-1 ( IGFBP-1 ) and sex hormone-binding globulin ( SHBG ) were performed before administering gonadotrophin-releasing hormone agonist ( GnRHa ) . Two weeks later , human menopausal gonadotrophin ( HMG ) was given in a st and ard individualized protocol according to ovarian response , until human chorionic gonadotrophin ( HCG ) was given . Serum concentrations of insulin , IGF-1 , and IGFBP-1 were unaffected by GnRHa . The BMI correlated positively with insulin and inversely with IGFBP-1 serum concentrations and insulin and IGFBP-1 were inversely correlated . The amount of HMG required correlated positively with BMI and insulin concentrations and inversely with IGFBP-1 in the whole group and these correlations were maintained in the sub-group of lean women . No correlation was observed between HMG requirements and IGF-1 or other hormones . Women with hyperinsulinaemia and low IGFBP-1 concentrations required significantly more HMG . Multiple regression analysis revealed that insulin concentration is the most significant determinant of HMG requirement even when dissociated from BMI . We concluded that requirements of HMG in PCOS is not merely determined by obesity but by a cardinal role of insulin concentrations which , when high , induce , hypothetically , a hyper and rogenic intrafollicular milieu OBJECTIVE Our purpose was to evaluate the relationship of obesity , hyperinsulinemia , and hyper and rogenemia on serum insulin-like growth factor binding protein-1 levels in women with the polycystic ovarian syndrome . STUDY DESIGN Insulin-like growth factor binding protein-1 , insulin , and and rogen levels were studied during a 3-hour intravenous glucose tolerance test in 16 women with polycystic ovarian syndrome ( nine obese and seven nonobese ) and 20 healthy control women ( 10 obese and 10 nonobese ) . RESULTS Positive correlations were observed between basal ( r = 0.77 , p = 0.04 ) and area under curve ( r = 0.86 , p < 0.001 ) insulin-like growth factor binding protein-1 with basal and rostenedione in the nonobese women with polycystic ovarian syndrome but not in other groups of women examined or between other and rogens and insulin-like growth factor binding protein-1 . An inverse relationship was observed between log area under curve insulin-like growth factor binding protein-1 levels and log body mass index in polycystic ovarian syndrome ( r = -0.54 , p = 0.03 ) and in normal women ( r = -0.43 , p = 0.06 ) . The log area under curve insulin-like growth factor binding protein-1 level was approximately an inverse linear function of log area under curve insulin response for both women with polycystic ovarian syndrome ( r = -0.70 , p < 0.001 ) and control women ( r = -0.72 , p < 0.001 ) . Additionally , after the area under curve insulin response during intravenous glucose tolerance testing was controlled for , the decline in area under curve insulin-like growth factor binding protein-1 responses was on average 66 % less in both obese and nonobese women with polycystic ovarian syndrome compared with same-weight controls ( 95 % confidence interval 110 % to 270 % , p = 0.04 ) . CONCLUSION These data indicate that insulin and body mass index are the major determinants of circulating insulin-like growth factor binding protein-1 and that chronic hyper and rogenemia does not appear to further reduce serum insulin-like growth factor binding protein-1 levels in obese or normal-weight women with polycystic ovarian syndrome BACKGROUND Serum uric acid levels have emerged as a cardiovascular risk factor , and interventions aim ed to decrease its level have been related with an improvement in clinical and non- clinical cardiovascular outcomes . METHODS Serum uric acid levels were measured in 40 polycystic ovary syndrome ( PCOS ) patients and 40 non-hyper and rogenic women matched for BMI and grade of obesity , and were followed-up in 34 PCOS patients who were r and omized to an oral contraceptive containing 35 mg ethinyl-estradiol plus 2 mg cyproterone acetate ( Diane(35 ) Diario ) or metformin ( 850 mg twice daily ) for 24 weeks . RESULTS There were no statistically significant differences in uric acid levels between PCOS and non-hyper and rogenic control women . Considering all PCOS and non-hyper and rogenic control women as a whole , obese women showed higher uric acid concentrations than lean and overweight women , and the main determinant of serum uric acid level was the BMI . In PCOS women , Diane(35 ) Diario treatment was related with a decrease in uric acid levels ( P = 0.018 ) , whereas no changes were observed with metformin . CONCLUSIONS Obesity is the main determinant of serum uric acid concentrations in PCOS patients , yet amelioration of and rogen excess with an anti and rogenic contraceptive pill results in a significant decrease in these levels , an effect that is not observed with metformin . Clinical Trials.gov NLM Identifier : NCT00428311 There is growing evidence that obesity in women lead to a more severe form of hyper and rogenism and other endocrine abnormalities which may have some health implication s later in life . Obese females are at higher risk for metabolic syndrome due to severe hyper and rogenemia . Calculated values for free testosterone are equivalent to those obtained by equilibrium dialysis , which is one of the reference measurement procedures ( RMP ) for estimation of free testosterone and may be capable of replacing values estimated using RMP 's . For adult women correlations of body mass index ( BMI ) with calculated free ( cFT ) and bioavailable testosterone ( cBT ) are still rare , while these data are reported for peripubertal and adolescent girls . In this study we aim ed to investigate the association between BMI and different and rogen parameters ( including calculated free and bioavailable testosterone , free and rogen index , and sex hormone-binding globulin [ SHBG ] ) in adult women with Hirsutism and with PCOS . In hirsute women with BMI > or = 25 kg/m2 measured total testosterone ( TT ) was significantly higher , SHBG was significantly lower and the calculated and rogen parameter ( FAI , cFT and cBT ) were significantly higher compared to women with BMI < 25 kg/m2 . In PCOS women with BMI > or = 25 kg/m2 TT was significantly higher , SHBG was significantly lower and the calculated and rogen parameter ( FAI , cFT and cBT ) were also significantly higher compared to women with BMI < 25 kg/m2 . In both the Hirsutism and PCOS-group there was a positive correlation between BMI and TT , cFT , and cBT , while BMI was negatively correlated with SHBG . In summary , in adult women with Hirsutism and PCOS obesity is associated with increased levels of TT and decreased levels of SHBG result ing in significant elevated calculated free and bioavailable testosterone levels . Obesity might lead to a more severe form of hyper and rogenism with elevated calculated free and bioavailable testosterone in the study population PURPOSE To describe our clinical experience in using Metformin combined with a high protein-low carbohydrate diet to restore normal menstrual cycles in teenaged females with polycystic ovary syndrome ( PCOS ) . METHODS To enter the study , patients had to have well-documented PCOS , be oligo- ( six cycles or less in the preceding year ) or amenorrheic ( absence of menstrual cycles for 1 year ) , and not have exclusionary diseases or drugs . Accompanying a high protein-low carbohydrate diet , Metformin ( 1.5 - 2.55 g/day ) was given for 10.5 + /- 6.4 months ( range , 4.5 - 26.5 months ) . Follow-up every 8 - 10 weeks for > or = 6 months was scheduled with interval history , review of menstrual status , assessment of any Metformin-related  side effects , brief physical examination , and determination of weight and blood pressure . RESULTS All 11 girls had normal fasting blood glucose and glycohemoglobin . Pre-Metformin , five girls were amenorrheic , three had only one menstrual cycle in the previous year , and three had > or = 6 cycles/year . With Metformin , 10 of 11 girls ( 91 % ) resumed regular normal menses ; 39 % of 38 follow-up visits with regular normal menstrual cycles were ovulatory with normal luteal-phase serum progesterone ( > or = 2.3 ng/mL ) . Of the 11 girls , nine ( 82 % ) lost weight ; five girls lost > or = 11 lb and seven lost > or = 5 lb . After adjusting for weight reduction , with Metformin , estradiol and progesterone rose ( p = .0014,.027 , respectively ) ( changes consistent with resumption of regular normal menses ) , total plasma cholesterol fell ( p = .026 ) , and there was a downward trend in testosterone ( p = .068 ) . CONCLUSION Metformin safely ameliorates the endocrinopathy of PCOS in previously oligo-amenorrheic teenage females with PCOS , facilitating resumption of normal menses in most girls OBJECTIVE To prospect ively assess whether metformin diet safely provides primary and secondary prevention of  gestational diabetes ( GD ) . DESIGN Assess development of GD on metformin diet . SETTING Outpatient clinical research center . PATIENT(S ) One hundred forty-two nondiabetic women with polycystic ovary syndrome ( PCOS ) who had at least one live-birth ( LB ) pregnancy on metformin diet ( 172 pregnancies , 180 LBs ) . INTERVENTION(S ) Women were given 26 % protein , 44 % carbohydrate diets , without calorie restriction during pregnancy . Metformin ( 2 - 2.55 g/d ) was given preconception , through pregnancy . MAIN OUTCOME MEASURE(S ) Development of GD . RESULT ( S ) On metformin , GD developed in 12 ( 7 % ) of 172 LB pregnancies . Forty-seven women had at least one previous LB pregnancy ( n = 64 ) without metformin , with GD developing in 19 ( 30 % ) . Subsequently , on metformin , these 47 women had 50 LB pregnancies , developing GD in 6 ( 12 % ) , which was a statistically significant difference . Of 15 women who had previous GD without metformin , GD developed in 5 ( 31 % ) of 16 subsequent pregnancies on metformin . Of 32 women who were previously free of GD without metformin , GD developed in 1 ( 3 % ) of 34 subsequent pregnancies on metformin .  Previous GD without metformin was the only statistically significant explanatory variable for current GD on metformin . CONCLUSION ( S ) Metformin diet during pregnancy in women with PCOS facilitates primary and secondary prevention of GD Our specific aim was to assess associations of thrombophilia , hypofibrinolysis , and polycystic ovary syndrome ( PCOS ) with  recurrent pregnancy loss ( RPL ) ( > /=3 consecutive pregnancy losses < 20 weeks gestation ) . Prospect i ve studies were performed in 33 Caucasian women referred for diagnosis and treatment of PCOS who were subsequently found to have RPL and in 16 Caucasian women referred for diagnosis and treatment of RPL , who did not have PCOS . Cases ( PCOS-RPL , RPL without PCOS ) were compared with controls ( 116 healthy Caucasian females ) for the G1691A Factor V Leiden , G20210A prothrombin , C677 T methylenetetrahydrofolate reductase ( MTHFR ) , plasminogen activator inhibitor 4G/5 G , and platelet glycoprotein PL A1A2 gene mutations . Cases were compared with controls ( 44 healthy adult Caucasian females ) for serologic coagulation tests including homocysteine , proteins C , S , free S , antithrombin III , anticardiolipin antibodies IgG and IgM , dilute Russel 's viper venom time , activated partial thromboplastin time , Factor VIII , Factor XI , lipoprotein (Lp)(a ) , and plasminogen activator inhibitor activity ( PAI-Fx ) . The 33 Caucasian women with PCOS subsequently found to have RPL were 10 % of a cohort of 322 Caucasian women who had > /= 1 previous pregnancy and had been referred for diagnosis and therapy of PCOS over a 4.3-year period . The Factor V Leiden G1691 mutation was present in 6 of 33 women ( 18 % ) with PCOS-RPL and in 3 of 16 women with RPL without PCOS ( 19 % ) versus 2 of 116 ( 1.7 % ) female controls , Fisher 's P ( p(f ) ) = .0016 , p(f ) = .013 . The 33 PCOS-RPL cases also differed from the 44 female controls for high PAI-Fx ( > 21.1 U/mL ) , 38 % versus 8 % , p(f ) = . 004 . The thrombophilic G1691A Factor V Leiden mutation is associated with RPL in women with and without PCOS ; hypofibrinolysis ( high PAI-Fx ) is also associated with RPL in women with PCOS Visceral fat ( VF ) increases with the menopause and is an independent predictor of the metabolic syndrome , diabetes , and cardiovascular disease ( CVD ) in women . Little is known about how hormonal changes during the menopausal transition are related to the increase in VF . We aim ed to determine the relationship between bioavailable testosterone and VF in middle-aged women at various stages of the menopausal transition and whether this relationship is independent of age and other CVD risk factors . The Study of Women 's Health Across the Nation ( SWAN ) is a longitudinal , community-based study . This report uses baseline data from a population -based longitudinal ancillary study at the Chicago site to examine the cross-sectional relationship between testosterone and computed tomography (CT)-assessed VF  in women at different stages of the menopausal transition . Included are 359 women ( 47.2 % black ) , aged 42 - 60 years , who were r and omly selected from a complete community census in which a 72 % participation rate was achieved . In multivariate models , bioavailable testosterone was associated with VF independent of age , race , percent total body fat , and other cardiovascular risk factors . Bioavailable testosterone was a stronger predictor than estradiol and was interchangeable in its strength of association with sex hormone-binding globulin ( SHBG ) . As bioavailable testosterone was associated with VF even after adjusting for insulin resistance , this suggests that it plays an important role in regional fat distribution . Our findings may have direct implication s in explaining the effect of menopause-related testosterone predominance on VF accumulation and subsequent cardiovascular risk Adolescent girls with polycystic ovary syndrome ( PCOS ) have increased levels of factors constituting the metabolic syndrome : centripetal obesity , hypertension , hypertriglyceridemia , low high-density lipoprotein cholesterol ( HDL-C ) , and hyperinsulinemia . Given the strong association reported between early , persistent obesity and development of metabolic syndrome 10 years later in girls , we speculated that if adolescent girls without PCOS had obesity measures similar to girls with PCOS , they would exhibit similar metabolic syndrome-cardiovascular disease risk factors . Within this context , we compared 37 adolescent girls with PCOS and 2 sample s of normal , regularly cycling adolescent girls ( controls ) of similar ages , selected from the Cincinnati Clinic of the National Heart , Lung , and Blood Institute Growth and Health Study . The first sample included 157 controls selected using a stratified r and om sample based on age . As expected , girls with PCOS had higher body mass index ( BMI ) , waist circumference , insulin , systolic blood pressure ( SBP ) and diastolic blood pressure , triglycerides ( TGs ) , lower HDL-C , and higher low-density lipoprotein cholesterol ( LDL-C ) and free testosterone ( FT ) than controls . A second sample consisted of girls matched one to one with girls with PCOS for BMI and age . Comparisons of group differences were not significant for insulin , lipids , or blood pressure ;  girls with PCOS had a trend toward higher values for waist circumference ( median , 92.7 vs 87.5 cm ; P = .07 ) and much higher median FT ( 4.25 vs 1.42 ng/mL , P = .0001 ) . After matching for BMI and age , by conditional regression analysis , we showed that the groups were not differentiated ( P > .15 ) by insulin , HDL-C , LDL-C , TG , SBP , or diastolic blood pressure , but were differentiated by higher FT ( P = .0024 ) and waist circumference ( P = .0024 ) in PCOS than in controls . Prospect i ve longitudinal analyses of NHGS controls showed that changes in BMI from ages 9 to 10 years to ages 15 to 16 years were positively associated with changes in waist circumference ( P < .0001 ) , LDL-C ( P = .01 ) , TG ( P = .008 ) , and SBP ( P = .002 ) . These findings suggest that if adolescent girls achieve adiposity equal to girls with PCOS , they then acquire major components of the metabolic syndrome , and excluding high FT and waist circumference , comparable increased cardiovascular disease risk BACKGROUND In 20 adolescents age < or = 17 ( 16 + /- 1 yr ) with polycystic ovary syndrome ( PCOS ) , we assessed efficacy and safety of metformin-diet for 1 year in treatment of endocrinopathy and coronary heart disease ( CHD ) risk factors . METHODS Calories were targeted to 1,500 - 1,800/ day if body mass index ( BMI ) was < 25 or to 1,200 - 1,500/day if BMI was > or = 25 , along with 2,550 mg metformin . RESULTS Median weight fell from 85.5 to 78.4 kg ( p = 0.004 ) , waist circumference from 91 to 84 cm ( p = 0.017 ) , triglyceride from 108 to 71 mg/dl ( p = 0.008 ) , insulin from 20.5 to 15 microU/ml ( p = 0.018 ) , HOMA-IR from 2.0 to 1.5 ( p = 0.026 ) , and testosterone from 45.5 to 31.5 ng/dl ( p = 0.03 ) . The percentage of cycles with normal menses rose from a pre-treatment median of 8 % to 100 % , p < 0.0001 . CONCLUSIONS In adolescents ( < or = age 17 yr ) with PCOS , metformin-diet safely ameliorates CHD risk factors and endocrinopathy while facilitating resumption of regular menses OBJECTIVE To evaluate the influence of the opioid system on the hypothalamic-pituitary-adrenal axis in women with polycystic ovary syndrome ( PCOS ) . DESIGN Controlled clinical study . SETTING Academic research environment . PATIENT(S ) Eight lean and 12 obese women with PCOS , and seven lean and 5 obese control subjects . INTERVENTION(S ) Each patient received an i.v . bolus of naloxone at a dose of 125 microgram per kilogram of body weight ; 48 hours later , each patient received 16 mg of loperamide p.o . MAIN OUTCOME MEASURE(S ) Sample s were collected for 2 hours for the naloxone test and for 3 hours for the loperamide test .  Levels of adrenocorticotropic hormone ( ACTH ) and cortisol were measured in all plasma sample s. RESULT ( S ) The obese women with PCOS had a greater ACTH and cortisol response to opiate blockade than either the lean women with PCOS or the control subjects , but there was no difference between the lean or obese control subjects and the lean women with PCOS . There was no difference in the responsiveness of the hypothalamic-pituitary-adrenal axis to loperamide between the PCOS and control groups . CONCLUSION ( S ) The data indicate that the sensitivity of the hypothalamic-pituitary-adrenal axis to opioids can not be altered in women with PCOS . However , abnormalities of the hypothalamic-pituitary-adrenal axis in women with PCOS could be central in origin , as suggested by the effects of naloxone administration , and probably are related to the anthropometric characteristics of these hyper and rogenic patients The objective of the present study was to estimate the prevalence of the different pathological conditions causing clinical ly evident and rogen excess and to document the degree of long-term success of suppressive and /or anti and rogen hormonal therapy in a large consecutive population of patients . All patients presenting for evaluation of symptoms potentially related to and rogen excess between October 1987 and June 2002 were evaluated , and the data were maintained prospect ively in a computerized data base . For the assessment of therapeutic response , a retrospective review of the medical chart was performed , after the exclusion of those patients seeking fertility therapy only , or with inadequate follow-up or poor compliance . A total of 1281 consecutive patients were seen during the study period . Excluded from analysis were 408 patients in whom we were unable to evaluate hormonal status , determine ovulatory status , or find any evidence of and rogen excess . In the remaining population of 873 patients , the unbiased prevalence of and rogen-secreting neoplasms was 0.2 % , 21-hydroxylase-deficient classic adrenal hyperplasia ( CAH ) was 0.6 % , 21-hydroxylase-deficient nonclassic adrenal hyperplasia ( NCAH ) was 1.6 % , hyper and rogenic insulin-resistant acanthosis nigricans ( HAIRAN ) syndrome was 3.1 % , idiopathic hirsutism was 4.7 % , and polycystic ovary syndrome ( PCOS ) was 82.0 % . Fifty-nine ( 6.75 % ) patients had elevated and rogen levels and hirsutism but normal ovulation . A total of 257 patients were included in the assessment of the response to hormonal therapy . The mean duration of follow-up was 33.5 months ( range , 6 - 155 ) . Hirsutism improved in 86 % , menstrual dysfunction in 80 % , acne in 81 % , and hair loss in 33 % of patients . The major side effects noted were irregular vaginal bleeding ( 16.1 % ) , nausea ( 13.0 % ) , and headaches ( 12.6 % ) ; only 36.6 % of patients never complained of side effects . In this large study of consecutive patients presenting with clinical ly evident and rogen excess , specific identifiable disorders ( NCAH , CAH , HAIRAN syndrome , and and rogen-secreting neoplasms ) were observed in approximately 7 % of subjects , whereas functional and rogen excess , principally PCOS , was observed in the remainder . Hirsutism , menstrual dysfunction , or acne , but not alopecia , improved in the majority of patients treated with a combination suppressive therapy ; although more than 60 % experienced side effects OBJECTIVE To determine whether polycystic ovary syndrome ( PCOS ) is related to leptin dysregulation . DESIGN Prospect i ve study . SETTING Department of Obstetrics and Gynecology in a university hospital . PATIENT(S ) Fifty patients with PCOS ( 33 nonobese and 17 obese ) and 32 control women ( 19 nonobese and 13 obese ) were included in the study . INTERVENTION(S )  Serum leptin levels were measured in patients with PCOS and the controls . Correlations between leptin levels and serum hormone levels ( FSH , LH , free testosterone , and rostenedione , DHEA-S and fasting insulin )  were studied . MAIN OUTCOME MEASURE(S ) Serum leptin levels and correlations between leptin levels and the hormonal parameters . RESULT ( S ) Mean serum leptin levels were not significantly higher in patients with PCOS compared to the control group . Leptin levels were found to be significantly higher in the obese subgroups both in patients with PCOS and in the control women .  Leptin levels were found to be higher in obese patients with PCOS compared to obese controls ; however , when the levels were evaluated again with covariance analysis excluding body mass index , there was no statistically significant difference . Leptin levels had a positive correlation with body mass index , both in patients with PCOS and the controls . CONCLUSION ( S ) Leptin levels were not higher in patients with PCOS compared to the control group ; the leptin level was correlated with the amount of fat tissue not only in patients with PCOS but also in healthy women Objective Ethinylestradiol ( EE ) combined with the anti and rogenic progestin cyproterone acetate ( CPA ) is a possible treatment in polycystic ovary syndrome ( PCOS ) . We investigated the impact of EE/CPA on lipid and carbohydrate metabolism in women with PCOS , who were otherwise healthy . Method The 31 women were separated into two groups paired by body mass index ( BMI ): Group A ( control , n = 15 ) were cycled with 10 mg medroxyprogesterone acetate ( MPA ) x 10 days ( Provera ® , Pharmacia & Upjohn ) every month for 3 months ; Group B ( n = 16 ) were treated with 35 μg EE/2 mg CPA ( Diane 35 ® , Schering ) for 3 months . Metabolic and hormonal conditions were similar in both groups . Results Group A showed no change in any hormone or metabolic parameter . Group B showed a significant decrease in free and rogen index ( −81 % ) and increase in sex hormone binding globulin ( + 639 % ) , a decrease in low density lipoprotein cholesterol ( −14 % ) and total cholesterol/high density lipoprotein ( HDL ) cholesterol index ( −19 % ) , and increases in HDL cholesterol ( + 23 % ) and triglycerides ( + 82 % ) ( p < 0.001 ) . Fasting insulin increased in 18 % , the glucose/insulin index worsened in 8 % , and the plasma glucose disappearance worsened in 12 % , with no statistical significance ( p = 0.092 , p = 0.308 and p = 0.237 , respectively ) . Conclusion Treatment of PCOS with EE/CPA induces important favorable changes regarding hormone parameters associated with hyper and rogenism , significant favorable changes in lipid profile except for triglyceride increase , and no significant change in carbohydrate metabolism ( measured by fasting insulin , glucose/insulin index and plasma glucose disappearance ) . MPA cycling does not change any of these parameters Polycystic ovary syndrome ( PCOS ) is a common endocrine condition in women of reproductive age associated with obesity . It may involve dysregulation of ghrelin , a hormone implicated in appetite regulation . The effect of diet composition on ghrelin is unclear . Overweight women with and without PCOS were r and omized to a high-protein ( 40 % carbohydrate , 30 % protein ; 10 PCOS , six non-PCOS ) or st and ard protein diet ( 55 % carbohydrate , 15 % protein ; 10 PCOS , six non-PCOS ) for 12 wk of energy restriction and 4 wk of weight maintenance . Diet composition had no effect on fasting or postpr and ial ghrelin or measures of satiety .  Non-PCOS subjects had a 70 % higher fasting baseline ghrelin ( P = 0.011 ) , greater increase in fasting ghrelin ( 57.5 vs. 34.0 % , P = 0.033 ) , and greater maximal decrease in postpr and ial ghrelin after weight loss ( -144.1 + /- 58.4 vs. -28.9 + /- 14.2 pg/ml , P = 0.02 ) than subjects with PCOS . Subjects with PCOS were less satiated ( P = 0.001 ) and more hungry ( P = 0.007 ) after a test meal at wk 0 and 16 than subjects without PCOS . Appetite regulation , as measured by subjective short-term hunger and satiety and ghrelin homeostasis , may be impaired in PCOS BACKGROUND Surprisingly , the prevalence of polycystic ovary syndrome ( PCOS ) in otherwise unselected overweight or obese women is unknown , despite obesity being frequent in patients with PCOS . We conducted the present study to obtain an unbiased estimate of the prevalence of PCOS in unselected overweight and obese premenopausal women from Spain . METHODS All premenopausal women reporting to the Department of Endocrinology , Hospital Universitario Ramón y Cajal , for dietary treatment of overweight or obesity from May 2002 to December 2005 were prospect ively recruited . Women referred for any other reason were automatically excluded to avoid selection bias . Diagnosis of PCOS relied on the presence of clinical and /or biochemical hyper and rogenism , oligo-ovulation , and exclusion of secondary causes . Anthropometric measurements , hirsutism scores , and and rogen , gonadotropin , metabolic , and lipid profiles were obtained . RESULTS Of a total of 113 consecutive women recruited , 32 ( 28.3 % ) were diagnosed as having PCOS ( 95 % confidence interval , 20.0%-36.6 % ) . The prevalence of PCOS was not different when considering the degree of obesity . Another 3 women presented with hyper and rogenemia without oligo-ovulation , 2 had idiopathic hirsutism , 2 had chronic oligomenorrhea without clinical or biochemical hyper and rogenism , and 2 had oligomenorrhea with hyperprolactinemia , precluding the diagnosis of PCOS . The remaining 72 women ( 63.7 % ) had no evidence of hyper and rogenism or reproductive abnormalities . CONCLUSIONS Our results demonstrate a 28.3 % prevalence of PCOS in overweight and obese women from Spain , which is markedly increased compared with the 5.5 % prevalence of PCOS in lean women of our country . Therefore , PCOS must be routinely ruled out in overweight and obese premenopausal women seeking advice for weight loss Women with polycystic ovary syndrome ( PCOS ) are insulin resistant , have insulin secretory defects , and are at high risk for glucose intolerance . We performed this study to determine the prevalence of glucose intolerance and parameters associated with risk for this in PCOS women . Two-hundred and fifty-four PCOS women , aged 14 - 44 yr , were prospect ively evaluated at 2 centers , 1 urban and ethnically diverse ( n = 110 ) and 1 rural and ethnically homogeneous ( n = 144 ) . The rural PCOS women were compared to 80 control women of similar weight , ethnicity , and age . A 75-g oral glucose challenge was administered after a 3-day 300-g carbohydrate diet and an overnight fast with 0 and 2 h blood sample s for glucose levels .  Diabetes was categorized according to WHO criteria . The prevalence of glucose intolerance was 31.1 % impaired glucose intolerance ( IGT ) and 7.5 % diabetes . In nonobese PCOS women ( body mass index , < 27 kg/m2 ) , 10.3 % IGT and 1.5 % diabetes were found . The prevalence of glucose intolerance was significantly higher in PCOS vs. control women ( chi2 = 7.0 ; P = 0.01 ; odds ratio = 2.76 ; 95 % confidence interval = 1.23 - 6.57 ) . Variables most associated with postchallenge glucose levels were fasting glucose levels ( P < 0.0001 ) , PCOS status ( P = 0.002 ) , waist/hip ratio ( P = 0.01 ) , and body mass index ( P = 0.021 ) . The American Diabetes Association criteria applied to fasting glucose significantly underdiagnosed diabetes compared to the WHO criteria ( 3.2 % vs. 7.5 % ; chi2 = 4.7 ; P = 0.046 ; odds ratio = 2.48 ; 95 % confidence interval = 1.01 - 6.69 ) . We conclude that 1 ) PCOS women are at significantly increased risk for IGT and type 2 diabetes mellitus at all weights and at a young age ; 2 ) these prevalence rates are similar in 2 different population s of PCOS women , suggesting that PCOS may be a more important risk factor than ethnicity or race for glucose intolerance in young women ; and 3 ) the American Diabetes Association diabetes diagnostic criteria failed to detect a significant number of PCOS women with diabetes by postchallenge glucose values BACKGROUND Diagnosing polycystic ovary syndrome ( PCOS ) in adolescence is clinical ly challenging . The prevalence of clinical , ultrasound and biochemical features of PCOS in a community-based adolescent population using current diagnostic criteria has not previously been described . METHODS This was a prospect i ve cohort study with 244 unselected post-menarchal girls , mean age 15.2 years , of whom 91 % were Caucasian . Subjects were recruited from a large population -based birth cohort ( the Raine cohort ) .  Clinical hyper and rogenism ( HA ) was quantified using Ferriman-Gallwey scores . In the early follicular phase ( Day 2 - 6 ) , we measured circulating and rogens  and  sex hormone-binding globulin  by immunoassay , and ovarian morphology was assessed by transabdominal ultrasound examination .  BMI and waist-hip ratio were measured . RESULTS Normal ranges for early follicular phase and rogens in adolescence were derived for this population . The top 5 and 10 % of circulating free testosterone levels were 45.6 and 34.5 pmol/l , respectively . Fifty-one percent of girls reported menstrual irregularity . Clinical HA was uncommon , being observed in only 3.5 % of girls . Mean ovarian volume was greater than that reported by others in adult women and 35 % of girls had polycystic ovary morphology on transabdominal ultrasound . Taking the upper 5 % of free testosterone as HA , 42 girls ( 18.5 % ) would have met the Rotterdam criteria for PCOS , 11 girls ( 5 % ) the And rogen Excess Society criteria and 7 girls ( 3.1 % ) the National Institutes of Health criteria . CONCLUSIONS Menstrual irregularity is common in adolescence and does not relate to clinical or biochemical HA . Diagnostic criteria for PCOS which include ovarian volume and morphology may be of limited use in adolescence BACKGROUND In a prospect i ve observational study of 42 pregnancies in 39 Caucasian women ( age 30 + /- 4 years ) with polycystic ovary syndrome ( PCOS ) , we examined effects of metformin on maternal insulin , insulin resistance ( IR ) , insulin secretion ( IS ) , weight gain , development of gestational diabetes ( GD ) , testosterone and plasminogen activator inhibitor activity . We assessed the hypothesis that diet-metformin ( MET ) lessens the physiological gestational increase in IR and reduces gestational weight gain , thus reducing GD . METHODS Preconception , in an out-patient clinical research centre , MET 1.5 ( eight pregnancies ) to 2.55 g/day ( 34 pregnancies ) was started . Women with body mass index < 25 or > or=25 kg/m(2 ) were given a 2000 or 1500 calorie/day , high-protein ( 26 % of calories ) , low-carbohydrate ( 44 % ) diet . Calorie restrictions were dropped after conception . RESULTS On MET , GD developed in three out of 42 pregnancies ( 7.1 % ) . Median entry weight ( 94.5 kg ) fell to 82.7 on MET at the last preconception visit ( P = 0.0001 ) , fell further to 81.6 during the first trimester , was 83.6 in the second trimester , and 89.1 kg in the third trimester . Median weight gain during pregnancy was 3.5 kg . The median percentage reduction in serum insulin was 40 % on MET at the last preconception visit ; insulin did not increase in the first or second trimesters ( P > 0.05 ) , and rose 10 % in the third trimester . The median percentage reduction in HOMA IR was 46 % on MET at the last preconception visit ; IR did not increase ( P > 0.05 ) in the first , second or third trimesters . HOMA insulin secretion fell 45 % on MET at the last preconception visit , did not increase in the first trimester , rose 24 % in the second trimester , and rose 109 % in the third trimester . Testosterone fell 30 % on MET at the last preconception visit ( P = 0.01 ) and then rose 74 , 61 and 95 % during trimesters 1 , 2 and 3 ; median testosterone during the third trimester did not differ from pre-treatment levels . CONCLUSIONS By reducing preconception weight , insulin , IR , insulin secretion and testosterone , and by maintaining these insulin-sensitizing effects throughout pregnancy , MET-diet reduces the likelihood of developing GD , and prevents and rogen excess for the fetus Objective : To determine the prevalence of clinical polycystic ovary syndrome ( PCOS ) in 14- to 18-year-old high school girls in Isfahan , Iran . Methods : In this cross-sectional study , 1,000 high school girls ( 14–18 years old ) were selected by multi-stage r and om sampling from different high schools in Isfahan . Following physical examination , a single physician recorded the presence of hirsutism , severe acne , and rogenic alopecia , menstrual dysfunction and obesity using a vali date d question naire . Clinical PCOS was diagnosed if menstrual dysfunction and clinical hyper and rogenism were detected . Results : Clinical PCOS was present in 30 ( 3 % ) , hirsutism in 60 ( 6 % ) , menstrual dysfunction in 74 ( 7.4 % ) and severe acne in 47 ( 4.7 % ) of the population studied . Conclusion : The prevalence of clinical PCOS in our study population was similar to those of other studies ; however , the prevalence could have been higher with hormonal assessment This study explored the effect of the anti- and rogen spironolactone on sex-hormone binding globulin ( SHBG ) and the distribution of circulating testosterone ( T ) into various free and bound fractions in seven women with hirsutism assessed before and then monthly for three months on a regimen of spironolactone , 100 mg bid as the sole therapeutic agent . Blood sample s were taken at each assessment time for a battery of and rogen parameters and serum T fractions studies . None of the women were judged obese based upon body mass index values . After three months of spironolactone therapy , there was little change in the hirsutism index , and measurement of serum T , and rostenedione , DHEA-S and 17ß-estradiol showed no significant changes , the same occurring with SHBG-binding capacity . However , there was a shift in the distribution of circulating T , with a decrease in SHBG-bound T and an increase in albumin-bound and free T ( non-SHBG-bound fractions ) . As previous reports suggest that non-SHBG-bound fractions represent bioavailable fractions , the current data suggests that T fraction studies may not be clinical ly useful parameters of hyper and rogenism in women receiving anti and rogen therapy BACKGROUND The association of body-mass index ( BMI ) from adolescence to adulthood with obesity-related diseases in young adults has not been completely delineated . METHODS We conducted a prospect i ve study in which we followed 37,674 apparently healthy young men for incident angiography-proven coronary heart disease and diabetes through the Staff Periodic Examination Center of the Israeli Army Medical Corps . The height and weight of participants were measured at regular intervals , with the first measurements taken when they were 17 years of age . RESULTS During approximately 650,000 person-years of follow-up ( mean follow-up , 17.4 years ) , we documented 1173 incident cases of type 2 diabetes and 327 of coronary heart disease . In multivariate models adjusted for age , family history , blood pressure , lifestyle factors , and biomarkers in blood , elevated adolescent BMI ( the weight in kilograms divided by the square of the height in meters ; mean range for the first through last deciles , 17.3 to 27.6 ) was a significant predictor of both diabetes ( hazard ratio for the highest vs. the lowest decile , 2.76 ; 95 % confidence interval [ CI ] , 2.11 to 3.58 ) and angiography-proven coronary heart disease ( hazard ratio , 5.43 ; 95 % CI , 2.77 to 10.62 ) . Further adjustment for BMI at adulthood completely ablated the association of adolescent BMI with diabetes ( hazard ratio , 1.01 ; 95 % CI , 0.75 to 1.37 ) but not the association with coronary heart disease ( hazard ratio , 6.85 ; 95 % CI , 3.30 to 14.21 ) . After adjustment of the BMI values as continuous variables in multivariate models , only elevated BMI in adulthood was significantly associated with diabetes ( β=1.115 , P=0.003 ; P=0.89 for interaction ) . In contrast , elevated BMI in both adolescence ( β=1.355 , P=0.004 ) and adulthood ( β=1.207 , P=0.03 ) were independently associated with angiography-proven coronary heart disease ( P=0.048 for interaction ) . CONCLUSIONS An elevated BMI in adolescence -- one that is well within the range currently considered to be normal -- constitutes a substantial risk factor for obesity-related disorders in midlife . Although the risk of diabetes is mainly associated with increased BMI close to the time of diagnosis , the risk of coronary heart disease is associated with an elevated BMI both in adolescence and in adulthood , supporting the hypothesis that the processes causing incident coronary heart disease , particularly atherosclerosis , are more gradual than those result ing in incident diabetes . ( Funded by the Ch aim Sheba Medical Center and the Israel Defense Forces Medical Corps . ) OBJECTIVE Muscle mass plays an important role in determining cardiovascular and metabolic risks in polycystic ovary syndrome ( PCOS ) . In addition , whether lean mass influences carotid intima-media thickness ( IMT ) in PCOS has not been assessed . DESIGN Prospect i ve investigation . METHODS Ninety-five women with PCOS were age- and weight-matched to 90 ovulatory controls . All women had dual X-ray absorptiometry for lean , fat and bone mass  , and bone mass density ( BMD )  . Serum testosterone , sex hormone-binding globulin , insulin , and glucose and carotid IMT  were determined . Free and rogen index ( FAI ) and insulin resistance ( by QUICKI ) were calculated . RESULTS In PCOS , waist circumference and insulin were higher and QUICKI lower than in controls ( P<0.01 ) . Trunk fat mass , % trunk fat , and lean mass were higher in PCOS compared to controls ( P<0.01 ) , while total bone mass and BMD were similar . IMT was increased in PCOS ( P<0.01 ) but only 15 % of PCOS patients had abnormal ( > or = 0.9 mm ) values . Lean mass correlated with fat parameters , insulin , QUICKI , and FAI , but not with total testosterone ; and after adjustments for insulin and QUICKI , lean mass still correlated with fat mass ( P<0.01 ) but not FAI . Lean mass correlated with IMT ( P<0.01 ) , but this was dependent on insulin . However , excluding those patients with abnormal IMT values , IMT correlated with lean mass independently of insulin . Bone mass correlated with lean and fat mass , but not with insulin or and rogen . PCOS patients with ' pathological ' IMT values had higher % trunk fat , lean mass , and insulin , lower QUICKI , and higher testosterone and FAI compared with those with normal IMT . CONCLUSION Lean mass is increased in PCOS , while bone mass is similar to that of matched controls . The major correlates of lean mass are fat mass and insulin but not and rogen . Lean mass also correlated with IMT , and although influenced by insulin , small changes in IMT may partially reflect changes in muscle mass , while clearly abnormal values relate to more severe abnormalities of PCOS
BACKGROUND Polycystic ovary syndrome ( PCOS ) is closely associated with obesity but the prevalence of obesity varies between published studies .
The objective of this research was to describe the prevalence of overweight , obesity and central obesity in women with and without PCOS and to assess the confounding effect of ethnicity , geographic regions and the diagnostic criteria of PCOS on the prevalence .