Comparative study of the therapeutic effects of oral pills containing desogestrel, cyproterone acetate and drospirenone, in patients with polycystic ovary syndrome (PCOS)

Background: Androgen excess may correlate with metabolic risk in polycystic ovary syndrome (PCOS). The aim of the study was to determine the role of total testosterone to dihydrotestosterone (TT/DHT) ratio in assessing the adverse metabolic outcome in PCOS. Methods: This cross-sectional study encompassed 40 PCOS women recruited on the basis of revised Rotterdam criteria 2003, and 40 age-matched control subjects. TT, sex hormone binding globulin (SHBG) and insulin levels were measured by chemiluminescent microparticle immunoassay (CMIA) while DHT by enzyme-linked immunosorbent assay (ELISA). In addition, TT/DHT ratio, free androgen index (FAI), and insulin resistance (IR) by homeostatic model of assessment of insulin resistance (HOMA-IR) were calculated. Results: TT/DHT ratio was significantly higher in PCOS group than control group (P < 0.001). No significant difference was found for DHT (P = 0.261). PCOS patients had significantly higher TT (0.69 ± 0.26 vs. 0.30 ± 0.13 ng/mL; P < 0.001), FAI (P < 0.001) and low SHBG (P = 0.004) compared to controls. TT/DHT ratio was significantly higher in PCOS with impaired glucose tolerance (IGT) (P = 0.037) and metabolic syndrome (MetS) (P = 0.041). The best cutoff value for TT/DHT ratio to diagnose PCOS was observed to be 2.38 (sensitivity: 70%, specificity: 32.5% and area under the curve (AUC): 0.753). TT/DHT ratio also showed positive correlation with weight (r = 0.323, P = 0.042), waist circumference (WC) (r = 0.372, P = 0.018), HOMA-IR (r = 0.385, P = 0.014), 2-h post 75-g glucose (2h-PG), (r = 0.413, P = 0.008) and triglyceride (TG) level (r = 0.402, P = 0.010) in PCOS. Conclusions: There is a close relation between the TT/DHT ratio and adverse metabolic outcome in PCOS. Therefore, TT/DHT ratio may be considered as a predictor of adverse metabolic findings in PCOS. J Endocrinol Metab. 2019;9(6):186-192 doi: https://doi.org/10.14740/jem601

Objective: To investigate the correlation between body composition parameters, adiponectin, leptin and the adiponectin/leptin ratio and the LH/FSH ratio in women with polycystic ovary syndrome (PCOS).&#x0D; Methods: A cross-sectional study was conducted at Reproductive Cluster Yasmin, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia, with sixty women with PCOS and sixty healthy women as controls (matched for age and BMI). Body composition parameters, including body weight, body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), percent body fat (PBF), visceral fat area (VFA), percent subcutaneous fat (PSF) and skeletal muscle mass (SMM), were measured; levels of fasting glucose, fasting insulin, testosterone, and sex hormone binding globulin (SHBG) were measured; and homeostatic model assessment for insulin resistance (HOMA-IR) values, anti-Mullerian hormone (AMH), free androgen index (FAI), Ferriman-Gallwey (FG) score, adiponectin levels, leptin levels, adiponectin/leptin ratio, LH, FSH and LH/FSH ratio were measured.&#x0D; Results: Body composition parameters (body weight, BMI, WC, WHR, PBF, VFA, PSF, SMM) were not significantly different between women with PCOS and controls. Fasting insulin (P&lt;0.05), HOMA-IR (P&lt;0.05), AMH (P&lt;0.01), FAI (P&lt;0.01), FG score (P&lt;0.01) and LH/FSH ratio (P&lt;0.05) were higher in PCOS women. Adiponectin (P&lt;0.01) was lower in PCOS women, while leptin and the adiponectin/leptin ratio were not significantly different between groups. Most of body composition parameters, adiponectin, leptin and adiponectin/leptin ratio were correlated with HOMA-IR in both groups.&#x0D; SMM was positively correlated with the LH/FSH ratio, while body weight, BMI, WC, PBF, VFA, and PSF were inversely correlated with the LH/FSH ratio in PCOS patients but not in controls. WHR was not correlated in either group. Leptin (r=-0.278; P&lt;0.05) was negatively correlated with the LH/FSH ratio only in the PCOS group. Adiponectin (r=0.394; P&lt;0.01) and the adiponectin/leptin ratio (r=0.413; P&lt;0.01) were also positively correlated with the LH/FSH ratio only in the PCOS group. AMH was correlated with the LH/FSH ratio, whereas testosterone level, FAI, FG score, fasting insulin level and HOMA-IR value were not correlated with the LH/FSH ratio in PCOS women.&#x0D; Conclusion: Most of the body composition parameters, leptin, adiponectin and the adiponectin/leptin ratio were significantly correlated with HOMA-IR in both groups. However, correlations of those parameters with LH/FSH ratio were found only in PCOS but not in women without PCOS. Adiponectin and leptin may play a significant role in the mechanism of neuroendocrine disorders in PCOS, which is characterized by an increased LH/FSH ratio.&#x0D; Keywords: adiponectin, adiponectin/leptin ratio, body composition, HOMA-IR, leptin, LH/FSH ratio, PCOS

Introduction: There are several phenotypes of polycystic ovarian syndrome (PCOS), and the different phenotypes may differ metabolically. Methods: In the present retrospective study, women with PCOS having normal fasting insulin sensitivity (n = 88) were compared with women with PCOS showing impaired insulin sensitivity (n = 46) using the HPCOS (Hungarian Polycystic ovarian syndrome) database. Results: The impaired insulin sensitivity group has significantly higher body mass index (BMI) and HOMA index than the normal fasting insulin sensitivity group (BMI (kg/m2): 22.0 vs. 28.1, p < 0.0001, HOMA index: 0.96 vs. 2.38, p < 0.0001). The sex hormone binding globulin (SHBG) level was significantly lower, and the free androgen index proved itself significantly higher in the impaired insulin sensitivity group (p < 0.05). Linear regression analysis showed a negative association of BMI with SHBG levels in both groups, while BMI had a positive correlation with insulin concentrations in both groups. However, the SHBG levels were negatively associated with insulin concentrations in the impaired insulin sensitivity group, but this inverse association could not be observed in the normal fasting insulin sensitivity group. Conclusions: The inverse linear correlation of SHBG with HOMA index and serum insulin level is not evident in all PCO syndrome phenotypes, thus SHBG has limited applicability for characterizing carbohydrate metabolism and serum insulin sensitivity.

To investigate and analyze the clinical presentation, hormonal profile, and metabolic abnormalities of obese women with polycystic ovary syndrome (PCOS). The data of the anthropometric measurements, clinical manifestations of hyperandrogenism, serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol (E(2)), testosterone (T), prolactin (PRL), dehydro-epiandrosterone sulfate (DHEAS), sex-hormone-binding globulin (SGBG), and 17-oxyhydroprogesterone (17-OHP), fasting plasma glucose (FPG) and fasting insulin (FINS) detected after oral glucose tolerance test (OGTT), serum lipid levels, including total cholesterol (Chol), triglycerides (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL), homeostasis model assessment (HOMA) and area under curve (AUC) so as to assess the insulin resistance (IR), free androgen index (FAI) to estimate the extent of hyperandrogenism, HOMA IS and DeltaI(30)/DeltaG(30) used to assess the function of islet beta cells, were collected from 192 women with PCOS, aged 24 +/- 6, that were divided into 2 groups according to the body mass index (BMI): Group A (n = 70) with the BMI > or = 25 kg.m(-2) and Group B (n = 122) with the BMI < 2 5 kg.m(-2), and 65 age-matched bilateral tubal block factor infertile women served as controls that were divided into 2 groups as well: Group C (n = 25) with the BMI > or = 25 kg.m(-2); and Group D (n = 79) with the BMI < 25 kg.m(-2), and underwent a cross-sectional study. (1) Clinical phenotype: The presence of obesity was 36.46% (70/192) of which 80.00% (56/70) was central obesity. The incidence of acanthosis nigricans was 17.18% (33/192), 35.71% in Group A and 6.56% in Group B. (P < 0.01). Groups A and C showed increased frequency of acanthosis nigricans compared with Group B. The value of FAI of Group A was 3.40 +/- 1.84, significantly higher than those of Group B (1.75 +/- 1.20) and Group C (1.65 +/- 0.90), (both P < 0.01). The LH/FSH ratio of Group B was 2.41 +/- 1.13, significantly higher than those of Groups A, C, and D (all P < 0.01). (2) Hormonal profile: The IR rate was 43.23% in the 192 patients, 82.86% in Group A and 20.49% in Group B. The LH and LH/FSH ratio were significantly higher in Group B than in Groups A, C, and D (all P < 0.01); T level was higher in Groups A and B than in Group C and D (all P < 0.05). SHBG was lower in Group A (108.70 +/- 81.35 nmol.L(-1)) and Group C (150.34 +/- 106.23 nmol.L(-1)) compared with Group B (192.49 +/- 98.30 nmol.L(-1)) and Group D (231.84 +/- 90.09 nmol.L(-1)) (P < 0.01 and P < 0.05). FAI level was 3.40 +/- 1.84 in Group A, significantly higher than those of Groups B (1.75 +/- 1.20), C (1.65 +/- 0.90), and D (0.84 +/- 0.45) (all P < 0.01). The FINS, TG, and HOMA IR of Groups A and C were all significantly higher than those of Groups B and D (all P < 0.01). The OGTT GAUC was significantly higher than those of Groups B, C, and D (P = 0.006, 0.028, and 0.031 respectively). (3) Metabolic profile: The prevalence of IR was 43.23% (83/192) with a higher prevalence rate in Group A (82.76%, 58/70) compared with Group B (20.49%, 25/122). The values of FINS, HOMA IR, GAUC, IAUC, and TG were all higher in Group A than in Group B (all P < 0.01). BMI and WHR were positively correlated with FAI and HOMA-IR (all P < 0.01), whereas negatively correlated with LH/FSH ratio (r = -0.345, -0.260, P < 0.01). There were no significant differences in HOMA-IS and DeltaI(30)/DeltaG(30) among these groups (all P > 0.05). Obese PCOS women have more severe hyperandrogenism, IR and hyperinsulinism than normal-weight PCOS women, which may have some health implications later in life.

Endogenous sex hormones and risk of venous thromboembolism in young women

Clinical and endocrine characteristics of the main polycystic ovary syndrome phenotypes

Two weeks of metformin improves clomiphene citrate-induced ovulation and metabolic profiles in women with polycystic ovary syndrome

Periodontal disease in polycystic ovary syndrome

Background: Polycystic ovarian syndrome (PCOS) is the most frequent androgen disorder of ovarianfunction. This was a cross-sectional study designed to evaluate the levels of sex hormone-binding globulin(SHBG), fasting insulin and some select androgens in women with polycystic ovarian syndrome (PCOS) inNnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria.Materials and Methods: Seventy four (74) women aged between 18-40 years were conveniently selected.37 of them attending the gynecological clinic were diagnosed with PCOS based on the Rotterdamcriteria. The remaining 37 participants were apparently healthy hospital staff recruited as control. Bloodsample was collected from all the participants for determination of SHBG, fasting insulin, testosterone,dehydroepiandrosterone sulfate (DHEA-S) and estradiol (E2) levels using standard laboratory methods.Results: Fasting insulin, testosterone, DHEA-S in participants with PCOS were significantly highercompared with their corresponding control participants (p = 0.005, 0.001, 0.001 respectively), while SHBGin participants with PCOS was significantly lower compared with the control participants (p = 0.002). Bodymass index (BMI) and free androgen index ratio (FAI) were significantly higher in participants with PCOScompared with their corresponding controls (p = 0.043, 0.001). Waste/hip ratio showed a strong negativecorrelation with levels of SHBG and E2 in participants with PCOS (p = 0.025, 0.015, r = -0.368, 0.397respectively), while BMI showed a strong negative correlation with E2 in participants with PCOS (r =-0.374, p = 0.023).Conclusion: Significantly higher BMI value shows evidence of obesity and or overweight in femaleparticipants with PCOS. Significantly higher levels of testosterone, DHEA-S, fasting insulin, FAI, withlower SHBG suggests androgen excess and hyperinsulinemia which may subsequently predispose thewomen to type II diabetes.

Background: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder in women of reproductive age and is frequently associated with insulin resistance and hyperandrogenism. Insulin resistance plays a pivotal role in aggravating androgen excess and contributes to both reproductive and metabolic complications. Evidence from Pakistani populations regarding this relationship remains limited. Objective: To assess the association between insulin resistance and hyperandrogenism among women diagnosed with PCOS in Pakistan. Methods: This cross-sectional analytical study was conducted at Sheikh Zayed Hospital, Lahore, and Arif Memorial Teaching Hospital, Pakistan, from January 2023 to May 2024. A total of 90 women aged 18–40 years diagnosed with PCOS according to the Rotterdam criteria were included. Clinical hyperandrogenism was assessed using the modified Ferriman–Gallwey score, while biochemical evaluation included fasting glucose, insulin, total testosterone, and sex hormone-binding globulin levels. Insulin resistance was determined using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Statistical analysis was performed to evaluate correlations between insulin resistance and hyperandrogenic parameters. Results: Insulin resistance was observed in 64.4% of participants. Significant positive correlations were found between HOMA-IR and total testosterone, free androgen index, and modified Ferriman–Gallwey score, while a significant inverse correlation was observed with sex hormone-binding globulin levels (p &lt; 0.001). These associations remained significant after adjustment for body mass index. Conclusion: Insulin resistance is highly prevalent among Pakistani women with PCOS and shows a strong independent association with hyperandrogenism. Early metabolic screening and targeted interventions may help reduce disease severity and long-term metabolic complications. Keywords: Polycystic, Insulin, Hyperandrogenism, Resistance, Metabolism

Background Polycystic ovary syndrome (PCOS) is one of the most prevalent endocrine and metabolic disorders among women of reproductive age and is frequently exacerbated by obesity. Alterations in metabolic and hormonal regulators such as ghrelin, leptin, and Sex Hormone-Binding Globulin (SHBG) may contribute to the complex pathophysiology observed in affected women. Understanding these biochemical changes within the local population is essential for diagnostic accuracy and clinical management in Fallujah City. Objective To compare serum levels of ghrelin, leptin, Sex Hormone-Binding Globulin (SHBG), insulin, glucose, and Luteinizing Hormone (LH) between obese women with PCOS and healthy obese controls. Methods This case&ndash;control study was performed from October 15, 2024, to January 15, 2025, at the Laboratory Department at Fallujah Teaching Hospital , Anbar Governorate,Iraq in addition to several private laboratories in Fallujah City. A total of seventy obese women aged 18&ndash;45 years were enrolled and divided into two groups: 35 healthy controls and 35 women diagnosed with PCOS based on ultrasound findings and clinical evaluation by a specialist . Blood samples were collected, centrifuged, and analyzed for insulin, glucose, LH, SHBG, leptin, and ghrelin. Results The findings demonstrated a significant decrease in serum SHBG and ghrelin levels in the PCOS group compared with controls, whereas glucose, insulin, leptin, and LH levels were significantly increased (p &le; 0.001). Conclusion The biochemical profile of obese women with PCOS in this study reveals clear disturbances in both metabolic and hormonal parameters. Reduced ghrelin and SHBG level , alongside increased leptin, insulin, glucose, and LH, highlight the complex metabolic burden associated with PCOS and underscore the importance of early biochemical evaluation in this population.

Polycystic ovarian syndrome (PCOS) is a most common endocrinopathy in women of reproductive age group characterised by various metabolic and reproductive disturbances. Vitamin D is a fat-soluble vitamin having major influence on reproductive health. The beneficial effects of vitamin D on reproduction may be attributed to ovulation stimulation as well as improved implantation. Since infertility is the frequent presentation in patients with PCOS, we aim to determine the circulating vitamin D levels in infertile patients with PCOS in comparison with normal fertile controls and to correlate it with other endocrine parameters. A cross sectional study was conducted in a tertiary care hospital including 111 infertile patients presenting with PCOS and 107 normal fertile controls in the age group 18-39yrs. Circulating FSH, LH, Total testosterone, SHBG (sex hormone binding globulin) and vitamin D levels were measured in both the groups by chemiluminescence immunoassay. Free androgen index (FAI) was calculated. Circulating vitamin D levels in PCOS patients was compared with normal fertile controls using unpaired ‘t’ test and correlated with other endocrine parameters like FSH, LH, Testosterone, SHBG and FAI using Pearson correlation analysis. Mean circulating vitamin D levels in cases were significantly lower compared to controls (17.08 Vs 26.95, p&lt;0.001). Vitamin D showed a significant negative correlation with testosterone (r -0.66, p&lt;0.001), FAI (r -0.41, p&lt;0.001) and significant positive correlation with SHBG (r 0.18, p&lt; 0.001). No significant correlation was observed between circulating vitamin D levels with other endocrine parameters like FSH, LH and LH:FSH ratio. Low circulating vitamin D levels in infertile PCOS patients and its correlation with endocrine parameters found in our study suggest the possible role of this fat-soluble vitamin in pathogenesis and complications of PCOS.

Objective To explore the clinical efficacy and safety Diane-35 and metformin combined treatment for endometrial atypical hyperplasia (EAH) and early endometrial carcinoma (EEC) in polycystic ovary syndrome (PCOS) patients. Methods PCOS patients with endometrium lesion were re-cruited. All patients were treated with Diane-35 (1 tablet per day, for 21 d per month) plus metformin (1 000 mg, qd) for 6 months. Endometrial biopsies for pathological evaluation before, during and after treatment were conducted. Other clinical parameters included body weight (BW), body mass index (BMI), follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), sex hormone-binding globulin (SHBG), free androgen index (FAI), insulin area under curve (IAUC), homeostasis model assessment of insulin resistance (HOMA-IR) were detected as well. After successful conversion of endometrial lesions, we continued to give patients with Dydrogesterone (10 mg/d, for 14 d per month) and metformin. Results Totally 43 PCOS patients with endometrium lesion (30 EAH and 13 EEC) were re-cruited. After 6-month treatment, the endometrium in all PCOS patients was confirmed by pathological evaluation to be reversed to normal epithelia with Diane-35 plus metformin treatment. By the end of 6-month treatment, mean BMI, TT, FAI, HOMA-IR were decreased respectively (P<0.05), while SHBG were increased (P<0.05). The complete response (CR) rate was 100%. During 6-18 months of follow-up, 2 EAH patients relapsed, and both of whom did not continue to use progesterone therapy monthly; 2 EEC relapsed, who had complicated with ovary tumor. Conclusion Diane 35, a low-dose oral contraceptives with anti-androgen activity, when used in combination with metformin can completely revert the EEC and EAH to normal endometrial cell in PCOS patients, even in those who have been failure to high-dose progestin treatment before. Diane-35 with metformin combination treatment may be a good choice for the EAH and EEC in PCOS patients, which enables these patients to preserve the fertility. Key words: Polycystic ovary syndrome (PCOS); Endometrial atypical hyperplasia (EAH); Early endometrial carcinoma (EEC); Diane-35 combined with metformin

Plasma adiponectin and insulin resistance in women with polycystic ovary syndrome

The purpose of this study was to investigate the effect of calorie restriction on serum concentrations of sex hormone binding globulin (SHBG) in women with normal or polycystic ovaries (PCO) and to examine the possible role of insulin and insulin-like growth factor-I (IGF-I) in mediating changes in SHBG levels. Six normal subjects with mean (SD) body mass index (BMI) 25.5 (2.2) and five subjects with PCO (BMI 36.1 (3.7)) were studied before and after 2 or (PCO only) 4 weeks of a very low calorie diet (330 kcal/day; Cambridge Diet). In both normal women and patients with PCO there was a twofold increase in SHBG concentrations after 2 weeks and this was sustained in the PCO subjects for a further 2 weeks. The rise in SHBG was accompanied by a fall in free testosterone concentrations. There were parallel changes in serum insulin and IGF-I concentrations which decreased during the diet and there were significant negative correlations of SHBG with insulin in both normal subjects (r = -0.62) and women with PCO (r = -0.60). In addition, serum concentrations of an insulin-dependent small molecular weight (34 kDa) binding protein for IGF-I (IGF-BPI) increased significantly during dieting in both groups and were negatively correlated with serum insulin (controls, r = -0.56; PCO, r = -0.68) and positively correlated with serum SHBG levels (controls, r = 0.69; PCO, r = 0.63). In summary, these data indicate that in both normal subjects and those subjects with PCO, calorie restriction results in a highly significant increase in SHBG concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)