Compressive analysis of polycystic ovarian syndrome in female students of Kursk from India, Malaysia and Africa

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women, affecting 4.8 % to 18.6 % of women of reproductive age. Between 10 and 19 years of age, PCOS occurs in 3.39 % to 8.03 % of adolescents. Confirmation of diagnosis in adolescent age is difficult because manifestations of PCOS are similar to normal puberty signs (e. g., irregular menstrual cycle, acne, etc.). New evidence-based guidelines have been issued in 2018 highlighting the diagnostic criteria for establishing PCOS diagnosis in adolescents. These guidelines also recommend a separate identification of risk group patients – adolescent patients for whom both diagnostic PCOS criteria have not yet been confirmed and who should continue to be monitored. It is important to diagnose this disease as early as possible in order to initiate lifestyle adjustments and possibly also begin treatment in a timely manner.In the long term, PCOS increases the risk of developing infertility and type 2 diabetes, cardiovascular disease, insulin resistance and metabolic syndrome. Increased body weight occurring in 40–70 % of adolescents with PCOS significantly increases the risk of chronic non-communicable diseases at a later stage, and maintains PCOS symptoms. PCOS and associated symptoms reduce health-related quality of life (HRQOL). Binge eating is more common in patients with PCOS. The most effective tactics of therapy are lifestyle changes, so it is particularly important to recognise patients at increased risk of developing PCOS, to diagnose them early and to offer treatment that is most relevant to the needs of the individual and improves their quality of life.The aim of the doctoral thesis is to explore intergenerational, genetic, quality of life and binge eating aspects in teenagers with PCOS.The study contains several sections. To evaluate the intergenerational bond, 57 teenagers with PCOS and their mothers were included in Section I. The section studies the relationship between patients with PCOS and their mothers. In addition to PCOS patients, Section II also includes healthy adolescent patients and patients at risk. The role of the most common variation of protein-coding genes involved in the activity of the Hypothalamic-Pituitary-Ovarian axis (FSHR, ESR2, LHCGR, GNRHR) in PCOS development and in the PCOS clinical presentation was studied by including 63 adolescents with a diagnosis of PCOS, 67 healthy control patients and 22 patients at risk. The role of CYP21A2 gene variations in PCOS development and clinical phenotype was established in 55 PCOS patients, 49 control patients and 23 patients at risk. Additionally, components of HRQOL, binge eating and factors affecting the total HRQOL were analysed in 63 PCOS patients and 66 control patients. The study concluded that it was not possible to predict clinical symptoms associated with PCOS in adolescents based on PCOS symptoms in their mothers. The role of protein-coding gene variations that are involved in the functioning of sex hormones was also not found, in regard to PCOS development. However, it was found that the homozygous minor allele carriers within variations of specific genes (ESR2 rs4986938 and LHCGR rs2293275) had a higher total testosterone level in blood than patients who were not carriers of these alleles. The most important components that affected HRQOL in adolescents with PCOS were the diagnosis of PCOS as such, the degree of binge eating, and the percentile of the body mass index. At the same time, HRQOL was most affected by concerns about body hair and body weight. There was no difference in the frequency of binge eating between PCOS patients and adolescent control group patients.In this study, no link was found between the diagnosis of PCOS or associated symptoms in mothers and the phenotype of adolescents with PCOS. Individual alleles have been associated with the clinical presentation of PCOS. There is a better understanding of the components of HRQOL that affect PCOS the most and require particular attention in clinical practice. Further research with a larger sample-size is needed. Furthermore, longitudinal data on the population studied in this project would provide a more accurate insight into the development of the disease at a later age.

Periodontal disease in polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is an endocrine disorder that can result in reduced health-related quality of life (HRQOL). Metabolic changes, particularly insulin resistance and obesity, play a significant role in PCOS pathogenesis. This study examined associations between metabolic factors and HRQOL in PCOS patients. A cross-sectional study of 77 patients was conducted at University Medical Center Mainz. At the time of inclusion in the study, patients had to be over 18 and not undergoing active PCOS therapy. A desire to conceive or fertility therapy led to exclusion. Participants were over 18, not undergoing PCOS therapy, and not seeking pregnancy. HRQOL and psychological distress were measured using the Modified-PCOS-Questionnaire (MPCOSQ) and Hospital Anxiety and Depression Scale (HADS). Linear regression analyses assessed associations between metabolic markers and HRQOL, with significant variables included in a multivariate model. Worsening metabolic markers were linked to lower HRQOL, especially in body hair and menstrual symptom domains. Markers such as HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) levels (P=0.040), elevated VAI (Visceral Adiposity Index) (P=0.035), and increased FLI (Fatty Liver Index) (P=0.023) were associated with diminished HRQOL. In the multivariate regression analysis, only a BMI ≥25kg/m2 (P=0.001) emerged as a statistically significant value. This study showed a significant correlation between metabolic markers, including BMI, FLI, VAI, HOMA-IR, and HRQOL in PCOS patients. BMI was the most meaningful predictor for HRQOL. BMI, despite being controversial and prone to errors, may be more indicative of HRQOL than specific metabolic markers.

Can cluster analysis be used to differentiate between normo-ovulatory women with normal ovaries and normo-ovulatory women with polycystic ovarian morphology (PCOM) in a non-subjective manner? Cluster analysis can be used to accurately and non-subjectively differentiate between normo-ovulatory women with normal ovaries and normo-ovulatory women with PCOM. Currently, PCOM is diagnosed using a fixed threshold level, i.e. 12 or more follicles per ovary, and is one of the diagnostic criteria of polycystic ovary syndrome (PCOS). However, PCOM is also encountered in normo-ovulatory women, suggesting that it could just represent a normal variant. On the other hand, recent studies have shown subtle endocrine abnormalities in women with isolated PCOM that resemble those found in women with PCOS. Because of the strong correlation between anti-Müllerian hormone (AMH) and follicle number, a high serum AMH level has been proposed as a surrogate marker for PCOM and could, therefore, be integrated in the diagnostic classifications for PCOS. This was a retrospective observational cohort study. Original cohorts had been recruited for previous studies between 1998 and 2010. Two hundred ninety-seven regularly cycling women and 700 women with PCOS were eligible for inclusion. Cluster analysis was performed in 297 regularly cycling women. After exclusion of 'PCOM' clusters, each 'non-PCOM' cluster (young, n = 118 and old, n = 100) was included in the construction of a receiver operating characteristics curve to test the diagnostic performance of follicle number per ovary (FNPO) and serum AMH in discriminating similarly aged full-blown PCOS patients (n = 411 and 237, respectively) from normal regularly cycling non-PCOM women. The optimal number of clusters was four; age was the most important classifying variable, followed by the FNPO and serum AMH. Two distinct clusters of normo-ovulatory women with PCOM were isolated and differed solely by age, i.e. 'young' and 'old'. Both 'PCOM' clusters had their similarly aged counterpart of 'non-PCOM' clusters. Likewise, two clusters comprised women younger than 30 years, with (n = 28, 'PCOM regularly cycling women') or without (n = 118, 'normal regularly cycling women') features of PCOM (increased FNPO and/or serum AMH). The two other clusters in older women could be labelled 'normal regularly cycling women' or 'PCOM regularly cycling women' (n = 100 and 51, respectively). The prevalence of PCOM was significantly greater in old than in young regularly cycling women controls. In the young population, after exclusion of the 'PCOM regularly cycling women', the diagnostic performance of AMH, expressed by area under the curve (AUC) (AUC = 0.903; CI (0.876-0.930)) to differentiate PCOS women from normal regularly cycling women was similar to that using the FNPO (AUC = 0.915, CI (0.891-0.940)) (P = 0.25), confirming results from earlier studies. In the old population, the diagnostic performance of AMH was greater than that of FNPO (AUCs = 0.948 (0.927-0.970) vs 0.874 (0.836-0.912), respectively, P = 0.00035). Cut-off levels of AMH and antral follicle count distinguishing regularly cycling non-PCOM women from PCOS women were higher in young women than in older women. Data of normal women were obtained from earlier studies, aiming to measure normal endocrine values. Apparently, the strong effect of age in cluster analysis revealed a dichotomy in the age distribution among the cohort of regularly cycling women included. This was involuntary since in none of the original studies, eligibility was limited by age and there was considerable overlap in age ranges of the cohorts. Transvaginal ultrasound was performed using a 6.5-8 mHz probe and our data confirm that this threshold level for FNPO is still valid if using such probe frequencies, although the use of devices with a maximum frequency lower than 8 mHz has become obsolete. Obviously, newer ultrasound scanner using higher transducer frequency will facilitate the detection of more follicles. Our data support the use of AMH as a surrogate for ultrasound to define PCOM, which is one of the three items of the Rotterdam classification. They also show that age should be taken into account to define the optimal threshold. The fact that the prevalence of PCOM was increased in the older regularly cycling women, may be due to 'attenuated' PCOS, a phenomenon that has been described in ageing women with PCOS. These women might have had anovulatory cycles in the past and have become ovulatory with increasing age, and were, therefore, eligible for this study. However, since most women included at older age have had spontaneous pregnancies in the past, PCOM at older age may be associated with a subclinical form of PCOS, which may also be present in young regularly cycling women. No funding was received for this study. J.S.E.L. has received grants and support from Ferring, MSD, Organon, Merck-Serono, Schering Plough and Serono during recruitment and analysis of data for this study. S.L.F., A.D. and D.D. do not have any conflict of interest.

Increased monocyte chemoattractant protein-1 levels indicating early vascular damage in lean young PCOS patients

Polycystic ovary syndrome (PCOS) is a complex and prevalent endocrine condition among reproductive-age women associated with adverse metabolic consequences. Metabolic syndrome (MetS) is a cluster of risk factors conferring an increased risk for type 2 diabetes (DM2) and cardiovascular disease (CVD). Research has been limited, in part, due to marked heterogeneity in criteria employed to determine MetS, retrospective data collection, and the use of older or less accurate criteria to diagnose PCOS and polycystic ovarian morphology (PCOM). We aimed to 1) examine the prevalence of MetS and evaluate DM2 and CVD risk factors in reproductive-age Canadian women with PCOS; and, 2) assess the relevance of MetS to clinical and biochemical features of PCOS using a prospective comprehensive approach and a rigorously-defined PCOS population. Baseline observations were evaluated in 237 women with PCOS (Androgen Excess and PCOS [AE-PCOS] Society 2006 criteria for PCOS and AE-PCOS Society 2014 recommendations to determine PCOM) and 42 healthy controls (18-36 years). Clinical and biochemical measures of MetS (International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute 2009), DM2 (Diabetes Canada Clinical Practice Guidelines 2018), and CVD risk factors (AE-PCOS Society statement 2010) were assessed. The prevalence of MetS was 29.5% in women with PCOS; that is, approximately 6-fold higher than age-matched controls (P<0.001). Women with PCOS presented with higher glucose abnormality, acanthosis nigricans, total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio, and lower sex-hormone binding globulin (SHBG) concentrations when compared with controls after accounting for differences in the body mass index (BMI; P<0.01). Women with both PCOS and MetS exhibited exacerbated insulin and glucose responses to a 75-gram glucose tolerance test, increased TC/HDL-C ratio, TC, and SHBG concentrations, as well as increased hirsutism and acanthosis nigricans when compared to women with PCOS without MetS after adjusting for BMI (P≤0.05). Canadian reproductive-age women with PCOS whose PCOM were characterized according to the AE-PCOS Society 2014 recommendations have a high prevalence of MetS and exhibit adverse cardiometabolic and DM2 risk profiles. MetS is associated with increased hyperandrogenism and hypercholesterolemia in women with PCOS attributed to inherent insulin resistance, hyperinsulinemia, and synergistic effects of concomitant obesity. Screening and regular monitoring for CVD and DM2 risk factors are reinforced for women with PCOS across the reproductive lifespan.

Study question What mechanisms are involved in the ovarian alterations of Polycystic Ovary Syndrome (PCOS) and Morphology? Summary answer PCOS patients associated a distinctive impairment of oxidative phosphorylation and dysregulated complement system in their follicular compartments not found in Polycystic Ovarian Morphology (PCOM) women. What is known already PCOS is a major cause of female infertility characterized by aberrant follicular development and hormonal imbalances leading to reproductive symptoms such as anovulation, poor oocyte quality, and hyperandrogenism. Likewise, PCOM is present in 16-25% of women with regular menses, but the clinical relevance of this ovarian phenotype and its correlation with PCOS remains unclear. Therefore, to establish the specific molecular mechanisms underlying the ovarian alterations in PCOS using High-throughput techniques will allow us to provide a better clinical management and a differential diagnosis with PCOM women. Study design, size, duration Cross-sectional molecular study including samples from 26 patients undergoing an IVF cycle between 2019-2022 at Hospital La Fe (Valencia, Spain). Eight women were considered PCOS, eleven PCOM and seven were control fertile patients. Granulosa cells (GCs) and follicular fluid (FF) samples were obtained during oocyte retrieval to perform RNA-seq and proteomic analysis, respectively. Participants/materials, setting, methods Women with two or more Rotterdam-criteria were considered as PCOS, while PCOM was defined by polycystic ovarian morphology on ultrasound with regular ovulatory cycles. RNA from GCs was obtained and sequenced using NextSeq500-Illumina to identify differentially expressed genes (DEGs) using DESeq2 (R-software). The proteome of FF samples was established by LC-MS/MS and differentially expressed proteins (DEPs) analyzed with limma package. Functional enrichment analysis of DEGs and DEPs (FDR&amp;lt; 0.05) was performed based on KEGG database. Main results and the role of chance RNA-seq data revealed clear distinctions between GCs from PCOS and control women, with 526 DEGs. By contrast, the transcriptomes of PCOS and PCOM were more similar, with only 34 DEGs. Notably, oxidative phosphorylation emerged as the most enriched pathway in both comparisons, showing a differential expression in PCOS. Indeed, 6 out of 12 shared DEGs (MT-TP, MT-ND4L, MT-ND2, MT-ATP8, MT-ND4, and MT-ATP6), were mitochondrial genes found upregulated in PCOS vs. PCOM and control samples. These findings suggest that granulosa cells from PCOS present a dysregulation in oxidative phosphorylation, potentially linked to alterations in those genes associated with the mitochondrial electron transport chain. The proteomic analysis showed 37 DEPs in the FF of PCOS compared with controls, being these DEPs mainly involved in the complement and coagulation cascades, PI3K-AKT pathway, oocyte meiosis and ferroptosis. Furthermore, the PCOS vs. PCOM analysis revealed 42 DEPs, significantly enriched also in complement and coagulation cascades, ferroptosis and glutathione metabolism. Interestingly, fifteen proteins were differentially expressed in both comparisons, with four of them related to the complement system (PROS1, C1S, C1QB and MASP2), suggesting that an alteration in this system at follicular fluid level might be one of the hallmarks of PCOS. Limitations, reasons for caution Further experimental studies are required to validate the specific changes identified in our study. Moreover, to establish how these alterations in the follicular compartments affect the oocytes of PCOS patients should also be explored. Wider implications of the findings Our study focused on specific mechanisms involved in PCOS ovarian alterations, providing new insights into potential biomarkers for an accurate diagnosis and management of this pathology. Dysregulations in oxidative phosphorylation and complement system might play a crucial role in PCOS multifactorial nature, contributing to impaired folliculogenesis and decreased oocyte quality. Trial registration number Not Applicable

Health‐Related Quality of Life Among Adolescents with Polycystic Ovary Syndrome

The aim of this study was to assess the psychological features in women with different polycystic ovary syndrome (PCOS) phenotypes [National Institute of Health (NIH) and non-NIH diagnostic criteria] and women without PCOS. An observational, cross-sectional study compared overweight (BMI ≥ 25 kg/m(2)) premenopausal women with PCOS (n = 29 NIH and n = 25 non-NIH) and controls (n = 27). Anxiety and depression were compared between women with NIH or non-NIH PCOS and women without PCOS. Health-related quality of life (HRQoL) domains related to emotions, body hair, weight, infertility and menstrual problems were compared between women with NIH and non-NIH PCOS. Overall, women with PCOS had worse anxiety (P = 0.007) and depression (P = 0.048) compared with women without PCOS. Both women with NIH PCOS and non-NIH PCOS presented more often with moderate anxiety (P = 0.005 and P = 0.01, respectively) compared with women without PCOS. Women with NIH PCOS had worse HRQoL related to infertility (P = 0.012), emotions (P = 0.02) and weight (P = 0.016). No significant differences were observed between the two PCOS phenotypes for HRQoL domains related to body hair or menstrual problems. Both NIH (β = 0.30, P = 0.024) and non-NIH (β = 0.32, P = 0.016) PCOS status predicted anxiety, whereas age (β = 0.35, P = 0.008) and free androgen index (β = 0.31, P = 0.027) predicted depression. PCOS is associated with anxiety and depression. Non-NIH phenotypes present with similar psychological profiles to NIH PCOS, indicating increased psychological dysfunction in PCOS, even in milder reproductive phenotypes. However, women with NIH PCOS appear to have worse HRQoL in some areas than women with non-NIH PCOS. Psychological function and HRQoL should be considered in all women with PCOS.

The manifestations of polycystic ovary syndrome (PCOS), a ubiquitous reproductive disorder, may vary significantly depending on the severity of a number of endocrine and metabolic changes. Although no diagnostic criteria are presently available for PCOS for perimenopausal and menopausal women, the condition can still be suspected in case of a previous diagnosis of the condition, a chronic history of irregular menstrual cycles and hyperandrogenism, and/or polycystic ovarian morphology during the reproductive period. PCOS is associated with long-term health risks, including obesity, diabetes, hypertension, dyslipidemia, metabolic syndrome and cardiovascular risk factors during reproductive age, especially in patients possessing classic phenotypes. The aim of this review was to outline the available data about the impact of PCOS on long-term health risks after reproductive age in patients with PCOS. Previously, it was assumed that women with PCOS would be more prone to develop cardiometabolic diseases after reproductive age but current data suggest that in accordance with the healing in the phenotypic characteristics of PCOS, no deterioration appears to occur in cardiometabolic health in these patients. While there is substantial evidence for a greater prevalence of abnormal subclinical atherosclerotic markers among younger patients with PCOS, data for older women are insufficient. However, there is also support for an increased risk of endometrial cancer in PCOS patients. Extensive prospective cohort studies in which healthy controls as well as patients with defining PCOS phenotypes are observed and monitored from the early reproductive period into the late postmenopausal period should now be performed in order to clarify morbidities and mortality in aging women with PCOS.

ObjectivesThe aim of the present study was to evaluate the prevalence of polycystic ovary syndrome (PCOS), its phenotypical and cardio-metabolic features in a community sample of the Iranian population in comparison to healthy eumenorrheic, non-hirsute women without polycystic ovaries. The second aim was to assess the cardio-metabolic characteristics of women who suffered from one criteria of PCOS compared to those healthy eumenorrheic, non-hirsute women.MethodsIn this cross-sectional population-based study, a total of 1,960 eligible women, aged (18–45 years) were recruited from the Tehran-Lipid and Glucose-Study participants and were classified as the three groups of (i) women with PCOS by the Rotterdam criteria, (ii) non-PCOS women with one criteria of PCOS and (iii) healthy eumenorrheic, non-hirsute women without polycystic ovaries morphology (PCOM) as the control group. Further PCOS women were extended to four phenotypes of hyperandrogenism, oligo-anovulation, polycystic ovaries (phenotype A), hyperandrogenism, oligo/anovulation (phenotype B), hyperandrogenism, polycystic ovaries (phenotype C) and oligo-anovulation, polycystic ovaries (phenotype D). Cardio-metabolic profiles and the prevalence of comorbidities of metabolic syndrome (MetS) and lipid abnormalities were compared among these groups linear, and the median regression models adjusted for age and body mass index.ResultsThe prevalence of PCOS according to the diagnostic criteria of the NIH, Rotterdam and AE-PCOS Society were 13.6, 19.4, and 17.8, respectively. Among those who met the Rotterdam criteria, 23.9, 46.3, 21.6, and 8.2% had phenotypes A, B, C, and D, respectively. Among the remaining 1,580 women who did not fulfil the PCOS criteria, 108 (6.8%) suffered from only oligo/anovulation, 332 (21%) only hyperandrogenism/hyperandrogenemia, 159 (16.2%) only PCOM in ultrasound and 981 (62%) were healthy eumenorrheic, non-hirsute women without PCOM. The study revealed that some adiposity indices and lipid abnormalities in PCOS phenotypes with hyperandrogenism (A, B, and C) were worse than in healthy women. By contrast, women with phenotype D did not differ from the healthy ones in terms of adiposity and lipid abnormalities. However, the respective values for other cardio-metabolic profiles and MetS rates in different phenotypes of PCOS were similar to the healthy women. Only the prevalence of MetS in phenotype A was significantly higher than in the healthy women. There were no statistically significant differences between participants with one criteria of PCOS and healthy counterparts in terms of most adiposity indexes, cardio-metabolic factors, and comorbidity of MetS and its components. However, women with hyperandrogenism had a significantly higher level of the waist to height ratio (WHtR) and hypertriglyceridemia than their healthy counterparts.ConclusionPCOS, mainly classical phenotypes A and B, are common among Iranian women of reproductive age. Women with PCOS who had androgen excess exhibited the worst lipid profile, and those who had full three criteria of the syndrome exhibited the higher rate of MetS. However, women with only ovulatory dysfunction and only PCOM had similar cardio-metabolic characteristics, compared to healthy subjects. These data suggest that routine screening for metabolic disturbances may be needed in the prevention of cardio-metabolic disorders in patients with more serious phenotypes of PCOS.

The role of vitamin D in polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is the most common endocrine-gynecologic disorder affecting women of childbearing age. It has a wide range of clinical manifestations, including menstrual irregularity, infertility, hirsutism, acne, and obesity. Studies have confirmed that PCOS can significantly reduce a patient's health-related quality of life (HRQoL). The pathophysiology of PCOS is poorly understood, but it is believed to be caused by the interaction of several factors. Moreover, there is a lack of information about HRQoL among PCOS women in Saudi Arabia. This study aims to assess the HRQoL of PCOS patients by using the Arabic Version of the Polycystic Ovarian Syndrome Health-Related Quality of life Questionnaire (AR-PCOSQ) in Riyadh city. A descriptive cross-sectional study was conducted on 281 women in Riyadh city using the translated questionnaire (AR-PCOSQ) to explore PCOS quality of life among Saudi females. The eligibility criteria were Saudi female who had been diagnosed with PCOS, living in Riyadh city, aged 18 and above, and willing to participate. The sample size was estimated using the 10-events-per variable rule for prediction models (REF). Informed consent was taken from all participants and a Google Form was used to create the survey and collect data. The higher score represents poor QOL. However, the analysis revealed that higher scores of the weight-related QOL had the greatest impact on patients' quality of life in older age groups, including women aged 26 to 35 (beta = 0.143, 95% CI, 0.023 to 0.304, p-value = 0.046) and women aged > 35 (beta = 0.229, 95% CI, 0.039 to 0.428, p = 0.011). Other domains of QOL, such as emotions, body hair, infertility, and menstrual problems, were not significantly predicted by any of the women's demographic characteristics. The findings revealed that PCOS-related conditions such as weight problems, menstrual irregularity, and infertility were associated with a reduction in quality of life.

The polycystic ovarian syndrome (PCOS) is the most common endocrine disorder affecting female fertility. In this study, we examined the symptomatology of PCOS and the health-related quality of life among infertility patients suffering from PCOS with different socio-cultural and ethnic background. Symptomatology of PCOS, body composition characteristics as well as socio-economic factors were examined in 49 PCOS infertility patients of the University Clinic for Gynecology and Obstetrics, in Vienna, who originated from two socio-cultural subgroups, Austrian women and Moslem immigrant women. Additionally, the Cronins health-related quality of life questionnaire of women with PCOS was used in order to examine the impact of PCOS symptoms on the individual quality of life of the affected women. In terms of the appearance of the symptoms, the typical heterogeneity of PCOS could be found in both subgroups with no differences. However, differences in the health-related quality of life were impressive. Health-related quality of life of women from an Islamic background was affected to a greater degree than that of Austrian women, although no differences in symptomatology were found. This was true of all five domains investigated (infertility, overweight, hirsutism, menstrual irregularities and emotional problems). First of all, infertility was a dramatic problem for immigrant women. Islamic women had very high reproductive pressure. The Moslem immigrant PCOS women suffer more from infertility than do Austrian women. Health professionals should be sensitive to the ethnicity, religious and cultural background of their patients to provide the best possible medical support.

Hyperandrogenism in Polycystic ovary syndrome (PCOS) negatively affects health-related quality of life (HRQOL). Anti-androgens may improve both biochemical and patient-related outcomes. To evaluate the impact of combined finasteride and spironolactone on HRQOL in married and unmarried women with PCOS using PCOSQOL-47 and PCOSQOL-42, respectively. A total of 263 married and 236 unmarried women with PCOS were enrolled from two tertiary centers. All received finasteride (5mg) and spironolactone (100mg) daily and were followed every four months over a year. HRQOL was assessed using PCOSQOL-47 for married and PCOSQOL-42 for unmarried women, alongside evaluating their biochemical and clinical hyperandrogenism. After one year, significant reductions were observed in total and free testosterone, dehydroepiandrosterone sulfate, body mass index (BMI), and a decrease in modified Ferriman-Gallwey (mFG) scores. Both groups showed marked HRQOL improvement, greater in unmarried women. In PCOSQOL-47, psychological and emotional domains improved most, while fertility and sexual domains improved least. In PCOSQOL-42, menstrual and fertility domains had the highest gains, while coping improved least. Both groups had a 25% reduction in mFG score and 5% reduction in BMI. This is the first study to evaluate combined finasteride and spironolactone on HRQOL domains in PCOS using PCOSQOL-47 and PCOSQOL-42. Prior studies assessing anti- androgens used other tools, without distinction between married and unmarried women. Combined finasteride and spironolactone significantly improved all HRQOL scales and reduced hyperandrogenism within the first four months in women with PCOS, supporting its role alongside lifestyle measures.