The menstrual cycle regularization following d-chiro-inositol treatment in PCOS women: a retrospective study

Abstract

Polycystic ovary syndrome is characterized by irregular cycles, hyperandrogenism, polycystic ovary at ultrasound and insulin resistance. The effectiveness of d-chiro-inositol (DCI) treatment in improving insulin resistance in PCOS patients has been confirmed in several reports. The objective of this study was to retrospectively analyze the effect of DCI on menstrual cycle regularity in PCOS women. This was a retrospective study of patients with irregular cycles who were treated with DCI. Of all PCOS women admitted to our centre, 47 were treated with DCI and had complete medical charts. The percentage of women reporting regular menstrual cycles significantly increased with increasing duration of DCI treatment (24% and 51.6% at a mean of 6 and 15 months of treatment, respectively). Serum AMH levels and indexes of insulin resistance significantly decreased during the treatment. Low AMH levels, high HOMA index, and the presence of oligomenorrhea at the first visit were the independent predictors of obtaining regular menstrual cycle with DCI. In conclusion, the use of DCI is associated to clinical benefits for many women affected by PCOS including the improvement in insulin resistance and menstrual cycle regularity. Responders to the treatment may be identified on the basis of menstrual irregularity and hormonal or metabolic markers.     

Endometrial cancer in young, normal-weight women

OBJECTIVE: To determine if young, normal-weight women with endometrial cancer have unique risk factors and clinical characteristics when compared with young, overweight and obese women with endometrial cancer. METHODS: Between 1989 and 2003, 1531 patients were treated for endometrial cancer. 188 (12%) of these women were premenopausal and under the age of 50 at time of diagnosis. The patients were divided into three groups based on body mass index (BMI): normal weight (BMI < 25 kg/m2), overweight (BMI 25-30 kg/m2) and obese (BMI > or = 30 kg/m2). Clinical and pathologic characteristics were compared. RESULTS: Of the 188 young endometrial cancer patients, 47 (25%) were of normal weight, 31 (17%) overweight and 106 (56%) obese. 4% of normal-weight, 12% of overweight and 0% of obese patients met criteria for Lynch syndrome/hereditary non-polyposis colorectal cancer (HNPCC). Irregular menstrual cycles were reported by 30% normal-weight, 32% of overweight and 61% of obese women (P = 0.001). 17% of normal-weight, 7% of overweight and 14% of obese women had a history of infertility (P = 0.723). Nulliparity was noted in 57% of normal-weight, 47% of overweight and 57% of obese patients (P = 0.583). Diabetes was reported in 4% of normal-weight, 13% of overweight and 35% of obese patients (P < 0.001). 28% of normal-weight, 26% of overweight and 14% of obese patients had synchronous primary tumors of the endometrium and ovary. CONCLUSIONS: As expected, a significantly higher proportion of obese and overweight women had diabetes and irregular menstrual cycles. Among the normal-weight women, a high proportion were nulliparous, had a history of infertility, irregular menstrual cycles and synchronous tumors of the endometrium and ovary when compared with the general population. This suggests that hormonal factors, and possibly polycystic ovarian syndrome (PCOS), may contribute to the development of endometrial cancer in young normal-weight women.     

育龄期妇女体毛状况调查及其在多囊卵巢综合征诊断中的初步应用

目的探讨适合济南市多囊卵巢综合征（PCOS）患者的多毛诊断标准。方法按照Ferriman．Gallwey（F-G）体毛评价方法,对623例济南市汉族育龄期妇女（普通群体组）、131例PCOS患者（PCOS组）及84例非PCOS不孕患者（非PCOS对照组）,上唇、下颌、上臂、大腿、胸部、上腹、下腹、背上部、腰骶部9个激素相关部位与前臂、小腿2个激素无关部位的体毛分布情况进行调查;并分别以不同的临界值评价各组妇女的多毛发生率。结果（1）普通群体组妇女的激素相关部位体毛总分（F-G总分）、激素无关部位体毛总分均呈偏态分布,其第95百分位数均为2分;F-G总分与其激素无关部位体毛总分呈正相关关系（r=0．310,P〈0．01）。（2）以F-G总分≥2分为临界值,多毛发生率非PCOS对照组为4．8％（4／84）,PCOS组为48．1％（63／131）,两组比较,差异有统计学意义（X^2=47．68,P〈0．01）;以国外的多毛诊断标准F-G总分≥6分为临界值,非PCOS对照组无多毛病例,PCOS组1例,两组比较,差异无统计学意义（X^2=0．64,P=0．42）。（3）普通群体组妇女中F-G总分与年龄呈负相关关系（X^2=-0．128,P〈0．01）,与上唇、胸部、下腹的体毛评分呈正相关关系（r=0．712、0．594、0．522,P均〈0．01）。PCOS组患者F—G总分与上唇、下腹、胸部的体毛评分呈正相关关系（r=0．879、0．710、0．682,P均〈0．01）,非PCOS对照组与上唇的体毛评分密切相关（r=0．950,P〈0．01）。（4）多毛（F-G总分≥2分）发生率分别与普通群体组妇女下腹、上唇、胸部（列联系数：0．489、0．461、0．420,P均〈0．01）及PCOS组患者上唇、胸部、下腹（列联系数：0．560、0．532、0．503,P均〈0．01）相关。结论（1）F-G总分〉12分是适宜于济南市妇女的多毛诊断临界值。（2）以F-G总分〉12分为诊断标准,PCOS患者存在显著的多毛现象。（3）上唇、胸部、下腹是育龄期普通群体妇女和PCOS患者多毛的主要部位。     

The Prevalence of Polycystic Ovaries on Ultrasound Scanning in a Population of Randomly Selected Women

Summary: Polycystic ovaries (PCO) diagnosed by ultrasound have been commonly reported amongst healthy women. The study aimed to determine the prevalence of PCO in a population of women from the community, and to relate it to clinical and endocrinological data. Twelve hundred women chosen randomly from electoral rolls were invited to take part in the study. Two hundred and fifty five women (21%) who met eligibility criteria agreed to participate and 183 women (16%) finally completed the study. Seventy two women did not attend. An ultrasound scan and blood tests were taken on day 5–9 of their menstrual cycles. Data about their menstrual periods and reproductive history was collected. The prevalence of PCO was 21% (39 of 183). No differences existed between women with PCO and normal ovaries with respect to uterine size, body mass index, luteinizing hormone levels, serum hormone binding globulin levels and fertility status. Hirsutism (Ferriman Gallwey score >7), elevated testosterone levels and irregular menstrual cycles were significantly more frequent amongst women with PCO. Mean ovarian volume was larger in women with PCO irrespective of the use of hormonal contraception. Fifty nine per cent of women with PCO had irregular menstrual cycles or elevated Ferriman Gallwey scores or both. There was no detectable effect of PCO on parity or miscarriage although only 70% of women with PCO had evidence of an adequate ovulation compared to 95% of women with normal ovaries.     

Analysis of gonadotropin pulsatility in hirsute women with normal menstrual cycles and in women with polycystic ovary syndrome

OBJECTIVE: To study the relation between plasma gonadotropin pulsatility, androgen levels, and estrogen levels in patients with polycystic ovary syndrome (PCOS), in hirsute women with normal menstrual cycles, and in healthy women. DESIGN: Prospective study. SETTING: University medical center-based cellular and molecular endocrinology laboratory. PATIENT(S): Eight healthy women (group 1), 9 hirsute women with normal menstrual cycles (group 2), and 19 women with PCOS (group 3). INTERVENTION(S): Plasma concentrations of LH and FSH were measured by RIA every 15 minutes for 12 hours. Main Outcome Measure(s): Rhythmic parameters of 12-hour LH and FSH secretion. RESULT(S): Rhythmic parameters of 12-hour LH secretion were significantly higher in patients with PCOS (group 3) than in controls (group 1) or in hirsute women with normal menstrual cycles (group 2). The frequency of LH pulses was statistically higher in patients with PCOS (group 3) than in controls (group 1). Statistically significant correlations were found when the frequency of LH pulses was plotted against basal LH concentrations and rhythmic parameters of 12-hour LH secretion. CONCLUSION(S): Luteinizing hormone pulse amplitude was higher in patients with PCOS than in hirsute women with normal menstrual cycles or in healthy women. The LH pulse frequency was increased only in patients with PCOS compared with healthy women and not in hirsute women with normal menstrual cycles.     

Relationship between serum müllerian-inhibiting substance and other reproductive hormones in untreated women with polycystic ovary syndrome and normal women.

OBJECTIVE: To examine the relationship of serum müllerian-inhibiting substance (MIS), E(2), free-T, LH, and FSH in untreated women with polycystic ovary syndrome (PCOS) and in women with normal menstrual cycles. DESIGN: A prospective study. Setting: University Departments of Obstetrics and Gynecology and Surgery. PATIENT(S): Twenty-seven women with PCOS and 20 women with normal menstrual cycles. INTERVENTION(S): Serum was collected from women with PCOS and from normal women during the early follicular phase of the menstrual cycle, stored frozen until assayed. MAIN OUTCOME MEASURE(S): Serum levels of MIS, E(2), free-T, TSH, LH, and FSH were measured. RESULT(S): Serum müllerian-inhibiting substance levels in PCOS patients were significantly higher compared with normal women (+/- SE; 5.3 +/- 0.7 and 1.4 +/- 0.2 ng/mL, respectively). An inverse correlation (r = -0.5965) was found between serum levels of MIS and E(2) in PCOS women, but not in normal women. Women with PCOS had higher serum LH levels than those of normal women (15.2 +/- 1.2 and 5.0 +/- 0.7 mIU/mL). CONCLUSION: In this study, women with PCOS have significantly higher serum MIS levels than normal women. The inverse relationship between müllerian-inhibiting substance and E(2) levels suggests that MIS may modulate ovarian E(2) synthesis and have a role in the disordered folliculogenesis characteristic of PCOS.     

Examination of the chin or lower abdomen only for the prediction of hirsutism

OBJECTIVE: To test the hypothesis that scoring terminal hair growth on only the chin or abdomen can serve as a reliable predictor for hirsutism. DESIGN: A prospective observational study. PATIENT(S): Six hundred and ninety-five consecutive hyperandrogenic women seen between June 1987 and December 1997. MAIN OUTCOME MEASURE(S): All hirsutism exams were performed by one examiner. Hirsutism was scored using a modification of the Ferriman-Gallwey (F-G) method. An F-G score of > or = 8 defined hirsutism. RESULT(S): Of the 695 women examined 352 (50.1%) had hirsutism scores of 8. Thirty percent (79 of 344) of women who had an F-G score of <8 had previously underwent electrology. If either the chin or lower abdomen hair growth score was > or = 2, the sensitivity was 100% for the prediction of hirsutism, although the specificity was 27%. The positive predictive value (PPV) for hirsutism using a hair score of > or = 2 at either of these sites was 58%. CONCLUSION(S): A hair growth score of > or = 2 on the chin or lower abdomen only was found to be a highly sensitive predictor for hirsutism. However, because of its very low PPV, this screening method is virtually useless in populations where the hirsutism frequency is expected to be low, about 5%. However, this screening method for the detection of hirsutism would be useful for the study of high-risk populations with an expected hirsutism prevalence of >20% (e.g., family studies).     

Screening for insulin resistance in women with polycystic ovarian syndrome.

INTRODUCTION: Insulin resistance is implicated in the pathogenesis of polycystic ovarian syndrome (PCOS). Insulin-sensitizing agents are increasingly used in the treatment of infertility and hirsutism in PCOS. However, not all women with PCOS are insulin-resistant. OBJECTIVE: To assess the degree of insulin resistance within a clinic population of women referred for treatment of oligomenorrhoea or infertility. DESIGN: We evaluated 25 consecutive PCOS outpatients referred for treatment of menstrual dysfunction/infertility and a matched control group. All underwent a standard oral glucose tolerance test (OGTT) with serial insulin measurements. Insulin sensitivity was calculated using homeostasis model assessment (HOMA). RESULTS: Five of the 25 clinic patients had abnormal glucose handling (two had previously unknown type 2 diabetes and three had impaired glucose tolerance). Fasting and 2-h insulin levels were significantly higher in the PCOS women. Mean HOMA-S (insulin sensitivity) was even lower for PCOS women with normal GTT status (mean (95% confidence interval): 0.53 (0.34-0.72)) than for controls (0.94 (0.84-1.04)) (F = 4.2, p < 0.001). HOMA-B (pancreatic beta-cell function) was nearly tripled for normal GTT status PCOS women at 273 (205-342) versus 105 (70-139) for controls (F = 6.8, p < 0.001). CONCLUSIONS: The results suggest a role for routine measurement of HOMA-S in identifying women with PCOS with insulin resistance with a view to targeting them with insulin-sensitizing agents.     

济南市汉族育龄妇女PCOS患病状况的初步调查

目的:探讨济南市汉族育龄妇女多囊卵巢综合征(PCOS)患病状况及其临床特点。方法:以2003年ESHRE/ASRM建议诊断标准,按流行病学整群抽样方法调查济南市1027例育龄妇女中PCOS的患病状况。结果:(1)以ESHRE/ASRM 3条指标符合2条的原则检出PCOS 85例,群体患病率为6.46%;(2)检出的PCOS中稀发排卵、多囊样卵巢(PCO)、高睾酮(T)血症、临床高雄(F-G≥6多毛和痤疮)分别占89.4%、72.94%、57.65%、38.8%(1.18%和38.8%);每两项指标组合:稀发排卵+PCO、稀发排卵+高T、PCO+高T分别占60%、45.9%、38.8%;符合3条指标而临床、生化高雄仅有其一者占48.2%,两者均有占11.8%;不孕占7.06%、肥胖占8.23%。按汉族妇女F-G≥2分标准,群体PCOS中多毛率为37.65%。结论:(1)PCOS占济南市汉族育龄妇女的6.46%。(2)ESHRE/ASRM标准总体上是适合济南汉族育龄妇女PCOS检出的标准,多项指标可提高检出的特异度;(3)多毛作为临床高雄指标F-G≥2分更适于汉族人群。     

Aging women with polycystic ovary syndrome who achieve regular menstrual cycles have a smaller follicle cohort than those who continue to have irregular cycles

OBJECTIVE: To examine whether follicle loss due to ovarian aging is responsible for the occurrence of regular menstrual cycles in aging women with polycystic ovary syndrome (PCOS), the size of the FSH-sensitive follicle cohort was estimated by the exogenous follicle-stimulating hormone ovarian reserve test (EFORT) and related to the follicle count as measured by ultrasound. DESIGN: Prospective study. SETTING: Reproductive endocrinology unit of an academic medical center. PATIENT(S): Twenty-seven aging women with PCOS (35.8-49.4 years): 20 with regular menstrual cycles and 7 with oligomenorrhea or amenorrhea. INTERVENTION(S): EFORT and transvaginal ultrasound. MAIN OUTCOME MEASURE(S): Baseline (cycle day 2, 3, or 4) FSH, androstenedione (A), T, E(2), and inhibin B levels, the E(2) and inhibin B increment after the EFORT, and the follicle count. RESULT(S): After correction for the body mass index (BMI), the inhibin B increment was higher in the irregular menstrual group, but the E(2) increment did not differ significantly between the two groups. Ultrasound showed a median follicle count of 8.5 (4.0-18.0) in women with regular menstrual cycles (n = 16), compared with 18.0 (8.0-35.0) in irregularly menstruating women (n = 7). The follicle count was significantly correlated to the FSH-induced E(2) increment (r = 0.656) as well as to the inhibin B increment (r = 0.654). The regularly menstruating group was significantly older, had a higher basal FSH concentration, and had lower androgens than the irregularly menstruating group. CONCLUSION(S): The smaller follicle count, the older age, the higher FSH concentration, and the lower FSH-induced inhibin B increment found in women with PCOS and a regular menstrual cycle confirm that a decrease in the size of the follicle cohort due to ovarian aging is largely responsible for the regular menstrual cycles in aging PCOS women.     

Clinical characteristics, metabolic features, and phenotype of Chinese women with polycystic ovary syndrome: a large-scale case–control study

Aim

The Rotterdam criteria extend the phenotypic spectrum of polycystic ovary syndrome (PCOS). The study was to investigate the clinical and biochemical features of a large-scale clinic based on the samples of Chinese women and to evaluate the value of Rotterdam criteria on Chinese PCOS women.

Methods

One thousand four hundred and four Chinese women were involved in our study, among whom, 719 cases were diagnosed as PCOS based on 2003 Rotterdam criteria, and 685 women without history of hyperandrogenism and with regular menstrual cycles were recruited as control. Clinical features, ultrasonographic (ovarian follicle number and volume), hormonal and metabolic parameters were commenced as outcome measures.

Results

Among 719 PCOS women, 6.1 % had hirsutism, 13.3 % had acne, 21.1 % had hyperandrogenism, 94.2 % had polycystic ovaries on ultrasonographic examination, and 88.6 % had menstrual abnormality. About one-third of the total PCOS patients were insulin resistant. The most frequent PCOS phenotype is the non-hyperandrogenic phenotype (O + P). Total testosterone, LH/FSH ratio, body mass index (BMI), and Ferriman and Gallwey scores (F–G) were all significantly higher in PCOS groups compared with non-PCOS group. Women with PCOS and obesity had higher serum testosterone, fasting insulin, longer menstrual cycle and larger ovarian follicle number, and LH/FSH ratio, estradiol or ovarian volume were similar between obese and normal BMI women. The LH level was statistically lower in the obese PCOS group.

Conclusions

Rotterdam criteria are generally applicable to Chinese population. Chinese women with PCOS showed lower rates of hyperandrogenemia, hirsutism, obesity, and insulin resistance. Obesity aggravates menstrual irregularity and increases the follicle number and serum total testosterone level.     

The impact of insulin resistance on the outcome of laparoscopic ovarian electrocautery in infertile women with the polycystic ovary syndrome.

In this study we assessed how insulin resistance affects pregnancy rates in infertile women with the polycystic ovary syndrome (PCOS) treated with laparoscopic ovarian electrocautery. Sixty-four PCOS women were included in the study in a consecutive fashion. Following the CIGMA (continuous infusion of glucose with model assessment) test, 28 women were classified as insulin resistant and 36 women as non-insulin resistant. After the ovarian electrocautery patients were observed for 12-18 months. If pregnancy did not ensue, they were referred for one or more cycles of in vitro fertilization (IVF). Following ovarian electrocautery the non-insulin-resistant women more frequently achieved a regular menstrual cycle and ovulation than the insulin-resistant PCOS women. Consequently 18 (50%) of the non-insulin-resistant PCOS women achieved a pregnancy versus only five (18%) of women in the insulin-resistant PCOS group. Following treatment with both ovarian electrocautery and IVF, 27 (75%) of the non-insulin resistant PCOS women achieved a successful pregnancy, while 13 (46%) of the insulin-resistant PCOS group achieved this. In conclusion, insulin resistance may be an important marker of a poor outcome of treatment in PCOS infertility. Further studies are needed to evaluate the possible effect of treatment alternatives to alleviate the unfavorable influences of insulin resistance and hyperinsulinemia on ovulation induction in PCOS women.     

Efficacy of an oral contraceptive containing drospirenone in the treatment of women with polycystic ovary syndrome.

OBJECTIVE: To investigate the efficacy of a combined oral contraceptive containing 30 microg ethinyloestradiol and 3 mg drospirenone in the treatment of hyperandrogenism affecting women with the polycystic ovary syndrome (PCOS). METHODS: Prospective open study of 20 women for six cycles. At the beginning and at the end of the study the following values were determined: the Ferriman-Gallwey (F-G) score, body mass index, waist/hip ratio, serum levels of testosterone, SHBG, immune reactive insulin (IRI), glucose, the free androgenic index, and insulin resistance (HOMA-IR). RESULTS: All 20 women completed six cycles of therapy. The medication was well tolerated. At the end of the study there was a significant improvement of hirsutism, expressed in the decrease of the F-G score, accompanied by a decrease of testosterone and an increase of SHBG values. The carbohydrate metabolism was not affected significantly. CONCLUSION: The combined oral contraceptive containing 30 microg ethinyloestradiol and 3 mg drospirenone is an effective drug in the treatment of hyperandrogenism in women with PCOS; it elicits few side effects and does not significantly influence insulin resistance.     

Basal leptin concentrations in women with normal and dysfunctional ovarian conditions.

OBJECTIVE: To determine whether leptin is involved in ovarian function. METHODS: Fasting serum samples were obtained from 20 women with normal menstrual cycles who were either obese or non-obese: 12 non-obese patients with polycystic ovary syndrome (PCOS), 8 obese patients with PCOS, 10 patients with stress-related hypothalamic amenorrhea, and 8 patients with weight loss-related hypothalamic amenorrhea. RESULTS: Serum leptin levels were strongly related to body mass index (BMI) in each group, but there was no difference in the mean serum leptin levels among the BMI-matched study groups. A significant difference in the mean serum leptin levels was found between the non-obese and obese control groups (P<0.001) and between the non-obese and obese PCOS groups (P<0.001). CONCLUSIONS: These findings indicate that circulating leptin levels in women with normal menstrual cycles and those with ovarian dysfunction are strongly related to BMI. Leptin does not appear to be primarily involved in regulating ovarian function.     

Anti-Müllerian hormone levels during hormonal contraception in women with polycystic ovary syndrome

OBJECTIVE: The use of oral contraceptive (OC) pills alters the characteristic features of polycystic ovary syndrome (PCOS) complicating the diagnosis of this disease. Anti-Müllerian hormone (AMH) levels are high in PCOS patients and are stable throughout the menstrual cycle in healthy subjects. This study examined the influence of hormonal suppression with OC therapy on the serum AMH levels in women with PCOS and with normal menstrual cycles. STUDY DESIGN: Thirty women with PCOS and 15 women with normal menstrual cycles were enrolled in this prospective study. Serum was collected from the subjects during the early follicular phase of the menstrual cycle and after the sixth cycle of oral contraceptive therapy, and stored frozen until assayed. The effect of OC therapy on the serum AMH, estradiol (E(2)), luteinizing hormone (LH), follicle-stimulating hormone (FSH), free testosterone, total testosterone, and dehydroepiandrosterone sulfate (DHEA-S) levels was studied. In addition, ovarian volume and follicle count were assessed. RESULTS: The serum AMH levels in PCOS patients were significantly higher than in healthy women at baseline (+/-S.D.; 5.49+/-2.26 and 1.93+/-0.51 ng/ml, respectively; p=0.001). After six cycles of OC therapy, no significant changes in the AMH levels were observed in either the PCOS patients or normally cycling women. Ultrasound showed significant reductions in ovarian volume and follicle number and size at 6 months in both groups. CONCLUSION: Although significant reductions were observed in ovarian volume and follicle number, 6 months of contraceptive therapy did not change the serum AMH concentration in either group. AMH may be considered a new marker in PCOS patients who are already on contraceptive treatment.     

Polycystic ovarian syndrome, insulin resistance and thickness of the endometrium

INTRODUCTION: Disorders possibly associated with insulin resistance (IR) are hyperandrogenemia, hirsutism, irregular menstrual cycles, central obesity and polycystic ovarian syndrome (PCOS). It is known that PCOS is related to a high risk of endometrial hyperplasia after many years of estrogen stimulation from anovulation. OBJECTIVES: The purpose of the study was to estimate the thickness of the endometrium in women with IR without a diagnosis of PCOS and in women with PCOS without IR. STUDY DESIGN: Three groups of women included in the study: 15 women diagnosed as IR without PCOS, 16 women diagnosed as PCOS without IR and 20 women used as controls matched for age and body mass index (BMI) with the previous patients. Thickness of the endometrium was estimated in all cases with a transvaginal ultrasound in three consecutive measures during a cycle. RESULTS: The mean thickness of the endometrium was statistically higher in the PCOS group (11.1mm), and in the IR group (9.6mm), compared with the control group (6.2mm) (F=13.1, p<0.001). CONCLUSIONS: It is concluded that both in women diagnosed as having insulin resistance without PCOS, and in women with PCOS without insulin resistance, the ultrasonographically estimated thickness of the endometrium is relatively high and a closer follow-up of these women is required in order to detect those in risk to develop hyperplasia and/or atypia.     

Prevalence and related factors of irregular menstrual cycles in Korean women: the 5th Korean National Health and Nutrition Examination Survey (KNHANES-V, 2010–2012)

Introduction: There have been few population-based studies reporting medical, lifestyle and psychological factors associated with irregular menstrual cycles. This study aimed to elucidate the prevalence and related factors of irregular menstrual cycles in Korean women.

Methods: Cross-sectional data from the 5th Korean National Health and Nutrition Examination Survey were used. Eligible women were 19–40?years old, not currently taking oral contraceptives or using intrauterine devices, and not currently pregnant or breast feeding, and had no medical history of hysterectomy, thyroid diseases, cancers or renal failure. Finally, 3194 premenopausal women were recruited in this study. The prevalence and related factors of irregular cycles were obtained using a general linear model and logistic regression analyses in a complex sampling design.

Results: The prevalence of irregular cycles was 14.3%. Age and high-education level were associated with lower odds ratios (ORs) for irregular cycles (OR 0.91, 95% confidence interval (95% CI) 0.87–0.96, and OR 0.58, 95% CI 0.38–0.88, respectively). The ORs of body mass index, perceived stress and depressive mood were 1.05 (95% CI 1.01–1.10), 1.46 (95% CI 1.11–1.92) and 2.07 (95% CI 1.18–3.63), respectively.

Conclusions: Age, perceived stress, body mass index, depressive mood and education level, rather than obstetric factors or metabolic diseases were significant factors associated with irregular menstrual cycles in Korean women. Of these factors, perceived stress is the most significant factor associated with increased irregular menstrual cycles.     

The cardiovascular risk factor homocysteine is not elevated in young women with hyperandrogenism or hypoestrogenism

The aim of the present study was to determine whether the plasma concentrations of homocysteine (Hcy) are elevated in women with hypogonadotropic hypogonadism (a condition of chronic hypoestrogenism) and in women with polycystic ovarian syndrome (PCOS, a syndrome characterized by hyperandrogenemia). A cross-sectional study was performed. The plasma concentrations of Hcy were determined in 12 normal-cycling women, in 14 women with hypogonadotropic amenorrhea (HA), and in 20 women with PCOS. The plasma LH, FSH, E(2), testosterone, free testosterone, and androstenedione levels were measured. The blood samples analyzed were taken during the early follicular phase in controls and without regard to the menstrual phase in the patients. Twelve normal-cycling women were compared with 14 women with HA and with 20 women with PCOS. Women with HA or PCOS have plasma concentrations of Hcy similar to those of healthy women with normal menstrual cycles. The results suggest that young women with chronic hypoestrogenism (HA) or hyperandrogenism (PCOS) have plasma concentrations of Hcy similar to those of healthy women with normal menstrual cycles.     

Myo-inositol in patients with polycystic ovary syndrome: a novel method for ovulation induction.

BACKGROUND: Polycystic ovary syndrome (PCOS) is often characterized by chronic oligo- or anovulation (usually manifested as oligo- or amenorrhea), and hyperandrogenism. In addition, 30-40% of PCOS women have impaired glucose tolerance, and a defect in the insulin signaling pathway (inositol-containing phosphoglycan mediators) seems to be implicated in the pathogenesis of insulin resistance. PCOS patients are subfertile as a consequence of such ovulatory disorders and often need drugs, such as clomiphene citrate or follicle-stimulating hormone, for ovulation induction, which increases the risk of multiple pregnancy and ovarian hyperstimulation syndrome. We hypothesized that the administration of an isoform of inositol (myo-inositol), belonging to the vitamin B complex, would improve the insulin-receptor activity, restoring normal ovulatory function. MATERIALS AND METHODS: Twenty-five PCOS women of childbearing age with oligo- or amenorrhea were enrolled in the study. Ovulatory disorder due to PCOS was apparently the only cause of infertility; no tubal defect or deficiency of male semen parameters was found. Myo-inositol combined with folic acid (Inofolic) 2 g twice a day was administered continuously. During an observation period of 6 months, ovulatory activity was monitored with ultrasound scan and hormonal profile, and the numbers of spontaneous menstrual cycles and eventually pregnancies were assessed. RESULTS: Twenty-two out of the 25 (88%) patients restored at least one spontaneous menstrual cycle during treatment, of whom 18 (72%) maintained normal ovulatory activity during the follow-up period. A total of 10 singleton pregnancies (40% of patients) were obtained. Nine clinical pregnancies were assessed with fetal heart beat at ultrasound scan. Two pregnancies evolved in spontaneous abortion. CONCLUSION: Myo-inositol is a simple and safe treatment that is capable of restoring spontaneous ovarian activity and consequently fertility in most patients with PCOS. This therapy did not cause multiple pregnancy.     

Time of initiation of clomiphene citrate and pregnancy rate in polycystic ovarian syndrome.

OBJECTIVE: To investigate whether the timing of clomiphene citrate (CC) administration affects hormonal levels, follicular growth, endometrial thickness, and ovulation and pregnancy rates in women with polycystic ovarian syndrome (PCOS). METHODS: Of the 78 infertile women with PCOS who participated in this prospective, double-blind, randomized clinical trial, 37 collectively underwent 71 cycles of CC (100 mg/day) on days 1 through 5 of the menstrual cycle (group 1) and 41 collectively underwent 73 cycles of CC at the same concentration on days 5 through 9 (group 2). Hormonal levels, follicular growth, endometrial thickness, and ovulation and pregnancy rates were compared. RESULTS: The mean number of follicles and the maximum follicular size were greater in group 2. However, ovulation rates were 72.8% in group 1 and 70.8% in group 2 (P=.78), and pregnancy rates were 40.5% in group 1 and 19.5% in group 2 (P=.04). CONCLUSION: Treatment with CC is associated with higher rates of pregnancy if started early (days 1-5) in the menstrual cycle.