Open Access
Hyperandrogenism, menstrual irregularities and polycystic ovary syndrome : impact on female reproductive and metabolic health from early adulthood until menopause
Pekka Pinola
- 01 Jan 2016
TL;DR: In conclusion, irregular menstrual cycles, identified by a simple question at adolescence, represent a good marker of hyperandrogenemia, later metabolic risks and development of PCOS.
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Abstract: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of women of reproductive age, affecting 5–18% of them. Menstrual irregularities, hyperandrogenemia and obesity are key features in PCOS and they are suggested to be the most important metabolic risks linked to PCOS, but their respective roles are still under debate. Anti-Müllerian hormone (AMH) is involved in sexual differentiation and follicle growth and its level is increased in women with PCOS. The aims of this project were to clarify the significance of menstrual irregularities, hyperandrogenemia and serum levels of AMH in adolescence as predictive factors of the syndrome and to investigate the respective roles of obesity and hyperandrogenism as metabolic risk factors in women with PCOS from adolescence to late adulthood. The study populations were the Northern Finland Birth Cohort 1986 (N=3373 women) and a Nordic population including 1553 women with PCOS and 448 controls. At the age of 16 years, women with menstrual irregularities were more hyperandrogenic compared with women with normal menstrual cycles. Serum AMH levels correlated positively with those of testosterone at this age. They were higher in adolescents with menstrual irregularities compared with those with regular cycles and in women with hirsutism or PCOS at the age of 26 years. However, AMH was not a good marker of metabolic abnormalities in adolescence or a reliable tool to predict PCOS in later life. Androgen levels were higher in women with PCOS throughout life compared with controls. The parameters that best predicted PCOS at all ages were the free androgen index, and androstenedione. Women with PCOS exhibited increased abdominal obesity, altered insulin metabolism, worse lipid profiles and higher blood pressure from early adulthood until menopause compared with controls. The highest prevalence of metabolic syndrome was detected in obese and hyperandrogenic women with PCOS. In conclusion, irregular menstrual cycles, identified by a simple question at adolescence, represent a good marker of hyperandrogenemia, later metabolic risks and development of PCOS. Due to the persistence of hyperandrogenism and metabolic alterations, the treatment of PCOS should be focused on prevention and treatment of these problems as early as in adolescence in order to decrease future morbidity.
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Citations
Polycystic Ovaries A Common Finding in Normal Women
TL;DR: The prevalence of polycystic ovaries (PCO) in normal women of reproductive age was determined by pelvic ultrasound scanning of 257 volunteers who considered themselves to be normal and who had not sought treatment for menstrual disturbances, infertility, or hirsutism.
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Serum Testosterone Levels Decrease in Middle Age in Women With the Polycystic Ovary Syndrome
TL;DR: Testosterone levels were increased in younger and older women with PCOS compared with controls but were similar to controls in women 42-47 years of age, and Hyperandrogenism partly resolves before menopause in women withPCOS.
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The postmenopausal ovary is not a major androgen-producing gland
Beatrice Couzinet,Geri Meduri,Maria G. Lecce,Jacques Young,Sylvie Brailly,Hugues Loosfelt,Edwin Milgrom,Gilbert Schaison +7 more
TL;DR: Because androgen deficiency may impair sexual function and bring about adverse psychological changes, postmenopausal women may well benefit if androgen is added to classic hormone replacement therapy.
41
Reproductive hormone levels in gynecologic oncology patients undergoing surgical castration after spontaneous menopause
TL;DR: The data show that the long-held but inadequately proven thesis that postmenopausal oophorectomy dramatically reduces androgen levels is in fact true, and there is further evidence that the post menopausal ovary is an important source of potent and potentially aromatizable androgens.
37
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