Out of Order is a documentary film that explores the emotional and physical aspects of living with polycystic ovarian syndrome. This reproductive disorder affects between 5 and 10% of all women of reproductive age. This film features an animated, autobiographical look at director Kimberly Davis' personal experience with this condition.

Polycystic Ovary Syndrome, PCOS, is an endocrine condition among individuals born with ovaries. Though the condition name refers to the underdeveloped follicles as multiple cysts on the ovary, individuals living with PCOS frequently encounter menstrual irregularity, hirsutism (male-patterned body/facial hair), acne, and obesity. Prior research has noted that PCOS also is associated with psychological outcomes, most notably increased risk for depression and anxiety. However, relative to large amount of medical research on PCOS, few studies have examined these psychological outcomes and their etiology. Work is needed that uncovers the connection between the risks (e. g., stigma, weight bias, and quality of life), the protective (e.g., self-compassion, social support) factors that explain these psychological outcomes (e.g., depression, anxiety). The present study examined potential risks and protective factors that might explain the increased risk for depressive and anxiety symptoms in individuals living with PCOS. Specifically, we examined risk and protective factors reported by a gender (48% cisgender women, 52% gender diverse) and ethnically diverse (46% white non-Hispanic, 54% ethnically diverse) sample of individuals living with PCOS. Ages ranged from 19-46, with an average age of 29 (SD = 6.49). Individuals initially completed a qualitative interview by phone and were subsequently invited to participate in an online survey. Of the original 50 individuals living with PCOS, 46 completed the online survey through Redcap, answering questions about risk (perceived stigma, body image) and protective (self-compassion, social support) factors, and mental health (depression and anxiety). Results of bivariate correlations revealed that perceived stigma (r = .37, p = .02; r = .34, p = .03) and body image (r = .53, p = .00; r = .38, p = .02) were significantly related to more depressive and anxiety symptoms, respectively. In addition, self-compassion (r = -.72, p = .00; r = -.61, p = .00) and social support (r = -.42, p = .01; r = -.37, p = .02) were significantly related to fewer depressive and anxiety symptoms. Thus, this study found evidence that the more perceived stigma and negative body image, the more depressive and anxiety symptoms, whereas the more self-compassion and social support, the less depressive and anxiety symptoms in individuals living with PCOS. Importantly, the study had a small sample size, and the design was a self-report cross-sectional study. Thus, future research is needed that is longitudinal in design with large samples of diverse individuals with PCOS. Still, the present study is among the small literature attempting to understand the psychosocial risk and protective factors that may explain depressive and anxiety symptoms in this vulnerable population.

Context: Polycystic ovary syndrome (PCOS) is complex disorder associated with many metabolic abnormalities. PCOS is one of the most common endocrine disorders occurring in women of reproductive age and affects about 6-7% of the population. Women with PCOS have insulin resistance and hyperinsulinemia, thus increasing their risk of developing Type 2 diabetes mellitus, dyslipidemia, hypertension, cardiovascular disease, and endometrial cancer Overall Objective: To compare anthropometric features (weight, BMI, WC, body fat percent), antral follicle count (AFC), fasting glucose and insulin levels, HOMA score, menstrual bleeding patterns, and abdominal adiposity before and after a dietary intervention. Materials and Methods: The work presented herein represents a subset of the data being analyzed in an ongoing study titled "Lifestyle Intervention for Women with Polycystic Ovary Syndrome: The Role of a Pulse-Based Diet and Aerobic Exercise on Infertility Measures and Metabolic Syndrome Risk". PCOS was diagnosed by two of the three diagnostic criteria as defined by the Rotterdam consensus: a history of cycles >35 days in length, hyperandrogenism as defined by a Ferriman and Gallwey score of >6 or hyperandrogenemia, as well as polycystic ovaries (PCO), defined by >25 follicles visualized upon transvaginal ultrasonography (TVU). Participants were randomized to either a 16 week pulse-based diet or to a TLC diet for 16 weeks. All participants were asked to follow an exercise program for the 16 week duration of the intervention. Changes in demographic, anthropometric features AFC, fasting insulin levels, and intervals between menstrual cycles were assessed. Results: Twenty four women completed the 16 week dietary intervention to date (pulse n=13, TLC n=11). Participants were found to be similarly matched for age, weight, BMI, WC, and FAI. Weight (p=0.002) and body fat (p=0.0004) decreased significantly. No significant differences were detected in BMI and waist circumference. Antral follicle counts were decreased in the right ovary (p=0.04) but not the left ovary (p=0.11). There was no change in fasting glucose levels detected. There was a decrease in fasting insulin levels (p=0.02) and in HOMA score (p=0.02). No change in abdominal adiposity was detected (p=0.88). There was a tendency toward a change of fasting insulin levels and HOMA score due to the pulse-based diet. The average interval between menses decreased after the intervention (p=0.04). The longest length of time between menses also decreased after the intervention (p=0.01). Conclusions: Our hypothesis was partially supported. We observed significant decreases in weight, body fat percent, AFC in the right ovary, fasting insulin levels and intermenstrual intervals. In most women, the decreased intermenstrual interval translated into the resumption of menstrual cyclicity. However, the participants' BMI, WC, AFC in the left ovary, and abdominal adiposity were not affected. Consuming food of a lower glycemic index without a calorie restriction may help women with PCOS gain healthier anthropometric profiles, decrease serum insulin levels and insulin resistance, and increase the regularity of menstrual cycles. Further study involving weight reduction and dietary intervention with pulses may prove to be more successful than calorie reduction alone.

Objective: To determine whether serum phthalate concentrations differ in men and women with infertility compared to those without infertility in Saskatchewan Hypothesis: Serum phthalate concentrations will be greater in men and women with infertility compared to fertile men and women Setting: Patients undergoing assisted reproduction for the treatment of infertility; healthy volunteers recruited from the community Recruitment and sample collection: Infertile couples were recruited prior to in vitro fertilization (IVF) therapy for treatment of unexplained infertility (n=15), polycystic ovarian syndrome (PCOS, n=13), and male factor infertility (n=12); fertile men (n=15) and women (n=15) were recruited using poster advertisements. Blood samples were collected by venipuncture for phthalate analysis. Main outcome measures: Serum phthalates concentrations (ng/mL) Design: Prospective cohort pilot study Methods: In infertile couples, blood samples were collected on the following 3 days of the IVF cycle: early during ovarian stimulation, day of oocyte retrieval and day of embryo transfer. In healthy volunteers, 3 blood samples were collected over a 2 week period. Liquid chromatography and tandem mass spectrometry (LC-MS/MS) was conducted to quantify concentrations of four phthalates: di-n-butyl phthalate (DBP), diethyl phthalate (DEP), di-(2-ethylhexyl) phthalate (DEHP) and diisodecyl phthalate (DIDP). Phthalate concentrations were compared among the four study groups using non-parametric Kruskal-Wallis and Mann-Whitney U post hoc tests. Results: Serum DEHP and DEP concentrations did not differ among control, unexplained, PCOS, and male factor infertility groups in both men and women (p>0.05). DBP in women did not differ among study groups (p=0.205). In contrast, DBP was lesser in men with unexplained, PCOS, and male factor infertility compared to controls (p < 0.05). Similarly, DIDP was lesser in women of couples with unexplained, PCOS and male factor infertility groups compared to fertile women (p < 0.05). Less DIDP was detected in men with unexplained and male factor infertility compared to the control group (p < 0.05) Conclusion: Serum phthalate concentrations in serum were lesser or not different in infertility patients undergoing IVF compared to fertile volunteers. These findings do not support the notion that serum phthalate concentrations are associated with human infertility. Further research is needed to determine whether phthalate concentration in blood cells and adipose tissue differ in infertile versus fertile men and women.

Polycystic ovary syndrome (PCOS) is a common and complex endocrine condition with reproductive and metabolic complications, affecting up to 10% of reproductive-age women. Hyperandrogenemia, ovulatory dysfunction, and luteinising hormone hypersecretion are characteristic traits of PCOS however, it seems that the most concerning long-term key issues are metabolic problems associated with the syndrome, such as hyperinsulinemia, insulin resistance, obesity, dyslipidaemia and non-alcoholic liver disease. Despite the numerous studies on PCOS, its origin and pathophysiology are still not fully understood. However, there is increasing evidence that the adult PCOS phenotype is programmed in fetal life by androgen excess. Exposure to increased levels of testosterone in utero in rodents, sheep and monkeys result in adult reproductive and metabolic pathologies that parallel those seen in PCOS women. Since hyperandrogenemia is a hallmark of PCOS and daughters of PCOS mothers have elevated levels of androgens at birth, it is likely that prenatal androgenisation during early life predispose to the future development of PCOS. Animal models of PCOS provide an opportunity to examine the developmental aetiology and molecular mechanisms underlying the pathogenesis of this condition. Over last 10 years our lab has successfully utilised a well-established ovine model of PCOS, where pregnant ewes were treated with testosterone propionate (TP) through mid-gestation. From this model, we had a large sample bank of fixed and frozen tissues from the fetal, lamb and adolescent prenatally androgenised animals that allowed to carry a broad range of experiments. In addition, a new cohort of prenatally androgenised adult sheep enabled additional in vivo analysis. Past research documented that prenatal androgenisation result in hyperinsulinemia with altered pancreas structure and function, and early fatty liver without difference in body weight in adolescent sheep. This thesis examines the effects and consequences of increased in utero androgen exposure on metabolic dysregulation in adolescent and adult female sheep. During puberty, but not fetal or early life, there was decreased adipogenesis in subcutaneous adipose tissue (SAT), but not visceral adipose tissue (VAT), accompanied by decreased circulating concentrations of fibroblast growth factor 21 (FGF21), leptin and adiponectin, and increased concentrations of fasting free fatty acids (FFA) in prenatally androgenised sheep. This was countered by upregulated expression of FFA transporters in liver. As adults, TP-exposed animals had increased body weight, elevated fasting insulin and FFA concentrations but normal FGF21, leptin and adiponectin levels. Histological analysis revealed that adult TP-exposed animals had SAT hypertrophy, which was associated with increased expression of inflammatory markers and correlated with increased fasting FFA. Therefore, it is likely that impaired preadipocyte differentiation in SAT during adolescence resulted in hypertrophy and inflammation of adult SAT. This consequently lowered capacity of SAT to safely store fat and potentially explains metabolic perturbations observed in PCOS-like female sheep. To further investigate potential causes of obesity in adult PCOS-like sheep postprandial thermogenesis (PPT), an important constituent of energy expenditure, was measured through implantation of datalogger thermometers into interscapular adipose tissue. Adult prenatally androgenised sheep had decreased amplitude of PPT, without difference in basal body temperature, despite receiving the same caloric intake, and independent of obesity. These findings indicate that adult PCOS-like sheep have reduced capacity for energy expenditure, which is mirrored in women with PCOS. This reduced capacity for postprandial thermogenesis was correlated with hyperinsulinemia decreased noradrenaline levels and reduced thermogenic potential of brown and/or beige adipose tissue. This suggests that women with PCOS might be prenatally programmed to become obese. In summary, findings documented in this thesis provide better understanding into the pathophysiology of PCOS from puberty to adulthood and give opportunities for early clinical intervention to ameliorate the metabolic phenotype of PCOS.

Abstract The prevalence of the isolated ultrasonographic finding of polycystic ovaries (PCO) in the Finnish population and among women with a history of gestational diabetes (GDM) and changes in the present carbohydrate metabolism were investigated in the present study. One aim of this study was to investigate the prevalence of the recently discovered variant type LH (v-LH) in PCOS and to compare patient cohorts from Finland, the Netherlands, the United Kingdom and the United States of America. In addition, this study attempted to evaluate the nature of the ovarian streoidogenic response of women with PCOS to exogenously administered human chorionic gonadotrophin (hCG), human menotrophin (hMG) and follicle stimulating hormone (FSH). The effect of metformin on ovarian steroidogenesis was also studied. The prevalence of PCO was significantly higher in younger (≤ 35 years, 21.6%) than among older women (in ≥ 36 years, 7.8%). The overall prevalence of PCO in Finnish women was 14.2%. Women with previous GDM revealed a high prevalence of PCO (39.4%). The carrier frequency of the v-LHb allele in the entire study population was 18.5%. The frequency of the v-LH carrier was significantly lower in obese PCOS subjects in the Netherlands (2.0%) and Finland (4.5%). Women with previous GDM had impaired insulin sensitivity and β-cell function. They also had higher adrenal androgen secretion than the control women. Women with PCO and previous GDM had marked hyperinsulinemia which was not explained by obesity. Obese PCOS women achieved peak peripheral serum T concentrations at 48 hours after a hCG injection, preceded by peak levels of 17-OHP and E2 at 24 hours. In contrast, all steroids measured in the control women reached their maximum serum concentrations at 96 hours. HMG stimulated the production of ovarian androgens more efficiently than a urinary FSH after pituitary suppression with a gonadotrophin releasing hormone agonist (GnRHa). In conclusion, the prevalence of PCO is common in healthy Finnish women and even more common in women with a history of GDM. The ultrasonographic appearance of PCO may be a predictive factor with regards abnormal glucose tolerance during and after pregnancy and, these women should therefore be advised as to possible consequences. The high overall frequency of the v-LH allele in women in general and its low frequency in obese PCOS patients suggests that v-LH plays a role in reproductive functions and may counteract the pathogenesis of PCOS in obese individuals. The differences observed in steroid responses to hCG between normal and PCOS women might be explained by higher theca cell activity or mass in polycystic ovaries. Women with PCOS did not show a distinctly exaggerated steroidogenic response to hMG or FSH administration compared with control women. FSH administration also resulted in increased A and T production.

Polycystic ovarian syndrome (PCOS) is the most prevalent female endocrine disorder affecting between 5-15% of women. Characterized by a combination of polycystic ovaries, androgen excess, and abnormal ovulation, untreated PCOS may progress to metabolic abnormalities and increase the risk of adverse health outcomes. Adult PCOS is evaluated using the Rotterdam Consensus Criteria, which requires two of three clinical findings. PCOS is a condition of exclusion, and it is essential to consider differential pathologies before diagnosis. PCOS is a heterogeneous condition, and treatment is fitted to the symptoms that each individual experiences. The physiological effects of PCOS present during puberty, typically around the average age of menarche. The exact etiology of PCOS is unknown, and preventing and curing the condition is not yet possible. Metabolic disturbances caused by PCOS, including insulin resistance and increased blood glucose level, are treated with similar methods as diabetes type 2. Insulin sensitizing agents are used to treat insulin resistance caused by PCOS. The primary treatment for insulin resistance in this population is metformin (Glucophage) due to its relatively safe use and effectiveness in normalizing insulin sensitivity and assisting with normalizing weight. The correlation of PCOS with insulin resistance, central obesity, and metabolic syndrome highlights the importance of diet and exercise supplementation for this population. Weight loss of only 5% in obese and overweight PCOS patients can significantly improve PCOS symptoms, including insulin resistance, androgen levels, and fertility. Exercise alone helps increase the sensitivity of skeletal muscle to insulin and decreases metabolic syndrome risk. The effect of PCOS on the hypothalamic-pituitary-gonadal axis can be detrimental to ovulation and implantation of a fertilized egg. Treatments that suppress the HPG-axis cannot be continued during attempts to become pregnant and throughout pregnancy. Ovulation-inducing agents can improve the rate of ovulation and increase fertility; however, some women may become resistant to these treatments. Clomiphene citrate (Clomid) is often the primary drug used to induce ovulation; however, monotherapy with letrozole has shown greater improvements in pregnancy and live birth rates. Gonadotropins may also be successful treatments, but there is an accompanied increased risk of ovarian hypersensitivity syndrome and multiple pregnancies. Laparoscopic ovarian drilling may help decrease androgen production in the ovary and briefly increase pregnancy capability. During pregnancy, metformin may help decrease the risk of gestational diabetes; however, the long-term effect of fetal exposure to metformin is not well studied. Cosmetic symptoms of PCOS, including hirsutism and acne vulgaris, may cause severe social stress. PCOS women are at additional risk of depression and anxiety. Cosmetic and mental health concerns, combined with the stress caused by the high prevalence of infertility in PCOS, highlight the need for psychological help to be considered in improving the overall quality of life. Combining cognitive behavioral therapy with treatments may help PCOS women maintain treatment and improve their quality of life. The most effective treatment may require modification throughout a patient’s life due to the variance in gonadocorticoid levels throughout a female’s life. Post-menopausal women continue to have excess androgens and estrogens in circulation. High levels of ovarian and adrenal production of gonadocorticoids combined with decreased circulating binding globulins can lead to stress on the metabolic and cardiovascular systems in PCOS after menopause. Continuous levels of increased triglycerides increase the risk for atherosclerosis and adverse cardiac events. PCOS women have an increased risk of endometrial and ovarian cancer, while a link between breast cancer and PCOS is widely disputed. There is 1.66 times higher risk for cardiovascular events, including 1.96 times greater risk for stroke in women with PCOS compared to non-PCOS women when controlled for weight. As we begin to understand the increased risk factors for hypertension, hyperlipidemia, and cardiovascular stress with PCOS, it is crucial to understand how to diagnose and treat PCOS patients in the early stages of the disorder. Irregularities in typical puberty and menarche in adolescents increase the difficulty of diagnosis and may delay a diagnosis.

Bakgrund: Polycystiskt ovarialsyndrom (PCOS) är den vanligaste endokrina sjukdomen som drabbar upp till 13 procent av kvinnor i fertil ålder. PCOS innebär en obalans av kvinnliga könshormoner som leder till multipla cystor på äggstockarna. Syndromet medför en rubbning av kvinnans hormonella och metabola funktioner. Egenvård är en viktig del i behandlingen vid PCOS. För att sjuksköterskan ska kunna ge varje kvinna/patient den bästa och individanpassade omvårdnaden behöver hen ha kunskap om hur kvinnor upplever egenvård vid PCOS. Syfte: Syftet var att beskriva kvinnors upplevelser av egenvård vid polycystiskt ovarialsyndrom. Metod: En litteraturöversikt med induktiv ansats genomfördes av kvalitativa artiklar. Tolv resultatartiklar kvalitetsgranskades för att inkluderas i resultatet och analyserades med hjälp av Fribergs fyra analyssteg. Resultat: Litteraturöversiktens resultat presenteras med två huvudkategorier: Betydelsen av balans och Betydelsen av kunskap. Kvinnor med PCOS upplevde utmaningar i sin egenvård och konstaterade vikten av att hitta balans och hållbara livsstilsförändringar. Motivationen spelade stor roll och ett eget engagemang var viktigt för att ta kontroll över sina symtom. Kvinnorna upplevde en brist på individuella egenvårdsråd från sjukvården vilket bidrog till svårigheter att lyckas med livsstilsförändringar och en upplevd avsaknad av empati och förståelse från sjukvården. Detta resulterade i att kvinnorna sökte sig online för egenvårdsråd för att hantera sin PCOS. Slutsats: Upplevelsen som kvinnor med PCOS har av egenvård beror till stor del på egenvårdsbrist. Det är därför viktigt att hälso- och sjukvården har kunskap och engagemang för att kunna stötta kvinnor med PCOS i sin egenvård.

Polycystic ovary syndrome (PCOS) is an endocrine system disorder that affects women of reproductive age. If not treated properly, PCOS can lead to infertility. Lack of proper treatment of PCOS may also result in medical complications such as diabetes or heart disease. The rural clinic where this project took place did not have a mandatory guideline for treatment of PCOS; therefore, no standardized method of diagnosis or treatment of PCOS existed. The purpose of this project, guided by the IOWA evidence-based practice model, was to educate providers on the evidence-based guideline for diagnosis and treatment of PCOS outlined by the Endocrine Society Taskforce. The guideline was selected after a comprehensive literature review and was used to develop an educational program that was provided to 5 nurse practitioners, the medical director and staff. A pre-test post-test design was used to determine if the participants understood the content from the guideline that was presented. Results showed that the researcher-developed test administered to participants yielded scores of 74 on the pre-test and increased after the education program with all participants scoring 100 on the post-test. The guideline used for the education was then presented to the clinic for implementation with the assistance of the medical director's support. The project provided an evidence-based guideline for diagnosing and treating PCOS and raised awareness of PCOS among all staff in a rural clinic where many patients with PCOS are treated. Positive social change may result as providers are better prepared to deliver evidence-based care for PCOS and as infertility and complications of untreated PCOS are reduced.

Introduction: Polycystic ovarian syndrome (PCOS) is the most common endocrine disease in fertile woman. PCOS is a complex chronic heterogenous disease with many different symptoms that can make life difficult for the affected and their relatives. Yet there is a problem regarding the awareness of the disease in both the general public and in the knowledge of healthcare providers. Because of the disease is heterogeneous the treatment must be individual but recent studies indicate that there are problems regarding patient information, diagnosis and support from healthcare providers.   Purpose: The aim of this study was to investigate women with PCOS experiences regarding the encounter with healthcare personnel.  Method: Literature review with a descriptive design of twelve articles with qualitative studies from Cinahl and PubMed. All of the articles were reviewed using SBU’s template for qualitative articles. A content analysis in six steps were performed.  Results: Two categories appeared through the data analysis: Negative and positive experiences of the encounter with healthcare personnel. Negative experiences included not being taken seriously, lacking of information, perceived lack of empathy, commitment and knowledge among healthcare personnel. Positive experiences included adequate information and an empathic approach from the healthcare personnel.   Conclusion: Empathy, commitment and adequate information are the three most important aspects regarding a good approach from the healthcare personnel which can improve the treatment of the disease for women with PCOS. To improve the encounter, healthcare personnel need to have more knowledge about the condition and get more time to give information, guiding and to form the relationship between patient and healthcare provider. This would give the healthcare providers the opportunity to live up to the expectations given by the international guidelines regarding PCOS management and assessment. / Introduktion: Polycystiskt ovarialsyndrom (PCOS) är det vanligaste endokrina sjukdomstillståndet hos fertila kvinnor. PCOS är en komplex, kronisk en sjukdom med många olika symtom som kan göra livet svårt för de drabbade och deras närstående. Trots detta finns det problem rörande kunskap om sjukdomen hos både allmänheten och vårdgivare. Eftersom sjukdomen är heterogen måste behandlingen individualiseras men studier visar på att det finns problem med information, diagnos och stöd från vårdgivare.  Syfte: Syftet med studien var att undersöka hur kvinnor med PCOS upplever bemötandet från sjukvården.Metod: Deskriptiv litteraturstudie av tolv artiklar med kvalitativa studier från Cinahl och PubMed. Alla studier granskade utifrån SBU:s mall för granskning av kvalitativa studier. En innehållsanalys i sex steg genomfördes.  Resultat: I analysen framkom två kategorier: negativa och positiva upplevelser av bemötande från vårdpersonal. Negativa upplevelser inkluderade att inte bli tagen på allvar, bristfällig information och bristande kunskap, empati och engagemang hos vårdpersonal. Positiva upplevelser inkluderade tillräcklig information och ett empatiskt bemötande från vårdpersonalen. Slutsats: Empati, engagemang och tillräcklig information är de tre viktigaste aspekterna av ett gott bemötande från vårdpersonal. Dessa tre aspekter kan förbättra hur kvinnor med PCOS kan hantera sin sjukdom. För att förbättra vårdpersonalens bemötande behöver deras kunskap om PCOS ökas och mer tid behöver avsättas till information, rådgivning och utvecklandet av en relation mellan vårdpersonal och patient. Detta skulle kunna leda till att vårdpersonal får de förutsättningar som behövs för att leva upp till de riktlinjer för behandling av PCOS som finns.