Aim: To describe the lived experience of women with polycystic ovary syndrome (PCOS). Method: Eight scientific articles of appropriate quality were found, analyzed, condensed and synthesized. Different experiences by women with PCOS were found and ordered into themes. The findings were then anchored in associated literature and discussed. Results: Four different themes were found: Feeling different; Disturbing symptoms; Searching for answers; Care treatment. Each of these themes offered areas of improvement in regard to nursing care. Conclusions: Extra attention to the psychosocial aspects of health for women with PCOS should be taken to improve nursing care. The exchange of information between nursing staff and patients needs to be better adapted to the individual informational needs of women with PCOS.

Bakgrund: Runt 5-10 % av kvinnor i fertil ålder har en diagnos av polycystiskt ovariesyndrom men ännu fler lider av syndromet utan en diagnos. Polycystiskt ovariesyndrom innebär att en kvinnas ena eller båda äggstockar är fyllda med cystor och att hon har en hormonstörning. Kosthållning har en betydande effekt på hur syndromet visar sig. Syfte: Se vad olika kostmetoder har för effekter på kvinnor med polycystiskt ovariesyndrom och vilken metod som är bäst. Metod: En litteraturstudie som analyserar tio vetenskapliga artiklar i fyra olika teman. Resultat: En hög-proteinkost, en kosthållning med lågt GI och ökad fysisk aktivitet ger alla tre positiva effekter på syndromet. En fettsnål kost ger mer negativa effekter än vad en fettrik kost ger. Studien visar att viktminskning också förbättrar syndromet. Slutsats: Mer forskning behövs om olika kostmetoders effekter på kvinnor med polycystiskt ovariesyndrom i större studiepopulationer och olika kostmetoder har olika effekter på hur polycystiskt ovariesyndrom visar sig. / Background: About 5-10 % of women in fertile age have been diagnosed with polycystic ovary syndrome diagnosis with many other women also having polycystic ovary syndrome without diagnoses. Polycystic ovary syndrome is a disease where a woman’s ovaries are filled with cysts, along with related hormonal disorders. Diets can help reduce the symptoms of this syndrome. Aim: See how various dietary approaches impacts on women with polycystic ovary syndrome and to see which approach is the best. Method: A literature review that analyzes ten different scientific articles. Four major themes were extracted from this review. Results: A high-protein diet, a diet with low GI and increased physical activity are three different approaches that are show to provide positive effects in people who suffer from this syndrome. Low-fat diets did not show positive effects. The study shows that the syndrome also becomes better with a weight loss. Conclusion: More research is needed on the various dietary approaches effects on women with polycystic ovary syndrome in larger study populations to identify the effects of different dietary approaches.

BACKGROUND. Polycystic ovarian syndrome is one of the commonest endocrinopathies in women of reproductive age. The prevalence of the disease is estimated to be around 5 % in general population (Azziz, 2004). Literature on the prevalence of PCOS in Black women is limited (Knochenhauer, 1998). This syndrome is a diagnostic conundrum due to the phenotypic variability of these women. The PCOS woman also has a greater disposition for impaired glucose homeostasis as well as hyperlipidaemia. OBJECTIVE. The hormonal and metabolic profiles of South African women with PCOS have not been described. Ethnic differences in the prevalence of PCOS have also not been well explored. Our study aims to describe and compare the phenotypic profile of African and Indian women with PCOS and to determine the frequency of insulin resistance and hyperlipidaemia in these women. METHODS. A retrospective audit of all patients attending gynaecology endocrine and infertility clinics over the period June 2005 to June 2009 was carried out. The biochemical and clinical profiles were analysed and a comparative analysis between the two largest groups, Indian and Black women were done. All women that attended these clinics were subjected to a fasting lipogram and fasting serum glucose. An abnormal fasting serum glucose would have necessitated a full glucose tolerance test. RESULTS. A total of 110 patients were analysed in this study. There were 87 Indian patients, 16 Black patients, 5 Coloured patients and 2 White patients. Eighty nine percent of PCOS women studied had an increased body mass index (>25). There was an increased LH:FSH in 66 (75.9%) of Indian women and 13 (81.3%) of Black women. Increased androgens were present in 26 (30.2%) in Indian women and 6 (37.5%) of Black women. An increase in fasting insulin was found in 48 (55.2%) of the Indian women and 5 (31.3%) of the Black women. Twenty five (29.1%) Indian women had an increase in fasting serum glucose compared to 1 (6.3%) in Black women. In the Indian population, 13 (14.9%) were found to have Diabetes Mellitus, and 9 (10.3%) had an impaired glucose tolerance test. In the Black population only 1 patient had impaired glucose tolerance. There were no Black patients with Diabetes Mellitus. No Black women were found to have hyperlipidaemia, however 12 (14.3%) Indian women were affected. None of these differences between the races were statistically significant. The major limitation of the study was the sample size of Black women. This is an ongoing study, and aims to recruit more Black women. This will be able to adequately address the correct perspective regarding the metabolic and cardiovascular abnormalities in these women. CONCLUSION. The prevalence of insulin resistance and hyperlipidaemia in local women with PCOS was 50.9%.and 11.3% respectively. Menstrual irregularities and infertility are the most frequent presenting complaints of women with PCOS. Features of hyperandrogenism are not common presenting complaints in South African women. There are no differences in the hormonal and clinical profile of South African Indian and Black women with PCOS, however, there is a trend toward Indian women having a greater prevalence of glucose abnormalities than Black women. We recommend further studies in the management of the metabolic abnormalities in local women with PCOS, in an attempt to develop a protocol to manage the metabolic complexities of PCOS. / Thesis (M.Med)-University of KwaZulu-Natal, Durban, 2010.

Follicular growth and maturation are tightly regulated processes, which involve the participation of endocrine, autocrineparacrine factors and intracellular molecules. Due to the numerous research efforts, a large number of regulators and their mechanisms of regulation of follicular growth and differentiation have been established. Although the abnormal expression and activities of some of these regulators are believed to be associated with ovarian dysfunction diseases, such as polycystic ovarian syndrome (PCOS), the etiology and pathogenesis of this syndrome are not completely understood. In this thesis, we have identified two novel regulators of follicular growth and differentiation and examined the cellular and molecular mechanisms that contribute to the folliculogenesis. We present here that chemerin reduces FSH-induced steroidogenic enzyme expression and steroid hormone production in follicles and granulosa cells. Prohibitin expression is upregulated by chemerin and knockdown of prohibitin attenuates the suppressive role of chemerin on steroidogenesis, an action regulated by Akt. Using an androgenized rodent model, we also present the dysregulation of chemerin and prohibitin and their association with dysregulated follicular steroidogenesis. Our data and preliminary clinical studies demonstrate the potential involvement of chemerin and prohibitin in the etiology of PCOS. These studies significantly improve the knowledge of ovarian functions and the pathophysiology of PCOS, and provide important clues for the development of novel diagnosis biomarkers and new treatment strategies for this complex syndrome.

Background: The progesterone metabolite allopregnanolone is involved in several clinical conditions in women, e.g. premenstrual dysphoric disorder. It is a very potent GABA-steroid with GABA-A receptor effects similar to other GABA-agonists, e.g. benzodiazepines, and it causes sedation. An objective way to examine effects on the GABA-A receptor in humans is to measure saccadic eye velocity (SEV), which is reduced by GABA-agonists, e.g. allopregnanolone. Animal studies suggest that allopregnanolone is involved in the regulation of gonadotropin secretion via the GABA-A receptor, but this has not been studied in humans. Polycystic ovary syndrome (PCOS) is the most common endocrine disturbance among women of fertile age (5–10%), characterized by polycystic ovaries, menstrual dysfunction, hyperandrogenity, and 50% have obesity. Studies have shown higher allopregnanolone levels in overweight people. PCOS women have increased levels of androstanediol, an androgen metabolite which is an GABA-A receptor agonist. Tolerance often occurs when persons are exposed to high levels of GABAergic modulators. It has not been studied whether GABA-A receptor sensitivity in PCOS women is changed. Another progesterone metabolite, isoallopregnanolone, is the stereoisomere of allopregnanolone but has not been shown to have any GABA-A receptor effect of its own. Instead it has often been used to control steroid specificity to allopregnanolone. Aims: To compare the effects of allopregnanolone and isoallopregnanolone on gonadotropin secretion. To compare allopregnanolone levels, GABA-A receptor sensitivity to allopregnanolone and effects on gonadotropin secretion in both cycle phases and PCOS conditions. To examine pharmacokinetics and pharmacodynamic properties for isoallopregnanolone. Method: In the follicular phase healthy women were examined for the effect of allopregnanolone or isoallopregnanolone on gonadotropin secretion. PCOS women and healthy women in both cycle phases were given allopregnanolone and the differences in effects on SEV were examined, as well as changes in serum levels of gonadotropins and allopregnanolone at baseline and during the test day. Pharmacokinetics and GABA-A receptor sensitivity using SEV were explored for isoallopregnanolone in healthy women. Results: Allopregnanolone decreases gonadotropin serum levels in healthy controls in both cycle phases, but has no effect on gonadotropin secretion in women with PCOS. PCOS women have higher baseline serum levels of allopregnanolone than follicular phase controls, but lower levels than luteal phase controls. PCOS women show greater reduction in SEV to allopregnanolone than controls. Isoallopregnanolone has no effect on gonadotropin secretion. There is an effect of isoallopregnanolone on SEV, explained by a metabolism of isoallopregnanolone into allopregnanolone. Conclusion: There are significant differences in the GABA-A receptor response to a GABA-steroid in different endocrine conditions in women of fertile age examined with saccadic eye velocity. The GABA-steroid allopregnanolone decreases gonadotropin serum levels in healthy women but not in PCOS women. The lack of effect on gonadotropins by isoallopregnanolone suggests an involvement of the GABA-A receptor.

Polycystic ovary syndrome (PCOS) is one of the most common and complex endocrinopathies among reproductive-aged women. Symptom heterogeneity among clinical cases and in sibling studies suggests that PCOS is a multifactorial disease with environmental components. Investigators hypothesize that endocrine disruptors may contribute to the pathophysiological origins of PCOS in utero. The goal of this literature review is to present and compare the available research investigating the developmental origins of PCOS deriving from prenatal exposure to three major classes of endocrine disruptors: bisphenol A (BPA), phthalates, and androgenic endocrine disruptors. Considerable evidence has been found to suggest links between fetal exposure to endocrine disruptors and PCOS. Rodent studies reported that maternal BPA exposure dysregulates postnatal development and sexual maturation. In rats, gestational exposure to dibutyl phthalate (DBP) and di(2-ethylhexyl)phthalate (DEHP) resulted in polycystic ovaries among first and third generation offspring. Additionally, serum DBP concentrations are higher among women with PCOS. Regarding DEHP, animal studies have shown that prenatal exposure results in an endocrinological profile similar to PCOS. Nicotine and 3,4,4'-trichlorocarbanilide (TCC) are known androgenic endocrine disruptors. Inducing prenatal exposure to excess androgens in animal models has successfully recreated a PCOS-like phenotype that includes abnormal ovarian function, anovulatory cycling, impaired fertility, and increased visceral fat distribution. Based on the literature, endocrine disruptors appear to have an etiological role in PCOS development through prenatal exposure and thus may pose one of the greatest hazards to fetal health and development.

Polycystic ovary syndrome is a complex, heterogeneous disease that affects 5-10% of reproductive-aged women. It is characterized by clinical or biochemical hyperandrogenism, oligo-anovulation, and polycystic ovary morphology. Instigating endocrine findings include aberrantly rapid gonadotropin-releasing hormone pulsatile secretion, elevated luteinizing hormone, sub-optimal levels of follicle-stimulating hormone, and hyperandrogenism. Metabolic symptoms are also present including hyperinsulinemia, insulin resistance, and dyslipidemia. These endocrine and metabolic findings are also accompanied by ovarian dysfunction and improper folliculogenesis. Because aberrant functioning of the hypothalamic-pituitary-gonadal axis is central to the pathophysiology of polycystic ovary syndrome, it is beneficial to examine it for abnormalities. Polycystic ovary syndrome has been shown to have both genetic and environmental components. Its strong genetic component has been demonstrated in twin studies, family association studies, candidate gene studies, and genome-wide association studies. Previous genome-wide association studies have found many candidate genes including those for DENND1A (differentially expressed in normal and neoplastic cells domain containing 1A), THADA (thyroid adenoma-associated protein), FSHR (follicle-stimulating hormone receptor), and LHR (luteinizing hormone receptor). This, together with the central endocrine abnormalities, prompted this review on polymorphisms of receptors of the hypothalamic-pituitary-gonadal axis, including those for gonadotropin-releasing hormone, luteinzing hormone, follicle-stimulating hormone, estrogen, and progesterone, as well as anti-müllerian hormone. Studies on single-nucleotide polymorphisms of these receptors were found on PubMed, Web of Science, and Google Scholar and subsequently analyzed. Many different single-nucleotide polymorphisms were studied, but only a handful of them have been subjected to repeated studies. Only rs2293275 of the luteinizing hormone receptor and rs2349415 of the follicle-stimulating hormone receptor, both at 2p16.3, were found to have a possible role in the etiology of polycystic ovary syndrome, but all eight were found to have a possible phenotypic role: rs13405728, rs2293275, and rs4539842 of the luteinizing hormone receptor; rs6165, rs6166, rs2268361, and rs2349415 of the follicle-stimulating hormone receptor; and rs2002555 of the anti-müllerian hormone receptor. The limitations most affecting the results of these studies include small sample sizes, heterogeneous study populations, lack of generalizability due to ethnicity, and lack of control or adjustment for confounders. It is necessary to develop a standardized study protocol and separate polycystic ovary syndrome patients based on phenotype in order to obtain stronger results in the future.

Orientador: Silvia Regina Rogatto / Banca: Ilce Mara de Syllos Colus / Banca: Maria Inês M. Campos Pardini / Resumo: A Síndrome do Ovário Policístico (SOP) é uma doença heterogênea que acomete principalmente mulheres em idade reprodutiva e é caracterizada por alterações clínicas como hiperandrogenismo, anovulação crônica e irregularidades menstruais e metabólicas, como resistência insulínica, obesidade, hiperlipidemia e diabetes mellitus tipo 2. Esta síndrome está associada com o risco aumentado de desenvolvimento de doenças cardiovasculares e tromboembólicas. A síndrome HAIR-AN possui manifestações clínicas semelhantes a SOP, porém por critérios de classificação atuais, compõe diagnóstico diferencial apresentando resistência insulínica severa e hiperandrogenismo. Considerando o fenótipo heterogêneo destas patologias, polimorfismos em genes da via de esteróides e da insulina podem estar associados com hiperandrogenismo e hiperinsulinemia. Foram genotipadas para os polimorfismos nos genes ER-α, ER-β, INSR, IGF2 e PAI-1 41 mulheres com fenótipo SOP, 16 com fenótipo HAIR-AN e 49 controles livres da doença. As regiões polimórficas dos genes ER-α e ER-β foram submetidas a análise automatizada no seqüenciador ABI Prism 377 DNA Sequencer para determinação do número de repetições [TA]n e [CA]n, respectivamente. Os alelos foram classificados em curtos ou longos (ER-α - alelos curtos: <15 e longos ≥15 repetições; ER-β - os alelos curtos: ≤22 e longos >22 repetições). A genotipagem de INSR e IGF2 contendo os polimorfismos C/T e A/G, respectivamente, foi realizada por PCR-RFLP com as enzimas de restrição PmlI e ApaI, respectivamente. Para a observação do polimorfismo 5G/4G do gene PAI-1, utilizou-se a técnica de PCR-SSCP e seqüenciamento direto. Não foram observadas diferenças estatísticas significativas entre os genótipos dos genes ER-α, ER-β, INSR, IGF2 e PAI-1 entre casos e controles... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Polycystic Ovary Syndrome (PCOS) is a heterogeneous disorder which is common in reproductive age women and characterized by reproductive and clinical manifestations as hyperandrogenism, anovulatory infertility, increased ovarian secretion, and hyperinsulinaemia, as insulin resistance, type 2 diabetes mellitus, and obesity. The PCOS have been associated with increased risk for development cardiovascular and thromboembolic events. The syndrome of hyperandrogenism, insulin resistance, and acanthosis nigricans (HAIR-AN syndrome) was included in the PCOS subset. However, actually HAIR-AN syndrome shows a differential diagnosis with severe insulin resistance and hyperandrogenism. Genetic polymorphisms in insulin action and steroid pathways genes can be associated with hyperinsulinaemia and hyperandrogenism in PCOS and HAIR-AN patients. The ER-alfa, ER-ß, INSR, IGF2, and PAI-1 genes polymorphisms were evaluated in 41 women with PCOS, 16 women with HAIR-AN, and 49 disease-free control women. The ER-alfa and ER-ß genes polymorphisms were investigated by automated analysis (ABI Prism 377 DNA Sequencer) to determine the [TA]n and [CA]n repeats number, respectively. The alleles were classified as short and long (ER-alfa: <15 and .15 repeats, respectively; and ER-alfa: .22 and >22 repeats, respectively). The INSR and IGF2 genes polymorphisms (C/T and A/G, respectively) were performed by PCR-RFLP methodology using the PmlI and ApaI restriction enzymes, respectively. The PAI-1 gene polymorphisms (5G/4G) were detected by PCR- SSCP and direct sequencing methodologies. No statistical differences were observed between cases and controls for all genes analyzed. However, the comparison between clinical and laboratorial data with the genotypes showed statistical differences (p<0,05). The grouped polymorphisms analysis performed by NeoGene Analysis software defined genotypic classes that can be associated with pathophysiology of the PCOS. / Mestre

Follicular growth and maturation are tightly regulated processes, which involve the participation of endocrine, autocrineparacrine factors and intracellular molecules. Due to the numerous research efforts, a large number of regulators and their mechanisms of regulation of follicular growth and differentiation have been established. Although the abnormal expression and activities of some of these regulators are believed to be associated with ovarian dysfunction diseases, such as polycystic ovarian syndrome (PCOS), the etiology and pathogenesis of this syndrome are not completely understood. In this thesis, we have identified two novel regulators of follicular growth and differentiation and examined the cellular and molecular mechanisms that contribute to the folliculogenesis. We present here that chemerin reduces FSH-induced steroidogenic enzyme expression and steroid hormone production in follicles and granulosa cells. Prohibitin expression is upregulated by chemerin and knockdown of prohibitin attenuates the suppressive role of chemerin on steroidogenesis, an action regulated by Akt. Using an androgenized rodent model, we also present the dysregulation of chemerin and prohibitin and their association with dysregulated follicular steroidogenesis. Our data and preliminary clinical studies demonstrate the potential involvement of chemerin and prohibitin in the etiology of PCOS. These studies significantly improve the knowledge of ovarian functions and the pathophysiology of PCOS, and provide important clues for the development of novel diagnosis biomarkers and new treatment strategies for this complex syndrome.

Common features of polycystic ovary syndrome (PCOS), including hyperandrogenism, ovarian dysfunction and obesity, can be highly distressing. We compared 40 women with PCOS to women with infertility but not PCOS, and to women with neither PCOS nor infertility, on measures of depression and body image. Women with PCOS reported higher depression scores and greater body dissatisfaction (p < .001) than comparison group women. Body image was strongly associated with depression overall, even after controlling body mass. Among women with PCOS, body dissatisfaction measures and education explained 66 percent of the variance in depression, suggesting explanations of the PCOS-depression link should consider the role of potentially mediating psychosocial variables.