Lino Del Pup , Andrea Borini
How to improve fertility in women with anovulatory polycystic ovary syndrome (PCOS)Gynecological and Reproductive Endocrinology and Metabolism 2020; 1(4):208-214
Polycystic ovary syndrome (PCOS) patients wishing to conceive should be told that the first line of treatment is lifestyle improvement. The main components of this are physical exercise, reduction of sedentary behaviors and weight normalization or maintenance of body weight within normal limits. A healthy diet, low in simple sugars and with anti-inflammatory effects, should be recommended. Inositol may improve insulin sensitivity and ovulation rate. Oocyte quality may be improved if melatonin is added. In addition, supplementation of vitamins D and B12, and of thyroxin, could be added if these are deficient. The metabolic and hormonal milieu should be as physiologic as possible and exposure to pollutants should be kept to a minimum, particularly in the periconceptional period.
Alessandro D Genazzani, Veronica Tomatis, Alba Manzo, Francesca Ressa, Martina Caroli, Martina Piccinini, Fedora Ambrosetti, Melania Arnesano, Giulia Despini, Blazej Meczekalski
Treatment with carnitines, L-arginine and N-acetyl cysteine in patients affected by functional hypothalamic amenorrhea (FHA) induces hormonal and metabolic changesEuropean Gynecology and Obstetrics. 2020; 2(4):239-245
Context: Functional hypothalamic amenorrhea (FHA) is a frequent stress-induced reproductive blockade, often reversible by removing stress factors. No specific therapeutic strategies have been defined for FHA, although a number of interventions have been proposed.
Aims: This study was conducted to evaluate the modulations induced by integrative administration of carnitines, L-arginine (LArg) and N-acetyl cysteine (NAC).
Design: Twenty-nine (n=29) patients with FHA were evaluated before and after an integrative treatment with L-carnitine (500 mg) and acetyl-L-carnitine (250 mg) combined with LArg (500 mg), NAC (50 mg), and vitamins E and C as antioxidants, administered daily. Hormonal plasma determinations of LH, FSH, prolactin, estradiol, cortisol, DHEAS, androstenedione, testosterone, progesterone, insulin, and amylase were performed before and after 12 weeks of integrative treatment.
Results: Plasma levels of amylase and insulin were found to be decreased and increased, respectively, after the treatment. When FHA patients were compared according to their baseline LH plasma levels, i.e. above (normo-LH) versus below (hypo-LH) 3 mIU/ml, the integrative treatment was found to be greatly effective in hypo-LH FHA subjects: LH and insulin increased, while amylase and cortisol decreased.
Conclusion: Stress-induced neuroendocrine impairments parallel the metabolic imbalance in FHA. The improvements observed after administering a combination of carnitines with anti-oxidants such as LArg, NAC, and vitamins E and C allow this approach to be considered a putative treatment option.
Anthony C. Hackney, Hannah N. Willett
Testosterone Responses to Intensive, Prolonged Endurance Exercise in WomenEndocrines 2020, 1(2), 119-124
Objective: To examine the response of testosterone in women to an intensive, prolonged endurance exercise bout that mimicked a competitive event.
Methods: Ten healthy eumenorrheic women ran to exhaustion at ~100% of their ventilatory threshold in their follicular menstrual cycle phase. Testosterone measures were assessed pre-exercise, immediately, 30 min, 60 min, 90 min, and 24 h post-exercise.
Results: At exhaustion (75.1 ± 7.0 min), total (56%), free (36%), and bioavailable testosterone (50%) were increased from pre-exercise values (p < 0.05). At 24 h post-exercise, these measures were decreased from pre-exercise values (−21%, −31%, −18%, respectively; p < 0.05). Effect sizes for these changes ranged from medium to large in magnitude. Conclusion: Testosterone was elevated in the early recovery period following exhaustive endurance exercise but was reduced by 24 h afterward. These outcomes are comparable to responses seen in men when sex-based concentration differences are considered.
Yun Chen, Xin Zheng, Danyan M, Silan Zheng, Yan Han, Weijuan Su, Wei Liu, Fangsen Xiao,Mingzhu Lin, Xiaohong Yan, Tongjin Zhao, Changqin Liu
Neck circumference is a good predictor for insulin resistance in women with polycystic ovary syndromeFertil Steril 2021;115:753–60
Objective: To assess the role of neck circumference (NC) in assessing insulin resistance (IR) in polycystic ovary syndrome (PCOS).
Design: A cross-sectional study. Setting: University-affiliated hospital. Patient(s): One hundred forty-three women with PCOS were recruited from November 2018 to February 2020.
Main Outcome Measure(s): The associations of NC with IR and the cutoff points of NC for IR.
Result(s): The prevalence rates of IR were 64.3%. The patients with PCOS with IR had significantly greater values of systolic blood pressure, NC, body mass index, waist-to-hip ratio, waist circumference, fasting blood glucose, fasting insulin, and homeostasis model assessment of insulin resistance (HOMA-IR). Pearson correlation analysis showed body mass index (log-transformed), waist circumference, waist-to-hip ratio, and HOMA-IR (log-transformed) were positively correlated with NC. Multivariable linear regression showed that NC was significantly associated with HOMA-IR (log-transformed), with the standardized regression coefficient of 0.330 with adjustment for potential confounding factors. Furthermore, multivariate logistic regression analyses showed NC was associated significantly with increased risk of IR, with the adjusted odds ratio of 1.423. Additionally, NC was able to identify IR in women with PCOS; the optimal cut-off points was 34.3 cm (Youden index ¼ 0.586).
Conclusion(s): Neck circumference is positively associated with IR in women with PCOS. We suggest NC as a novel, simple, practical, and reliable anthropometric measure to be used to predict the risk of IR in patients with PCOS.
Libera Troìa, Simona Martone, Giuseppe Morgante, Stefano Luisi
Management of perimenopause disorders: hormonal treatmentGynecological Endocrinology 2021, 37: 195-200
Perimenopause represents a transition period of a woman’s life during which physiological, affective, psychological, and social changes mark progression from a woman’s fertile life to menopause, with wide sexual hormones fluctuations until the onset of hypergonadotropic hypogonadic amenorrhea. Contraception during menopause should not only avoid unwanted pregnancies, but also improve quality of life and prevent wide range of condition affecting this population. Hormonal contraceptives confer many noncontraceptive benefits for women approaching menopause: treatment of abnormal uterine bleeding, relief from vasomotor symptoms, endometrial protection in women using estrogen therapy, musculoskeletal protection, and mood disorders protection. The main point remains selecting the most adequate contraceptive option for each woman, considering her risk factor, comorbidities, and keeping in mind the possibility of continuing contraception until reaching menopause and even further, creating a bridge between perimenopause and menopause hormonal therapy. Correct perimenopause management should rely on individualized medical therapy and multidisciplinary approach considering lifestyle and food habits as part of general good health of a woman.
Yikun Lia , Jing Wang, Jiamiao Yang, Jian Chen , Wenting Zhou , Chengcheng Qiao , Shanmei Shen, Yan Bi
The correlation between vitamin D, glucose homeostasis and androgen level among polycystic ovary syndrome patients: a cross-sectional studyGYNECOLOGICAL ENDOCRINOLOGY 2021, VOL. 37, NO. 3, 235–239
Background: Polycystic ovary syndrome (PCOS) is one of the most common systemic reproductive endocrine diseases. This study is aimed at determining vitamin D (vit D) status and establishing whether serum 25-hydroxy vitamin D [25(OH)D] is associated with glucose homeostasis and the level of androgen in PCOS.
Material and Methods: A total of 290 women with PCOS participated in this cross-sectional study. Glucose homeostasis was assessed by a 75-g oral glucose tolerance test and the concentration of serum 25-hydroxy vitamin D was determined among all subjects. The homeostasis model assessment of insulin resistance (HOMA-IR) was taken as the indicator of insulin resistance. Beta cell function was estimated using the insulinogenic index and the disposition index. Free androgen index (FAI) was used to represent the androgen level.
Results: In our study, 7.2% of the patients had Vit D severe deficiency, 75.2% had Vit D deficiency and 15.5% had vit D insufficiency. The level of serum 25(OH)D showed a significant positive association with insulinogenic index (r ¼ 0.147, p < .05), disposition index (r ¼ 0.280, p < .05), and SHBG (r ¼ 0.178, p < .05) but exhibited a negative association with HOMA-IR (r ¼ 0.198, p < .05), FAI (r ¼ 0.178, p < .05). Adjusted age and BMI, 25(OH)D would be the dependent variable on disposition index [B ¼ 0.259, 95%CI(0.041,0.477)] and FAI [B ¼ 0.125, 95%CI(0.232, 0.017)]. Conclusions: According to our results, the low levels of serum 25(OH)D were common in women with PCOS, which was speculated to be associated with glucose homeostasis and the androgen level.
Satoru Ikenoue, Feizal Waffarn, Masanao Ohashi, Mamoru Tanaka, Daniel L Gillen, Claudia Buss, Sonja Entringer, Pathik D Wadhwa
Placental Corticotrophin-Releasing Hormone is a Modulator of Fetal Liver Blood PerfusionJournal of Clinical Endocrinology & Metabolism 2021, 106, 3: 646–653
Context Variation in fetal liver blood flow influences fetal growth and postnatal body composition. Placental corticotrophin-releasing hormone has been implicated as a key mediator of placental-fetal perfusion.
Objective To determine whether circulating levels of placental corticotrophin-releasing hormone across gestation are associated with variations in fetal liver blood flow.
Design Prospective cohort study.
Methods Fetal ultrasonography was performed at 30 weeks’ gestation to characterize fetal liver blood flow (quantified by subtracting ductus venosus flow from umbilical vein flow). Placental corticotrophin-releasing hormone was measured in maternal circulation at approximately 12, 20, and 30 weeks’ gestation. Multiple regression analysis was used to determine the proportion of variation in fetal liver blood flow explained by placental corticotrophin-releasing hormone. Covariates included maternal age, parity, pre-pregnancy body mass index, gestational weight gain, and fetal sex.
Results A total of 79 uncomplicated singleton pregnancies were analyzed. Fetal liver blood flow was 68.4 ± 36.0 mL/min (mean ± SD). Placental corticotrophin-releasing hormone concentrations at 12, 20, and 30 weeks were 12.5 ± 8.1, 35.7 ± 24.5, and 247.9 ± 167.8 pg/mL, respectively. Placental corticotrophin-releasing hormone at 30 weeks, but not at 12 and 20 weeks, was significantly and positively associated with fetal liver blood flow at 30 weeks (r = 0.319; P = 0.004) and explained 10.4% of the variance in fetal liver blood flow.
Conclusions Placental corticotrophin-releasing hormone in late gestation is a possible modulator of fetal liver blood flow and may constitute a biochemical marker in clinical investigations of fetal growth and body composition.
Sun Y Lee, Elizabeth N Pearce
Testing, Monitoring, and Treatment of Thyroid Dysfunction in PregnancyJournal of Clinical Endocrinology & Metabolism, 2021, 3: 883–892
Both hyperthyroidism and hypothyroidism can have adverse effects in pregnancy. The most common causes of thyrotoxicosis in pregnancy are gestational transient thyrotoxicosis and Graves’ disease. It is important to distinguish between these entities as treatment options differ. Women of reproductive age who are diagnosed with Graves’ disease should be counseled regarding the impact of treatment options on a potential pregnancy. Although the absolute risk is small, antithyroid medications can have teratogenic effects. Propylthiouracil appears to have less severe teratogenicity compared to methimazole and is therefore favored during the first trimester if a medication is needed. Women should be advised to delay pregnancy for at least 6 months following radioactive iodine to minimize potential adverse effects from radiation and ensure normal thyroid hormone levels prior to conception. As thyroid hormone is critical for normal fetal development, hypothyroidism is associated with adverse obstetric and child neurodevelopmental outcomes. Women with overt hypothyroidism should be treated with levothyroxine (LT4) to a thyrotropin (thyroid-stimulating hormone; TSH) goal of <2.5 mIU/L. There is mounting evidence for associations of maternal hypothyroxinemia and subclinical hypothyroidism with pregnancy loss, preterm labor, and lower scores on child cognitive assessment. Although there is minimal risk of LT4 treatment to keep TSH within the pregnancy-specific reference range, treatment of mild maternal thyroid hypofunction remains controversial, given the lack of clinical trials showing improved outcomes with LT4 treatment..