Search

Background: Endometriosis is a common condition affecting 1–10% of all women. The condition is highly associated with pain. Most women with endometriosis are treated as elective outpatients, but these patients sometimes need to visit the emergency department. The aim of this study was to describe experiences and expectations related to repeated gynaecological emergency (GED) visits among women with endometriosis. Method: This qualitative study with semi structured interviews were conducted with ten patients diagnosed with endometriosis who visited the GED at a tertiary university hospital four or more times within a 12-month period. Data were analysed by thematic content analysis. Result: Two main themes was identified which embodied the women's overall experience, grouped into: "Living with pain" and "Patients´ needs when seeking GED", with six underlying themes. Several women described their visit to the GED as a "lottery", as they never knew what kind of treatment they would receive. Being listened to was most important for the women. Individualized care plans did not exist for most of the women in this study, although they repeatedly needed to visit the GED. [ABSTRACT FROM AUTHOR]

Objectives To examine the global prevalence of polycystic ovary syndrome (PCOS) among adolescents across world regions, comparing the 2003 Rotterdam consensus criteria with the current International Evidence-based PCOS Guideline criteria which omits polycystic ovarian morphology (PCOM). Design Systematic review and meta-analysis, Prospero CRD42022372029. Methods OVID MEDLINE, All EBM, PsycInfo, EMBASE, and CINAHL were searched from 1990 to November 2023 for studies assessing the prevalence of PCOS in unselected adolescent populations. Results Overall, 15 708 articles were identified. After removal of duplicates, 11 868 titles and abstracts and 445 full texts were assessed. Of these, 24 articles reporting on 23 studies from five world regions were included. In meta-analysis of 20 studies (n = 14 010 adolescents), global prevalence was 9.8% (95% CI 7.2, 12.3) according to original Rotterdam criteria, and 6.3% (95% CI 3.9, 8.8) according to International Evidence-based Guideline criteria. Global PCOS prevalence based on self-report was 9.8% (95% CI 5.5, 14.1). Grouped by WHO region, prevalence ranged from 2.9% (95% CI 2.0, 3.9) in the Western Pacific region to 11.4% (95% CI 7.1, 15.7) in the South-East Asia region according to guideline criteria. Conclusion This paramount global meta-analysis on adolescent PCOS diagnosis directly informed the 2023 International PCOS Guideline. Guideline criteria generated a global PCOS prevalence of 6.3%, compared with 9.8% on Rotterdam criteria (including PCOM). Excluding PCOM, which overlaps with normal pubertal transition, is expected to deter over-diagnosis. To avoid under-diagnosis, the Guideline recommends identifying those with either irregular cycles or hyperandrogenism as being "at risk"; this group should undergo longitudinal serial evaluations until adulthood. [ABSTRACT FROM AUTHOR]

Objective: Characteristic features of polycystic ovary syndrome (PCOS) include insulin resistance and an increased risk for type 2 diabetes. To promote improved insulin sensitivity, insulin sensitisers have been used in PCOS. However, direct comparisons across these agents are limited. This study compared the effects of metformin, rosiglitazone and pioglitazone in the management of PCOS to inform the 2023 International Evidence‐based PCOS Guideline. Design: Systematic review and meta‐analysis of the literature. Patients: Women with PCOS and treatment with insulin sensitisers. Measurements: Hormonal and clinical outcomes, as well as side effects. Results: Of 1660 publications identified, 13 randomised controlled trials were included. Metformin was superior in lowering weight (mean difference [MD]: −4.39, 95% confidence interval [CI]: −7.69 to −1.08 kg), body mass index (MD: −0.95, 95% CI: −1.41 to −0.49 kg/m2) and testosterone (MD: −0.10, 95% CI: −0.18 to −0.03 nmol/L) versus rosiglitazone, whereas there was no difference when comparing metformin to pioglitazone. Adding rosiglitazone or pioglitazone to metformin did not improve metabolic outcomes. However, rosiglitazone seemed superior to metformin in lowering lipid concentrations. Conclusions: Metformin should remain the first‐line insulin sensitising treatment in adults with PCOS for the prevention and management of weight and metabolic features. The addition of thiazolidinediones appears to offer little benefit. [ABSTRACT FROM AUTHOR]

Context Polycystic ovary syndrome (PCOS) affects more than 1 in 10 women. Objective As part of the 2023 International PCOS Guidelines update, comparisons between combined oral contraceptive pills (COCP), metformin, and combination treatment were evaluated. Data Sources Ovid Medline, Embase, PsycINFO, All EBM, and CINAHL were searched. Study Selection Women with PCOS included in randomized controlled trials (RCTs). Data Extraction We calculated mean differences and 95% CIs regarding anthropometrics, metabolic, and hyperandrogenic outcomes. Meta-analyses and quality assessment using GRADE were performed. Data Synthesis The search identified 1660 publications; 36 RCTs were included. For hirsutism, no differences were seen when comparing metformin vs COCP, nor when comparing COCP vs combination treatment with metformin and COCP. Metformin was inferior on free androgen index (FAI) (7.08; 95% CI 4.81, 9.36), sex hormone binding globulin (SHBG) (−118.61 nmol/L; 95% CI −174.46, −62.75) and testosterone (0.48 nmol/L; 95% CI 0.32, 0.64) compared with COCP. COCP was inferior for FAI (0.58; 95% CI 0.36, 0.80) and SHBG (−16.61 nmol/L; 95% CI −28.51, −4.71) compared with combination treatment, whereas testosterone did not differ. Metformin lowered insulin (−27.12 pmol/L; 95% CI −40.65, −13.59) and triglycerides (−0.15 mmol/L; 95% CI −0.29, −0.01) compared with COCP. COCP was inferior for insulin (17.03 pmol/L; 95% CI 7.79, 26.26) and insulin resistance (0.44; 95% CI 0.17, 0.70) compared with combination treatment. Conclusions The choice of metformin or COCP treatment should be based on symptoms, noting some biochemical benefits from combination treatment targeting both major endocrine disturbances seen in PCOS (hyperinsulinemia and hyperandrogenism). [ABSTRACT FROM AUTHOR]

Polycystic ovary syndrome (PCOS) affects about 12% of women of reproductive age. In 2018, the first evidence‐based guideline on assessment and management of PCOS was published, and an updated extended guideline was released in August 2023. These guidelines followed best practice and are endorsed by 39 organizations worldwide, making them the most robust source of evidence to guide clinical practice. In the 2023 guideline, diagnostic criteria have been further refined as polycystic ovary morphology can now be assessed with gynecological ultrasound or elevated anti‐Müllerian hormone levels. A healthy lifestyle should be at the focus of care for all women with PCOS; however, with no specific diet or physical exercise recommended. The latest evidence on medical treatments and fertility management are reviewed, including special considerations regarding long‐term follow‐up of metabolic and psychiatric comorbidities and pregnancy in women with PCOS. Here we summarize the recommendations from a Nordic perspective. [ABSTRACT FROM AUTHOR]

Introduction: Hyperemesis gravidarum affects 0.3%–3% of pregnant women each year and is the leading cause of hospitalization in early pregnancy. Previous systematic reviews of available treatments have found a lack of consistent evidence, and few studies of high quality. Since 2016, no systematic review has been conducted and an up‐to date review is requested. In a recent James Lind Alliance collaboration, it was clear that research on effective treatments is a high priority for both patients and clinicians. Material and methods: Searches without time limits were performed in the AMED, CINAHL, Cochrane Library, EMBASE, Medline, PsycINFO, and Scopus databases until June 26, 2023. Studies published before October 1, 2014 were identified from the review by O'Donnell et al., 2016. Selection criteria were randomized clinical trials and non‐randomized studies of interventions comparing treatment of hyperemesis gravidarum with another treatment or placebo. Outcome variables included were: degree of nausea; vomiting; inability to tolerate oral fluids or food; hospital treatment; health‐related quality of life, small‐for‐gestational‐age infant; and preterm birth. Abstracts and full texts were screened, and risk of bias of the studies was assessed independently by two authors. Synthesis without meta‐analysis was performed, and certainty of evidence was assessed using the GRADE approach. PROSPERO (CRD42022303150). Results: Twenty treatments were included in 25 studies with low or moderate risk of bias. The certainty of evidence was very low for all treatments except for acupressure in addition to standard care, which showed a possible moderate decrease in nausea and vomiting, with low certainty of evidence. Conclusions: Several scientific knowledge gaps were identified. Studies on treatments for hyperemesis gravidarum are few, and the certainty of evidence for different treatments is either low or very low. To establish more robust evidence, it is essential to use validated scoring systems, the recently established diagnostic criteria, clear descriptions and measurements of core outcomes and to perform larger studies. [ABSTRACT FROM AUTHOR]

The article responds to a letter from de Zegher and Ibáñez regarding the use of metformin and combined oral contraceptive pills (COCPs) in the management of polycystic ovary syndrome (PCOS). The authors argue that metformin should not be considered as first-line therapy for PCOS, as there is no evidence of overall symptomatic benefits compared to COCPs. They emphasize the importance of evidence-based medicine and personalized treatment for individuals with PCOS. The authors encourage further research to determine effective therapies for PCOS. [Extracted from the article]

This article is a response to a critique of a previous article on the treatment of polycystic ovary syndrome (PCOS). The authors clarify that their focus was on presenting updated guidelines and evidence-based treatments, rather than exploring the syndrome's pathogenesis. They acknowledge the role of insulin resistance in PCOS but note that not all women with PCOS are insulin resistant. The authors also mention that the treatment options proposed by the critics were not included in their article due to insufficient evidence. They emphasize that their article aimed to summarize the updated guidelines from a Nordic perspective. [Extracted from the article]

Introduction: To address the question of whether women with polycystic ovary syndrome (PCOS) reach menopause later than age-matched controls, we conducted a follow-up cohort study of women with well-characterized PCOS that was diagnosed 24 years ago. The hypothesis was that women with PCOS would reach menopause later than non-PCOS women. Parity during these 24 years was also studied.Material and Methods: Twenty-seven women diagnosed with PCOS in 1992 (mean age 29.5 years) were re-examined in 2016 (mean age 52.4 years). Randomly selected women, n = 94 (mean age 52.4 years), from the same geographic area included in the World Health Organization MONICA study, Gothenburg, Sweden, served as controls.Results: The mean menopausal age in women with PCOS was higher than in controls (53.3 ± 2.2 years vs 49.3 ± 3.5 years, P < 0.01). Serum-follicle stimulating hormone levels were lower in the PCOS women than in controls (31.0 ± 28.1 IU/L vs 52.3 ± 37.7 IU/L, P = 0.01). There was no difference in parity between women with PCOS (1.9 ± 1.3 children, range 0-4) and controls (1.7 ± 1.0, range 0-4 children).Conclusions: Women with PCOS reached menopause 4 years later and had lower serum-follicle stimulating hormone compared with age-matched controls. Neither parity nor nulliparity differed between women with PCOS and controls. [ABSTRACT FROM AUTHOR]

Background: There are few studies in unselected populations describing reproductive outcomes in women with polycystic ovary syndrome (PCOS) at the end of their reproductive years., Objective: To compare parity and maternal age at deliveries and explore factors associated with advanced maternal age in a large, unselected population-based cohort, followed prospectively for 25 years., Study Design: Women randomly selected from the general population and included in the prospective Australian Longitudinal Study on Women´s Health were assessed approximately every third year from 1996 (age 18 - 23 years) to 2021 (age 43 - 48 years). Women with and without self-reported PCOS diagnosis ((n=981 and n=13 266, respectively) were compared., Results: Overall 9.9% of women reported having PCOS and by 43 - 48 years. Compared to women without PCOS, those with PCOS had fewer births (1.7 ± 1.3 vs. 1.9 ± 1.2, p<0.001), and more were nulliparous (23% vs. 18%, p=0.003). Women with PCOS were older at their first and second childbirths (29.5 ± 5.5 vs. 28.8 ± 5.5 years and 32.1 ± 5.2 vs. 31.1 ± 5.0 years, p<0.001 for both). PCOS was associated with increased odds of advanced maternal age at first childbirth, adjusted odds ratio (aOR) 1.40 (95% confidence interval 1.10-1.80), and increased odds of gestational diabetes, aOR 3.90 (2.99-5.10). However, type 2 diabetes and hypertension were not associated with advanced maternal age (aOR 0.81 (0.43-1.50) and aOR 0.78 (0.59-1.03), respectively. Within the PCOS group, a late PCOS diagnosis was associated with increased odds of advanced maternal age, aOR 1.98 (1.22-3.22)., Conclusion: Women with PCOS have lower parity and give birth at a later age compared to women without PCOS. PCOS is associated with advanced maternal age, with subsequent increased pregnancy complications. Later PCOS diagnosis is associated with double the rate of advanced maternal age at birth, emphasizing the importance of timely diagnosis., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: Polycystic ovary syndrome (PCOS), affecting more than every 10th woman of reproductive age, is associated with increased risk factors for cardiovascular disease (CVD). Most knowledge regarding longtime consequences concerning morbidity is based on women where ovarian wedge resection (WR) was used as a surgical treatment, a method not used today. The aim of this study was to compare women with PCOS who had and had not undergone WR, regarding risk factors for CVD. The hypothesis was that women who had undergone WR had a more severe PCOS phenotype, and that this cohort thus had more associated CVD risk factors compared with women diagnosed through non-invasive methods., Study Design: A cross-sectional study was performed. A PCOS cohort who underwent WR in the 1950-60 s (n = 27) were compared with a PCOS cohort diagnosed by NIH-criterions in the 1990s without WR (n = 32). Both cohorts were examined at perimenopausal age., Results: No differences were seen in prevalence of hypertension, obesity or type 2 diabetes mellitus (T2DM) between the women with PCOS with or without WR, respectively. The results were persistent irrespective of the lower mean BMI in the WR group, 26.4 vs. 30.7 kg/m 2 , p = 0.01. In the stratified group of overweight and obese, there was no difference in T2DM 27% vs 25% or hypertension 27% vs 25%, in WR and non-WR women with PCOS, respectively. The cohort diagnosed through WR had higher free androgen index (6.3 vs. 2.1, p < 0.01) and total testosterone (2.20 vs. 0.99 nmol/L, p < 0.01)., Conclusion: No differences in CVD risk factors were found in perimenopausal women with PCOS with or without a previous WR, and irrespective of body weight. The results indicate that CVD morbidity and mortality from studies in women with PCOS who have undergone WR are generalizable to women with PCOS who have not undergone WR., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objective: Despite the clear evidence of increased cardiovascular disease (CVD) risk factors, the long-term effect on CVD and mortality is still uncertain in women with PCOS, especially in the elderly. Studies in elderly women with PCOS are lacking. The objective was to study morbidity/mortality in PCOS women compared with a reference group up to a mean age above 80 years., Study Design: A well-defined cohort of women with PCOS, examined in 1987 and 2008, was re-examined 32 years later in 2019 (age range 72-91 years), in parallel with an age-matched reference group. For deceased women register data was used, for women alive interviews were done, and medical records studied. Blood pressure and blood tests were analyzed. Morbidity and mortality data was available in 35/36 women with PCOS, and in 99/118 women in the reference group., Results: At mean age 81 years there was no difference in all-cause mortality (HR 1.1, ns), CVD-related mortality (HR 1.7, ns), all CVD (HR 1.2, ns), hypertension (HR 1.8, ns), type 2 diabetes (HR 1.7, ns), in levels of blood lipids, glucose, insulin or thyroid hormones. Comparing baseline data from the deceased and living women with PCOS, no differences were found regarding age, menopausal age, BMI, HOMA-IR, FAI, total testosterone or SHBG. However, deceased women with PCOS had a higher WHR (0.87 vs. 0.80; p-value < 0.01) at baseline., Conclusions: No evidence of increased all-cause mortality or CVD was found in women with PCOS. The elevated testosterone levels and CVD risk profile in PCOS present during perimenopause do not seem to be associated with increased CVD morbidity/mortality risk later in life., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)