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- Forslund, Maria, 1978
(författare)
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Polycystic ovary syndrome in a lifetime perspective
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Polycystic ovary syndrome (PCOS) is common, affecting 9-18% of women. PCOS is associated with symptoms due to hyperandrogenism and ovarian dysfunction, but is also associated with the metabolic syndrome including obesity, insulin resistance and elevated blood lipids. The post-menopausal consequences are uncertain, due to the lack of long-term studies. Aim: To increase the knowledge about ageing women with PCOS. Material and method: Two cohorts of women with PCOS and their age-matched controls have been followed prospectively: cohort 1 (PCOS n = 33 and controls n = 94) on two occasions, and cohort 2 (PCOS n = 37 and controls n = 120) on three occasions. The women with PCOS from the two cohorts together cover an age range from 20 to 91 years. Results: Women with PCOS reached the menopause four years later than controls. Parity and nulliparity did not differ. 19% of the women with PCOS had developed type 2 diabetes mellitus (T2DM) at perimenopause, vs. 1% of controls, but all women who developed T2DM were obese and had a high waist hip ratio already at mean age 30 years. Health-related quality of life did not differ at mean age 52 years. Women with PCOS had persistently lower FSH up to a mean age of 81 years, where hirsutism was more frequent (33 vs 4%), but biochemical hyperandrogenism did not differ. Cardiovascular disease (CVD) events, CVD-related or all-cause mortality did not differ at this age. Conclusion: Women with PCOS did not suffer from increased mortality or increased CVD events, despite increased risk factors. This might be caused by possible protective factors such as a delayed menopause, and hormonal factors that differed from those of the controls at senescence.
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| 2. |
- Forslund, Maria, 1978, et al.
(författare)
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Type 2 diabetes mellitus in women with polycystic ovary syndrome during a 24-year period: importance of obesity and abdominal fat distribution.
- 2020
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Ingår i: Human reproduction open. - : Oxford University Press (OUP). - 2399-3529. ; 2020:1
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Tidskriftsartikel (refereegranskat)abstract
- What are the predictive factors for later development of type 2 diabetes (T2DM) in women with polycystic ovary syndrome (PCOS)?Obesity and abdominal fat distribution in women with PCOS in the mid-fertile years were the major risk factors for T2DM development 24years later when lifestyle factors were similar to controls.Women with PCOS have an increased prevalence of T2DM.A longitudinal and cross-sectional study was performed. Women with PCOS were examined in 1992 and in 2016. Randomly selected, age-matched women from the general population served as controls.Women with PCOS (n=27), attending an outpatient clinical at a tertiary care centre for infertility or hirsutism were diagnosed in 1992 (mean age 30years) and re-examined in 2016 (mean age 52years). Women from the World Health Organization MONItoring of trends and determinants for CArdiovascular disease (WHO MONICA-GOT) 2008, aged 38-68years, served as controls (n=94), and they were previously examined in 1995. At both at baseline and at follow-up, women had blood samples taken, underwent a clinical examination and completed structured questionnaires, and the women with PCOS also underwent a glucose clamp test at baseline.None of women with PCOS had T2DM at baseline. At the 24-year follow-up, 19% of women with PCOS had T2DM versus 1% of controls (P<0.01). All women with PCOS who developed T2DM were obese and had waist-hip ratio (WHR) >0.85 at baseline. No difference was seen between women with PCOS and controls regarding use of high-fat diet, Mediterranean diet or amount of physical activity at follow-up at peri/postmenopausal age. However, women with PCOS had a lower usage of a high-sugar diet as compared to controls (P=0.01). The mean increases in BMI and WHR per year were similar in women with PCOS and controls during the follow-up period.The small sample size of women with PCOS and the fact that they were recruited due to infertility or hirsutism make generalization to women with milder forms of PCOS uncertain.Obesity and abdominal fat distribution, but not hyperandrogenism per se, in women with PCOS in the mid-fertile years were the major risk factors for T2DM development 24years later when peri/postmenopausal. Lifestyle factors were similar to controls at that time.The study was financed by grants from the Swedish state under the agreement between the Swedish government and the country councils, the ALF-agreement (ALFGBG-718611), the Gothenburg Medical Association GLS 694291 and 780821, the Swedish Heart Lung Foundation and Hjalmar Svensson Foundation. The authors have no conflict of interest.
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