Aerobic Training Improves Quality of Life in Women with Polycystic Ovary Syndrome.

PURPOSE: To investigate the effects of a supervised aerobic exercise training intervention on health-related quality of life (HRQL), cardiorespiratory fitness, cardiometabolic profile, and affective response in overweight/obese women with polycystic ovary syndrome (PCOS). METHODS: Twenty-seven overweight/obese inactive women with PCOS (body mass index, ≥ 25 kg·m; age 18 to 34 yr) were allocated into an exercise group (n = 14) and a control group (n = 13). Progressive aerobic exercise training was performed three times per week (~150 min·wk) over 16 wk. Cardiorespiratory fitness, HRQL, and cardiometabolic profile were evaluated before and after the intervention. Affective response (i.e., feeling of pleasure/displeasure) was evaluated during the exercise sessions. RESULTS: The exercise group improved 21% ± 12% of cardiorespiratory fitness (P < 0.001) and HRQL in the following domains: physical functioning, general health, and mental health (P < 0.05). Moreover, the exercise group decreased body mass index, waist circumference, systolic and diastolic blood pressure, and total cholesterol level (P < 0.05). The affective response varied from "good" to "fairly good" (i.e., positive affective response) in an exercise intensity-dependent manner during the exercise training sessions. CONCLUSIONS: Progressive aerobic exercise training improved HRQL, cardiorespiratory fitness, and cardiometabolic profile of overweight/obese women with PCOS. Moreover, the participants reported the exercise training sessions as pleasant over the intervention. These results reinforce the importance of supervised exercise training as a therapeutic approach for overweight/obese women with PCOS.

Polycystic ovary syndrome: aggressive or protective factor for the retina? Evaluation of macular thickness and retinal nerve fiber layers using high-definition optical coherence tomography.

Objective. To compare macular thickness (MT) and retinal nerve fiber layers (RNFL) between women with polycystic ovary syndrome (PCOS) and healthy women. Materials and Methods. The study included 45 women with PCOS and 47 ovulatory women undergoing clinical-gynecological and ophthalmic evaluations, including measurement of MT, RNFL, and optic disc parameters using optical coherence tomography. Results. The superior RNFL around the optic nerve was significantly thicker in PCOS than in healthy volunteers (P = 0.036). After stratification according to insulin resistance, the temporal inner macula (TIM), the inferior inner macula (IIM), the nasal inner macula (NIM), and the nasal outer macula (NOM) were significantly thicker in PCOS group than in control group (P < 0.05). Both the presence of obesity associated with insulin resistance (P = 0.037) and glucose intolerance (P = 0.001) were associated with significant increase in the PC1 mean score, relative to MT. A significant increase in the PC2 mean score occurred when considering the presence of metabolic syndrome (P < 0.0001). There was a significant interaction between obesity and inflammation in a decreasing mean PC2 score relative to macular RNFL thickness (P = 0.034). Conclusion. Decreased macular RNFL thickness and increased total MT are associated with metabolic abnormalities, while increased RNFL thickness around the optic nerve is associated with hormonal changes inherent in PCOS.

Anthropometric indices of central obesity how discriminators of metabolic syndrome in Brazilian women with polycystic ovary syndrome.

BACKGROUND: Central obesity is highly prevalent in women with polycystic ovary syndrome (PCOS) and is strongly associated with metabolic syndrome (MetS). OBJECTIVES: To define cut-off points of waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), and conicity index (C-Index) to discriminate metabolic syndrome (MetS) in Brazilian women with PCOS. METHODS: In a cross-sectional study, anthropometric, biochemical and clinical parameters were measured in 113 Brazilian PCOS women (27.2 ± 4.5 years). Receiver operating characteristic (ROC) analysis was used to find out the cut-off points of anthropometric indices to predict MetS according with National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) criteria. RESULTS: Considering the ROC curve analysis the WC and WHtR had a similar performance in predicting MetS and these parameters were better than WHR and C-Index. The optimal cut-off values of the anthropometric indices for discriminate MetS were: WC = 95 cm; WHtR = 0.59; WHR = 0.88; and C-Index = 1.25. By using these cut-off points the sensitivity and specificity rates of WC and WHtR were higher than those observed for WHR and C-Index. CONCLUSION: Our results indicated that WC and WHtR are more accurate than WHR and C-Index to predict MetS in Brazilian PCOS women.

[Correlation between complaints of stress urinary incontinence and the one-hour pad test in postmenopausal women]. / Correlação entre as queixas de incontinência urinária de esforço e o pad test de uma hora em mulheres na pós-menopausa.

OBJECTIVE: to correlate complaints of stress urinary incontinence and the results of a one-hour pad test in pre- and postmenopausal women. METHODS: cross-sectional study conducted on 60 postmenopausal volunteers divided into two groups: one consisting of 34 women with involuntary loss of urine due to stress incontinence and the other consisting of 26 women without involuntary loss of urine. A control group of 15 premenopausal women with normal menstrual cycles and no urinary complaints was also used. All women underwent clinical and laboratory analysis as well as the one-hour pad test. Patients were considered to be incontinent when sanitary pad weight post-test was more than 1 g. Data were submitted to descriptive statistics, parametric ANOVA, post-hoc Tukey test and Pearson's correlation. RESULTS: all postmenopausal women presented with stress urinary incontinence during the pad test, both those with urinary loss (4 g) and with no previous loss (3.5 g). A strong correlation was observed between urinary loss and time since menopause (r=0.8; p<0.01) and body mass index (r=0.7; p=0.01). Premenopausal women were continent during the pad test (0.4 g). CONCLUSIONS: the results of the one-hour pad test showed that all postmenopausal women exhibited stress urinary incontinence, including those without urine loss on effort. Urine loss was correlated with time since menopause and body mass index.

Correlação entre as queixas de incontinência urinária de esforço e o pad test de uma hora em mulheres na pós-menopausa / Correlation between complaints of stress urinary incontinence and the one-hour pad test in postmenopausal women

OBJETIVO: correlacionar as queixas de incontinência urinária de esforço e os resultados da aplicação do pad test de uma hora em mulheres na pré e pós-menopausa. MÉTODOS: estudo transversal, composto por 60 voluntárias na pós-menopausa, divididas em dois grupos: um com 34 mulheres com queixa de perda involuntária de urina aos esforços, outro com 26 mulheres sem queixas de perda de urina aos esforços. Há também a presença de um Grupo Controle composto por 15 mulheres na pré-menopausa, com ciclo menstrual normal e sem queixas urinárias. Todas as mulheres foram avaliadas quanto à clínica e laboratorialmente, e submetidas ao pad test por uma hora. A paciente foi considerada incontinente quando o peso do absorvente após o teste foi maior do que 1 g. Os resultados obtidos foram submetidos à estatística descritiva, ao teste paramétrico ANOVA, ao pós-teste de Turkey e à correlação de Pearson. RESULTADOS: todas as mulheres na pós-menopausa apresentaram incontinência urinária de esforço durante o pad test, tanto as que referiram perda urinária (4 g), como as sem perda urinária prévia (3,5 g). Nessas mulheres, observou-se uma forte correlação das perdas de urina com o tempo de menopausa (r=0,8; p<0,01) e com o índice de massa corpórea (IMC) (r=0,7; p= 0,01). As mulheres na pré-menopausa mantiveram-se continentes durante o pad test (0,4 g). CONCLUSÕES: os resultados obtidos com a aplicação do pad test de uma hora mostraram que todas as mulheres na pós-menopausa apresentavam incontinência urinária de esforço, inclusive aquelas que não apresentavam queixa de perda de urina aos esforços. Essa perda de urina correlaciona-se com o tempo de menopausa e com o IMC.

OBJECTIVE: to correlate complaints of stress urinary incontinence and the results of a one-hour pad test in pre- and postmenopausal women. METHODS: cross-sectional study conducted on 60 postmenopausal volunteers divided into two groups: one consisting of 34 women with involuntary loss of urine due to stress incontinence and the other consisting of 26 women without involuntary loss of urine. A control group of 15 premenopausal women with normal menstrual cycles and no urinary complaints was also used. All women underwent clinical and laboratory analysis as well as the one-hour pad test. Patients were considered to be incontinent when sanitary pad weight post-test was more than 1 g. Data were submitted to descriptive statistics, parametric ANOVA, post-hoc Tukey test and Pearson's correlation. RESULTS: all postmenopausal women presented with stress urinary incontinence during the pad test, both those with urinary loss (4 g) and with no previous loss (3.5 g). A strong correlation was observed between urinary loss and time since menopause (r=0.8; p<0.01) and body mass index (r=0.7; p=0.01). Premenopausal women were continent during the pad test (0.4 g). CONCLUSIONS: the results of the one-hour pad test showed that all postmenopausal women exhibited stress urinary incontinence, including those without urine loss on effort. Urine loss was correlated with time since menopause and body mass index.

[Evaluation of cardiovascular risk by the LAP index in non-obese patients with polycystic ovary syndrome]. / Avaliação do risco cardiovascular por meio do índice LAP em pacientes não obesas com síndrome dos ovários policísticos.

OBJECTIVE: To analyze the cardiovascular risk of non-obese women with polycystic ovary syndrome (PCOS) by the LAP index (lipid accumulation product). SUBJECTS AND METHODS: 283 patients (18-34 years) assigned at the University Hospital of the Federal University of Rio Grande do Norte, Natal-RN, were divided into four groups: 1) lean PCOS (n = 35); 2) healthy lean (n = 162); 3) overweight PCOS (n = 28); 4) healthy overweight (n = 58). RESULTS: Patients with PCOS showed higher values of the LAP index than healthy controls: lean (22.26 vs. 15.87 cm.mmol/L; p = 0.007); overweight (40.83 vs. 26.32 cm.mmol/L; p = 0.001). The percentage of women above the 75th percentile of the LAP index was also higher in the subgroups with PCOS: lean (17.1 vs. 6.8%; p = 0.04); overweight (37.5 vs. 13.8%; p = 0.01). CONCLUSIONS: In our sample, patients with PCOS showed higher cardiovascular risk assessed by the LAP index in relation to healthy women, even in the absence of obesity.

Avaliação do risco cardiovascular por meio do índice LAP em pacientes não obesas com síndrome dos ovários policísticos / Evaluation of cardiovascular risk by the LAP index in non-obese patients with polycystic ovary syndrome

OBJETIVO: Analisar o risco cardiovascular de mulheres não obesas com síndrome dos ovários policísticos (SOP) por meio do índice LAP (lipid accumulation product). SUJEITOS E MÉTODOS: 283 pacientes (18-34 anos) alocadas do Hospital Universitário da Universidade Federal do Rio Grande do Norte, Natal-RN, foram divididas em quatro grupos: 1) SOP magras (n = 35); 2) saudáveis magras (n = 162); 3) SOP com sobrepeso (n = 28); 4) saudáveis com sobrepeso (n = 58). RESULTADOS: Pacientes com SOP apresentaram valores superiores do índice LAP em comparação às saudáveis: magras (22,26 vs. 15,87 cm.mmol/L; p = 0,007); sobrepeso (40,83 vs. 26,32 cm.mmol/L; p = 0,001). O percentual de mulheres acima do percentil 75 do índice LAP também foi superior nos subgrupos com SOP: magras (17,1 vs. 6,8 por cento; p = 0,04); sobrepeso (37,5 vs. 13,8 por cento; p = 0,01). CONCLUSÕES: Na amostra estudada, as pacientes com SOP apresentaram maior risco cardiovascular avaliado pelo índice LAP, quando comparadas a mulheres saudáveis, mesmo na ausência de obesidade.

OBJECTIVE: To analyze the cardiovascular risk of non-obese women with polycystic ovary syndrome (PCOS) by the LAP index (lipid accumulation product). SUBJECTS AND METHODS: 283 patients (18-34 years) assigned at the University Hospital of the Federal University of Rio Grande do Norte, Natal-RN, were divided into four groups: 1) lean PCOS (n = 35); 2) healthy lean (n = 162); 3) overweight PCOS (n = 28); 4) healthy overweight (n = 58). RESULTS: Patients with PCOS showed higher values of the LAP index than healthy controls: lean (22.26 vs. 15.87 cm.mmol/L; p = 0.007); overweight (40.83 vs. 26.32 cm.mmol/L; p = 0.001). The percentage of women above the 75th percentile of the LAP index was also higher in the subgroups with PCOS: lean (17.1 vs. 6.8 percent; p = 0.04); overweight (37.5 vs. 13.8 percent; p = 0.01). CONCLUSIONS: In our sample, patients with PCOS showed higher cardiovascular risk assessed by the LAP index in relation to healthy women, even in the absence of obesity.

Índices de obesidade central e fatores de risco cardiovascular na síndrome dos ovários policísticos / Central obesity index and cardiovascular risk factors in polycystic ovary syndrome

FUNDAMENTO: A obesidade abdominal apresenta elevada prevalência em mulheres com síndrome dos ovários policísticos (SOP) e está associada a um aumento do risco cardiovascular. OBJETIVO: Verificar a acurácia da circunferência da cintura (CC), da relação cintura-quadril (RCQ), da relação cintura-estatura (RCEST) e do índice de conicidade (índice C), no que se refere à detecção de fatores de risco cardiovascular (FRCV) em mulheres com SOP. MÉTODOS: Por meio de estudo transversal, foram alocadas 102 mulheres (26,5 ± 5 anos) com diagnóstico de SOP, de acordo com o consenso de Rotterdam. O colesterol total (CT), os triglicerídeos (TG), o LDL-colesterol (LDL-C), o HDL-colesterol (HDL-C), a glicemia de jejum, a glicemia após teste oral de tolerância à glicose (TOTG) e a pressão arterial (PA) foram avaliados em todas as pacientes, além das variáveis antropométricas. RESULTADOS: A relação cintura-estatura foi o marcador que apresentou correlações positivas significativas com o maior número de FRCV (PA, TG e glicemia após TOTG), destacando-se ainda a correlação negativa com HDL-C. Todos os marcadores antropométricos avaliados se correlacionaram positivamente com PA, enquanto CC e RCQ apresentaram correlação positiva também com TG. No tocante à acurácia para detecção de FRCV, os indicadores antropométricos considerados apresentaram taxas de sensibilidade superiores a 60 por cento, com destaque para a RCEST, que apresentou sensibilidade superior a 70 por cento. CONCLUSÃO: A RCEST demonstrou ser o indicador antropométrico com a melhor acurácia para a predição de FRCV. Nesse sentido, propõe-se a inclusão desse parâmetro de fácil mensuração na avaliação clínica para o rastreamento de mulheres com SOP e FRCV.

BACKGROUND: Women with polycystic ovary syndrome (PCOS) present a high prevalence of abdominal obesity, which is associated with an increased cardiovascular risk. OBJECTIVE: To verify the accuracy of the waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and the conicity index (CI) in the detection of cardiovascular risk factors (CVRF) in women with PCOS. METHODS: The present transversal study allocated 102 women (26.5 ± 5 years) with a diagnosis of PCOS, according to the Rotterdam criteria. Total cholesterol (TC), triglycerides (TG), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), fasting glucose, glucose after the oral glucose tolerance test (OGTT) and blood pressure (BP) were evaluated in all patients, in addition to the anthropometric variables. RESULTS: The WHtR was the marker that presented significant positive correlations with the highest number of CVRF (BP, TG and post-OGTT glucose), whereas there was a negative correlation with HDL-C. All the evaluated anthropometric markers were positively correlated with BP, whereas WC and WHR also presented a positive correlation with TG. Regarding the accuracy for the detection of CVRF, the anthropometric markers presented a sensibility > 60 percent, especially the WHtR, which had a sensibility > 70 percent. CONCLUSION: The WHtR showed to be the most accurate anthropometric indicator for the prediction of CVRF. In this sense, we propose the inclusion of this easily-measured parameter in the clinical assessment for the screening of women with PCOS and CVRF.

[Central obesity index and cardiovascular risk factors in polycystic ovary syndrome]. / Indices de obesidade central e fatores de risco cardiovascular na síndrome dos ovários policísticos.

BACKGROUND: Women with polycystic ovary syndrome (PCOS) present a high prevalence of abdominal obesity, which is associated with an increased cardiovascular risk. OBJECTIVE: To verify the accuracy of the waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and the conicity index (CI) in the detection of cardiovascular risk factors (CVRF) in women with PCOS. METHODS: The present transversal study allocated 102 women (26.5 +/- 5 years) with a diagnosis of PCOS, according to the Rotterdam criteria. Total cholesterol (TC), triglycerides (TG), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), fasting glucose, glucose after the oral glucose tolerance test (OGTT) and blood pressure (BP) were evaluated in all patients, in addition to the anthropometric variables. RESULTS: The WHtR was the marker that presented significant positive correlations with the highest number of CVRF (BP, TG and post-OGTT glucose), whereas there was a negative correlation with HDL-C. All the evaluated anthropometric markers were positively correlated with BP, whereas WC and WHR also presented a positive correlation with TG. Regarding the accuracy for the detection of CVRF, the anthropometric markers presented a sensibility > 60%, especially the WHtR, which had a sensibility > 70%. CONCLUSION: The WHtR showed to be the most accurate anthropometric indicator for the prediction of CVRF. In this sense, we propose the inclusion of this easily-measured parameter in the clinical assessment for the screening of women with PCOS and CVRF.

Prevalence of the metabolic syndrome and its components in Brazilian women with polycystic ovary syndrome.

OBJECTIVE: To determine the prevalence of the metabolic syndrome (MetS) and its components in Brazilian women with polycystic ovary syndrome (PCOS). DESIGN: Cross-sectional study. SETTING: University Hospital, Federal University of Rio Grande do Norte, Natal-RN, Brazil. PATIENT(S): 102 women with PCOS by the Rotterdam consensus criteria. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Clinical and biochemical parameters for MetS as defined by the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP III). RESULT(S): The prevalence for individual components of MetS were high-density lipoprotein cholesterol level <50 mg/dL in 69.6%, waist circumference >or=88 cm in 57.9%, triglyceride level >or=150 mg/dL in 31.7%, blood pressure >or=130/85 mm Hg in 18.6%, and fasting glucose concentrations >or=110 mg/dL in 2.9%. Three or more of these individual criteria were present in 29 (28.4%) of the patients. The prevalence of MetS increased with body mass index: 3.2%, 19.2% and 52.3% for normal, overweight, and obese women, respectively. CONCLUSION(S): These findings indicate that Brazilian women with PCOS have a high prevalence of MetS and its individual components, particularly a decreased high-density lipoprotein cholesterol level. Thus, these women are at increased risk of diabetes mellitus and cardiovascular disease.

Considerações sobre a gestação na vigência do uso de metformina, em portadoras da síndrome dos ovários policísticos / Considerations about pregnancy following use of metformin in patients with polycystic ovary syndrome

O uso da metformina, um agente hipoglicemiante oral que aumenta a sensibilidade à insulina, tem sido amplamente difundido entre os ginecologistas na abordagem da síndrome dos ovários policísticos (SOP). Enquanto muitos benefícios metabólicos, reprodutivos e clínicos têm sido relatados a partir de trials não randomizados, a observação detalhada dos resultados provenientes de estudos controlados se faz necessária. Nosso objetivo nessa revisão descritiva é aprimorar o conhecimento sobre o perfil de segurança do uso da metformina durante a gravidez, baseado em evidências clínicas publicadas na literatura. São analisados também outros aspectos, incluindo os efeitos da metformina sobre as taxas de aborto espontâneo no primeiro trimestre, teratogenicidade e desenvolvimento de pré-eclâmpsia e diabetes gestacional, em mulheres com SOP. Os autores realizaram ampla revisão da literatura disponível sobre o assunto, utilizando a base de dados MEDLINE. Referências de artigos selecionados foram identificadas para relevantes citações adicionais. Os autores esperam assim contribuir para o uso mais criterioso da metformina na SOP, especialmente na situação particular das pacientes que engravidam durante o uso da droga, alertando que as evidências disponíveis apontam para a necessidade da realização de estudos controlados e randomizados, até que conclusões definitivas sobre o assunto possam ser tomadas.

Efeito da idade materna sobre os resultados perinatais / Effect of maternal age on perinatal outcomes

Objetivo: analisar a relaçäo entre a idade materna e a ocorrência de resultados perinatais adversos na populaçäo do Rio Grande do Norte. Métodos: foram analisados os registros oficiais de 57.088 nascidos vivos no Estado do Rio Grande do Norte no ano de 1997. Os dados foram obtidos do Sistema de Informaçäo sobre Nascidos Vivos do Ministério da Saúde. A populaçäo estudada foi dividida em Grupos I, II e III, segundo a faixa etária materna: 10 a 19, 20 a 34 e 35 anos ou mais, respectivamente. As variáveis analisadas foram: duraçäo da gestaçäo, peso ao nascer e tipo de parto. A análise estatística foi realizada utilizando-se o teste X². Resultados: observamos uma maior incidência de parto pré-termo no Grupo I (4,3 por cento), em comparaçäo ao Grupo II (3,7 por cento) (p = 0,0028). A taxa de cesariana foi menor nos Grupos I e III, em comparaçäo ao Grupo II (p<0,0001). Evidenciamos freqüência significativamente maior de recém-nascidos de baixo peso nos Grupos I (8,4 por cento) e III (8,3 por cento), quando comparados ao Grupo II (6,5 por cento) (p<0,0001). Conclusöes: a gravidez nos extremos da vida reprodutiva esteve associada com maior freqüência de parto pré-termo e baixo peso ao nascer, entretanto, com relaçäo ao tipo de parto, foi observada maior freqüência de parto normal do que no grupo de gestantes com idade entre 20 e 34 anos