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Using Multivariate Statistics

Polycystic ovary syndrome (PCOS) is now recognized as an important metabolic as well as reproductive disorder conferring substantially increased risk for type 2 diabetes. Affected women have marked insulin resistance, independent of obesity. This article summarizes the state of the science since we last reviewed the field in the Endocrine Reviews in 1997. There is general agreement that obese women with PCOS are insulin resistant, but some groups of lean affected women may have normal insulin sensitivity. There is a post-binding defect in receptor signaling likely due to increased receptor and insulin receptor substrate-1 serine phosphorylation that selectively affects metabolic but not mitogenic pathways in classic insulin target tissues and in the ovary. Constitutive activation of serine kinases in the MAPK-ERK pathway may contribute to resistance to insulin's metabolic actions in skeletal muscle. Insulin functions as a co-gonadotropin through its cognate receptor to modulate ovarian steroidogenesis. Ge...

Insulin Resistance and the Polycystic Ovary Syndrome Revisited: An Update on Mechanisms and Implications

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Multivariate Data Analysis With Readings

Polycystic ovary syndrome (PCOS) is characterized by a constellation of clinical symptoms that include irregular menses due to chronic oligo-ovulation, phenotypic features of hyperandrogenism, and obesity The term “polycystic ovary” refers to ovarian morphology with increased ovarian stroma and a ring of cortical follicles Core biochemical features include hyperandrogenism and insulin resistance The pathogenesis of PCOS remains a topic of debate Treatment of PCOS typically focuses on mitigating the impact of hyperandrogenism, insulin resistance, and chronic oligo-ovulation and restoring fertility when desired

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Polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age, with a prevalence of up to 10%. Various diagnostic criteria have been proposed, generally centered around the features of hyperandrogenism and/or hyperandrogenemia, oligo-ovulation and polycystic ovarian morphology. Insulin resistance is present in a majority of cases, with compensatory hyperinsulinemia contributing to hyperandrogenism via stimulation of ovarian androgen secretion and inhibition of hepatic sex hormone-binding globulin production. Adipose tissue dysfunction has been implicated as a contributor to the insulin resistance observed in PCOS. Environmental and genetic factors also have a role in the development of PCOS. The syndrome is associated with numerous morbidities, including infertility, obstetrical complications, type 2 diabetes mellitus, cardiovascular disease, and mood and eating disorders. Despite these morbidities, PCOS may be common in our society owing to evolutionary advantages of the syndrome in ancient times, including smaller family sizes, reduced exposure to childbirth-related mortality, increased muscle mass and greater capacity to store energy. The diagnosis of PCOS hinges on establishing key features while ruling out other hyperandrogenic or oligo-ovulatory disorders. Treatment is focused on the goals of ameliorating hyperandrogenic symptoms, inducing ovulation and preventing cardiometabolic complications.

Polycystic ovary syndrome: etiology, pathogenesis and diagnosis

1.31-5.95, P , 0.008), but the risk of ovarian and breast cancers was not significantly increased (OR, 1.41; 95% CI, 0.93-2.15, P , 0.11 and OR, 0.95; 95% CI, 0.64-1.39, P , 0.78, respectively). However when studies which included women aged over 54 years were excluded from the analysis, the risk for women with PCOS increased further for endometrial cancer (OR, 4.05; 95% CI, 2.42-6.76, P , 0.00001), became significantly increased for ovarian cancer (OR, 2.52; 95% CI, 1.08-5.89, P , 0.03), but remained non-significant for breast cancer (OR, 0.78; 95% CI, 0.46-1.32, P , 0.35). conclusions: This is the first meta-analysis to examine gynaecological cancers in women with PCOS younger than 54 years of age compared with controls of similar age. Current data suggest that women of all ages with PCOS are at an increased risk of endometrial cancer but the risk of ovarian and breast cancer was not significantly increased overall. These results highlight the potential risk of gynaecological cancer morbidities associated with

Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis

BACKGROUND - Our aim was to assess differences in anxiety and depression between women with and without (controls) polycystic ovary syndrome (PCOS). 
METHODS - We conducted a systematic review and meta-analysis of published literature comparing women with PCOS to control groups on anxiety and depression. Electronic databases were searched up to 17 December 2010. The inverse variance method based, as appropriate, on a random- or fixed-effects model in Review Manager, Version 5 was used to analyse the data. 
RESULTS - Twelve comparative studies were included; all studies assessed depression (910 women with PCOS and 1347 controls) and six also assessed anxiety (208 women with PCOS and 169 controls). Analysis revealed higher depression (Z = 17.92, P < 0.00001; Hedges’ g = 0.82; 95% CI 0.73–0.92) and anxiety (Z = 5.03, P < 0.00001; Hedges’ g = 0.54; 95% CI 0.33–0.75) scores in the participants with, than without, PCOS. Studies controlling for BMI showed a smaller difference between women with PCOS and controls on anxiety and depression scores than studies not controlling for BMI. 
CONCLUSIONS - Women with PCOS on average tend to experience mildly elevated anxiety and depression, significantly more than women without PCOS. Women with PCOS with lower BMI tended to have slightly lower anxiety and depression scores, suggesting that having a lower BMI reduces anxiety and depression. Future studies might consider (i) controlling for BMI, (ii) stratifying by medication use in order to control for any anti-androgenic effects of medication and (iii) excluding women with polycystic ovaries from control groups.

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Anxiety and depression in polycystic ovary syndrome: a systematic review and meta-analysis

OBJECTIVE: There is some evidence that men and women deal with stress in different ways; for example, a meta-analysis found that women prefer to focus on emotions as a coping strategy more than men do. However, sex differences in preferences for therapy is a subject little explored. DESIGN: A cross-sectional online survey. METHOD: Participants (115 men and 232 women) were recruited via relevant websites and social media. The survey described therapies and asked participants how much they liked each. Their coping strategies and help-seeking behaviour were assessed too. RESULTS: Survey data were analysed using multiple linear regression. After familywise adjustment of the alpha for multiple testing to p < .0125, and controlling for other relevant variables, men liked support groups more than women did (β = -.163, p < .010), used sex or pornography to cope with stress more than women did (Exp[B] = .280, p < .0002), and thought that there is a lack of male-friendly options more than women did (Exp[B] = .264, p < .002). The majority of participants expressed no preference for the sex of their therapist, but of those who did, men were only slightly more likely to prefer a female therapist whereas women were much more likely to prefer females (p < .0004). Even after familywise adjustment, there were still more significant findings than would be expected by chance (p < .001, two-tailed). CONCLUSIONS: Although there are many similarities in the preferences of men and women regarding therapy, our findings support the hypothesis that men and women show statistically significant differences of relevance to clinical psychologists. PRACTITIONER POINTS: Men are less inclined than women to seek help for psychological issues This study demonstrates that men and women show significant differences in some aspects of therapy, coping behaviour, and help-seeking It is possible that men would be more inclined to seek help if therapies catered more for men's preferences Practitioners can learn to improve the success of their practice by taking the gender of clients into account.

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Gender differences in preferences for psychological treatment, coping strategies, and triggers to help-seeking

The aetiology of polycystic ovary syndrome (PCOS) is poorly understood, but an intrauterine hyperandrogenic environment has been implicated. This study was designed to assess whether the female offspring of mothers with PCOS are exposed to raised levels of testosterone (T) in utero. In this case-control study, three groups of pregnant women were recruited from the labour ward: PCOS women with a female baby (n = 10, PCOS girls); control women with a female baby (n = 20, control girls) and control women with a male baby (n = 10, control boys). Maternal and umbilical vein (UV) blood was assayed for T levels. UV T in PCOS girls was significantly raised, compared with control girls (p < 0.012). The difference in UV T between PCOS girls and control boys was not significant (p < 0.254). This is the first demonstration of a hyperandrogenic in utero environment in PCOS pregnancies; UV T in female infants is raised to male levels.

Umbilical vein testosterone in female infants born to mothers with polycystic ovary syndrome is elevated to male levels

Highlights: * Gender differences in toy choice exist and appear to be the product of both innate and social forces. * Despite methodological variation in the choice and number of toys offered, context of testing, and age of child, the consistency in finding sex differences in children's preferences for toys typed to their own gender indicates the strength of this phenomenon and the likelihood that has a biological origin. * The time playing with male‐typed toys increased as boys got older, but the same pattern was not found in girls; this indicates that stereotypical social effects may persist longer for boys or that there is a stronger biological predisposition for certain play styles in boys.

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John A. Barry

Papers

Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis

Anxiety and depression in polycystic ovary syndrome: a systematic review and meta-analysis

Gender differences in preferences for psychological treatment, coping strategies, and triggers to help-seeking

Umbilical vein testosterone in female infants born to mothers with polycystic ovary syndrome is elevated to male levels

Sex Differences in Children's Toy Preferences: A Systematic Review, Meta-Regression, and Meta-Analysis.