Do Pregnancy and Parenthood Affect the Course of PCO Syndrome? Initial Results from the LIPCOS Study (Lifestyle Intervention for Patients with Polycystic Ovary Syndrome [PCOS])

Abstract

Introduction: The impact of pregnancy and parenthood on the long-term course of PCOS (polycystic ovary syndrome is still not known. The LIPCOS study (Lifestyle Intervention for Patients with Polycystic Ovary Syndrome [PCOS] – using the example of pregnancy and parenthood) systematically investigates long-term changes in PCOS symptoms. Method and Patients: The LIPCOS pilot study sent out a questionnaire to 403 patients who had presented with oligomenorrhea between 1991 and 2002. The prospective LIPCOS main study systematically investigated 64 women using structured interviews about lifestyle changes in the last 10 years, created a detailed hormone profile of these women and carried out vaginal ultrasound to calculate ovarian score. Results: Ovarian volume and ovarian score were not significantly lower for women with children (n = 25) compared to women with PCOS who had not had children (n = 39; p = 0.226). More women with children than women who did not have children currently reported a regular daily lifestyle, and the difference was statistically significant (92 % [n = 23/25] vs. 61.5 % [n = 24/39]; p = 0.009). Ten years ago or before the birth of their first child, respectively, no such difference was found between both groups (52 vs. 51.3 %). Over the last 10 years, women with children were more likely to have shorter cycles compared to women without children (p = 0.441). 88 % of women with children compared to 69.2 % of women without children reported that currently they had a “healthy diet” (p = 0.130). Serum testosterone levels were slightly lower for women with children (67.6 % of the upper limits of normal ranges) compared to women without children (80 % of the upper limits of normal ranges), but because of the small subgroup sizes the difference was not statistically significant (p = 0.106). Conclusion: The LIPCOS study shows for the first time that pregnancy and parenthood may have an impact on the long-term course of PCOS. Women with children reported shorter cycles and had lower testosterone levels compared to women without children.

Zusammenfassung

Einleitung: Bislang ist der Einfluss von Schwangerschaft und Elternschaft auf die Langzeitentwicklung des PCO-Syndroms unbekannt. In der LIPCOS-Studie (Lebensstilintervention bei Polycystischem Ovar Syndrom [PCOS] – am Beispiel Schwangerschaft und Elternschaft) werden systematisch Langzeitveränderungen der PCOS-Symptome betrachtet. Methoden und Patientinnen: Die LIPCOS-Pilotstudie lud 403 Patientinnen, die sich zwischen 1991 und 2002 mit Oligomenorrhö vorgestellt hatten, zur Beantwortung eines Fragebogens ein. Die prospektive LIPCOS-Hauptstudie untersuchte 64 Frauen mit PCO-Syndrom systematisch mittels strukturierten Interviews zu Lebensstilveränderungen in den letzten 10 Jahren, detailliertem Hormonprofil und vaginaler Sonografie mit Ovarscore. Ergebnisse: Sowohl das Ovarvolumen wie auch der Ovarscore waren bei Müttern (n = 25) nicht signifikant geringer als bei PCO-Frauen ohne Kinder (n = 39; p = 0,226). Statistisch signifikant mehr Mütter als kinderlose Frauen hatten aktuell einen regelmäßigen Tagesablauf (92 % [n = 23/25] vs. 61,5 % [n = 24/39]; p = 0,009). Zehn Jahre zuvor bzw. vor Geburt des 1. Kindes war dies in beiden Gruppen mit 52 vs. 51,3 % nicht unterschiedlich gewesen. Mütter hatten häufiger eine Zyklusverkürzung als kinderlose Teilnehmerinnen in den letzten 10 Jahren (p = 0,441). 88 % der Mütter vs. 69,2 % der kinderlosen Teilnehmerinnen gaben aktuell „bewusste Ernährung“ an (p = 0,130). Die Serum-Testosteronwerte waren etwas niedriger bei Müttern (67,6 % der oberen Normgrenze) als bei kinderlosen Frauen (80 % der oberen Normgrenze), aufgrund der kleinen Untergruppen jedoch nicht signifikant unterschiedlich (p = 0,106). Schlussfolgerung: In der LIPCOS-Studie wird erstmals gezeigt, dass Schwangerschaft und Elternschaft einen Einfluss auf den longitudinalen Verlauf eines PCO-Syndroms haben könnten. Mütter berichteten über kürzere Zykluslängen und zeigten niedrigere Testosteronspiegel als kinderlose Frauen.

Key words

infertility - pregnancy - testosterone - hormones - androgen - ovary

Schlüsselwörter

Infertilität - Schwangerschaft - Testosteron - Hormone - Androgen - Ovar

• References

• 1 Conway G, Dewailly D, Diamanti-Kandarakis E et al. ESE PCOS Special Interest Group. The polycystic ovary syndrome: a position statement from the European Society of Endocrinology. Eur J Endocrinol 2014; 171: 1-29
• 2 Franks S, Stark J, Hardy K. Follicle dynamics and anovulation in polycystic ovary syndrome. Hum Reprod Update 2008; 14: 367-378
• 3 Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev 1997; 18: 774-800
• 4 Ehrmann DA. Polycystic ovary syndrome. N Engl J Med 2005; 352: 1223-1236
• 5 DeUgarte CM, Bartolucci AA, Azziz R. Prevalence of insulin resistance in the polycystic ovary syndrome using the homeostasis model assessment. Fertil Steril 2005; 83: 1454-1460
• 6 Moran LJ, Hutchison SK, Norman RJ et al. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev 2011; (7) CD007506
• 7 Fauser BJCM, Chang J, Aziz R et al. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Rotterdam ESHRE. Hum Reprod 2004; 19: 41-47
• 8 Geisthövel F, Botsch F, Wacker A et al. A novel classification of functional androgenization (FA) in women. Hum Reprod 2005; 20: 485
• 9 Sample WF, Lippe BM, Geyepes MT. Gray-scale ultrasonography of the normal female pelvis. Radiology 1977; 125: 477-483
• 10 Vigorito C, Giallauria F, Paloma S et al. Beneficial effects of a three- month structured exercise training program on cardiopulmonary functional capacity in young women with polycystic ovary syndrome. J Clin Endocrinol Metab 2007; 92: 1379-1384
• 11 Legro RS. Impact of metformin, oral contraceptives, and lifestyle modification on polycystic ovary syndrome in obese adolescent women: do we need a new drug?. J Clin Endocrinol Metab 2008; 93: 4218-4220
• 12 Chaput JP, St-Onge MP. Increased food intake by insufficient sleep in humans: are we jumping the gun on the hormonal explanation?. Front Endocrinol (Lausanne) 2014; 5: 116
• 13 Thaler MA, Seifert-Klauss V, Luppa PB. The biomarker sex hormone-binding globulin – from established applications to emerging trends in clinical medicine. Best Pract Res Clin Endocrinol Metab 2015; DOI: 10.1016/j.beem.2015.06.005.