Polikistik Over Sendromu’nda Metabolik Sendrom

Kalp ve damar hastalığı (kalp, beyin ve bacaklara oksijen taşıyan damarların tıkanması veya daralması) ihtimalini arttıran en az 3 özellik biraraya gelerek metabolik sendromu oluşturmaktadır(1,2,3,4);

1-Kan basıncı yüksekliği (≥ 130 /85 mmHg)

2-Vücudun üst kısmında yani karın ve bel bölgesinde bulunan yağ miktarının artması (bel çevresi ≥ 80 cm)

3-Açlık kan şekeri (glukoz) yüksekliği (≥ 100 mg/dL)

4-Kan yağlarından faydalı olan HDL-C miktarının azalması (≤ 50 mg/dL)

5-Kan yağlarından trigliserid miktarının artması ( ≥150 mg/dL)

Polikistik over sendromu olan kadınlarda metabolik sendrom daha sık görülmektedir.(12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36).

Polikistik over sendromu olan normal kilolu veya zayıf ya da fazla kilolu veya şişman kadınların bir kısmında karın ve bel çevresinde yağ miktarı fazla (erkek tipi yağlanma) olduğu için bel çevresi kalınlığı görülmektedir(5,6,7,8,9). Polikistik over sendromu olan ve bel çevresi kalın kadınlarda bel çevresi kalın olmayan aynı kiloya sahip kadınlara göre daha fazla oranda metabolik sendrom görülmektedir(10,11).

Polikistik over sendromu’nda fazla kilolu ve şişman olan veya normal kilolu fakat bel çevresi kalın (erkek tipi yağlanma) olan kadınların büyük çoğunluğunda insülin direnci görülmektedir(37,38,45,46). İnsülin direncinin ilerlemesi, kötüye gitmesi sonucunda bozulmuş glukoz (şeker) toleransı ve şeker hastalığı (Diabetes mellitus) gelişmektedir(39,40,41,42,43,44,47). Polikistik over sendromu olan kadınlarda genellikle insülin direnci daha hızlı bir şekilde ilerlediği, kötüye gittiği için bozulmuş şeker toleransı ve şeker hastalığı ergenlik (adolesan) döneminden itibaren daha genç yaşlarda ortaya çıkmaktadır(41,43,48). Bu nedenle polikistik over sendromu olan kadınlarda genç yaşlardan itibaren metabolik sendrom daha çok görülmektedir(14,16,24,25,49,50,51,52).

Erkeklik hormonlarının (androgen) etkisinin fazla olduğunu (hiperandrogenism) gösteren tüylenme artışı, erkek tipi saç dökülmesi, ciltte yağlanma artışı ve sivilce şikayetleri ile birlikte yumurta gelişiminin durması (anovulasyon) ya da yavaşlaması (oligoovulasyon) nedeniyle adet kanamasının gecikmesi (oligomenorrhea) veya olmaması (amenorrhea) şeklinde adet düzensizliği yaşayan kadınlar polikistik over sendromu’nun A grubuna girmektedir(53,54,55,56). A grubuna giren kadınlarda insülin direnci, bozulmuş şeker toleransı ve şeker hastalığı ve bunun sonucunda da metabolik sendrom ergenlik döneminden itibaren genç yaşlarda (< 40 yaş) polikistik over sendromu olmayan kadınlara göre daha sık görülmektedir(57,58,59,60,61,62,63,64).

Polikistik over sendromu’nun etkisi ve şiddeti 30 lu yaşlardan itibaren 40 lı yaşları takiben ve menopoz sonrası dönemde gittikçe azalmaktadır. Polikistik over sendromu olan kadınlarda fazla olan erkeklik hormonlarının miktarları (hiperandrogenism) yaş ilerledikçe 20 li yaşlardan itibaren özellikle 40 lı yaşları takiben azalmaktadır(72). Fazla sayıda olan yumurta (antral folikül) sayısının azalmasına bağlı olarak da yaş ilerledikçe bu kadınların  adet kanamaları daha düzenli (eumenorrhea) olmaya başlamakta ve hatta 30 lu yaşların ortalarından itibaren daha kolay gebe kalabilmektedirler(73,74,75,76). Polikistik over sendromu’nda görülen bu iyileşme nedeniyle 40 yaşından sonra ya da menopoz sonrasındaki dönemde fark kapanmakta olup polikistik over sendromu olan kadınlarda insülin direnci, bozulmuş şeker toleransı, şeker hastalığı ve metabolik sendrom polikistik over sendromu olmayanlarla aynı sıklıkta görülmektedir(33,65,66,67,68,69,70,71).

Polikistik over sendromu olan kadınların bir kısmında faydalı bir yağ olan HDL-kolesterol kan dolaşımında normalden daha az miktarda bulunurken, trigliserid ve LDL-kolesterol ise normalden daha fazla miktarlarda bulunmaktadır(77,78,79,80). Polikistik over sendromu olan kadınların büyük bir kısmında görülen insülin direnci HDL-kolesterol ve trigliserid miktarlarını etkilemektedir. LDL-kolesterol miktarındaki artış ise daha çok erkeklik hormonlarının (androgen) etkisinin fazla olması (hiperandrogenism) ile ilişkilidir(58,77,78,79,80).

Kalp ve damar hastalığı ihtimalini arttıran metabolik sendrom’un özelliklerden biri de kan basıncının yüksek (130 /80 mmHg) olmasıdır(58,81). Polikistik over sendromu olan kadınlarda kan basıncı yüksekliği sık görülmektedir(58,81,82). Bu kadınlarda kan basıncını en çok insülin direnci etkilemektedir(83). Erkeklik hormonlarının (androgen) etkisinin fazla olması (hiperandrogenism) da kan basıncını insülin direncinden daha az olmakla birlikte etkilemektedir(58,84,85,86).

Polikistik over sendromu olan kadınların kalp ve damar hastalıkları açısından mutlaka değerlendirilmesi gerekmektedir! Bu kadınların çok genç yaşlarda adet düzensizliği, çocuk isteği, tüylenme artışı, sivilce ve saç dökülmesi için kadın doğum uzmanına ya da cildiye uzmanına başvurmaları aslında yüksek olan kalp ve damar hastalıkları ve metabolik sendrom riskinin erken yaşlarda tespit edilmesi açısından önemli bir avantaj sağlamaktadır. Fakat, maalesef çoğunlukla kendi branşlarının dışında olduğu için ya da hastanın başvuru şikayetiyle ilgili olmadığı için kadın doğum ve cildiye uzmanları çok basit bir şekilde ölçülebilen kan basıncı, bel ve basen çevresi ölçümünü çoğunlukla yapmamaktadır. Çok genç yaşlarda doktora başvurmalarına rağmen bu kadınlarda sorun çıkma ihtimali yüksek olan kan yağları (trigliserid, kolesterol), insülin direnci, bozulmuş şeker toleransı ve şeker hastalığı testleri de çoğunlukla yapılmamaktadır.

Kaynaklar

1-Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, Spertus JA, Costa F; American Heart Association; National Heart, Lung, and Blood Institute. Circulation. 2005 Oct 25;112(17):2735-52.

2-National Institues of Health. Third Report of the Cholesterol Education Program Expert Panel on Detection, Ealuation, and Treatment of High blood Cholesterol in Adults (Adult Treatment Panel III). NIH Publication 01-3670. Bethesda, MD:  National Institues of Health. 2001.

3-Comment on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (EGIR). Balkau B, Charles MA. Diabet Med. 1999 May;16(5):442-3.

4-The metabolic syndrome–a new worldwide definition. Alberti KG, Zimmet P, Shaw J; IDF Epidemiology Task Force Consensus Group. Lancet. 2005 Sep 24-30;366(9491):1059-62.

5-The polycystic ovary syndrome: a position statement from the European Society of Endocrinology. Conway G, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Franks S, Gambineri A, Kelestimur F, Macut D, Micic D, Pasquali R, Pfeifer M, Pignatelli D, Pugeat M, Yildiz BO; ESE PCOS Special Interest Group. Eur J Endocrinol. 2014 Oct;171(4):P1-29.

6-Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. Moran LJ, Misso ML, Wild RA, Norman RJ. 2010 Jul-Aug;16(4):347-63.

7-Circulating levels of adipose products and differences in fat distribution in the ovulatory and anovulatory phenotypes of polycystic ovary syndrome. Carmina E, Bucchieri S, Mansueto P, Rini G, Ferin M, Lobo RA. Fertil Steril. 2009 Apr;91(4 Suppl):1332-5.

8-Body composition characteristics and body fat distribution in lean women with polycystic ovary syndrome. Kirchengast S, Huber J. Hum Reprod. 2001 Jun;16(6):1255-60.

9-Abdominal fat quantity and distribution in women with polycystic ovary syndrome and extent of its relation to insulin resistance. Carmina E, Bucchieri S, Esposito A, Del Puente A, Mansueto P, Orio F, Di Fede G, Rini G. J Clin Endocrinol Metab. 2007 Jul;92(7):2500-5.

10-Indicators for metabolic disturbances in anovulatory women with polycystic ovary syndrome diagnosed according to the Rotterdam consensus criteria. Goverde AJ, van Koert AJ, Eijkemans MJ, Knauff EA, Westerveld HE, Fauser BC, Broekmans FJ. Hum Reprod. 2009 Mar;24(3):710-7.

11-Metabolic features of the reproductive phenotypes of polycystic ovary syndrome. Moran L, Teede H. Hum Reprod Update. 2009 Jul-Aug;15(4):477-88.

12-The prevalence of metabolic disorders in various phenotypes of polycystic ovary syndrome: a community based study in Southwest of Iran. Tehrani FR, Rashidi H, Khomami MB, Tohidi M, Azizi F. Reprod Biol Endocrinol. 2014  Sep 16;12:89.

13-The frequency of metabolic syndrome is higher among PCOS Brazilian women with menstrual irregularity plus hyperandrogenism. Melo AS, Vieira CS, Romano LG, Ferriani RA, Navarro PA. Reprod Sci. 2011 Dec;18(12):1230-6.

14-Age- and body mass index-related differences in the prevalence of metabolic syndrome in women with polycystic ovary syndrome. Panidis D, Tziomalos K, Macut D, Kandaraki EA, Tsourdi EA, Papadakis E, Katsikis I. Gynecol Endocrinol. 2013 Oct;29(10):926-30.

15-Risk of metabolic complications in the new PCOS phenotypes based on the Rotterdam criteria. Shroff R, Syrop CH, Davis W, Van Voorhis BJ, Dokras A. Fertil Steril. 2007 Nov;88(5):1389-95.

16-Adolescent girls with polycystic ovary syndrome have an increased risk of the metabolic syndrome associated with increasing androgen levels independent of obesity and insulin resistance. Coviello AD, Legro RS, Dunaif A. J Clin Endocrinol Metab. 2006 Feb;91(2):492-7.

17-Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. Apridonidze T, Essah PA, Iuorno MJ, Nestler JE. J Clin Endocrinol Metab. 2005 Apr;90(4):1929-35.

18-Screening women with polycystic ovary syndrome for metabolic syndrome. Dokras A, Bochner M, Hollinrake E, Markham S, Vanvoorhis B, Jagasia DH. Obstet Gynecol. 2005 Jul;106(1):131-7.

19-Prominent role of low HDL-cholesterol in explaining the high prevalence of the metabolic syndrome in polycystic ovary syndrome. Gambineri A, Repaci A, Patton L, Grassi I, Pocognoli P, Cognigni GE, Pasqui F, Pagotto U, Pasquali R. Nutr Metab Cardiovasc Dis. 2009 Dec;19(11):797-804.

20-Incidence and treatment of metabolic syndrome in newly referred women with confirmed polycystic ovarian syndrome. Glueck CJ, Papanna R, Wang P, Goldenberg N, Sieve-Smith L. Metabolism. 2003 Jul;52(7):908-15.

21-Prevalence of the metabolic syndrome in German women with polycystic ovary syndrome. Hahn S, Tan S, Sack S, Kimmig R, Quadbeck B, Mann K, Janssen OE. Exp Clin Endocrinol Diabetes. 2007 Feb;115(2):130-5.

22-Prevalence of the metabolic syndrome in women with a previous diagnosis of polycystic ovary syndrome: long-term follow-up. Hudecova M, Holte J, Olovsson M, Larsson A, Berne C, Sundstrom-Poromaa I. Fertil Steril. 2011 Nov;96(5):1271-4.

23-The metabolic syndrome in young Korean women with polycystic ovary syndrome. Park HR, Choi Y, Lee HJ, Oh JY, Hong YS, Sung YA. Diabetes Res Clin Pract. 2007  Sep;77 Suppl 1:S243-6.

24-Using the androgen excess-PCOS society criteria to diagnose polycystic ovary syndrome and the risk of metabolic syndrome in adolescents. Roe AH, Prochaska E, Smith M, Sammel M, Dokras A. J Pediatr. 2013 May;162(5):937-41.

25-Prevalence and risk of metabolic syndrome in adolescent Indian girls with polycystic ovary syndrome using the 2009 ‘joint interim criteria’. Bhattacharya SM, Jha A. J Obstet Gynaecol Res. 2011 Oct; 37(10): 1303-7.

26-Cardiovascular risks and metabolic syndrome in Hong Kong Chinese women with polycystic ovary syndrome. Cheung LP, Ma RC, Lam PM, Lok IH, Haines CJ, So WY, Tong PC, Cockram CS, Chow CC, Goggins WB. Hum Reprod. 2008  Jun;23(6):1431-8.

27-Metabolic syndrome in polycystic ovary syndrome. Carmina E. Minerva Ginecol. 2006 Apr;58(2):109-14.

28-Metabolic syndrome in young Czech women with polycystic ovary syndrome. Vrbíková J, Vondra K, Cibula D, Dvoráková K, Stanická S, Srámková D, SindelkaG, Hill M, Bendlová B, Skrha J. Hum Reprod. 2005 Dec; 20(12):3328-32.

29-Evaluation of metabolic syndrome frequency and premature carotid atherosclerosis in young women with polycystic ovary syndrome. Vural B, Caliskan E, Turkoz E, Kilic T, Demirci A. Hum Reprod. 2005 Sep;20(9):2409-13.

30-Biochemical hyperandrogenism is associated with metabolic syndrome independently of adiposity and insulin resistance in Romanian polycystic ovary syndrome patients. Albu A, Radian S, Fica S, Barbu CG. Endocrine. 2015 Mar;48(2):696-704.

31-Polycystic ovary syndrome and metabolic syndrome in Indigenous Australian women. Boyle J, Cunningham J, Norman RJ, Dunbar T, O’Dea K. Intern Med J. 2015  Dec;45(12):1247-54.

32-Phenotype and metabolic profile of South Asian women with polycystic ovary syndrome (PCOS): results of a large database from a specialist Endocrine Clinic. Wijeyaratne CN, Seneviratne Rde A, Dahanayake S, Kumarapeli V, Palipane E, Kuruppu N, Yapa C, Seneviratne Rde A, Balen AH. Hum Reprod. 2011 Jan;26(1):202-13.

33-The risk of metabolic syndrome in polycystic ovary syndrome: A systematic review and meta-analysis. Behboudi-Gandevani S, Amiri M, Bidhendi Yarandi R, Noroozzadeh M, Farahmand M, Rostami Dovom M, Ramezani Tehrani F. Clin Endocrinol (Oxf). 2018  Feb;88(2):169-184.

34- Metabolic syndrome in polycystic ovary syndrome: a systematic review, meta-analysis and meta-regression. Lim SS, Kakoly NS, Tan JWJ, Fitzgerald G, Bahri Khomami M, Joham AE, Cooray SD, Misso ML, Norman RJ, Harrison CL, Ranasinha S, Teede HJ, Moran LJ. Obes Rev. 2019 Feb;20(2):339-352.

35-Metabolic Syndrome in Polycystic Ovary Syndrome. Pasquali R. Front Horm Res. 2018;49:114-130.

36-Beyond fertility: polycystic ovary syndrome and long-term health. Cooney LG, Dokras A. Fertil Steril. 2018 Oct;110(5):794-809.

37-Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Diabetes. 1989 Sep;38(9):1165-74.

38-Prediction models for insulin resistance in the polycystic ovary syndrome. Gennarelli G, Holte J, Berglund L, Berne C, Massobrio M, Lithell H.Hum Reprod. 2000 Oct;15(10):2098-102.

39-Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. Legro RS, Kunselman AR, Dodson WC, Dunaif A.J Clin Endocrinol Metab. 1999 Jan;84(1):165-9.

40-Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Ehrmann DA, Barnes RB, Rosenfield RL, Cavaghan MK, Imperial J. Diabetes Care. 1999 Jan;22(1):141-6.

41-Screening for abnormal glucose tolerance in adolescents with polycystic ovary syndrome. Palmert MR, Gordon CM, Kartashov AI, Legro RS, Emans SJ, Dunaif A. J Clin Endocrinol Metab. 2002 Mar;87(3):1017-23.

42-Polycystic ovarian syndrome (PCOS): a significant contributor to the overall burden of type 2 diabetes in women. Talbott EO, Zborowski JV, Rager JR, Kip KE, Xu X, Orchard TJ.J Womens Health (Larchmt). 2007 Mar;16(2):191-7.

43-Relative risk of conversion from normoglycaemia to impaired glucose tolerance or non-insulin dependent diabetes mellitus in polycystic ovarian syndrome. Norman RJ, Masters L, Milner CR, Wang JX, Davies MJ. Hum Reprod. 2001 Sep;16(9):1995-8.

44-Glucose intolerance in a large cohort of mediterranean women with polycystic ovary syndrome: phenotype and associated factors. Gambineri A, Pelusi C, Manicardi E, Vicennati V, Cacciari M, Morselli-Labate AM, Pagotto U, Pasquali R. Diabetes. 2004 Sep;53(9):2353-8.

45-Use of fasting blood to assess the prevalence of insulin resistance in women with polycystic ovary syndrome. carmina E , Lobo RA. Fertil Steril. 2004  Sep;82(3):661-5.

46-Prevalence of insulin resistance in the polycystic ovary syndrome using the homeostasis model assessment. DeUgarte CM, Bartolucci AA, Azziz R. Fertil Steril. 2005 May;83(5):1454-60.

47-Predictors of progression from impaired glucose tolerance to NIDDM: an analysis of six prospective studies. Edelstein SL, Knowler WC, Bain RP, Andres R, Barrett-Connor EL, Dowse GK, Haffner SM, Pettitt DJ, Sorkin JD, Muller DC, Collins VR, Hamman RF. Diabetes. 1997  Apr;46(4):701-10.

48-Changes in glucose tolerance over time in women with polycystic ovary syndrome: a controlled study. Legro RS, Gnatuk CL, Kunselman AR, Dunaif A. J Clin Endocrinol Metab. 2005 Jun;90(6):3236-42.

49-Extent of metabolic risk in adolescent girls with features of polycystic ovary syndrome. Hart R, Doherty DA, Mori T, Huang RC, Norman RJ, Franks S, Sloboda D, Beilin L, Hickey M. Fertil Steril. 2011 Jun;95(7):2347-53.

50-What is the Risk of Metabolic Syndrome in Adolescents with Normal BMI who have Polycystic Ovary Syndrome? Aydin Y, Hassa H, Burkankulu D, Arslantas D, Sayiner D, Ozerdogan N. J Pediatr Adolesc Gynecol. 2015  Aug;28(4):271-4.

51-Prevalence of metabolic syndrome and related characteristics in obese adolescents with and without polycystic ovary syndrome. Rossi B, Sukalich S, Droz J, Griffin A, Cook S, Blumkin A, Guzick DS, Hoeger KM. J Clin Endocrinol Metab. 2008 Dec;93(12):4780-6.

52-Association between polycystic ovarian syndrome, overweight, and metabolic syndrome in adolescents. Rahmanpour H, Jamal L, Mousavinasab SN, Esmailzadeh A, Azarkhish K. J Pediatr Adolesc Gynecol. 2012 Jun;25(3):208-12.

53-Zawadski JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome;towards a rational approach. In: Dunaif A, Givens JR, Haseltine F, editors. Polycystic ovary syndrome. Vol. 1992. Boston, MA: Black-well Scientific; 1992. pp. 377–84.

54-Rotterdam ESHRE/ASRM-sponsored PCOS Consencus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks relatedto polycystic ovary syndrome. Fertil Steril. 2004 Jan;81(1):19-25.

55- Rotterdam ESHRE/ASRM-sponsored PCOS Consencus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Hum Reprod. 2004 Jan;19(1):41-7.

56-The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Azziz R, Dewailly D, Diamanti-Kandarakis E, Escobar-Morrreale HF, Futterweit W, Janssen OE, Legro RS, Norman RJ, Taylor AE, Witchel SF. Fertil Steril. 2009 Feb;91(2):456-88.

57-Relative contributions of oligomenorrhea and hyperandrogenemia to the risk of metabolic syndrome in midlife women. Polotsky AJ, Allshouse A, Crawford SL, Harlow SD, Khalil N, Santoro N, Legro RS. J Clin Endocrinol Metab. 2012 Jun;97(6):E868-77.

58-Normo- and hyperandrogenic women with polycystic ovary syndrome exhibit an adverse metabolic profile through life. Pinola P, Puukka K, Piltonen TT, Puurunen J, Vanky E, Sundström-Poromaa I, Stener-Victorin E, Lindén Hirschberg A,Ravn P, Skovsager Andersen M, Glintborg D, Mellembakken JR, Ruokonen A, Tapanainen JS, Morin-Papunen LC. Fertil Steril. 2017 Mar;107(3):788-795.

59-Is the risk for cardiovascular disease increased in all phenotypes of the polycystic ovary syndrome? Daskalopoulos GN, Karkanaki A, Karagiannis A, Mikhailidis DP, Athyros VG. Angiology. 2011 May;62(4):285-90.

60-Long or highly irregular menstrual cycles as a marker for risk of type 2 diabetes mellitus. Solomon CG, Hu FB, Dunaif A, Rich-Edwards J, Willett WC, Hunter DJ, Colditz GA, Speizer FE, Manson JE. JAMA. 2001 Nov 21;286(19):2421-6.

61-Metabolic characteristics of women with polycystic ovaries and oligo-amenorrhoea but normal androgen levels: implications for the management of polycystic ovary syndrome. Barber TM, Wass JA, McCarthy MI, Franks S. Clin Endocrinol (Oxf). 2007 Apr;66(4):513-7.

62-Metabolic cardiovascular disease risk factors in women with self-reported symptoms of oligomenorrhea and/or hirsutism: Northern Finland Birth Cohort 1966 Study. Taponen S, Martikainen H, Järvelin MR, Sovio U, Laitinen J, Pouta A, Hartikainen AL, McCarthy MI, Franks S, Paldanius M,Ruokonen A; Northern Finland Birth Cohort 1966 Study. J Clin Endocrinol Metab. 2004 May;89(5):2114-8.

63-Hyperandrogenemia is implicated in both the metabolic and reproductive morbidities of polycystic ovary syndrome. Sung YA, Oh JY, Chung H, Lee H. Fertil Steril. 2014 Mar;101(3):840-5.

64-Phenotypic variation in hyperandrogenic women influences the findings of abnormal metabolic and cardiovascular risk parameters. Carmina E, Chu MC, Longo RA, Rini GB, Lobo RA.J Clin Endocrinol Metab. 2005  May;90(5):2545-9.

65-Polycystic ovary syndrome is a risk factor for diabetes and prediabetes in middle-aged but not elderly women: a long-term population-based follow-up study. Kazemi Jaliseh H, Ramezani Tehrani F, Behboudi-Gandevani S, Hosseinpanah F, Khalili D, Cheraghi L, Azizi F. Fertil Steril. 2017  Dec;108(6):1078-1084.

66-Does the risk of diabetes and heart disease in women with polycystic ovary syndrome lessen with age? Azziz R. Fertil Steril. 2017 Dec;108(6):959-960.

67-Women with polycystic ovary syndrome wedge resected in 1956 to 1965: a long-term follow-up focusing on natural history and circulating hormones. Dahlgren E, Johansson S, Lindstedt G, Knutsson F, Odén A, Janson PO, Mattson LA, Crona N, Lundberg PA. Fertil Steril. 1992 Mar;57(3):505-13.

68-Cardiovascular disease and risk factors in PCOS women of postmenopausal age: a 21-year controlled follow-up study. Schmidt J, Landin-Wilhelmsen K, Brännström M, Dahlgren E. J Clin Endocrinol Metab. 2011 Dec;96(12):3794-803.

69-Mortality of women with polycystic ovary syndrome at long-term follow-up. Pierpoint T, McKeigue PM, Isaacs AJ, Wild SH, Jacobs HS. J Clin Epidemiol. 1998 Jul;51(7):581-6.

70-Cardiovascular disease in women with polycystic ovary syndrome at long-term follow-up: a retrospective cohort study. Wild S, Pierpoint T, McKeigue P, Jacobs H. Clin Endocrinol (Oxf). 2000 May;52(5):595-600.

71-Cardiovascular Disease and 10-Year Mortality in Postmenopausal Women with Clinical Features of Polycystic Ovary Syndrome. Merz CN, Shaw LJ, Azziz R , Stanczyk FZ, Sopko G, Braunstein GD, Kelsey SF, Kip KE, Cooper-DeHoff RM, Johnson BD,Vaccarino V, Reis SE, Bittner V, Hodgson TK, Rogers W, Pepine CJ. J Womens Health (Larchmt). 2016 Sep;25(9):875-81.

72-Androgen levels in adult females: changes with age, menopause, and oophorectomy. Davison SL, Bell R, Donath S, Montalto JG, Davis SR. J Clin Endocrinol Metab. 2005 Jul;90(7):3847-53.

73-Women with polycystic ovary syndrome gain regular menstrual cycles when ageing. Elting MW, Korsen TJ, Rekers-Mombarg LT, Schoemaker J. Hum Reprod. 2000 Jan;15(1):24-8.

74-Serum testosterone levels decrease in middle age in women with the polycystic ovary syndrome. Winters SJ, Talbott E, Guzick DS, Zborowski J, McHugh KP. Fertil Steril. 2000 Apr;73(4):724-9.

75-Age-related differences in features associated with polycystic ovary syndrome in normogonadotrophic oligo-amenorrhoeic infertile women of reproductive years. Bili H, Laven J, Imani B, Eijkemans MJ, Fauser BC. Eur J Endocrinol. 2001 Dec;145(6):749-55.

76-Long-term follow-up of patients with polycystic ovary syndrome: reproductive outcome and ovarian reserve. Hudecova M, Holte J, Olovsson M, Sundström Poromaa I. Hum Reprod. 2009 May;24(5):1176-83.

77-Risk factors for coronary artery disease in lean and obese women with the polycystic ovary syndrome. Conway GS, Agrawal R, Betteridge DJ, Jacobs HS. Clin Endocrinol (Oxf). 1992 Aug;37(2):119-25.

78-Adverse lipid and coronary heart disease risk profiles in young women with polycystic ovary syndrome: results of a case-control study. Talbott E, Clerici A, Berga SL, Kuller L, Guzick D, Detre K, Daniels T, Engberg RA. J Clin Epidemiol. 1998 May;51(5):415-22.

79-A more atherogenic serum lipoprotein profile is present in women with polycystic ovary syndrome: a case-control study. Valkenburg O, Steegers-Theunissen RP, Smedts HP, Dallinga-Thie GM, Fauser BC, Westerveld EH, Laven JS. J Clin Endocrinol Metab. 2008 Feb;93(2):470-6.

80-Lipid levels in polycystic ovary syndrome: systematic review and meta-analysis. Wild RA, Rizzo M, Clifton S, Carmina E.Fertil Steril. 2011 Mar 1;95(3):1073-9.e1-11.

81-ACC/AHA 2017 definition of high blood pressure: implications for women with polycystic ovary syndrome. Marchesan LB, Spritzer PM. Fertil Steril. 2019 Mar;111(3):579-587.e1.

82-Hypertension in Reproductive-Aged Women With Polycystic Ovary Syndrome and Association With Obesity. Joham AE, Boyle JA, Zoungas S, Teede HJ. Am J Hypertens. 2015 Jul;28(7):847-51.

83-Hyperinsulinemia and obese phenotype differently influence blood pressure in young normotensive patients with polycystic ovary syndrome. Mioni R, Cà AD, Turra J, Azzolini S, Xamin N, Bleve L, Maffei P, Vettor R, Fallo F. Endocrine. 2017 Feb;55(2):625-634.

84-Relationship between androgen levels and blood pressure in young women with polycystic ovary syndrome. Chen MJ, Yang WS, Yang JH, Chen CL, Ho HN, Yang YS. Hypertension. 2007 Jun;49(6):1442-7.

85-Androgen receptor (AR) in cardiovascular diseases. Huang CK, Lee SO, Chang E, Pang H, Chang C. J Endocrinol. 2016 Apr;229(1):R1-R16.

86-Hypertension in women with polycystic ovary syndrome: prevalence and associated cardiovascular risk factors. Shi Y , Cui Y, Sun X, Ma G, Ma Z, Gao Q, Chen ZJ.Eur J Obstet Gynecol Reprod Biol. 2014 Feb;173:66-7.

Bunları da İnceleyin

Polikistik Over Sendromu’nda Lazer Epilasyon

Erkeklerde görüldüğü gibi bıyık, çene, favori, boyun, ense, göğüs arası, göğüs ucu, bel, omuz, sırt, karın, …