Talk:Polycystic ovary syndrome

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Talk:Polycystic ovary syndrome/unanswered question dump

Premature statements about simple genetic cause not supported in current scientific literature

Although this piece references "genetic causes" as an established scientific fact, nothing could be further from the truth, and of the two sources referenced, one is a 2002 paper which talks about a couple of gene loci, but not a genetic cause, and the other reference simply talks about genetic screening technologies but does not say that PCOS is "genetically caused". The reality is that it's probably gene-environment interactions(like most everything else), and this piece completely glosses over that issue and certainly could lead the unsophisticated or poorly informed reader to believe that a genetic cause in a simple sense was a virtual certainty – hardly the case. First of all, PCOS has a very strong association with maternal obesity, and with metabolic syndrome and insulin resistance, clues that this is not simply due to some 'aberrant' gene, but more likely an aberrant form of epigenetic metabolic programming associated with maternal obesity and its effects on the developing fetus. There are probably multiple Genetic polymorphisms that might contribute to PCOS, but that's really quite a far cry from dismissing all the environmental and lifestyle variables that look increasingly critical to this syndrome. This syndrome has only recently emerged in the context of the explosion of obesity in the United States, and it was thought to be exceptionally rare before that. I have cut and pasted a somewhat more balanced review of the genetic and environmental issues, which clearly needs some form of corrective attention in this treatment.

Steroids. 2011 Dec 8. [Epub ahead of print] Metabolic and cardiovascular genes in polycystic ovary syndrome: A candidate-wide association study (CWAS). Jones MR, Chua AK, Mengesha EA, Taylor KD, Chen YD, Li X, Krauss RM, Rotter JI; Reproductive Medicine Network, Legro RS, Azziz R, Goodarzi MO. Source

Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States. Abstract

The role of metabolic disturbance in polycystic ovary syndrome (PCOS) has been well established, with insulin resistance and the resulting compensatory hyperinsulinemia thought to promote hyperandrogenemia. Genome-wide association studies (GWAS) have established a large number of loci for metabolic conditions such as type 2 diabetes and obesity. A subset of these loci has been investigated for a role in PCOS; these studies generally have not revealed a confirmed role for these loci in PCOS risk. However, a large scale investigation of genes related to these pathways has not previously been performed. We conducted a two stage case control association study of 121,715 single nucleotide polymorphisms (SNPs) selected to represent susceptibility loci associated with traits such as type 2 diabetes, obesity measures, lipid levels and cardiovascular function using the Cardio-Metabochip in 847 PCOS cases and 845 controls. Several hypothesis-generating associations with PCOS were observed (top SNP rs2129107, P=3.8×10(-6)). We did not find any loci definitively associated with PCOS after strict correction for multiple testing, suggesting that cardio-metabolic loci are not major risk factors underlying the susceptibility to PCOS.

Douglas F Watt, PhD 209.6.17.71 (talk) 00:40, 3 January 2012 (UTC)

I'll try to take a look at that reference (a DOI would be nice - will try to check PubMed for one) and incorporate the various viewpoints once I'm able to take a look at all three articles in question (again) - I'm currently on vacation. Anyone else who wishes to come up with a compromise/reflecting-uncertainty/reflecting-disagreement version before I do is, of course, welcome to do so. (BTW, I disagree with you that associations with metabolic syndrome and insulin resistance necessarily imply a lack of Mendelian genetics being involved - these may be consequences, not causes, or both may be caused by the same thing - and, in regard to maternal obesity, I don't see why a relatively-simple genetic susceptibility is ruled out by this. Admittedly, as a geneticist I am biased...) I personally think that the article currently states that the causes are not purely genetic by any means, but as the author of much of the current version of these, I am again biased, and may (for instance) be seeing subtleties that the average reader may not. Allens (talk) 05:21, 3 January 2012 (UTC)

I also don't see the problem here. For one thing, "we didn't find any SNPs when looking at heart disease and metabolic disease" is not the same thing as "it is not genetic". The same kind of study would equally have "proven" that BRCA mutations don't cause breast cancer. If anything, this study confirms the commonly held view that PCOS is its own genetic disease that happens to cause metabolic disturbances, rather than being caused by metabolic disturbances.

Also, I think that part of the difference in opinions here is how you define "disease". Environmental factors clearly affect the severity of clinical symptoms, but they cannot produce the condition in someone who doesn't have the genetic susceptibility. I've never seen a report on a truly isolated or spontaneous case of PCOS without any hint of it in the family history; have you? But it's perfectly typical to find PCOS in a woman whose normal-weight mother or aunt is known to have had intractable acne, long menstrual cycles, enlarged ovaries, or unexplained infertility, but who was never properly worked up for PCOS. WhatamIdoing (talk) 05:57, 3 January 2012 (UTC)

prevalence

Prevalence in this article is stated as 5%, based on a single study. Yet there have been a plethora of studies attempting to establish the prevalence of PCOS, with results ranging from 5 to 15% (iirc). A single percentage ignores that range. It also ignores the fact that the diagnostic criteria for PCOS is in dispute, which means that to be specific (rather than giving a range), you need to specify which definition was used to establish that percentage. How is this usually dealt with here on Wikipedia? 24.1.140.128 (talk) 05:01, 15 January 2010 (UTC)milara

By finding the best sources we can—ideally from high-quality reviews or medical textbooks—and trying to accurately summarize what they say. It's often appropriate to avoid extremely recent publications, but on a relatively common medical condition like this, we shouldn't have any need to resort to studies more than approximately five years old. In addition to providing an overall range, it may be appropriate to provide information on prevalence in different racial groups.

When you believe an article needs improvement, please feel free to make those changes. Wikipedia is a wiki, so anyone can edit almost any article by simply following the edit this page link at the top. The Wikipedia community encourages you to be bold in updating pages. Don't worry too much about making honest mistakes—they're likely to be found and corrected quickly. If you're not sure how editing works, check out how to edit a page, or use the sandbox to try out your editing skills. New contributors are always welcome. You don't even need to log in (although there are many reasons why you might want to).

You are also welcome to read the doctors' mess, which is a page open to anyone who is interested in improving Wikipedia's articles about medical conditions. WhatamIdoing (talk) 05:35, 15 January 2010 (UTC)

cortisol

Cortisol levels seem to be critical to PCOS. Why no mention? —Preceding unsigned comment added by 75.82.70.58 (talk) 06:24, 10 May 2009 (UTC)

To patients looking for advice about their own symptoms

All you have to do is google "PCOS support group" and you will get literally scores of precise links where there are hundreds of people waiting to answer all your questions in warm fuzzy manners. Once again, wikipedia is not a source of medical advice unless you want to risk getting it from an anonymous 15 year old (I am not exaggerating), nor is it a support group or discussion forum. It seems harsh, but this page is especially hard hit. I will move all the above to an archive. Thanks for understanding. alteripse 21:05, 28 May 2007 (UTC)

Killing the link farm

I have deleted a bunch of external links to support groups and magazine articles about PCOS. The biggest problem is that half of the websites were listed twice (except the Australian group, which had four links), but in general I believe we need to remember that Wikipedia is not an advertising opportunity for our favorite organizations. Women with PCOS are smart enough to do their own Internet searches if they want more resources. WhatamIdoing (talk) 03:00, 27 November 2007 (UTC)

Agree. cheers, --7swords (talk) 09:49, 8 December 2007 (UTC)

Gestational diabetes

An anon added unsourced information about gestational diabetes recently. It was promptly removed. It might be worth sorting that out. PMID 18710713 is a (very) recent systematic study on the issue, and I found its conclusion slightly unusual: The odds ratio is 2.89, but they'd don't trust it. WhatamIdoing (talk) 15:00, 2 September 2008 (UTC)

To Women Looking for Information on PCOS Research Studies

Thought my source could be used as an additional resource for those accessing this PCOS page. Northwestern University's Feinberg School of Medicine (http://www.pcos.northwestern.edu/) provides information for those women wanting to get involved in PCOS research studies and whether certain genes increase a woman's chance of getting PCOS. Makofin (talk) 20:14, 19 November 2008 (UTC)Makofin

The University of Pennsylvania and Penn State University are conducting a NIH clinical randomized research trial to establish the relative roles of treatment of hyperandrogenism versus obesity in treating infertility and improving pregnancy outcomes among PCOS women. For more information about this study, acccess this link. (http://webapp.hmc.psu.edu/owlpcos/website/index.cfm)Owlpcos (talk) 18:53, 29 July 2009 (UTC)[1]

Alternative approaches - ayurveda

The recently added paragraph about ayurvedic remedies is uncited and poorly worded. I am not sure the information belongs in the article, but would have felt brash to delete it without discussion. --shingra (talk) 12:15, 27 May 2010 (UTC)

It didn't sound very encyclopedic, and I support its removal. WhatamIdoing (talk) 19:45, 2 June 2010 (UTC)

Trans fats as a cause?

This article previously mentioned trans fats as a potential cause of PCOS, but the entry was removed, mainly because the two sources ([2] and [3]) actually had not studied on people with PCOS, so their conclusions cannot be held as be valid for people with PCOS. My opinion in this case is that, because of the potential controversy of the subject, a reliable medical source (and one that specifically includes people with PCOS) is necessary for any mention of trans fats in the Cause section.Mikael Häggström (talk) 10:45, 21 September 2011 (UTC)

Review about PCOS and insulin resistance

50 pages! doi:10.1210/er.2011-1034 JFW | T@lk 11:33, 9 December 2012 (UTC)

doi:10.1210/jc.2013-2350 - new endocrine society guideline. JFW | T@lk 12:05, 26 December 2013 (UTC)

Shorter review in Am J Med doi:10.1016/j.amjmed.2014.04.017 JFW | T@lk 22:27, 11 October 2014 (UTC)

alternative treatments

this is for the discussion of the myo-inositol reference inserted a few minutes ago. As mentioned, this is a primary source, and so frowned upon by WP:MEDRS standards. But I've already engaged on user's talk page, so this is mainly for completeness' sake. I think the discussion should probably go here before re-inserting it, if it's found to be worthwhile to re-insert. -- [ UseTheCommandLine ~/talk ]# ▄ 04:03, 17 August 2013 (UTC)

People with ovaries

I saw a discussion at WT:MED that really belongs here, but changing all instances of "women" to "people with ovaries" seems problematic to me. To copy what I said there (because this discussion really belongs here anyway):

I'm a little mixed on this. Where "women" can be swapped with "people" without injury to the text ("people with PCOS") I see no harm. However, "people with ovaries" seems rather awkward, yet the proposed changes still haven't dealt with other text like "daughters" and "female" in the genetics section, which are then inconsistent. Rather than going back and forth I think it may be preferable to take the bull by the horn and say, early on, that "women" refers to biological sex rather than gender. Except... it's possible that this isn't always true; for example, it's possible that in an older general health survey the distinction between gender and sex wouldn't be considered. Ratios like "5-10% of women" may not even technically be valid if the number of people diagnosed with PCOS is divided by the number of "women" listed by a national census, though of course with a range that approximate the error is insignificant. Using a term taken from a source is never really wrong, but it might be improved on with an accurate explanation. Ultimately my feeling is that changing the summary of that many sources all at once based on a global find-and-replace is hazardous, and the flow of the article is adversely affected. Wnt (talk) 15:28, 25 October 2014 (UTC)

Coming from WP:MED... I'm against changing "women" to "people with ovaries", and have recently commented similarly (being against wording like that) at the Tanner scale article: With Grayfell commenting along the same lines, I relayed the following there: Anatomy does need to be gendered, or, more precisely, be clear on what is a male or a female body and the pubertal process involved in that when it comes to talking about puberty. Male and female bodies biologically exist. This page is about biology, not about gender identity. The sex and gender distinction exists for a reason, though not everyone subscribes to it. And like I recently stated here at the Same-sex marriage talk page, "biology is more complicated than just, for example, 'You have a Y chromosome, so you're a male.' But there's also the fact that, like I stated near the end of this section at the Transsexualism talk page, 'Intersex people are usually biologically classified as male or female (based on physical appearance and/or chromosomal makeup, such as XY female or XX male), and usually identify as male or female; it's not the usual case that an intersex person wants to be thought of as neither male nor female. Being thought of as neither male nor female is usually a third gender or genderqueer matter.' The same applies to transgender people (at least when you exclude genderqueer people from the category of transgender); they usually identify as male or female and/or as a man or a woman. 'I'm not aware of science having actually identified a third sex, though intersex people and hermaphroditic non-human animals are sometimes classified as a third sex (by being a combination of both)... ...but gender is a broader field and researchers have identified three or more genders (again, see the Third gender article).'" For how we are generally supposed to treat anatomy and medical topics on Wikipedia when it comes sex/gender, see Talk:Phimosis/Archive 2#Definition. Flyer22 (talk) 16:10, 25 October 2014 (UTC)

We should use the language of the sources. We could switch to male and female rather than men and women if that would make a difference. People with ovaries is silly.

Explaining this matters on every page in which we mention these terms is very much undue weight. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:21, 25 October 2014 (UTC)

I hadn't proposed to explain them on every page. My feeling generally on Wikipedia is that the presence of individual editor/reader comments is meaningful - that if people want to create an article, that means it is more worthy to be created than an article people don't want to create; if people want to ask a question, that means it is more worthy to be answered than if it is not asked. Our text is nowhere near perfect, so I see no harm in reacting locally to an expressed confusion without making a wiki-wide effort to treat every article the same way. Wnt (talk) 16:27, 25 October 2014 (UTC)

This looks like an effort to push the prefered language of a minority. Have dealt with the same at autism where all those without autism were going to be referred to as neurotypical. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:38, 25 October 2014 (UTC)

Well, I didn't accept the language - but I did accept that it would be desirable to define our language better.

Also... looking up polycystic ovary disease at PubMed, I got 12,000 hits that were reduced to 10 with the addition of transsexual; but one of these was this study claiming a 58% rate in Japanese transsexuals before hormone therapy. Also [4] suggests that hormone treatment does not cause polycystic ovary syndrome, and yet, previous studies had found much evidence of it in hormone-treated patients. I only looked at this a minute, but it sounds like there might be some interesting physical correlate of the desire to transsexuality in the morphology of the ovary. Anyway, whether it is a matter of prevalence or simply that it is disturbing to them, it seems like this article is of extra relevance to FTM transsexuality. Wnt (talk) 16:50, 25 October 2014 (UTC)

I think it makes sense to incorporate what happens if you're transsexual, but I don't think what's been done makes sense. Partly that's because you don't have to have ovaries to have PCOS symptoms: bilateral oopherectomy does not necessarily 100% "cure" PCOS as I've always understood it. See for example: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3563739/ So therefore, you do not have to be a person with ovaries to be a person with PCOS - you'd have to be very careful. Also, don't transsexual men get something PCOS-like, that might be getting mixed in here? http://humrep.oxfordjournals.org/content/16/4/612.long It's going to be a complex one, that needs ideally to be reflected in the content, not just in an editorial approach around inclusionary language. If we're not precise about the medical content, then it doesn't serve anyone well.Hildabast (talk) 00:13, 31 October 2014 (UTC)

Since I last reviewed this article, significant uncited POV has arrived

Bold claims are made that it isn't ovarian in nature in the lede, but zero citations. While modern medical science can change views rapidly in some areas, such changes always require a citation when documented. If citations are not found soon, I'll request Wiki Medicine to conduct a review/rewrite of what was once a B class article, but is far from being an F- article currently.Wzrd1 (talk) 06:17, 7 November 2014 (UTC)

Treatment for infertility: lotrozole

Lotrozole appears to be more effective than clomiphene in inducing ovulation. It has a higher percentage of live births and the same ammount of congenital anomalies. For some reason i can't edit the page.

Here's the source: http://www.nejm.org/doi/full/10.1056/NEJMoa1313517 — Preceding unsigned comment added by 193.2.8.42 (talk) 15:00, 27 January 2015 (UTC)

dietary supplements

about this dif by Alexander Bloome. Sources there are:

1. Zoe E CH (1998). "Polycystic ovarian syndrome: the metabolic syndrome comes to gynaecology". BMJ. 317 (7154): 329–32. PMID 9685283. {{cite journal}}: Vancouver style error: suffix in name 1 (help)
2. Sharifi F, Mazloomi S, Hajihosseini R, Mazloomzadeh S. (2012). "Serum magnesium concentrations in polycystic ovary syndrome and its association with insulin resistance". Gynecol Endocrinol. 28 (1): 7–11. doi:10.3109/09513590.2011.579663. PMID 21696337. {{cite journal}}: Cite has empty unknown parameter: |1= (help); Vancouver style error: punctuation in name 4 (help)
3. "The PCOS Diet Guide". DetoxScientific. 2015. Retrieved 21 April 2015.
4. Foroozanfard F, Jamilian M, Jafari Z, Khassaf A, Hosseini A, Khorammian H, Asemi Z (2015). "Effects of Zinc Supplementation on Markers of Insulin Resistance and Lipid Profiles in Women with Polycystic Ovary Syndrome: a Randomized, Double-blind, Placebo-controlled Trial". Exp Clin Endocrinol Diabetes. 123 (4): 215–20. doi:10.1055/s-0035-1548790. PMID 25868059.

• Source #1 is a review from 1998 and is too old per WP:MEDDATE. Sources 2 and 4 are WP:PRIMARY and fail WP:MEDRS. Source #3 is a spam link not acceptable for any content in WP.
• I initially left content based on source #1, but searched pubmed for a recent review and took the most recent one that discussed supplements, and used it here. The whole section from that article is as follows: "ALTERANTIVE THERAPIES FOR POLYCYSTIC OVARY SYNDROME. There is an emerging body of literature on the beneficial effects of complementary and alternative medicine (CAM) in reducing the severity of PCOS symptoms and metabolic complications. Acupuncture has been shown to improve insulin sensitivity, lower androgens and improve menstrual irregularity [71]. Herbal medicines and dietary supplements may have some benefit, but studies are small, uncontrolled and nonrandomized. Alternative therapies require further investigation before they can be confidently recommended." Jytdog (talk) 12:42, 22 April 2015 (UTC)

Source number one (the 1998 review) also does not appear to mention any of the minerals in the text added. Doc James (talk · contribs · email) 16:45, 22 April 2015 (UTC)

PCOS and anti-mullerian-hormone as a cause for menstrual cycle arrest

This comprehensive article from pubmed / hormones.gr explains in-depth the issue of Anti-Mullerian-Hormone excess in PCOS women and the effect on the development of the leading follicle in menstrual cycle resulting in the common ultrasound picture of "cystic" ovaries. I'd recommend to read the article fully and update the corresponding section of causes, diagnosis and treatment here in this wikipedia article. A possible way to restore menstrual cycle in PCOS women suffering from excessive AMH-increase would then be to "pump out" dysfunct follicles using either downregulation or alternating menstrual cycles with and without hormonal contraceptives and after 4 months seeing the result of having normally functional follicles and developing leading follicles as every other woman in reproductive age without PCOS would do. There are recent studies in pubmed about detailed sample values of AMH and their effect on pregnancy and live birth rates showing a close relationship of AMH and the success of reproductive medicine in PCOS women: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518483/ . Also measuring AMH levels can be used to assess the success of metformin or glitazone therapy of PCOS: http://www.ncbi.nlm.nih.gov/pubmed/25935176

All in all, nearly unbelievable why the role of AMH in PCOS women is so widely unknown seemingly... Malv0isin (talk) 02:28, 12 September 2015 (UTC)