Exercise decreases anti-müllerian hormone in anovulatory overweight women with polycystic ovary syndrome: a pilot study. Magnitude of daily energy deficit predicts frequency but not severity of menstrual disturbances associated with exercise and caloric restriction. Impact of electro-acupuncture and physical exercise on hyperandrogenism and oligo/amenorrhea in women with polycystic ovary syndrome: a randomized controlled trial. Evidence for a causal role of low energy availability in the induction of menstrual cycle disturbances during strenuous exercise training. Structured exercise training programme versus hypocaloric hyperproteic diet in obese polycystic ovary syndrome patients with anovulatory infertility: a 24-week pilot study. Luteinizing hormone pulsatility is disrupted at a threshold of energy availability in regularly menstruating women. Effects of exercise and nutritional counseling in women with polycystic ovary syndrome. Myo-inositol in patients with polycystic ovary syndrome: A novel method for ovulation induction Estrogen and progesterone exposure is reduced in response to energy deficiency in women aged 25-40 years. Overweight and obese anovulatory patients with polycystic ovaries: parallel improvements in anthropometric indices, ovarian physiology and fertility rate induced by diet. Hormonal profile of women with self-reported symptoms of oligomenorrhea and/or hirsutism: Northern Finland birth cohort 1966 study. Induction and prevention of low-T3 syndrome in exercising women. Prevalence and characteristics of the polycystic ovary syndrome in overweight and obese women. Effects of caloric intake timing on insulin resistance and hyperandrogenism in lean women with polycystic ovary syndrome. Correlation of biochemical markers and clinical signs of hyperandrogenism in women with polycystic ovary syndrome (PCOS) and women with non-classic congenital adrenal hyperplasia (NCAH) Diet, physical exercise and Orlistat administration increase serum Anti-Müllerian Hormone (AMH) levels in women with polycystic ovary syndrome (PCOS) Perceived exercise barriers are reduced and benefits are improved with lifestyle modification in overweight and obese women with polycystic ovary syndrome: a randomised controlled trial
Polycystic ovary syndrome ( PCOS ) is a common condition in women associated with menstrual irregularity and anovulation . While obesity worsens and weight loss or exercise improves reproduction function in PCOS , the mechanism for this is unclear . The aim of this study was to examine the effect of exercise on ovarian hormones [ anti-Müllerian hormone ( AMH ) ] and menstrual and ovulatory function in women with and without PCOS . Overweight women with ( n=7 ) and without ( n=8 ) PCOS of comparable age , weight and BMI undertook a 12-week intensified endurance exercise training program ( 1 h 3 times/week ) with no structured energy restriction . Primary outcomes were AMH , ovulation ( weekly urinary pregnanediol ) and menstrual regularity . Secondary outcomes were insulin resistance ( euglycemic hyperinsulinemic clamp ) and body composition ( computed tomography and dual X-ray absorptiometry ) . Exercise  decreased BMI , total and and roid fat mass and improved insulin sensitivity for all women . AMH was significantly higher in women with PCOS compared to controls before ( p<0.001 ) and after exercise ( p=0.001 ) . There was a significant interaction between AMH changes with exercise and PCOS status ( p=0.007 ) such that women without PCOS had no change in AMH ( + 1.4±5.2 pmol/l , p=0.48 ) while women with PCOS had a decrease in AMH ( - 13.2±11.7 pmol/l , p=0.025 ) . Exercise is associated with improvements in ovarian hormones in women with abnormal ovarian function . This suggests that mechanisms associated with ovarian dysfunction can be improved by exercise in PCOS We assessed the impact of energy deficiency on menstrual function using controlled feeding and supervised exercise over four menstrual cycles ( 1 baseline and 3 intervention cycles ) in untrained , eumenorrheic women aged 18 - 30 yr . Subjects were r and omized to either an exercising control ( EXCON ) or one of three exercising energy deficit ( ED ) groups , i.e. , mild ( ED1 ; -8 ± 2 % ) , moderate ( ED2 ; -22 ± 3 % ) , or severe ( ED3 ; -42 ± 3 % ) . Menstrual cycle length and changes in urinary concentrations of estrone-1-glucuronide , pregnanediol glucuronide , and midcycle luteinizing hormone were assessed . Thirty-four subjects completed the study . Weight loss occurred in ED1 ( -3.8 ± 0.2 kg ) , ED2 ( -2.8 ± 0.6 kg ) , and ED3 ( -2.6 ± 1.1 kg ) but was minimal in EXCON ( -0.9 ± 0.7 kg ) . The overall sum of disturbances ( luteal phase defects , anovulation , and oligomenorrhea ) was greater in ED2 compared with EXCON and greater in ED3 compared with EXCON AND ED1 . The average percent energy deficit was the main predictor of the frequency of menstrual disturbances ( f = 10.1 , β = -0.48 , r(2 ) = 0.23 , P = 0.003 ) even when weight loss was included in the model . The estimates of the magnitude of energy deficiency associated with menstrual disturbances ranged from -22 ( ED2 ) to -42 % ( ED3 ) , reflecting an energy deficit of -470 to -810 kcal/day , respectively . This is the first study to demonstrate a dose-response relationship between the magnitude of energy deficiency and the frequency of exercise-related menstrual disturbances ; however , the severity of menstrual disturbances was not dependent on the magnitude of energy deficiency Polycystic ovary syndrome ( PCOS ) , the most common endocrine disorder in women of reproductive age , is characterized by hyper and rogenism , oligo/amenorrhea , and polycystic ovaries . We aim ed to determine whether low-frequency electro-acupuncture ( EA ) would decrease hyper and rogenism and improve oligo/amenorrhea more effectively than physical exercise or no intervention . We r and omized 84 women with PCOS , aged 18 - 37 yr , to 16 wk of low-frequency EA , physical exercise , or no intervention . The primary outcome measure changes in the concentration of total testosterone ( T ) at week 16 determined by gas and liquid chromatography-mass spectrometry was analyzed by intention to treat . Secondary outcome measures were changes in menstrual frequency ; concentrations of and rogens , estrogens , and rogen precursors , and glucuroni date d and rogen metabolites ; and acne and hirsutism . Outcomes were assessed at baseline , after 16 wk of intervention , and after a 16-wk follow-up . After 16 wk of intervention , circulating T decreased by -25 % , and rosterone glucuronide by -30 % , and and rostane-3α,17β-diol-3-glucuronide by -28 % in the EA group ( P = 0.038 , 0.030 , and 0.047 , respectively vs. exercise ) ; menstrual frequency increased to 0.69/month from 0.28 at baseline in the EA group ( P = 0.018 vs. exercise ) . After the 16-wk follow-up , the acne score decreased by -32 % in the EA group ( P = 0.006 vs. exercise ) . Both EA and exercise improved menstrual frequency and decreased the levels of several sex steroids at week 16 and at the 16-wk follow-up compared with no intervention . Low-frequency EA and physical exercise improved hyper and rogenism and menstrual frequency more effectively than no intervention in women with PCOS . Low-frequency EA was superior to physical exercise and may be useful for treating hyper and rogenism and oligo/amenorrhea Cross-sectional and short-term prospect i ve studies in humans support the concept that low energy availability , and not other factors associated with exercise , causes the development of exercise-induced reproductive dysfunction . To rigorously test this hypothesis , we performed a longitudinal study , examining the role of low energy availability on both the development and the reversal of exercise-induced amenorrhea , using a monkey model ( Macaca fascicularis ) . Eight adult female monkeys developed amenorrhea ( defined as absence of menses for at least 100 d , with low and unchanging concentrations of LH , FSH , E2 , and P4 ) after gradually increasing their daily exercise to 12.3 + /- 0.9 km/d of running over a 7- to 24-month period . Food intake remained constant during exercise training . To test whether amenorrhea is caused by low energy availability , four of the eight amenorrheic monkeys were provided with supplemental calories ( 138 - 181 % of calorie intake during amenorrhea ) while they maintained their daily training . All four monkeys exhibited increased reproductive hormone levels and reestablished ovulatory cycles , with recovery times for circulating gonadotropin levels ranging from 12 - 57 d from the initiation of supplemental feeding . The rapidity of recovery within the reproductive axis in a given monkey was directly related to the amount of energy that was consumed during the period of supplemental feeding ( r = -0.97 ; P < 0.05 ) . Repeated measurements of plasma T3 concentrations , a marker of cellular energy availability , revealed a tight correlation between the changes in reproductive function and T3 levels , such that T3 significantly decreased ( 27 % ) with the induction and significantly increased ( 18 % ) with the reversal of amenorrhea ( P < 0.05 ) . These data provide strong evidence that low energy availability plays a causal role in the development of exercise-induced amenorrhea BACKGROUND Lifestyle modifications are successfully employed to treat obese and overweight women with polycystic ovary syndrome ( PCOS ) . The aims of the current pilot study were ( i ) to compare the efficacy on reproductive functions of a structured exercise training ( SET ) programme with a diet programme in obese PCOS patients and ( ii ) to study their clinical , hormonal and metabolic effects to eluci date potentially different mechanisms of action . METHODS Forty obese PCOS patients with anovulatory infertility underwent a  SET programme ( SET group , n = 20 ) and a hypocaloric hyperproteic diet ( diet group , n = 20 ) . Clinical , hormonal and metabolic data were assessed at baseline , and at 12- and 24-week follow-ups . Primary endpoint was cumulative pregnancy rate . RESULTS The two groups had similar demographic , anthropometric and biochemical parameters . After intervention , a significant improvement in menstrual cycles and fertility was noted in both groups , with no differences between groups . The frequency of menses and the ovulation rate were significantly ( P < 0.05 ) higher in the SET group than in diet group but the increased cumulative pregnancy rate was not significant . Body weight , body mass index , waist circumference , insulin resistance indexes and serum levels of sex hormone-binding globulin , and rostenedione and dehydroepi and rosterone sulphate changed significantly ( P < 0.05 ) from baseline and were significantly different ( P < 0.05 ) between the two groups . CONCLUSIONS Both SET and diet interventions  improve fertility in obese PCOS patients with anovulatory infertility . We hypothesize that in both interventions an improvement in insulin sensitivity is the pivotal factor involved in the restoration of ovarian function but potentially acting through different mechanisms To investigate the dependence of LH pulsatility on energy availability ( dietary energy intake minus exercise energy expenditure ) , we measured LH pulsatility after manipulating the energy availability of 29 regularly menstruating , habitually sedentary , young women of normal body composition for 5 d in the early follicular phase . Subjects expended 15 kcal/kg of lean body mass ( LBM ) per day in supervised exercise at 70 % of aerobic capacity while consuming a clinical dietary product to set energy availability at 45 and either 10 , 20 , or 30 kcal/kg LBM.d in two r and omized trials separated by at least 2 months . Blood was sample d daily during treatments and at 10-min intervals for the next 24 h. Sample s were assayed for LH , FSH , estradiol ( E2 ) , glucose , beta-hydroxybutyrate , insulin , cortisol , GH , IGF-I , IGF-I binding protein (IGFBP)-1 , IGFBP-3 , leptin , and T3 . LH pulsatility was unaffected by an energy availability of 30 kcal/kg LBM.d ( P > 0.3 ) , but below this threshold LH pulse frequency decreased , whereas LH pulse amplitude increased ( all P < 0.04 ) . This disruption was more extreme in women with short luteal phases ( P < 0.01 ) . These incremental effects most closely resembled the effects of energy availability on plasma glucose , beta-hydroxybutyrate , GH , and cortisol and contrasted with the dependencies displayed by the other metabolic hormones ( simultaneously P < 0.05 ) . These results demonstrate that LH pulsatility is disrupted only below a threshold of energy availability deep into negative energy balance and suggest priorities for future investigations into the mechanism that mediates the nonlinear dependence of LH pulsatility on energy availability This pilot study assessed the effects of exercise and nutritional counseling on hormonal , menstrual , and reproductive function in women with polycystic ovary syndrome ( PCOS ) . Twelve females with a clinical , biochemical , and ultrasonographic diagnosis of PCOS were r and omly assigned to endurance and resistance exercise plus nutritional counseling ( EN ) or nutritional counseling only ( N ) for a period of 12 weeks . Anthropometry , resting metabolic rate ( RMR ) , selected hormones , and ovarian follicle population were measured pre and post-intervention . Following the 12 week intervention , greater decreases in sum of 2 skinfolds ( p = 0.002 ) and a greater increase in estimated VO2 max ( p = 0.017 ) occurred in the exercise group . Significant decreases in waist girth ( p = 0.001 ) and insulin levels ( p = 0.03 ) occurred in both groups . Hormonal changes were not statistically significant ; however , a trend towards an improved hormonal profile , specifically sex-hormone binding globulin ( EN , 39 % increase ; N , 8 % increase ) and lutenizing hormone : follicle-stimulating hormone ( LH : FSH ) ( EN , 9 % decrease ; N , 27 % decrease ) occurred in the absence of weight loss . These findings suggest exercise and nutritional counseling may benefit the metabolic and reproductive abnormalities associated with PCOS Background . Polycystic ovary syndrome ( PCOS ) is often characterized by chronic oligo- or anovulation ( usually manifested as oligo- or amenorrhea ) , and hyper and rogenism . In addition , 30–40 % of PCOS women have impaired glucose tolerance , and a defect in the insulin signaling pathway ( inositol-containing phosphoglycan mediators ) seems to be implicated in the pathogenesis of insulin resistance . PCOS patients are subfertile as a consequence of such ovulatory disorders and often need drugs , such as clomiphene citrate or follicle-stimulating hormone , for ovulation induction , which increases the risk of multiple pregnancy and ovarian hyperstimulation syndrome . We hypothesized that the administration of an isoform of inositol ( myo-inositol ) , belonging to the vitamin B complex , would improve the insulin-receptor activity , restoring normal ovulatory function . Material s and methods . Twenty-five PCOS women of childbearing age with oligo- or amenorrhea were enrolled in the study . Ovulatory disorder due to PCOS was apparently the only cause of infertility ; no tubal defect or deficiency of male semen parameters was found . Myo-inositol combined with folic acid ( Inofolic ® ) 2 g twice a day was administered continuously . During an observation period of 6 months , ovulatory activity was monitored with ultrasound scan and hormonal profile , and the numbers of spontaneous menstrual cycles and eventually pregnancies were assessed . Results . Twenty-two out of the 25 ( 88 % ) patients restored at least one spontaneous menstrual cycle during treatment , of whom 18 ( 72 % ) maintained normal ovulatory activity during the follow-up period . A total of 10 singleton pregnancies ( 40 % of patients ) were obtained . Nine clinical pregnancies were assessed with fetal heart beat at ultrasound scan . Two pregnancies evolved in spontaneous abortion . Conclusion . Myo-inositol is a simple and safe treatment that is capable of restoring spontaneous ovarian activity and consequently fertility in most patients with PCOS . This therapy did not cause multiple pregnancy BACKGROUND Alterations in circulating steroids are believed to be important mediators of the impact that diet and exercise have on breast cancer risk and changes in bone density . This study aim ed to test the hypothesis that moderate exercise training combined with caloric restriction would produce significant menstrual disturbances and alterations in ovarian steroids in premenopausal women . METHODS Sedentary premenopausal women ( 25 - 40 years ; body mass index : 23.6 + /- 0.6 kg/m(2 ) ) assigned to either a light conditioning ( LC , n = 9 ) or an exercise combined with caloric restriction group ( EX + CR , n = 24 ) were studied for one screening , one baseline and four intervention periods equivalent to the length of subjects ' menstrual cycles . Exercise consisted of supervised training sessions , i.e. two LC or four EX + CR times per week , 30 - 60 min at a moderate intensity . The EX + CR group was prescribed a diet representing a caloric restriction of 20 - 35 % below baseline energy requirements , whereas the LC group remained eucaloric . Ovarian steroid exposure was determined with daily urinary estrone-1- and pregnanediol glucuronides ( E1 G and PdG , respectively ) and mid-cycle urinary LH measures . Fitness , body composition , and serum sex hormone binding globulin ( SHBG ) and serum estradiol ( E2 ) were assessed repeatedly . RESULTS The intervention produced significant increases in VO(2 ) max and decreases in both body weight ( -3.7 + /- 0.5 kg ; ranged from -8.8 to + 1.8 kg ) and percent body fat ( -4.5 + /- 0.7 % ; ranged from -12 to + 0.3 % ) , which were attributable primarily to changes in the EX + CR subjects ( time x group ; P < 0.05 ) . Serum E2 and urinary E1 G and PdG concentrations declined significantly across the intervention period ( time ; P < 0.05 ) , whereas SHBG increased transiently ( time ; P < 0.05 ) in the EX + CR subjects , with no significant changes observed in the LC group . The decrease in E1 G area under the curve was significantly related to the daily energy deficit ( R = 0.61 ; P = 0.003 ) , not the amount of weight lost . There was no significant impact of the intervention on menstrual cyclicity or the incidence of menstrual disturbances in either group . CONCLUSIONS A moderate aerobic exercise training program combined with modest weight loss in accordance with recommended guidelines produces significant reductions in ovarian steroid exposure without disrupting menstrual cyclicity in premenopausal women aged 25 - 40 years . Exposure to a daily energy deficit is a stronger predictor of the decline in estrogen exposure than decreases in body weight BACKGROUND This prospect i ve study evaluated the effect of weight reduction on anthropometric indices and ovarian morphology in anovulatory overweight patients with polycystic ovary syndrome ( PCOS ) . METHODS Thirty-three anovulatory overweight patients with PCOS were enrolled in the study . All had patent Fallopian tubes and chronic anovulation : 27 of them were oligo-amenorrhoeic . The partners were normospermic . Patients were prescribed a 1200 kcal/day diet , and physical exercise was recommended .  Anthropometric indices and ovarian imaging parameters were assessed at baseline and after weight loss of 5 and 10 % . RESULTS Twenty-five patients ( 76 % ) lost at least 5 % of their body weight . Eleven of these patients ( 33 % ) reached a 10 % decrease in weight . Waist circumference at the umbilical level , hip circumference , four skin folds , body mass index and fatty mass ratio were significantly reduced after 5 and 10 % weight loss . Ovarian morphology changed during the diet : we observed a significant reduction in ovarian volume and in the number of microfollicles per ovary . Among the 27 patients with oligo-amenorrhoea , 18 had a resumption of regular cycles and 15 experienced spontaneous ovulation ; 10 spontaneous pregnancies occurred in patients who lost at least 5 % of their weight . CONCLUSIONS Weight loss through a controlled low-calorie diet improves anthropometric indices in obese PCOS patients , reduces ovarian volume and microfollicle number and can restore ovulatory cycles , allowing spontaneous pregnancy The hormonal profiles of nested female patients ( n = 500 ) with self-reported symptoms typical of polycystic ovary syndrome ( PCOS ) , oligomenorrhea , and /or hirsutism and their r and omly selected controls ( n = 1026 ) at the age of 31 yr were analyzed in a general population -based Northern Finl and birth cohort 1966 to find out whether the symptomatic women also have the endocrine characteristics of PCOS and could be detected in a general population using simple questions . Higher medians of serum testosterone ( T ) ( 2.10 vs. 1.90 nmol/liter , P < 0.001 ) , LH ( 5.40 vs. 4.85 U/liter , P = 0.005 ) , insulin ( 53.8 vs. 51.66 pmol/liter , P = 0.040 ) , and free and rogen index ( FAI ) ( 4.01 vs. 3.03 , P < 0.001 ) and lower glucose/insulin ratio ( 91.1 x 10(8 ) vs. 94.9 x 10(8 ) , P = 0.048 ) and SHBG ( 52.4 vs. 60.7 nmol/liter , P < 0.001 ) were observed among the cases , but no difference was observed in cortisol and glucose levels between the cases and controls . Of all the women in the cohort , 10.2 % reported only oligomenorrhea and had biochemical findings similar to the whole case group . Those who reported only hirsutism ( 10.4 % ) were in between the case and control groups according to biochemical findings . The subjects who reported both oligomenorrhea and hirsutism ( 3.4 % ) had the highest T , LH , FAI , insulin , and glucose and the lowest SHBG and glucose/insulin ratio , compared with the case group and the groups with either symptom only indicating a dose-response manner in typical endocrine profile of PCOS by adding up symptoms . The levels of T and FAI were higher and SHBG lower in groups with overweight or obesity both at 14 and 31 yr , compared with groups with normal weight at 14 yr and overweight or obesity at 31 yr . In the group with normal weight at 14 and 31 yr and the group with overweight or obesity at 14 yr but normal weight at 31 yr , the levels of T and FAI were lowest and SHBG highest . T and FAI were higher and SHBG lower among the cases than the controls in groups stratified by weight development from adolescence to adulthood . In conclusion , this longitudinal study of a large , stable population indicates that women with self-reported symptoms of hirsutism and /or oligomenorrhea show endocrine characteristics of PCOS and can be detected in a general population using simple questions . These symptoms are markers of the underlying metabolic alterations possibly associated with increased health risks in later life To investigate the influence of exercise on thyroid metabolism , 46 healthy young regularly menstruating sedentary women were r and omly assigned to a 3 x 2 experimental design of aerobic exercise and energy availability treatments . Energy availability was defined as dietary energy intake minus energy expenditure during exercise . After 4 days of treatments , low energy availability ( 8 vs. 30 kcal.kg body wt-1.day-1 ) had reduced 3,5,3'-triiodothyronine ( T3 ) by 15 % and free T3 ( fT3 ) by 18 % and had increased thyroxine ( T4 ) by 7 % and reverse T3 ( rT3 ) by 24 % ( all P < 0.01 ) , whereas free T4 ( fT4 ) was unchanged ( P = 0.08 ) . Exercise quantity ( 0 vs. 1,300 kcal/day ) and intensity ( 40 vs. 70 % of aerobic capacity ) did not affect any thyroid hormone ( all P > 0.10 ) . That is , low-T3 syndrome was induced by the energy cost of exercise and was prevented in exercising women by increasing dietary energy intake . Selective observation of low-T3 syndrome in amenorrheic and not in regularly menstruating athletes suggests that exercise may compromise the availability of energy for reproductive function in humans . If so , athletic amenorrhea might be prevented or reversed through dietary reform without reducing exercise quantity or intensity BACKGROUND Surprisingly , the prevalence of polycystic ovary syndrome ( PCOS ) in otherwise unselected overweight or obese women is unknown , despite obesity being frequent in patients with PCOS . We conducted the present study to obtain an unbiased estimate of the prevalence of PCOS in unselected overweight and obese premenopausal women from Spain . METHODS All premenopausal women reporting to the Department of Endocrinology , Hospital Universitario Ramón y Cajal , for dietary treatment of overweight or obesity from May 2002 to December 2005 were prospect ively recruited . Women referred for any other reason were automatically excluded to avoid selection bias . Diagnosis of PCOS relied on the presence of clinical and /or biochemical hyper and rogenism , oligo-ovulation , and exclusion of secondary causes . Anthropometric measurements , hirsutism scores , and and rogen , gonadotropin , metabolic , and lipid profiles were obtained . RESULTS Of a total of 113 consecutive women recruited , 32 ( 28.3 % ) were diagnosed as having PCOS ( 95 % confidence interval , 20.0%-36.6 % ) . The prevalence of PCOS was not different when considering the degree of obesity . Another 3 women presented with hyper and rogenemia without oligo-ovulation , 2 had idiopathic hirsutism , 2 had chronic oligomenorrhea without clinical or biochemical hyper and rogenism , and 2 had oligomenorrhea with hyperprolactinemia , precluding the diagnosis of PCOS . The remaining 72 women ( 63.7 % ) had no evidence of hyper and rogenism or reproductive abnormalities . CONCLUSIONS Our results demonstrate a 28.3 % prevalence of PCOS in overweight and obese women from Spain , which is markedly increased compared with the 5.5 % prevalence of PCOS in lean women of our country . Therefore , PCOS must be routinely ruled out in overweight and obese premenopausal women seeking advice for weight loss In women with PCOS ( polycystic ovary syndrome ) , hyperinsulinaemia stimulates ovarian cytochrome P450c17α activity that , in turn , stimulates ovarian and rogen production . Our objective was to compare whether timed caloric intake differentially influences insulin resistance and hyper and rogenism in lean PCOS women . A total of 60 lean PCOS women [ BMI ( body mass index ) , 23.7±0.2 kg/m² ] were r and omized into two isocaloric ( ~1800 kcal ; where 1 kcal≈4.184 J ) maintenance diets with different meal timing distribution : a BF ( breakfast diet ) ( 980 kcal breakfast , 640 kcal lunch and 190 kcal dinner ) or a D ( dinner diet ) group ( 190 kcal breakfast , 640 kcal lunch and 980 kcal dinner ) for 90 days . In the BF group , a significant decrease was observed in both AUC(glucose ) ( glucose area under the curve ) and AUC(insulin ) ( insulin area under the curve ) by 7 and 54 % respectively . In the BF group , free testosterone decreased by 50 % and SHBG ( sex hormone-binding globulin ) increased by 105 % . GnRH ( gonadotropin-releasing hormone)-stimulated peak serum 17OHP ( 17α-hydroxyprogesterone ) decreased by 39 % . No change in these parameters was observed in the D group . In addition , women in the BF group had an increased ovulation rate . In lean PCOS women , a high caloric intake at breakfast with reduced intake at dinner results in improved insulin sensitivity indices and reduced cytochrome P450c17α activity , which ameliorates hyper and rogenism and improves ovulation rate . Meal timing and distribution should be considered as a therapeutic option for women with PCOS Background : Polycystic ovary syndrome ( PCOS ) is the most common cause of hyper and rogenism in women . Non-classic congenital adrenal hyperplasia ( NCAH ) is very close to PCOS . The diagnosis of hyper and rogenism is not based on the finding of decreased or increased levels of a single hormone . Objective : In our paper , we are going to test correlation between clinical signs and biochemical markers of hyper and rogenism . Material s and Methods : In this prospect i ve study , we calculated  free testosterone ( cFT ) , bioavailable testosterone ( cBT ) , free and rogen index ( FAI ) , free estrogen index ( FEI ) , total testosterone ( TT ) , sex-hormone binding globulin ( SHBG ) , estradiol ( E2 ) , dehydroepi and rosterone-sulfat ( DHEA-S ) , 17α -hydroxyprogesterone ( 17α -OHP ) , prolactin ( P ) , C-peptid and homeostasis model assessment for insulin resistance ( Homa-IR ) were measured in two groups of young untreated women with PCOS and NCAH . Results : In our research , we did not find any significant differences between PCOS and NCAH groups by age , hormonal and calculated parameters of and rogens . Waist to hip ratio ( WHP ) and body mass index ( BMI ) values were higher in the group of patients with PCOS than NCAH group . But in all patients we found positive correlation between hirsutism score and FAI , cFT , cBT , as well as we found negative correlation between hirsutism score and SHBG . We also tested hormonal and calculated parameters of and rogens between PCOS patients by upper body and lower body obesity , but we did not find any significant differences . There was not any difference by the hirsutism score in these groups either . Conclusion : In our research we found that the calculated values of cFT , cBT and FAI are helpful for determinate hirsutism score in all hirsute patients , despite of ovarian or adrenal hyper and rogenemia The present study investigates the combined effect of diet , physical exercise and Orlistat for 24 weeks , on serum Anti-Müllerian Hormone ( AMH ) levels in overweight and obese women with polycystic ovary syndrome ( PCOS ) and in overweight and obese controls . Sixty-one ( 61 ) selected women with PCOS and 20 overweight and obese controls followed an energy-restricted diet , physical exercise plus Orlistat administration ( 120 mg , 3 times per day ) for 24 weeks . At baseline , week 12 and week 24 , serum levels of AMH , FSH , LH , PRL , and rogens , sex hormone – binding globulin ( SHBG ) , glucose , and insulin were measured and Free And rogen Index ( FAI ) and Insulin Resistance ( IR ) indices were calculated . In PCOS women , serum AMH levels increased after 12 and 24 weeks of treatment . After 12 weeks LH and SHBG were increased , while Testosterone decreased . After 12 and 24 weeks , FAI was decreased and all indices of IR were significantly improved . We concluded that in overweight and obese women with PCOS Orlistat administration , combined with diet and physical exercise , for 24 weeks , result ed in significant weight loss , improvement of hyper and rogenism and insulin sensitivity , and increased serum AMH levels Background This study assessed the perceived benefits and barriers to exercise participation in overweight and obese women with polycystic ovary syndrome ( PCOS ) and monitored changes in response to a lifestyle intervention . Methods Forty-three overweight/obese PCOS women ( Age , 30.3(6.2 ) yrs ; BMI , 36.4(5.6 ) kg/m2 ) were r and omised to one of three 20-week lifestyle programs : diet only ( DO , n = 13 ) , diet and aerobic exercise ( DA , n = 11 ) and diet and combined aerobic-resistance exercise ( DC , n = 19 ) . Exercise Benefits /Barriers Scale ( EBBS ) , weight , aerobic fitness , depression and PCOS specific health-related quality of life were measured . Results Barriers score was related to depression ( r = 0.45 , P = 0.002 ) and aerobic fitness ( r = −0.32 , P = 0.04 ) , while benefits score was related to aerobic fitness ( r = 0.41 , P = 0.007 ) . EBBS , benefits and barriers scores improved overtime ( P ≤ 0.001 ) . Benefits subscales psychological outlook and social interaction increased ( P ≤ 0.001 ) and life enhancement and preventative health did not change ( P ≥ 0.3 ) . Physical performance increased only in DA ( P = 0.009 ) . There were no differences between treatments for any of the other subscales ( P ≥ 0.2 ) . Barriers subscales exercise milieu , time expenditure and physical exertion reduced ( P ≤ 0.003 ) and family discouragement did not change ( P = 0.6 ) . Conclusions This study demonstrated that lifestyle modification consisting of an energy-restricted diet with or without exercise training improved the perceived benefits from and barriers to exercise . Trial registration Australian New Zeal and Clinical Trials Register ACTRN12606000198527 , registered 26 May
Although scarce , the data available to date suggest that hyper and rogenism , such as that observed in PCOS , may likely be associated with oligomenorrhoea in exercising women , and may not always represent hypothalamic inhibition secondary to an energy deficiency .
To date , the predominant mechanism underlying  menstrual disturbances in exercising women supports an underlying energy deficiency-related aetiology , in which a failure to compensate dietary intake for the energy cost of exercise suppresses reproductive function .
Increasing evidence demonstrates that energy deficiency plays a causal role in the induction of amenorrhoea in  exercising women , and consistent with this mechanism are findings of glucoregulatory perturbations such as low triiodothyronine , reduced insulin secretion and elevated cortisol , growth hormone and ghrelin levels .
The menstrual disturbance that may differ in its energetic characteristics and , perhaps in its and rogenic and ovarian steroid environment , is oligomenorrhoea .
We conducted a systematic review of the literature to begin to underst and whether oligomenorrhoea in  exercising women is a mild sub clinical phenotype of polycystic ovarian syndrome ( PCOS ) in which exercise is conferring beneficial effects in protecting women from the classic PCOS phenotype , or whether oligomenorrhoea is part of the spectrum of menstrual disturbances caused by an energy deficiency that is often reported in exercising women with menstrual disturbances .