Polycystic ovary syndrome: A complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan

BMC Medicine

Volumn 8, Issue , 2010, Pages

  Teede, H ^a,b   Deeks, A ^a   Moran, L ^a  

^a MONASH UNIVERSITY   (Australia)

^b Diabetes Unit   (Australia)

Author keywords

[No Author keywords available]

Indexed keywords

ANDROGEN; ANTIANDROGEN; EFLORNITHINE; METFORMIN; ORAL CONTRACEPTIVE AGENT; PROGESTERONE DERIVATIVE;

AMENORRHEA; ANXIETY; BODY WEIGHT; CARDIOVASCULAR RISK; DEPRESSION; DRUG DOSE INCREASE; DYSLIPIDEMIA; ENVIRONMENTAL FACTOR; ETHNICITY; EXERCISE; GENOTYPE; HEALTH EDUCATION; HIRSUTISM; HUMAN; HYPERANDROGENISM; HYPERINSULINEMIA; IMPAIRED GLUCOSE TOLERANCE; INFERTILITY; INSULIN RESISTANCE; LIFESPAN; LIFESTYLE; LOW DRUG DOSE; NON INSULIN DEPENDENT DIABETES MELLITUS; OBESITY; OLIGOMENORRHEA; OVARY POLYCYSTIC DISEASE; PHENOTYPE; PREVALENCE; PSYCHOLOGICAL ASPECT; QUALITY OF LIFE; REVIEW; WEIGHT REDUCTION; CARDIOVASCULAR DISEASE; DIABETES MELLITUS; FEMALE; METABOLISM; OVARY; PATHOLOGY; PHYSIOLOGY; REPRODUCTION;

ANXIETY; CARDIOVASCULAR DISEASES; DEPRESSION; DIABETES MELLITUS; FEMALE; HIRSUTISM; HUMANS; HYPERANDROGENISM; INFERTILITY; OVARY; POLYCYSTIC OVARY SYNDROME; QUALITY OF LIFE; REPRODUCTION;

EID: 77954082318     PISSN: None     EISSN: 17417015     Source Type: Journal    
DOI: 10.1186/1741-7015-8-41     Document Type: Review

References (83)

1. Diamanti-Kandarakis E, Kouli CR, Bergiele AT, Filandra FA, Tsianateli TC, Spina GG, Zapanti ED, Bartzis MI. A survey of the polycystic ovary syndrome in the Greek island of Lesbos: hormonal and metabolic profile. J Clin Endocrinol Metab 1999, 84:4006-4011. 10.1210/jc.84.11.4006, 10566641.
2. Knochenhauer ES, Key TJ, Kahsar-Miller M, Waggoner W, Boots LR, Azziz R. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J Clin Endocrinol Metab 1998, 83:3078-3082. 10.1210/jc.83.9.3078, 9745406.
3. Asuncion M, Calvo RM, San Millan JL, Sancho J, Avila S, Escobar-Morreale HF. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metab 2000, 85:2434-2438. 10.1210/jc.85.7.2434, 10902790.
4. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004, 89:2745-2749. 10.1210/jc.2003-032046, 15181052.
5. March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod 2010, 25:544-551. 10.1093/humrep/dep399, 19910321.
6. Alvarez-Blasco F, Botella-Carretero JI, San Millan JL, Escobar-Morreale HF. Prevalence and characteristics of the polycystic ovary syndrome in overweight and obese women. Arch Intern Med 2006, 166:2081-2086. 10.1001/archinte.166.19.2081, 17060537.
7. Azziz R, Sanchez LA, Knochenhauer ES, Moran C, Lazenby J, Stephens KC, Taylor K, Boots LR. Androgen excess in women: experience with over 1000 consecutive patients. J Clin Endocrinol Metab 2004, 89:453-462. 10.1210/jc.2003-031122, 14764747.
8. Azziz R, Marin C, Hoq L, Badamgarav E, Song P. Health care-related economic burden of the polycystic ovary syndrome during the reproductive life span. J Clin Endocrinol Metab 2005, 90:4650-4658. 10.1210/jc.2005-0628, 15944216.
9. Clark AM, Thornley B, Tomlinson L, Galletley C, Norman RJ. Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. Hum Reprod 1998, 13:1502-1505. 10.1093/humrep/13.6.1502, 9688382.
10. Legro RS, Strauss JF. Molecular progress in infertility: polycystic ovary syndrome. Fertil Steril 2002, 78:569-576. 10.1016/S0015-0282(02)03275-2, 12215335.
11. Doi SA, Al-Zaid M, Towers PA, Scott CJ, Al-Shoumer KA. Ovarian steroids modulate neuroendocrine dysfunction in polycystic ovary syndrome. J Endocrinol Invest 2005, 28:882-892.
12. Legro RS, Castracane VD, Kauffman RP. Detecting insulin resistance in polycystic ovary syndrome: purposes and pitfalls. Obstet Gynecol Surv 2004, 59:141-154. 10.1097/01.OGX.0000109523.25076.E2, 14752302.
13. Vrbikova J, Cibula D, Dvorakova K, Stanicka S, Sindelka G, Hill M, Fanta M, Vondra K, Skrha J. Insulin sensitivity in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2004, 89:2942-2945. 10.1210/jc.2003-031378, 15181081.
14. Moran L, Teede H. Metabolic features of the reproductive phenotypes of polycystic ovary syndrome. Hum Reprod Update 2009, 15:477-488. 10.1093/humupd/dmp008, 19279045.
15. Diamanti-Kandarakis E, Papavassiliou AG. Molecular mechanisms of insulin resistance in polycystic ovary syndrome. Trends Mol Med 2006, 12:324-332. 10.1016/j.molmed.2006.05.006, 16769248.
16. Balen AH, Conway GS, Kaltsas G, Techatrasak K, Manning PJ, West C, Jacobs HS. Polycystic ovary syndrome: the spectrum of the disorder in 1741 patients. Hum Reprod 1995, 10:2107-2111.
17. Kiddy DS, Sharp PS, White DM, Scanlon MF, Mason HD, Bray CS, Polson DW, Reed MJ, Franks S. Differences in clinical and endocrine features between obese and non-obese subjects with polycystic ovary syndrome: an analysis of 263 consecutive cases. Clin Endocrinol (Oxf) 1990, 32:213-220. 10.1111/j.1365-2265.1990.tb00857.x, 2112067.
18. Shaw LJ, Bairey Merz CN, 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. Postmenopausal women with a history of irregular menses and elevated androgen measurements at high risk for worsening cardiovascular event-free survival: results from the National Institutes of Health-National Heart, Lung, and Blood Institute sponsored Women's Ischemia Syndrome Evaluation. J Clin Endocrinol Metab 2008, 93:1276-1284. 10.1210/jc.2007-0425, 2291491, 18182456.
19. Moran LJ, Pasquali R, Teede HJ, Hoeger KM, Norman RJ. Treatment of obesity in polycystic ovary syndrome: a position statement of the Androgen Excess and Polycystic Ovary Syndrome Society. Fertil Steril 2009, 92:1966-1982. 10.1016/j.fertnstert.2008.09.018, 19062007.
20. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome Society. Fertil Steril 2004, 81:19-25. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group.
21. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, Janssen OE, Legro RS, Norman RJ, Taylor AE, Witchel SF, . Androgen Excess Society Position statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. J Clin Endocrinol Metab 2006, 91:4237-4245. 10.1210/jc.2006-0178, 16940456, Androgen Excess Society.
22. Teede H, Hutchison SK, Zoungas S. The management of insulin resistance in polycystic ovary syndrome. Trends Endocrinol Metab 2007, 18:273-279. 10.1016/j.tem.2007.08.001, 17698366.
23. Deeks AA, Gibson-Helm ME, Teede HJ. Anxiety and depression in polycystic ovary syndrome: a comprehensive investigation. Fertil Steril 2010, 93:2421-2423. 10.1016/j.fertnstert.2009.09.018, 20117778.
24. Himelein MJ, Thatcher SS. Polycystic ovary syndrome and mental health: A review. Obst Gynecol Surv 2006, 61:723-732.
25. Boomsma CM, Eijkemans MJ, Hughes EG, Visser GH, Fauser BC, Macklon NS. A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Hum Reprod Update 2006, 12:673-683. 10.1093/humupd/dml036, 16891296.
26. Apridonidze T, Essah PA, Iuorno MJ, Nestler JE. Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2005, 90:1929-1935. 10.1210/jc.2004-1045, 15623819.
27. Legro RS, Kunselman AR, Dodson WC, Dunaif A. 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. J Clin Endocrinol Metab 1999, 84:165-169. 10.1210/jc.84.1.165, 9920077.
28. Coviello AD, Legro RS, Dunaif A. 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. J Clin Endocrinol Metab 2006, 91:492-497. 10.1210/jc.2005-1666, 16249280.
29. Palmert MR, Gordon CM, Kartashov AI, Legro RS, Emans SJ, Dunaif A. Screening for abnormal glucose tolerance in adolescents with polycystic ovary syndrome. J Clin Endocrinol Metab 2002, 87:1017-1023. 10.1210/jc.87.3.1017, 11889155.
30. Brassard M, AinMelk Y, Baillargeon JP. Basic infertility including polycystic ovary syndrome. Med Clin North Am 2008, 92:1163-1192. xi, 10.1016/j.mcna.2008.04.008, 18721657.
31. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, Janssen OE, Legro RS, Norman RJ, Taylor AE, Witchel SF, . Task Force on the Phenotype of the Polycystic Ovary Syndrome of The Androgen Excess and PCOS Society The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril 2009, 91:456-488. 10.1016/j.fertnstert.2008.06.035, 18950759, Task Force on the Phenotype of the Polycystic Ovary Syndrome of The Androgen Excess and PCOS Society.
32. Cedergren MI. Optimal gestational weight gain for body mass index categories. Obstet Gynecol 2007, 110:759-764.
33. Norman RJ, Dewailly D, Legro RS, Hickey TE. Polycystic ovary syndrome. Lancet 2007, 370:685-697. 10.1016/S0140-6736(07)61345-2, 17720020.
34. Meyer C, McGrath BP, Teede HJ. Overweight women with polycystic ovary syndrome have evidence of subclinical cardiovascular disease. J Clin Endocrinol Metab 2005, 90:5711-5716. 10.1210/jc.2005-0011, 16046590.
35. Wild RA, Painter PC, Coulson PB, Carruth KB, Ranney GB. Lipoprotein lipid concentrations and cardiovascular risk in women with polycystic ovary syndrome. J Clin Endocrinol Metab 1985, 61:946-951. 10.1210/jcem-61-5-946, 4044782.
36. Wild RA. Obesity, lipids, cardiovascular risk, and androgen excess. Am J Med 1995, 98:27S-32S. 10.1016/S0002-9343(99)80056-4, 7825638.
37. Talbott E, Clerici A, Berga SL, Kuller L, Guzick D, Detre K, Daniels T, Engberg RA. Adverse lipid and coronary heart disease risk profiles in young women with polycystic ovary syndrome: results of a case-control study. J Clin Epidemiol 1998, 51:415-422. 10.1016/S0895-4356(98)00010-9, 9619969.
38. Wild RA, Bartholomew MJ. The influence of body weight on lipoprotein lipids in patients with polycystic ovary syndrome. Am J Obstet Gynecol 1988, 159:423-427.
39. Dunaif A, Finegood DT. Beta-cell dysfunction independent of obesity and glucose intolerance in the polycystic ovary syndrome. J Clin Endocrinol Metab 1996, 81:942-947. 10.1210/jc.81.3.942, 8772555.
40. O'Meara N, Blackman JD, Ehrmann DA, Barnes RB, Jaspan JB, Rosenfield RL, Polonsky KS. Defects in beta-cell function in functional ovarian hyperandrogenism. J Clin Endocrinol Metab 1993, 76:1241-1247. 10.1210/jc.76.5.1241, 8496316.
41. Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes 1989, 38:1165-1174. 10.2337/diabetes.38.9.1165, 2670645.
42. Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev 1997, 18:774-800. 10.1210/er.18.6.774, 9408743.
43. Ehrmann DA, Barnes RB, Rosenfield RL, Cavaghan MK, Imperial J. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care 1999, 22:141-146. 10.2337/diacare.22.1.141, 10333916.
44. Barr ELM, Magliano DJ, Zimmet PZ, Polkinghorne KR, Atkins RC, Dunstan DW, Murray SG, Shaw JE. AusDiab 2005: The Australian Diabetes, Obesity and Lifestyle Study. 2006, Melbourne, Australia: International Diabetes Institute.
45. Norman RJ, Masters L, Milner CR, Wang JX, Davies MJ. Relative risk of conversion from normoglycaemia to impaired glucose tolerance or non-insulin dependent diabetes mellitus in polycystic ovarian syndrome. Hum Reprod 2001, 16:1995-1998. 10.1093/humrep/16.9.1995, 11527911.
46. Legro RS, Gnatuk CL, Kunselman AR, Dunaif A. Changes in glucose tolerance over time in women with polycystic ovary syndrome: a controlled study. J Clin Endocrinol Metab 2005, 90:3236-3242. 10.1210/jc.2004-1843, 15797965.
47. Boudreaux MY, Talbott EO, Kip KE, Brooks MM, Witchel SF. Risk of T2DM and impaired fasting glucose among PCOS subjects: results of an 8-year follow-up. Curr Diab Rep 2006, 6:77-83. 10.1007/s11892-006-0056-1, 16522285.
48. Alberti KG, Zimmet P, Shaw J. International Diabetes Federation: a consensus on Type 2 Diabetes prevention. Diabet Med 2007, 24:451-463. 10.1111/j.1464-5491.2007.02157.x, 17470191.
49. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002, 346:393-403. 10.1056/NEJMoa012512, 1370926, 11832527.
50. Dunstan D, Zimmet P, Welborne T, Sicree RTA, Atkins R, Cameron A, Shaw J, Chadaban S. Diabetes and associated disorders in Australia 2000 - the accelerating epidemic. Australian Diabetes, Obesity and Lifestyle Report 2001, Melbourne, Australia: The International Diabetes Institute.
51. Salley KE, Wickham EP, Cheang KI, Essah PA, Karjane NW, Nestler JE. Glucose intolerance in polycystic ovary syndrome - a position statement of the Androgen Excess Society. J Clin Endocrinol Metab 2007, 92:4546-4556. 10.1210/jc.2007-1549, 18056778.
52. Sam S, Legro RS, Essah PA, Apridonidze T, Dunaif A. Evidence for metabolic and reproductive phenotypes in mothers of women with polycystic ovary syndrome. Proc Natl Acad Sci USA 2006, 103:7030-7035. 10.1073/pnas.0602025103, 1459013, 16632599.
53. Crisosto N, Codner E, Maliqueo M, Echiburu B, Sanchez F, Cassorla F, Sir-Petermann T. Anti-Mullerian hormone levels in peripubertal daughters of women with polycystic ovary syndrome. J Clin Endocrinol Metab 2007, 92:2739-2743. 10.1210/jc.2007-0267, 17488788.
54. Baillargeon J, Carpentier AC. Brothers of women with polycystic ovary syndrome are characterised by impaired glucose tolerance, reduced insulin sensitivity and related metabolic defects. Diabetologia 2007, 50:2424-2432. 10.1007/s00125-007-0831-9, 17898989.
55. Unluhizarci K, Ozocak M, Tanriverdi F, Atmaca H, Kelestimur F. Investigation of hypothalamo-pituitary-gonadal axis and glucose intolerance among the first-degree female relatives of women with polycystic ovary syndrome. Fertil Steril 2007, 87:1377-1382. 10.1016/j.fertnstert.2006.11.075, 17336975.
56. Yilmaz M, Bukan N, Ersoy R, Karakoc A, Yetkin I, Ayvaz G, Cakir N, Arslan M. Glucose intolerance, insulin resistance and cardiovascular risk factors in first degree relatives of women with polycystic ovary syndrome. Hum Reprod 2005, 20:2414-2420. 10.1093/humrep/dei070, 15890734.
57. Meyer C, McGrath BP, Cameron J, Kotsopoulos D, Teede HJ. Vascular dysfunction and metabolic parameters in polycystic ovary syndrome. J Clin Endocrinol Metab 2005, 90:4630-4635. 10.1210/jc.2004-1487, 15870132.
58. Legro RS, Kunselman AR, Dunaif A. Prevalence and predictors of dyslipidemia in women with polycystic ovary syndrome. Am J Med 2001, 111:607-613. 10.1016/S0002-9343(01)00948-2, 11755503.
59. Ehrmann DA, Liljenquist DR, Kasza K, Azziz R, Legro RS, Ghazzi MN, Group PCTS. Prevalence and predictors of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2006, 91:48-53. 10.1210/jc.2005-1329, 16249284.
60. Barr EL, Zimmet PZ, Welborn TA, Jolley D, Magliano DJ, Dunstan DW, Cameron AJ, Dwyer T, Taylor HR, Tonkin AM, Wong TY, McNeil J, Shaw JE. Risk of cardiovascular and all-cause mortality in individuals with diabetes mellitus, impaired fasting glucose, and impaired glucose tolerance: the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). Circulation 2007, 116:151-157. 10.1161/CIRCULATIONAHA.106.685628, 17576864.
61. Pierpoint T, McKeigue PM, Isaacs AJ, Wild SH, Jacobs HS. Mortality of women with polycystic ovary syndrome at long-term follow-up. J Clin Epidemiol 1998, 51:581-586. 10.1016/S0895-4356(98)00035-3, 9674665.
62. Coffey S, Bano G, Mason HD. Health-related quality of life in women with polycystic ovary syndrome: a comparison with the general population using the Polycystic Ovary Syndrome Questionnaire (PCOSQ) and the Short Form-36 (SF-36). Gynecol Endocrinol 2006, 22:80-86. 10.1080/09513590600604541, 16603432.
63. Coffey S, Mason H. The effect of polycystic ovary syndrome on health-related quality of life. Gynecol Endocrinol 2003, 17:379-386. 10.1080/09513590312331290268, 14710585.
64. Deeks A, Gibson-Helm M, Teede H. Anxiety and depression in polycystic ovary syndrome (PCOS): a comprehensive investigation. Fertil Steril 2010, 93:2421-2423. 10.1016/j.fertnstert.2009.09.018, 20117778.
65. Chen TH, Lu RB, Chang AJ, Chu DM, Chou KR. The evaluation of cognitive-behavioral group therapy on patient depression and self-esteem. Arch Psychiatr Nurs 2006, 20:3-11. 10.1016/j.apnu.2005.08.005, 16442469.
66. Galletly C, Clark A, Tomlinson L, Blaney F. A group program for obese, infertile women: weight loss and improved psychological health. J Psychosom Obstet Gynaecol 1996, 17:125-128. 10.3109/01674829609025672, 8819023.
67. Huber-Buchholz MM, Carey DG, Norman RJ. Restoration of reproductive potential by lifestyle modification in obese polycystic ovary syndrome: role of insulin sensitivity and luteinizing hormone. J Clin Endocrinol Metab 1999, 84:1470-1474. 10.1210/jc.84.4.1470, 10199797.
68. Hamilton-Fairley D, Kiddy D, Anyaoku V, Koistinen R, Seppala M, Franks S. Response of sex hormone binding globulin and insulin-like growth factor binding protein-1 to an oral glucose tolerance test in obese women with polycystic ovary syndrome before and after calorie restriction. Clin Endocrinol (Oxf) 1993, 39:363-367. 10.1111/j.1365-2265.1993.tb02378.x, 7693380.
69. Wahrenberg H, Ek I, Reynisdottir S, Carlstrom K, Bergqvist A, Arner P. Divergent effects of weight reduction and oral anticonception treatment on adrenergic lipolysis regulation in obese women with the polycystic ovary syndrome. J Clin Endocrinol Metab 1999, 84:2182-2187. 10.1210/jc.84.6.2182, 10372729.
70. Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA 2005, 293:43-53. 10.1001/jama.293.1.43, 15632335.
71. Poehlman ET, Dvorak RV, DeNino WF, Brochu M, Ades PA. Effects of resistance training and endurance training on insulin sensitivity in nonobese, young women: a controlled randomized trial. J Clin Endocrinol Metab 2000, 85:2463-2468. 10.1210/jc.85.7.2463, 10902794.
72. NHaMRC Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults. 2003, Canberra, Australia: Australian Government Publishing Service, NHaMRC.
73. Moran LJ, Noakes M, Clifton PM, Tomlinson L, Galletly C, Norman RJ. Dietary composition in restoring reproductive and metabolic physiology in overweight women with polycystic ovary syndrome. J Clin Endocrinol Metab 2003, 88:812-819. 10.1210/jc.2002-020815, 12574218.
74. Stamets K, Taylor DS, Kunselman A, Demers LM, Pelkman CL, Legro RS. A randomized trial of the effects of two types of short-term hypocaloric diets on weight loss in women with polycystic ovary syndrome. Fertil Steril 2004, 81:630-637. 10.1016/j.fertnstert.2003.08.023, 15037413.
75. Moran LJ, Noakes M, Clifton PM, Wittert GA, Williams G, Norman RJ. Short-term meal replacements followed by dietary macronutrient restriction enhance weight loss in polycystic ovary syndrome. Am J Clin Nutr 2006, 84:77-87.
76. Kasim-Karakas SE, Almario RU, Cunningham W. Effects of protein versus simple sugar intake on weight loss in polycystic ovary syndrome (according to the National Institutes of Health criteria). Fertil Steril 2009, 92:262-270. 10.1016/j.fertnstert.2008.05.065, 18691705.
77. Hays JH, DiSabatino A, Gorman RT, Vincent S, Stillabower ME. Effect of a high saturated fat and no-starch diet on serum lipid subfractions in patients with documented atherosclerotic cardiovascular disease. Mayo Clin Proc 2003, 78:1331-1336. 10.4065/78.11.1331, 14601690.
78. Mavropoulos JC, Yancy WS, Hepburn J, Westman EC. The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: a pilot study. Nutr Metab 2006, 2:35.
79. Herriot AM, Whitcroft S, Jeanes Y. An retrospective audit of patients with polycystic ovary syndrome: the effects of a reduced glycaemic load diet. J Hum Nutr Diet 2008, 21:337-345. 10.1111/j.1365-277X.2008.00890.x, 18721400.
80. Meyer C, McGrath BP, Teede HJ. Effects of medical therapy on insulin resistance and the cardiovascular system in polycystic ovary syndrome. Diabetes Care 2007, 30:471-478. 10.2337/dc06-0618, 17327307.
81. Tang T, Lord JM, Norman RJ, Yasmin E, Balen AH. Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. Cochrane Database Syst Rev 2009, 4:CD003053.
82. Teede H, Zoungas S, Deeks A, Farrell E, Moran L, Vollenhoven B. Check: independent learning program for GPs. Polycystic ovary syndrome. 2008, Unit 432. South Melbourne, Victoria: Royal Australian College of General Practitioners, Royal Australian College of General Practitioners.
83. Zawadzki J, Dunaif A. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. Polycystic Ovary Syndrome Current Issues in Endocrinology and Metabolism 1992, 377-384. Boston, MA: Blackwell Scientific, Dunaif A, Givens J, Haseltine F, Marrian G.