Journal of Clinical Endocrinology & Metabolism, Vol 68, 173-179, Copyright © 1989 by Endocrine Society

ARTICLES

Clinical and hormonal characteristics of obese amenorrheic hyperandrogenic women before and after weight loss

R Pasquali, D Antenucci, F Casimirri, S Venturoli, R Paradisi, R Fabbri, V Balestra, N Melchionda and L Barbara
Institute of Clinical Medicine and Gastroenterology, S. Orsola Hospital, Bologna, Italy.

We studied a group of obese hyperandrogenic amenorrheic women to determine the effects of weight loss on anthropometry, hormonal status, menstrual cycles, ovulation, and fertility. Fourteen women had polycystic ovaries, two the hyperandrogenism-insulin resistance- acanthosis nigricans syndrome, one hirsutism of adrenal origin, and three idiopathic chronic anovulation. The duration of amenorrhea before the study ranged from 3-17 months [mean, 8.6 +/- 4.5 (+/- SD)]. All women ate a hypocaloric diet for a period of 8.0 +/- 2.4 months. Weight loss ranged from 4.8 to 15.2 kg (mean, 9.7 +/- 3.1 kg; 1.35 +/- 0.56 kg/month) and the waist to hip ratio, which was used as a measurement of body fat distribution, decreased from 0.86 +/- 0.1 to 0.81 +/- 0.06 (P less than 0.0001). The women's mean plasma testosterone and LH concentrations decreased significantly (P less than 0.001 and P less than 0.005, respectively). A significant positive correlation was found between the decreases in plasma testosterone levels and the decreases in glucose-stimulated insulin levels. Moreover, the decreases in the waist to hip ratio correlated positively with the decreases in glucose- stimulated insulin levels and inversely with the decreases in plasma 17 beta-estradiol. No relationships were found between weight loss and the changes in plasma insulin, steroid, and gonadotropin concentrations. The responsiveness to the weight reduction program was evaluated by comparing the number of menstrual cycles during the study period with the number reported before it. Eight women had significantly improved menstrual cyclicity (responders), while 12 did not (nonresponders). The clinical characteristics and hormone values were similar in responder and nonresponder women. In the group as a whole, 33% of the menstrual cycles during the study were ovulatory, and 4 pregnancies occurred. Hirsutism improved significantly in more than half of the women, as did acanthosis nigricans when present. We conclude that weight loss is beneficial in all obese hyperandrogenic women regardless of the presence of polycystic ovaries, the degree of hyperandrogenism, and the degree and distribution of obesity.

This article has been cited by other articles:

				L. J. Moran, M. Noakes, P. M. Clifton, and R. J. Norman The Use of Anti-Mullerian Hormone in Predicting Menstrual Response after Weight Loss in Overweight Women with Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., October 1, 2007; 92(10): 3796 - 3802. [Abstract] [Full Text] [PDF]

				A. Gambineri, L. Patton, A. Vaccina, M. Cacciari, A. M. Morselli-Labate, C. Cavazza, U. Pagotto, and R. Pasquali Treatment with Flutamide, Metformin, and Their Combination Added to a Hypocaloric Diet in Overweight-Obese Women with Polycystic Ovary Syndrome: A Randomized, 12-Month, Placebo-Controlled Study J. Clin. Endocrinol. Metab., October 1, 2006; 91(10): 3970 - 3980. [Abstract] [Full Text] [PDF]

				V. De Leo, M.C. Musacchio, G. Morgante, P. Piomboni, and F. Petraglia Metformin treatment is effective in obese teenage girls with PCOS Hum. Reprod., September 1, 2006; 21(9): 2252 - 2256. [Abstract] [Full Text] [PDF]

				L. Poretsky Polycystic Ovary Syndrome--Increased or Preserved Ovarian Sensitivity to Insulin? J. Clin. Endocrinol. Metab., August 1, 2006; 91(8): 2859 - 2860. [Full Text] [PDF]

				R. Pasquali and A. Gambineri Insulin-sensitizing agents in polycystic ovary syndrome. Eur. J. Endocrinol., June 1, 2006; 154(6): 763 - 775. [Abstract] [Full Text] [PDF]

				A. H Balen, M. Dresner, E. M Scott, and J. O Drife Should obese women with polycystic ovary syndrome receive treatment for infertility? BMJ, February 25, 2006; 332(7539): 434 - 435. [Full Text] [PDF]

				T. Tang, J. Glanville, C. J. Hayden, D. White, J. H. Barth, and A. H. Balen Combined lifestyle modification and metformin in obese patients with polycystic ovary syndrome. A randomized, placebo-controlled, double-blind multicentre study Hum. Reprod., January 1, 2006; 21(1): 80 - 89. [Abstract] [Full Text] [PDF]

				T. Reinehr, G. de Sousa, C. L. Roth, and W. Andler Androgens before and after Weight Loss in Obese Children J. Clin. Endocrinol. Metab., October 1, 2005; 90(10): 5588 - 5595. [Abstract] [Full Text] [PDF]

				I. E. Messinis Ovulation induction: a mini review Hum. Reprod., October 1, 2005; 20(10): 2688 - 2697. [Abstract] [Full Text] [PDF]

				M.A. Checa, A. Requena, C. Salvador, R. Tur, J. Callejo, J.J. Espinos, F. Fabregues, J. Herrero, and (Reproductive Endocrinology Interest Group of the Insulin-sensitizing agents: use in pregnancy and as therapy in polycystic ovary syndrome Hum. Reprod. Update, July 1, 2005; 11(4): 375 - 390. [Abstract] [Full Text] [PDF]

				J. Vrbikova and D. Cibula Combined oral contraceptives in the treatment of polycystic ovary syndrome Hum. Reprod. Update, May 1, 2005; 11(3): 277 - 291. [Abstract] [Full Text] [PDF]

				R. V. Mehta, K. S. Patel, M. S. Coffler, M. H. Dahan, R. Y. Yoo, J. S. Archer, P. J. Malcom, and R. J. Chang Luteinizing Hormone Secretion Is Not Influenced by Insulin Infusion in Women with Polycystic Ovary Syndrome Despite Improved Insulin Sensitivity during Pioglitazone Treatment J. Clin. Endocrinol. Metab., April 1, 2005; 90(4): 2136 - 2141. [Abstract] [Full Text] [PDF]

				V. Jayagopal, E. S. Kilpatrick, S. Holding, P. E. Jennings, and S. L. Atkin Orlistat Is as Beneficial as Metformin in the Treatment of Polycystic Ovarian Syndrome J. Clin. Endocrinol. Metab., February 1, 2005; 90(2): 729 - 733. [Abstract] [Full Text] [PDF]

				S. Ten and N. Maclaren Insulin Resistance Syndrome in Children J. Clin. Endocrinol. Metab., June 1, 2004; 89(6): 2526 - 2539. [Abstract] [Full Text] [PDF]

				R. J. Norman, M. Noakes, R. Wu, M. J. Davies, L. Moran, and J. X. Wang Improving reproductive performance in overweight/obese women with effective weight management Hum. Reprod. Update, May 1, 2004; 10(3): 267 - 280. [Abstract] [Full Text] [PDF]

				R. Homburg and C. B. Lambalk Polycystic ovary syndrome in adolescence--a therapeutic conundrum Hum. Reprod., May 1, 2004; 19(5): 1039 - 1042. [Abstract] [Full Text] [PDF]

				E. W. C. M. van Dam, F. Roelfsema, J. D. Veldhuis, S. Hogendoorn, J. Westenberg, F. M. Helmerhorst, M. Frolich, H. M. J. Krans, A. E. Meinders, and H. Pijl Retention of estradiol negative feedback relationship to LH predicts ovulation in response to caloric restriction and weight loss in obese patients with polycystic ovary syndrome Am J Physiol Endocrinol Metab, April 1, 2004; 286(4): E615 - E620. [Abstract] [Full Text] [PDF]

				S. E. Kasim-Karakas, R. U. Almario, L. Gregory, R. Wong, H. Todd, and B. L. Lasley Metabolic and Endocrine Effects of a Polyunsaturated Fatty Acid-Rich Diet in Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., February 1, 2004; 89(2): 615 - 620. [Abstract] [Full Text] [PDF]

				M. T. Sheehan Polycystic Ovarian Syndrome: Diagnosis and Management Clin. Med. Res., February 1, 2004; 2(1): 13 - 27. [Abstract] [Full Text] [PDF]

				M. S. Coffler, K. Patel, M. H. Dahan, R. Y. Yoo, P. J. Malcom, and R. J. Chang Enhanced Granulosa Cell Responsiveness to Follicle-Stimulating Hormone during Insulin Infusion in Women with Polycystic Ovary Syndrome Treated with Pioglitazone J. Clin. Endocrinol. Metab., December 1, 2003; 88(12): 5624 - 5631. [Abstract] [Full Text] [PDF]

				K. Patel, M. S. Coffler, M. H. Dahan, R. Y. Yoo, M. A. Lawson, P. J. Malcom, and R. J. Chang Increased Luteinizing Hormone Secretion in Women with Polycystic Ovary Syndrome Is Unaltered by Prolonged Insulin Infusion J. Clin. Endocrinol. Metab., November 1, 2003; 88(11): 5456 - 5461. [Abstract] [Full Text] [PDF]

				V. De Leo, A. la Marca, and F. Petraglia Insulin-Lowering Agents in the Management of Polycystic Ovary Syndrome Endocr. Rev., October 1, 2003; 24(5): 633 - 667. [Abstract] [Full Text] [PDF]

				L. J. Moran, M. Noakes, P. M. Clifton, L. Tomlinson, and R. J. Norman Dietary Composition in Restoring Reproductive and Metabolic Physiology in Overweight Women with Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., February 1, 2003; 88(2): 812 - 819. [Abstract] [Full Text] [PDF]

				J.G. Dolfing, K.E. Tucker, C.M. Lem, J. Uittenbogaart, J.C. Verzijl, and D.H. Schweitzer Low 11-deoxycortisol to cortisol conversion reflects extra-adrenal factors in the majority of women with normo-gonadotrophic normo-estrogenic infertility Hum. Reprod., February 1, 2003; 18(2): 333 - 337. [Abstract] [Full Text] [PDF]

				K. M. Fairfield, W. C. Willett, B. A. Rosner, J. E. Manson, F. E. Speizer, and S. E. Hankinson Obesity, Weight Gain, and Ovarian Cancer Obstet. Gynecol., August 1, 2002; 100(2): 288 - 296. [Abstract] [Full Text] [PDF]

				D. Cibula, M. Hill, M. Fanta, G. Sindelka, and J. Zivny Does obesity diminish the positive effect of oral contraceptive treatment on hyperandrogenism in women with polycystic ovarian syndrome? Hum. Reprod., May 1, 2001; 16(5): 940 - 944. [Abstract] [Full Text] [PDF]

				T. A Ricci, S. B Heymsfield, R. N Pierson Jr, T. Stahl, H. A Chowdhury, and S. A Shapses Moderate energy restriction increases bone resorption in obese postmenopausal women Am. J. Clinical Nutrition, February 1, 2001; 73(2): 347 - 352. [Abstract] [Full Text] [PDF]

				U. Muenstermann and J. Kleinstein Long-term GnRH analogue treatment is equivalent to laparoscopic laser diathermy in polycystic ovarian syndrome patients with severe ovarian dysfunction Hum. Reprod., December 1, 2000; 15(12): 2526 - 2530. [Abstract] [Full Text] [PDF]

				R. Pasquali, A. Gambineri, D. Biscotti, V. Vicennati, L. Gagliardi, D. Colitta, S. Fiorini, G. E. Cognigni, M. Filicori, and A. M. Morselli-Labate Effect of Long-Term Treatment with Metformin Added to Hypocaloric Diet on Body Composition, Fat Distribution, and Androgen and Insulin Levels in Abdominally Obese Women with and without the Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., August 1, 2000; 85(8): 2767 - 2774. [Abstract] [Full Text]

				P. Moghetti, R. Castello, C. Negri, F. Tosi, F. Perrone, M. Caputo, E. Zanolin, and M. Muggeo Metformin Effects on Clinical Features, Endocrine and Metabolic Profiles, and Insulin Sensitivity in Polycystic Ovary Syndrome: A Randomized, Double-Blind, Placebo-Controlled 6-Month Trial, followed by Open, Long-Term Clinical Evaluation J. Clin. Endocrinol. Metab., January 1, 2000; 85(1): 139 - 146. [Abstract] [Full Text]

				M. W. Elting, T. J.M. Korsen, L. T.M. Rekers-Mombarg, and J. Schoemaker Women with polycystic ovary syndrome gain regular menstrual cycles when ageing Hum. Reprod., January 1, 2000; 15(1): 24 - 28. [Abstract] [Full Text] [PDF]

				L. Poretsky, N. A. Cataldo, Z. Rosenwaks, and L. C. Giudice The Insulin-Related Ovarian Regulatory System in Health and Disease Endocr. Rev., August 1, 1999; 20(4): 535 - 582. [Abstract] [Full Text] [PDF]

				M.-M. Huber-Buchholz, D. G. P. Carey, and R. J. Norman Restoration of Reproductive Potential by Lifestyle Modification in Obese Polycystic Ovary Syndrome: Role of Insulin Sensitivity and Luteinizing Hormone J. Clin. Endocrinol. Metab., April 1, 1999; 84(4): 1470 - 1474. [Abstract] [Full Text]

				D. S. Willis, H. Watson, H. D. Mason, R. Galea, M. Brincat, and S. Franks Premature Response to Luteinizing Hormone of Granulosa Cells from Anovulatory Women with Polycystic Ovary Syndrome: Relevance to Mechanism of Anovulation J. Clin. Endocrinol. Metab., November 1, 1998; 83(11): 3984 - 3991. [Abstract] [Full Text]

				A. E. Taylor, B. McCourt, K. A. Martin, E. J. Anderson, J. M. Adams, D. Schoenfeld, and J. E. Hall Determinants of Abnormal Gonadotropin Secretion in Clinically Defined Women with Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., July 1, 1997; 82(7): 2248 - 2256. [Abstract] [Full Text] [PDF]

				S. Franks Polycystic Ovary Syndrome N. Engl. J. Med., September 28, 1995; 333(13): 853 - 861. [Full Text] [PDF]