Effects of the pharmacological interventions and a structured education in the management of polycystic ovary syndrome (PCOS)

Abdalla, Mohammed Altigani

Medicine
March 2022

Thesis or dissertation


Rights
© 2022 Mohammed Altigani Abdalla. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.
Abstract

Introduction
Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disorder that affects women of reproductive age and is associated with an array of metabolic disorders. Insulin resistance, increased body weight, dyslipidaemia and excess androgen are the main drive for PCOS symptoms and the associated health risks. Lifestyle modifications remain the first-line intervention to treat PCOS. However, there are various pharmacological options available as second-line treatment.
Methods
The first study was a systematic review and meta-analysis that evaluated the effect of the different pharmacological interventions on the lipid profiles, C-reactive protein (CRP), anthropometric indices, insulin resistance and the biochemical hyperandrogenaemia in women with PCOS. The second study was a feasibility pilot study of developing and implementing an evidence-based structured education for women with PCOS. The study has two parts; the first part was a patient’s perspectives survey where 320 women were surveyed to establish the need for developing an education programme. The second part was implementing and piloting the evidence-based structured education.
Results
In the systematic review and meta-analysis, pharmacological interventions including Metformin, Atorvastatin, Saxagliptin, Rosiglitazone and Pioglitazone of various dosage, frequencies and duration were associated with a significant reduction in the mean total cholesterol (TC), triglycerides (TGs), low-density lipoprotein cholesterol (LDL-C) and CRP. However, no significant effect was found on the high-density lipoprotein cholesterol (HDL-C). There was also a significant reduction in the mean fasting blood glucose (FBG), fasting insulin (FI) and the homeostatic model assessment of insulin resistance (HOMA-IR) when Metformin alone or combined with Acarbose, Pioglitazone and exenatide in various dosage, frequencies and duration was assessed. There was, however, no significant effect on the homeostatic model of the Beta-cell (HOMA-B).
There was also a significant reduction in the mean body weight, body mass index (BMI), waist circumference (WC) and the waist to hip ratio (WHR) when Metformin, Orlistat and Sitagliptin of various dosage, frequencies and duration were compared with placebo. In contrast, regardless of the duration, dosage, and frequencies, Rosiglitazone and Pioglitazone were associated with a significant increase in body weight, BMI, and WC.
The study also showed a significant increase in the ovulation rate, pregnancy rate and live birth rate when clomiphene citrate (CC) and letrozole alone or added to Metformin of various dosage, duration and frequencies were used. There was also a significant reduction in the mean total testosterone (TT), free testosterone (FT), dehydroepiandrosterone sulphate (DHEAS) and an increase in the sex hormone-binding globulin (SHBG) when metformin, dexamethasone, oral contraceptives pills (OCP), finasteride and Flutamide of various dosage, frequencies and duration were used. In the second study, there was a lack of knowledge about PCOS among women living with the condition. There was also a need for developing and implementing an evidence-based structured education for women living with PCOS. A single exposure to a structured education did not increased knowledge but provided valuable skills for women with PCOS.
Conclusions
This research work demonstrated a significant effect of the various pharmacological interventions used in PCOS management. The work also supports the concept of developing, implementing and integrating an evidence-based structured education in the management of women with PCOS.

Publisher
Hull York Medical School, The University of Hull and the University of York
Supervisor
Sathyapalan, Thozhukat; Soyiri, Ireneous
Qualification level
Doctoral
Qualification name
PhD
Language
English
Extent
9 MB
Identifier
hull:18564
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