Investigation of the biochemical and clinical phenotype in women with polycystic ovary syndrome

Download Statistics

Downloads

Downloads per month over past year

Kempegowda, Punith (2022). Investigation of the biochemical and clinical phenotype in women with polycystic ovary syndrome. University of Birmingham. Ph.D.

Preview

Kempegowda2022PhD.pdf
Text - Accepted Version
Available under License All rights reserved.
Download (7MB) | Preview

Abstract

Objectives
• Establish the distinct androgen signature in a healthy population
• Investigate whether people with PCOS have a high prevalence of anxiety, depression, and body dysmorphia
• Take steps to include people with PCOS in designing and delivering education regarding the condition can help us reduce the gaps in knowledge, attitude, and practice of PCOS.

Methods
The objectives were addressed in four parts:
• Morning serum and saliva samples were collected from 290 and 83 healthy volunteers respectively. Serum and salivary steroids were quantified by liquid chromatography-tandem mass spectrometry profiling assays (Healthy volunteer study).
• 1006 women completed an online survey which included validated questionnaires on four domains: Emotional wellbeing (anxiety and depression), body image, weight-related stigma, and sexual function (Blue Morpho study).
• 43 women aged 18-60 years were invited to complete an online survey about their lived experiences at the onset of the symptoms of PCOS, their journey during diagnosis, an explanation of PCOS to their younger self, and any advice for their younger self (PCOS Pearls study).
• HCP and people with PCOS underwent simulation-based and workshop-based learning respectively on four PCOS case scenarios. Data regarding confidence and expectations regarding PCOS were collected pre- and post-simulation. Wilcoxon Signed-Rank test was used to compare change in confidence levels. Thematic induction was used to identify areas of gaps between expectation and delivery of care (SIMBA-PCOS study).

Results
Healthy volunteer blood samples confirmed that 11-oxygenated androgens form a stable circulating pool of androgens during adulthood, while classic androgens decline with age and are subject to menstrual cycle-dependent variation. In Blue Morpho study, we found women of non-white ethnicity (611/1003) reported a higher depression (OR 1.96 [95% CI 1.41-2.73]) and lower BDD (OR 0.57 [95% CI 0.41-0.79]) rates, than white ethnic women (392/1003). In PCOS Pearls, we found that people with PCOS were impacted significantly by their symptoms and many women feel dissatisfied with the support they receive from healthcare professionals. In SIMBA PCOS, HCPs reported increased confidence to manage PCOS cases (simulated: +41.0%, p<0.001; non-simulated: +40.0%, p<0.001; all: +40.5%, p<0.001). There was 6.25% (p=0.0141) and 17.7% (p=0.0002) increase in PPI participants’ confidence in HCPs to diagnose and manage PCOS-related issues respectively.

Conclusions
A combination of classic and 11-oxygenated androgens can be used to understand the impact of androgen excess in PCOS. There is a need for tailored, multidisciplinary approach to the management of people with PCOS in the community and improving awareness amongst primary healthcare to improve patient care.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):