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Background: It is not known whether premenopausal women who report low sexual satisfaction and have low circulating testosterone levels will benefit from testosterone therapy. Objective: To evaluate the effects of exogenous testosterone in premenopausal women reporting diminished sexual function. Design: Randomized, double-blind, placebo-controlled, dose-ranging trial. Setting: 6 Australian medical centers. Patients: 261 women age 35 to 46 years who reported a decrease in satisfying sexual activity relative to their younger years and had a morning serum free testosterone level less than 3.8 pmol/L ( Intervention: 3 different doses of testosterone administered by a metered-dose transdermal spray for 16 weeks or placebo. Measurements: The primary outcome was the mean number of self-reported satisfactory sexual events (SSEs) over 28 days at week 16. The frequency of SSEs, total number of sexual events (every 4 weeks), scores from the modified Sabbatsberg Sexual Self-Rating Scale and the Psychological General Well-Being Index, and safety variables were also measured. Results: The number of SSEs increased during the treatment period in the active treatment groups and the placebo group. The mean number of SSEs over 28 days at week 16 was statistically significantly greater for women treated with the intermediate dose of testosterone therapy (one 90-[micro]L spray) than for women treated with placebo. The least-squares mean was 2.48 versus 1.70 SSEs, respectively (event rate ratio, 1.49 [95% CI, 1.01 to 2.18]; P = 0.04). The frequency of SSEs in women treated with low and high doses of testosterone did not differ from that in women who took placebo. The rate ratios based on the least-squares mean rates of SSEs during weeks 4 to 16 for each treatment group showed statistically significant or borderline significant increases in all testosterone groups compared with the placebo group. The rate ratios for the one 56-[micro]L spray, one 90-[micro]L spray, and two 90-[micro]L sprays treatment groups were 1.34 (CI, 0.97 to 1.85; P = 0.081), 1.48 (CI, 1.07 to 2.06; P = 0.018), and 1.38 (CI, 1.00 to 1.92; P = 0.052), respectively. At week 16, 95% of women treated with the one 90- = L dose had a free testosterone level less than the upper limit of the reference range for women. The most frequently reported adverse event was hypertrichosis, which was dose-related and mostly confined to the application site. No clinically relevant changes in blood test values, serum biochemical variables, or vital signs occurred. Limitation: The study duration was short, and the placebo effect was strong. Conclusion: A daily 90-[micro]L dose of tran;dermal testosterone improves self-reported sexual satisfaction for premenopausal women with reduced libido and low serum-free testosterone levels by a mean of 0.8 SSE per month. The rate of SSEs with higher and lower testosterone doses did not differ from that with placebo.

Background: Polycystic ovary syndrome (PCOS) is a common condition associated with obesity and with reproductive and metabolic dysfunction. Abnormalities in appetite regulation in PCOS patients may contribute to difficulties in weight management. Objective: We aimed to examine appetite, appetite hormones, and ad libitum food consumption before and after weight loss in overweight women with and without PCOS. Design: Overweight age- and weight-matched women with (n = 14) and without (n = 14) PCOS undertook an 8-wk energy-restricted diet (5185.3 [+ or -] 141.6 kJ/d). At baseline and study end, subjects consumed a test meal (936 kJ; 25% of energy from protein, 9% from fat, and 67% from carbohydrate). Subjective appetite and circulating glucose, insulin, ghrelin, cholecystokinin, and peptide YY were assessed at 0, 15, 30, 45, 60, 90, 120, and 180 min. A mixed buffet lunch was then offered to assess ad libitum food intake. Results: Weight loss (4.2 [+ or -] 3.9 kg) did not differ significantly between the 2 groups. Women with PCOS had significantly (P = 0.023) lower ghrelin concentrations before and after weight loss than did women without PCOS. The degree of postprandial ghrelin suppression was lower at weeks 0 (P = 0.048) and 8 (P = 0.069) in women with PCOS than in women without PCOS. There were no significant differences between the 2 groups in appetite responses, buffet consumption, or fasting or postprandial peptide YY and cholecystokinin before or after weight loss. Conclusions: PCOS was associated with lower fasting ghrelin and a smaller postprandial ghrelin suppression both before and after weight loss but was not associated with other postprandial gut peptides, subjective satiety, or food intake. It is not clear whether appetite regulation is impaired in PCOS. KEY WORDS Appetite, obesity, polycystic ovary syndrome, weight loss, ghrelin, cholecystokinin, peptide YY

Background: Polycystic ovary syndrome (PCOS), a common condition in women, improves with weight loss. Meal replacements in short-term weight loss and strategies for weight maintenance have not been investigated in PCOS. Objective: We compared in overweight women with PCOS the effects of meal replacements in short-term weight-loss and longer-term carbohydrate- or fat-restriction strategies on weight maintenance and improvements in reproductive and metabolic variables. Design: Overweight women with PCOS (n = 43; [bar.x] [+ or -] SD age: 32.1 [+ or -] 5.2 y; weight: 96.1 [+ or -] 18.4 kg) followed an 8-wk weight-loss regimen (2 meal replacements/d, 4904.4 [+ or -] 127 k J; phase 1) and then a 6-mo weight-maintenance carbohydrate- (< 120 g/d) or fat- ( Results: Thirty-four women completed phase 1, and 23 women completed phase 2; the proportion of dropouts was similar in the 2 groups. During phase 1, significant (P < 0.05) reductions in weight (5.6 [+ or -] 2.4 kg), waist circumference (6.1 [+ or -]2.5 cm), body fat (4.1 [+ or -] 2.2 kg), insulin (2.8 [+ or -] 1.1 mU/L), total testosterone (0.3 [+ or -] 0.7 nmol/L), and free androgen index (3.1 [+ or -] 4.6) occurred; these changes were sustained during phase 2. No significant differences between diet groups were seen for any variables. At 6 too, both approaches resulted in a net weight loss of 4.7 [+ or -] 4.6 kg. Improvements in menstrual cyclicity occurred for 16 (57.1%) of 28 subjects. Conclusions: Meal replacements are an effective strategy for the short-term management of PCOS. Advice on moderate fat or carbohydrate restriction was equally effective in maintaining weight reduction and improving reproductive and metabolic variables. KEY WORDS Polycystic ovary syndrome, weight loss, weight maintenance, glycemic index, meal replacement

Polycystic ovary syndrome (PCOS) is a common condition characterized by menstrual abnormalities and clinical or biochemical features of hyperandrogenism. The combination of raised levels of androgens, oestrogen, insulin and LKH explains the classic PCOS presentation of hirsutism, anovulation or dysfunctional bleeding and dysfunction of glucose metabolism.

Abstract Objective To assess the effectiveness of metformin in improving clinical and biochemical features of polycystic ovary syndrome. Design Systematic review and meta-analysis. Data sources Randomised controlled trials that investigated [...]

The definition of polycystic ovary syndrome is presented and the various forms of intervention are discussed.

A study is done to determine the occurrence of glucose tolerance abnormalities and to identify related risk factors in women with polycystic ovary syndrome (PCOS). Results show the prevalence of diabetes and glucose tolerance is high in women with PCOS, especially in older women.

Multiple pregnancy, with its adverse outcomes is a significant problem in assisted reproductive technology. Single embryo transfer (SET) is the only feasible solution for reducing the rate of multiple pregnancy and adequate education, based on available evidence, is one important way to promote the use of it.