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The Cochrane Database of Systematic... Aug 2020Metformin has been proposed as possibly a safer and more effective long-term treatment than the oral contraceptive pill (OCP) in women with polycystic ovary syndrome... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Metformin has been proposed as possibly a safer and more effective long-term treatment than the oral contraceptive pill (OCP) in women with polycystic ovary syndrome (PCOS). It is important to directly compare the efficacy and safety of metformin versus OCP in the long-term treatment of women with PCOS. This is an update of a Cochrane Review comparing insulin sensitising agents with the OCP and only includes studies on metformin.
OBJECTIVES
To assess the effectiveness and safety of metformin versus the OCP (alone or in combination) in improving clinical, hormonal, and metabolic features of PCOS.
SEARCH METHODS
In August 2019 we searched the Cochrane Gynaecology and Fertility Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and CINAHL, the trial registers, handsearched references of the identified articles, and contacted experts in the field to identify additional studies.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) of the use of metformin versus the OCP (alone or in combination) for women with PCOS.
DATA COLLECTION AND ANALYSIS
We used standard methods recommended by Cochrane. The primary review outcomes were the clinical parameters of hirsutism and adverse events, both severe (requiring stopping of medication), and minor. In the presence of substantial heterogeneity (I statistic > 50), which could be explained by pre-specified subgroup analyses on the basis of BMI, we reported the subgroups separately.
MAIN RESULTS
This is a substantive update. We identified 38 additional studies. We included 44 RCTs (2253 women), which comprised 39 RCTs on adult women (2047 women) and five RCTs on adolescent women (206 women). Evidence quality ranged from very low to low. The main limitations were risk of bias, imprecision and inconsistency. Metformin versus the OCP In adult women, we are uncertain of the effect of metformin compared to the OCP on hirsutism in subgroup body mass index (BMI) < 25 kg/m (mean difference (MD) 0.38, 95% confidence interval (CI) -0.44 to 1.19, 3 RCTs, n = 134, I = 50%, very low-quality evidence) and subgroup BMI > 30 kg/m (MD -0.38, 95% CI -1.93 to 1.17; 2 RCTs, n = 85, I = 34%, low-quality evidence). Metformin may be less effective in improving hirsutism compared to the OCP in the subgroup BMI 25 kg/m to 30 kg/m (MD 1.92, 95% CI 1.21 to 2.64, 5 RCTs, n = 254, I = 0%, low-quality evidence). Metformin may increase severe gastro-intestinal adverse events rate compared to the OCP (Peto odds ratio (OR) 6.42, 95% CI 2.98 to 13.84, 11 RCTs, n = 602, I = 0%, low-quality evidence). Metformin may decrease the incidence of severe other adverse events compared to the OCP (Peto OR 0.20, 95% CI 0.09 to 0.44, 8 RCTs, n = 363, I = 0%, low-quality evidence). There were no trials reporting on minor adverse events. In adolescents, we are uncertain whether there is a difference between Metformin and the OCP, on hirsutism and adverse events. Metformin versus metformin combined with the OCP In adult women, metformin may be less effective in improving hirsutism compared to Metformin combined with the OCP (MD 1.36, 95% CI 0.62 to 2.11, 3 RCTs, n = 135, I= 9%, low-quality evidence). We are uncertain if there was a difference between metformin and metformin combined with the OCP for severe gastro-intestinal adverse events (OR 0.74, 95% CI 0.21 to 2.53, 3 RCTs, n = 171, I = 0%, low-quality evidence), or for severe other adverse events (OR 0.56, 95% CI 0.11 to 2.82, 2 RCTs, n = 109, I = 44%, low-quality evidence). There were no trials reporting on minor adverse events. In adolescents, there were no trials for this comparison. The OCP versus metformin combined with the OCP In adult women, the OCP may be less effective in improving hirsutism compared to metformin combined with the OCP (MD 0.54, 95% CI 0.20 to 0.89, 6 RCTs, n = 389, I= 1%, low-quality evidence). The OCP may decrease the incidence of severe gastro-intestinal adverse events compared to metformin combined with the OCP (OR 0.20, 95% CI 0.06 to 0.72, 5 RCTs, n = 228, I = 0%, low-quality evidence). We are uncertain if there is a difference between the OCP and metformin combined with the OCP for severe other adverse events (OR 1.61, 95% CI 0.49 to 5.37, 4 RCTs, n = 159, I = 12%, low-quality evidence). The OCP may decrease the incidence of minor (gastro-intestinal) adverse events compared to metformin combined with the OCP (OR 0.06, 95% CI 0.01 to 0.44, 2 RCTs, n = 98, I = 0%, low-quality evidence). In adolescents, we are uncertain whether there is a difference between the OCP, compared to metformin combined with the OCP, on hirsutism or adverse events.
AUTHORS' CONCLUSIONS
In adult women with PCOS, metformin may be less effective in improving hirsutism compared to the OCP in the subgroup BMI 25 kg/m to 30 kg/m but we are uncertain if there was a difference between metformin and the OCP in subgroups BMI < 25 kg/m and BMI > 30kg/m. Compared to the OCP, metformin may increase the incidence of severe gastro-intestinal adverse events and decrease the incidence of severe other adverse events with no trials reporting on minor adverse events. Either metformin alone or the OCP alone may be less effective in improving hirsutism compared to metformin combined with the OCP. We are uncertain whether there is a difference between the OCP alone and metformin alone compared to metformin combined with the OCP for severe or minor adverse events except for the OCP versus metformin combined with the OCP where the OCP may decrease the incidence of severe and minor gastro-intestinal adverse events. In adolescent women with PCOS, we are uncertain whether there is a difference between any of the comparisons for hirsutism and adverse events due to either no evidence or very low-quality evidence. Further large well-designed RCTs that stratify for BMI are needed to evaluate metformin versus the OCP and combinations in women with PCOS, in particular adolescent women.
Topics: Acne Vulgaris; Adolescent; Adult; Body Mass Index; Cardiovascular Diseases; Contraceptives, Oral, Combined; Drug Therapy, Combination; Endometrial Neoplasms; Female; Hirsutism; Humans; Hypoglycemic Agents; Menstruation Disturbances; Metformin; Polycystic Ovary Syndrome; Randomized Controlled Trials as Topic; Young Adult
PubMed: 32794179
DOI: 10.1002/14651858.CD005552.pub3 -
Journal of Cosmetic Dermatology Apr 2022Although the negative impacts of idiopathic hirsutism (IH) on psychological aspects are well-documented, there is no enough study estimating the prevalence of this... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Although the negative impacts of idiopathic hirsutism (IH) on psychological aspects are well-documented, there is no enough study estimating the prevalence of this endocrine disorder.
OBJECTIVE
This meta-analysis was conducted to estimate the pooled prevalence of IH in the women population.
METHODS
PubMed, Scopus, and Web of Science databases were explored to obtain papers published from inception to September 2020 investigating the prevalence of IH in women. A meta-regression was conducted to assess the impact of polycystic ovary syndrome (PCOS) diagnostic criteria, and ethnicity on the pooled prevalence of IH.
RESULTS
Of 8346 records retrieved through searching databases and other sources, eight studies were selected for the final analyses. The pooled prevalence of idiopathic hirsutism among women, regardless of PCOS diagnostic criteria, and the race was 7.74% (95% CI: 4.10, 14.14). The meta-regression analysis showed that the pooled prevalence of idiopathic hirsutism did not significantly differ based on the PCOS diagnostic criteria and ethnicity. A subgroup analysis based on the PCOS criteria showed the pooled prevalence of 7.24% (95% CI: 2.84, 17.24), 13.05% (95% CI: 10.02, 16.81), and 3.12% (95% CI: 2.16, 4.48) for NIH (National Institutes of Health), Rotterdam, and not reported PCOS diagnostic criteria groups, respectively. The subgroup analysis based on the ethnicity estimated a pooled prevalence of 6.01% (95% CI: 1.87, 17.69) and 9.36% (4.07, 16.63) for European and Asian groups, respectively.
CONCLUSION
The meta-analysis demonstrated that the pooled prevalence of IH was 7.74% and there was no difference between PCOS criteria and ethnicity subgroups.
Topics: Female; Hirsutism; Humans; Polycystic Ovary Syndrome; Prevalence
PubMed: 34185950
DOI: 10.1111/jocd.14313 -
European Journal of Endocrinology Jul 2023To compare between different combined oral contraceptive pills (COCPs) as part of the update of the International Evidence-Based Guidelines on the Assessment and... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To compare between different combined oral contraceptive pills (COCPs) as part of the update of the International Evidence-Based Guidelines on the Assessment and Management of polycystic ovary syndrome (PCOS).
DESIGN
A systematic review and meta-analysis was performed, Prospero CRD42022345640.
METHODS
MEDLINE, EMBASE, All EBM, CINAHL, and PsycINFO was searched on July, 8, 2022, for studies including women with PCOS, comparing 2 different COCPs in randomized controlled trials.
RESULTS
A total of 1660 studies were identified, and 19 randomized controlled trials (RCTs) were included.Fourth-generation COCP resulted in lower body mass index (BMI) (mean difference [MD] 1.17 kg/m2 [95% confidence interval {CI} 0.33; 2.02]) and testosterone (MD 0.60 nmol/L [95% CI 0.13; 1.07]) compared with third-generation agents, but no difference was seen in hirsutism.Ethinyl estradiol (EE)/cyproterone acetate (CPA) was better in reducing hirsutism as well as biochemical hyperandrogenism (testosterone [MD 0.38 nmol/L {95% CI 0.33-0.43}]) and BMI (MD 0.62 kg/m2 [95% CI 0.05-1.20]) compared with conventional COCPs.There was no difference in hirsutism between high and low EE doses. No evidence regarding natural estrogens in COCP was identified.
CONCLUSION
With current evidence, combined regimens containing an antiandrogen (EE/CPA) may be better compared with conventional COCPs in reducing hyperandrogenism, but EE/CPA will not be recommended as a first-line COCP treatment by the pending PCOS guideline update, due to higher venous thrombotic events (VTE) risk in the general population. Later-generation progestins offer theoretical benefits, but better evidence on clinical outcomes is needed in women with PCOS.
TRIAL REGISTRATION
The protocol for the systematic review was registered prospectively in Prospero, CRD42022345640.
Topics: Female; Humans; Polycystic Ovary Syndrome; Hirsutism; Hyperandrogenism; Contraceptives, Oral, Combined; Ethinyl Estradiol; Cyproterone Acetate; Testosterone
PubMed: 37440702
DOI: 10.1093/ejendo/lvad082 -
Health & Social Care in the Community Nov 2022Increased rates of domestic violence (DV) have been associated with events such as public holidays, seasonal variations, disasters and economic crises. Sport is seen as... (Review)
Review
Increased rates of domestic violence (DV) have been associated with events such as public holidays, seasonal variations, disasters and economic crises. Sport is seen as gendered, exemplifying hegemonic masculinity and associated violence, with the link between sporting culture and violence against women well recognised. This paper reports on a systematic review of empirical research literature exploring the link between major sporting events and incidence of DV. We searched MEDLINE, CINAHL, PsycINFO, SPORTDiscus and Proquest Central databases from inception to December 2020 for quantitative studies examining major sports events and reports of DV using a pre-post comparison design. Study quality was assessed using the Kmet quality assessment tool. The review identified 1445 records following duplicate removal. Once screened and assessed for eligibility, 12 studies met the inclusion criteria. Results are presented qualitatively due to the heterogeneity across studies. Most studies originated in North America and the United Kingdom, used police records as their data source for measuring incidences of DV and few looked beyond the day of the sports event for recorded incidences of DV. Studies reviewed suggested that there is an association between certain major sports events and increased reporting of DV. However, studies' findings conflicted with regards to whether increases were associated with contact sports, the rivalry between competing teams, whether the events were emotionally salient and whether alcohol was a contributing factor. In conclusion, there is limited research globally. Heterogeneity and conflicting findings mean that more research is needed to understand the associations and inform community prevention/interventions to address DV.
Topics: Male; Female; Humans; Domestic Violence; Police; Sports; United Kingdom; Masculinity
PubMed: 36129100
DOI: 10.1111/hsc.14028 -
Journal of Cosmetic Dermatology Nov 2022This study aimed to evaluate the Standardized Mean Difference (SMD) of insulin resistance parameters in women with IH, compared to healthy and polycystic ovary syndrome... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
This study aimed to evaluate the Standardized Mean Difference (SMD) of insulin resistance parameters in women with IH, compared to healthy and polycystic ovary syndrome (PCOS) controls.
MATERIALS AND METHODS
PubMed, Scopus, Web of Sciences, and Embase were searched for retrieving studies published up to November 2021 investigating the insulin resistance parameters in women with IH, compared to control groups. Meta-regression and subgroup analysis were conducted to evaluate the effect of potential confounders, such as age, BMI, and study design.
RESULTS
A meta-analysis of 20 studies revealed that higher SMDs of fasting insulin (SMD: 0.58; 95% CI: 0.10, 1.06), HOMA-IR (SMD: 0.53; 95% CI: 0.09, 0.97), and FBS levels (SMD: 0.11; 95% CI: 0.03, 0.19) in women with IH than healthy. It also showed that the SMD of HOMA-IR was significantly lower in women with IH than PCOS patients (SMD: -0.49; 95% CI: -0.88, -0.09). A subgroup analysis of cross-sectional studies showed higher SMDs of fasting insulin (SMD: 0.86; 95% CI: 0.05, 1.68), HOMA-IR (SMD: 0.83; 95% CI: 0.01, 1.64), and FBS levels (SMD: 0.14; 95% CI: 0.00, 0.28) in women with IH than healthy, whereas there was no difference in the SMD of these metabolic parameters between IH and PCOS groups, except for SMD of HOMA-IR (SMD: -0.22; 95% CI: -0.42, -0.02).
CONCLUSIONS
The results of the study demonstrate that insulin resistance parameters are related to IH, although insulin resistance values in women with IH are not as high as in patients with PCOS. According to the results of the study, measuring these metabolic parameters can be beneficial to evaluate all hirsute women with IH.
Topics: Female; Humans; Hirsutism; Insulin Resistance; Cross-Sectional Studies; Polycystic Ovary Syndrome; Insulin
PubMed: 35531788
DOI: 10.1111/jocd.15070 -
Blood Reviews Nov 2023Despite recent advancements, treatment of cytopenia due to bone marrow failures (BMF) and myeloid neoplasms remains challenging. Androgens promote renewal and maturation... (Review)
Review
Despite recent advancements, treatment of cytopenia due to bone marrow failures (BMF) and myeloid neoplasms remains challenging. Androgens promote renewal and maturation of blood cells and may be beneficial in these forms. Here we report a systematic review of androgens use as single agent in hematologic conditions. Forty-six studies, mainly retrospective with various androgen types and doses, were included: 12 on acquired aplastic anemia (AA), 11 on inherited BMF, 17 on myelodysplastic syndromes (MDS), and 7 on myelofibrosis. Responses ranged from 50 to 70% in inherited BMF, 40-50% in acquired AA and MDS, while very limited evidence emerged for myelofibrosis. In acquired AA, response was associated with presence of non-severe disease; in MDS androgens were more effective on thrombocytopenia or mild to moderate anemia, whilst limited benefit was observed for transfusion dependent anemia. Toxicity profile mainly consisted of virilization and liver enzyme elevation, whilst the risk of leukemic evolution remains controversial.
Topics: Humans; Androgens; Primary Myelofibrosis; Retrospective Studies; Neoplasms; Anemia, Aplastic; Myelodysplastic Syndromes; Bone Marrow Failure Disorders; Pancytopenia; Myeloproliferative Disorders; Thrombocytopenia
PubMed: 37709654
DOI: 10.1016/j.blre.2023.101132 -
Science Progress 2022The prevalence and comorbidity of anxiety disorders are significantly different between women and men, with research showing a greater impact on women. The aim of this... (Review)
Review
The prevalence and comorbidity of anxiety disorders are significantly different between women and men, with research showing a greater impact on women. The aim of this review was to identify the psychosocial and biological factors that have been considered to explain this gender and sex difference in prevalence and determine whether these factors are related to any anxiety comorbidity differences between men and women. Following the PRISMA guidelines, we carried out a systematic review of studies published between 2008 and 2021 in PsycINFO and PubMed databases. Empirical and review studies evaluating psychosocial and biological factors that could influence the difference in prevalence and comorbidity between men and women were included. A qualitative narrative synthesis was performed to describe the results. From 1012 studies, 44 studies were included. Retrieved articles were categorized depending on their object of study: psychosocial factors (n = 21), biological factors (n = 16), or comorbidity (n = 7). Results showed that differences in anxiety between women and men have been analyzed by psychosocial and biological factors but rarely together. Among the psychosocial factors analyzed, masculinity may be a protective factor for anxiety development, while femininity can be a risk factor. In the studies that took biological factors into account, the potential influence of brain structures, genetic factors, and fluctuations in sexual hormones are pointed out as causes of greater anxiety in women. Concerning comorbidity, the results noted that women tend to develop other internalizing disorders (e.g. depression), while men tend to develop externalizing disorders (e.g. substance abuse). For an accurate understanding of differences between women and men in anxiety, both biological and psychosocial factors should be considered. This review highlights the need to apply the biopsychosocial model of health and the gender perspective to address differences in anxiety between sexes.
Topics: Female; Humans; Male; Prevalence; Sex Characteristics; Comorbidity; Anxiety Disorders; Anxiety; Biological Factors
PubMed: 36373774
DOI: 10.1177/00368504221135469 -
Qualitative Health Research Jan 2020Miscarriage is common, affecting one in five pregnancies, but the psychosocial effects often go unrecognized and unsupported. The effects on men may be subject to...
Miscarriage is common, affecting one in five pregnancies, but the psychosocial effects often go unrecognized and unsupported. The effects on men may be subject to unintentional neglect by health care practitioners, who typically focus on biological symptoms, confined to women. Therefore, we set out to systematically review the evidence of lived experiences of male partners in high-income countries. Our search and thematic synthesis of the relevant literature identified 27 manuscripts reporting 22 studies with qualitative methods. The studies collected data from 231 male participants, and revealed the powerful effect of identities assumed and performed by men or constructed for them in the context of miscarriage. We identified perceptions of female precedence, uncertain transition to parenthood, gendered coping responses, and ambiguous relations with health care practitioners. Men were often cast into roles that seemed secondary to others, with limited opportunities to articulate and address any emotions and uncertainties engendered by loss.
Topics: Abortion, Spontaneous; Adaptation, Psychological; Fathers; Female; Humans; Male; Pregnancy; Professional-Family Relations; Qualitative Research
PubMed: 31526062
DOI: 10.1177/1049732319870270 -
Psycho-oncology Sep 2022The purpose of this review was to synthesise the literature on the topic of masculinity and testicular cancer (TC) and investigate the relative impact of TC on men's... (Review)
Review
OBJECTIVE
The purpose of this review was to synthesise the literature on the topic of masculinity and testicular cancer (TC) and investigate the relative impact of TC on men's view of their masculinity.
METHODS
Searches were conducted across four databases (MEDline, PsycInfo, CINAHL Plus and Scopus) for articles published before April 2022 that included (1) TC and (2) masculinity. Two researchers independently rated studies for inclusion with a third resolving conflicts. Of the 6464 articles screened, 24 articles (10 quantitative and 14 qualitative) were included in the review. Articles were rated for quality and a narrative synthesis was performed.
RESULTS
Overall, results indicated some men experience a shift in the way they relate to their sense of masculinity following diagnosis and treatment for TC. Being single and without children was related to the experience of negative masculinity-related outcomes, possibly due to a compounding lack of relational support and being unable to conform to protector, provider traditions. Men who described testicle loss as symbolic of their diminished masculinity were also negatively impacted. However, recent, high-quality literature on the topic using standardised masculinity measures was limited.
CONCLUSION
Some men experience a reduced sense of masculinity after TC, however the impact of TC on masculinity remains person dependent. Further research using validated masculinity measures is required to uncover psycho-social variables that may account for whether and how meaning is made between TC and its treatment and any subsequent impact on perceived masculinity. Such factors may better support these men in life beyond cancer.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO. International Prospective Register of Systematic Reviews: CRD42020185649.
Topics: Child; Humans; Male; Masculinity; Neoplasms, Germ Cell and Embryonal; Testicular Neoplasms
PubMed: 35789023
DOI: 10.1002/pon.5994 -
Canadian Journal of Psychiatry. Revue... May 2021Suicide in Canadian men is high and rising. Research consistently indicates increased suicide risk in male subgroups including sexual minority, Indigenous, middle-aged,... (Review)
Review
OBJECTIVE
Suicide in Canadian men is high and rising. Research consistently indicates increased suicide risk in male subgroups including sexual minority, Indigenous, middle-aged, and military men. The current scoping review addresses the research question: Among male subgroups featured in Canadian suicide research, what are the key findings to inform suicide prevention efforts?.
METHOD
A scoping review was undertaken in accord with PRISMA-ScR guidelines. Structured searches were conducted in CIHAHL, Medline, PsychInfo, and Web of Science to identify studies reporting suicidality (suicidal ideation, plans and/or attempts) and suicide among men in Canada. Inclusion criteria comprised primary empirical studies featuring Canadian male subgroups published in English from 2009 to 2020 inclusive.
RESULTS
Sixty-eight articles met the inclusion criteria, highlighting significant rates of male suicidality and/or suicide in 3 categories: (1) health inequities ( = 29); (2) age-specific ( = 30); and (3) occupation ( = 9). The health inequities category included sexual minority men, Indigenous, and other marginalized males (i.e., homeless, immigrant men, and men who use opiates). Age-specific men focused on adolescents and youth, and middle-aged and older males. Active military, veterans, and first responders featured in the occupation category. Studies compared at risk male subgroups to females, general male populations, and/or other marginalized groups in emphasizing mental health disparities and increased suicide risk. Some men's suboptimal connections to existing mental health care services were also highlighted.
CONCLUSION
While male subgroups who are vulnerable to suicidality and suicide were consistently described, these insights have not translated to tailored upstream suicide prevention services for Canadian boys and men. There may be some important gains through integrating social and mental health care services for marginalized men, implementing school-based masculinity programs for adolescent males, orientating clinicians to the potential for men's mid-life suicide risks (i.e., separation, bereavement, retirement) and lobbying employers to norm help-seeking among activate military, veterans, and first responder males.
Topics: Adolescent; Aged; Canada; Female; Humans; Male; Masculinity; Men's Health; Middle Aged; Suicidal Ideation; Suicide Prevention
PubMed: 33719600
DOI: 10.1177/07067437211000631