(Abstracted from Lancet 2018;392:2697–2704) Infertility is common and affects about 10% to 15% of couples. In such couples, 1 in 500 women has infertility due to uterine causes, with uterine agenesis (Mayer-Rokitansky-Küster-Hauser [MRKH] syndrome), or due to hysterectomy, malformation, or the sequelae of infection or surgery.

This study suggests that isoflavone 100-mg regime treatment may be a safe and effective alternative therapy for menopausal symptoms and may offer a benefit to the cardiovascular system.

This study investigated the receptor mechanism(s) by which the hormone melatonin directly affects ovarian function. Expression of MT 1 and MT 2 melatonin receptor mRNA was detected in the rat ovaries both by reverse transcriptase-polymerase chain reaction and in situ hybridization with digoxigenin-labeled oligoprobes. Exposure of granulosa cells in culture to 17␤-estradiol seems to alter the state of melatonin receptor coupling. Indeed, the efficacy of 4P-PDOT on forskolin-stimulated cAMP formation was reversed from an MT 2 partial agonist in vehicle-treated cells to that of an MT 1 inverse agonist in 17␤-estradiol (0.1 M)-treated granulosa cells. We conclude that MT 1 and MT 2 melatonin receptors expressed in antral follicles and corpus luteum may affect steroidogenesis through cAMPmediated signaling. These results underscore the implications of the levels of ovarian estrogen when melatonin receptor ligands are used as therapeutic agents.

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OBJECTIVE:To examine the change in menopausal symptoms and cardiovascular risk factors in response to 4 months of daily 100-mg soy isoflavone in postmenopausal women. METHODS:In this double-blind, placebo-controlled study, 80 women were randomly assigned to isoflavone (n ‫؍‬ 40) and placebo (n ‫؍‬ 40) treatment. The menopausal Kupperman index was used to assess change in menopausal symptoms at baseline and after 4 months of treatment. Cardiovascular risk factors were assessed by evaluating plasma lipid levels, body mass index, blood pressure, and glucose levels in the participants. To examine the effects of this regime on endogenous hormone levels, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and 17␤-estradiol were measured. Transvaginal sonography was performed to quantify endometrial thickness. RESULTS:The data showed a decrease in menopausal symptoms (P < .01, paired t test, two-tailed, between baseline and isoflavone groups, and P < .01, unpaired t test, between placebo and isoflavone groups). Total cholesterol and low-density lipoprotein decreased significantly in the isoflavone group compared with the baseline or placebo group (P < .001, paired t test, two-tailed, between baseline and isoflavone groups, and P < .01, unpaired t test, between placebo and isoflavone groups). The isoflavone treatment appeared to have no effect on blood pressure, plasma glucose, and high-density lipoprotein and triglyceride levels.

Despite a unifying diagnosis of polycystic ovary syndrome, there are significant differences in the prevalence of metabolic syndrome and clustering of its components based on race and ethnicity, which may reflect contributions from both racial and environmental factors. Our findings indicate the prevalence of metabolic syndrome components varies in women with polycystic ovary syndrome, such that compared to White women from the United States, Black US women had the highest prevalence, whereas women from India and Norway had a higher prevalence of metabolic syndrome independent of obesity. The differences in clustering of components of metabolic syndrome based on ethnicity highlight the need to routinely perform complete metabolic screening to identify specific targets for cardiovascular risk reduction strategies in these reproductive-age women.

Both metformin and lifestyle changes may increase the number of menstrual cycles in PCOS. This effect was related to a decrease in BMI.