***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: STUDY QUESTION We aim ed to determine the impact of an oral contraceptive ( OC ) treatment on health-related quality of life ( HRQOL ) , depressive and anxiety symptoms in polycystic ovary syndrome ( PCOS ) . SUMMARY ANSWER OC therapy in PCOS improves hirsutism and menstrual disturbances , along with HRQOL . This improvement is not associated with any change in the prevalence of depressive and anxiety symptoms . WHAT IS KNOWN AND WHAT THIS ARTICLE ADDS : Limited data are available regarding the effects of an OC on HRQOL , and depressive and anxiety symptoms in PCOS . This study reports the effects of the ethinyl estradiol/drospirenone ( EE/DRSP ) OC on an HRQOL question naire for women with PCOS ( PCOSQ ) , depressive and anxiety symptoms after 6 months of treatment . DESIGN Prospect i ve observational study . All participants completed PCOSQ , Beck Depression Inventory , Hospital Anxiety and Depression Scale and General Health Question naire . Serum and rogens , fasting insulin , fasting and postload glucose values during an oral glucose tolerance test were measured . Changes in these variables and the scores of question naires were evaluated after 6 months of treatment with EE/DRSP ( 3 mg/30 μg ) . PARTICIPANTS AND SETTING Thirty-six patients with PCOS without a previous psychiatric diagnosis were included in the study . MAIN RESULTS AND THE ROLE OF CHANCE The main complaints of the patients were hirsutism and irregular menses . Accordingly , menstrual and hirsutism problems were the most serious concerns followed by emotional problems on the PCOSQ . Eight patients ( 22.2 % ) had clinical depression scores . After treatment , regular menstrual cycles were attained and hirsutism was significantly improved in all patients . Hirsutism and emotion domains of the PCOSQ improved at 6 months ( P < 0.05 for both ) . Depression was improved in five of eight depressive patients and four new patients showed increased depression scores . Overall , depression , anxiety mean scores and depression rates did not show a significant change . BIAS , CONFOUNDING AND OTHER REASONS FOR CAUTION The study is subject to the strengths and limitations of observational study design . A limitation of our study is the small sample size and lack of data related to possible confounding factors . GENERALIZABILITY TO OTHER POPULATION S Generalizable to Caucasian PCOS OBJECTIVE To evaluate the ability of women affected by functional hypothalamic secondary amenorrhea ( FHSA ) or polycystic ovary syndrome ( PCOS ) to adapt to stress . DESIGN Controlled clinical study . SETTING University hospital . PATIENT(S ) Thirty-one patients affected by FHSA , 29 patients with PCOS , and 30 eumenorrheic women . INTERVENTION(S ) The subjects took the Stroop Color Word ( Stroop CW ) test and underwent blood sampling . MAIN OUTCOME MEASURE(S ) Heart rate ( HR ) , systolic blood pressure ( SBP ) , diastolic blood pressure ( DBP ) , and serum cortisol levels . RESULT ( S ) The healthy controls had better Stroop CW scores than patients with FHSA . Serum cortisol levels significantly increased during Stroop CW with respect to the baseline in patients with FHSA or PCOS but not in the healthy controls . The SBP , DBP , and HR of the controls as well as SBP and DBP of patients with PCOS were significantly higher than those measured in patients with FHSA both at the baseline and during Stroop CW . CONCLUSION ( S ) Patients with FHSA do not cope as well as healthy patients , and their autonomic response to stress is worse than both controls and patients with PCOS CONTEXT The contribution of reproductive hormones to mood has been the focus of considerable research . Results from clinical and epidemiological studies have been inconsistent . It remains unclear whether alterations in serum hormone levels across the menopausal transition are linked to depressive symptoms . OBJECTIVES To evaluate the relationship between serum hormone levels and high depressive symptoms and whether hormone levels or their change might explain the association of menopausal status with depressive symptoms previously reported in a national sample of midlife women . DESIGN A longitudinal , community-based , multisite study of menopause . Data were collected at baseline and annually from December 1995 to January 2008 on a range of factors . Early follicular phase serum sample s were assayed for levels of estradiol , follicle-stimulating hormone , testosterone , and dehydroepi and rosterone sulfate . SETTING Seven communities nationwide . PARTICIPANTS A community-based sample of 3302 multiethnic women , aged 42 to 52 years , still menstruating and not using exogenous reproductive hormones .  Main Outcome Measure Depressive symptoms assessed with the Center for Epidemiological Studies Depression Scale ( CES-D ) . The primary outcome was a CES-D score of 16 or higher . RESULTS In multivariable r and om-effects logistic regression models , log-transformed testosterone level was significantly positively associated with higher odds of a CES-D score of 16 or higher ( odds ratio = 1.15 ; 95 % confidence interval , 1.01 - 1.31 ) across 8 years , and a larger increase in log-transformed testosterone from baseline to each annual visit was significantly associated with increased odds of a CES-D score of 16 or higher ( odds ratio = 1.23 ; 95 % confidence interval , 1.04 - 1.45 ) . Less education , being Hispanic , and vasomotor symptoms , stressful life events , and low social support at each visit were each independently associated with a CES-D score of 16 or higher . No other hormones were associated with a CES-D score of 16 or higher . Being perimenopausal or postmenopausal compared with being premenopausal remained significantly associated with a CES-D score of 16 or higher in all analyses . CONCLUSIONS Higher testosterone levels may contribute to higher depressive symptoms during the menopausal transition . This association is independent of menopausal status , which remains an independent predictor of higher depressive symptoms BACKGROUND We analyzed the neuroendocrine and immune cell responses to psychosocial stress in PCOS patients compared to BMI -matched healthy controls . METHODS Responses to public speaking stress were analyzed in 32 PCOS patients and 32 BMI -matched healthy controls . At baseline , during , and 10- and 45-min after stress , state anxiety , cardiovascular responses , cortisol , ACTH , as well as circulating leukocyte sub population s were analyzed , together with hsCRP and serum IL-6 concentrations . RESULTS In response to public speaking stress , both groups showed significant but comparable increases in state anxiety , and blood pressure ( all p<0.001 ; time effects ) . The ACTH and cortisol stress responses were significantly enhanced in PCOS ( both p<0.05 ; interaction effect ) . In addition , heart rate was significantly higher in PCOS ( p<0.05 ; group effect ) . PCOS patients displayed a reduced upregulation of IL-6 levels in response to stress ( p<0.05 ; interaction effect ) . Baseline levels of circulating leukocyte sub population s , IL-6 and hsCRP concentrations did not differ between BMI -matched controls and PCOS patients . PCOS patients were characterized by markedly increased psychological distress . CONCLUSIONS PCOS patients showed enhanced HPA-axis and heart rate reactivity as well as a reduced upregulation of IL-6 in response to stress . The altered stress reactivity in PCOS patients may constitute a link between depression , overweight , and the cardiovascular and diabetes risks associated with the diagnosis CONTEXT Polycystic ovary syndrome ( PCOS ) is associated with reduced health-related quality of life ( HRQOL ) and increased prevalence of depressive and anxiety disorders . The impact of PCOS-specific treatments on these co-morbidities is unclear . OBJECTIVE To assess the impact of weight loss and decreasing hyper and rogenism on HRQOL and mood and anxiety disorders in women with PCOS . DESIGN / SETTING / PARTICIPANTS A secondary analysis of a r and omized controlled trial ( OWL-PCOS ) of preconception treatment conducted at two academic centers in women ( age , 18 - 40 years ; body mass index , 27 - 42 kg/m(2 ) ) with PCOS defined by Rotterdam criteria . INTERVENTION Continuous oral contraceptive pill ( OCP ) or intensive lifestyle intervention or the combination ( Combined ) for 16 weeks . MAIN OUTCOME MEASURE(S ) Changes in HRQOL assessed by PCOSQ and SF-36 and prevalence of depression and anxiety disorder assessed by PRIME-MD PHQ . RESULTS The lowest scores were noted on the general health domain of the SF-36 and the weight and infertility domains on the PCOSQ . All three interventions result ed in significant improvement in the general health score on the SF-36 . Both the OCP and Combined groups showed improvements in all domains of the PCOSQ ( P < .01 ) compared to baseline scores . The Combined group had significant improvements in the weight , body hair , and infertility domains compared to a single treatment group ( P < .05 ) . In a linear regression model , change in weight correlated with improvements in the weight domain ( P < .001 ) and physical well-being ( P < .02 ) , change in T correlated with improvements in the hair domain ( P < .001 ) , and change in both weight and T correlated with the infertility ( P < .001 ) and menstrual domains ( P < .05 ) . CONCLUSIONS Both weight loss and OCP use result in significant improvements in several physical and mental domains related to quality of life , depressive symptoms , and anxiety disorders , and combined therapies offer further benefits in overweight/obese women with PCOS INTRODUCTION In the current study we aim ed to determine body image , self-esteem and depressive symptomatology in women with Polycystic ovary syndrome ( PCOS ) and compare with healthy controls . METHOD This study was conducted among the patients with untreated PCOS who admitted to the Outpatient Clinic of Gynecology and Obstetrics of Faculty of Medicine of Selçuk University . A total 83 consecutive women with PCOS met the criteria of present study were included in the study . Age matched healthy controls ( n=64 ) were recruited from employees at Selçuk University Hospital . PCOS was defined according to Rotterdam criteria . After socio-demographic characteristics of the participants were recorded ,  Body Image Scale , Rosenberg Self-Esteem Scale and Beck Depression Inventory  were completed by the participants . RESULTS Patients with PCOS and healthy controls did not differ in some sociodemographic variables , including age , education and economic status ( p>.05 ) . Previous psychiatric history was more prevalent among the PCOS group ( p<. 05 ) . Body mass index ( BMI ) was ≤25 kg/m2 in both groups . BMI values in the PCOS group were significantly higher than in the controls ( p<.05 ) . BDI scores were significantly higher in the PCOS group compared to that in the healthy controls ( p<.05 ) . There was no significant difference between the PCOS group and healthy controls in BIS and RSES scores ( p>.05 ) . CONCLUSION The present study suggests that PCOS seems to be associated with depressive symptomatology . Furthermore , rising BMI values of these women may be an indicator for the onset of PCOS . However , these results should be confirmed by prospect i ve studies CONTEXT The polycystic ovary syndrome ( PCOS ) is the commonest endocrine abnormality in women of reproductive age . OBJECTIVE To determine the rate of hospital admissions for women with PCOS in Western Australian population in comparison to women without PCOS . DESIGN A population -based retrospective cohort study using data linkage in a statewide hospital morbidity data base system . SETTING All hospitals within Western Australia . PARTICIPANTS A total of 2566 women with PCOS hospitalized from 1997 - 2011 and 25 660 r and omly selected age-matched women without a PCOS diagnosis derived from the electoral roll . MAIN OUTCOME MEASURES Hospitalizations by ICD-10-M diagnoses from 15 years were compared . RESULTS Hospitalizations were followed until a median age of 35.8 years ( interquartile range , 31.0 - 39.9 ) . PCOS was associated with more nonobstetric and non-injury-related hospital admissions ( median , 5 vs 2 ; P < .001 ) , a diagnosis of adult-onset diabetes ( 12.5 vs 3.8 % ) , obesity ( 16.0 vs 3.7 % ) , hypertensive disorder ( 3.8 vs 0.7 % ) , ischemic heart disease ( 0.8 vs 0.2 % ) , cerebrovascular disease ( 0.6 vs 0.2 % ) , arterial and venous disease ( 0.5 vs 0.2 % and 10.4 vs 5.6 % , respectively ) , asthma ( 10.6 vs 4.5 % ) , stress/anxiety ( 14.0 vs 5.9 % ) , depression ( 9.8 vs 4.3 % ) , licit/illicit drug-related admissions ( 8.8 vs 4.5 % 
    Output:
    
SUMMARY ANSWER Women with PCOS have significantly increased odds of moderate and severe depressive and anxiety symptoms , independent of obesity , and the symptoms are weakly associated with age , BMI , elevated testosterone , hirsutism and IR .
WHAT IS KNOWN ALREADY Previous studies have reported that women with PCOS have an increased prevalence of mild depressive and anxiety symptoms or an increase in mean depression and anxiety scores , although these scores are usually within the normal range .
Thus , it is therefore not clear whether these findings are clinical ly significant .
WIDER IMPLICATION S OF THE FINDINGS This evidence - synthesis analysis shows that PCOS diagnosis is associated with an increased risk of moderate and severe depressive and anxiety symptoms and suggests that providers should consider screening women with PCOS for both depression and anxiety .