***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: BACKGROUND We assessed the prevalence of mood disturbance among women with prospect ively documented polycystic ovary syndrome ( PCOS ) . METHODS Thirty-two women with PCOS completed the Center for Epidemiological Studies -Depression Rating Scale ( CES-D ) . Clinical and biochemical characteristics were assessed . RESULTS Sixteen women had CES-D scores indicative of depression . Depression was associated with greater insulin resistance ( P=0.02 ) and higher body mass index ( P=0.05 ) . Women receiving oral contraceptives  for the treatment of PCOS were less depressed than patients not receiving treatment ( P=0.03 ) . LIMITATIONS Possible selection bias , use of a screening tool alone without further diagnostic evaluation of depression , small sample s size and lack of direct comparison with an age matched control group , should be considered in interpretation of these results . CONCLUSION Findings suggest a high prevalence of depression among women with PCOS , and an association between depression and PCOS markers 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 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 Hirsutism is a common and distressing symptom frequently encountered in women with polycystic ovary syndrome ( PCOS ) , who also show relative insulin resistance . The aim of this trial , in which hirsutism was the primary end point , was to compare the efficacy of the oral antihyperglycemic medication metformin with that of an established treatment , combined ethinyl estradiol and cyproterone acetate .  Patients ( n = 52 ) were r and omized to receive either metformin ( 500 mg , three times daily ) or Dianette ( ethinyl estradiol , 35 micro g ; cyproterone acetate , 2 mg ) treatment for 12 months , with assessment s before treatment , at 6 months , and at 12 months . Both objective and subjective methods of evaluating hirsutism were used , and in addition , patient perceptions were examined . The results show that metformin is potentially an effective treatment for moderate to severe hirsutism in women with PCOS . They also suggest that in some respects ( Ferriman-Gallwey score and patient self- assessment ) , it is more efficacious than the st and ard treatment ( Dianette ) . The objective evaluation of hair diameter reduction showed that both treatments were moderately effective at multiple anatomical sites . Dianette treatment was responsible for profound suppression of and rogen activity , in contrast to metformin , which induced negligible change . However , metformin did reduce markers of insulin resistance . The data suggest that hirsutism may be effectively treated by reducing hyperinsulinemia Women with polycystic ovary syndrome ( PCOS ) have chronic low level inflammation which can increase the risk of atherogenesis . We evaluated the status of circulating macrophage migration inhibitory factor ( MIF )  , a proinflammatory cytokine involved in atherogenesis , in women with PCOS and weight-matched controls . Two-way analysis of variance models adjusted for age were fit to evaluate the effect of PCOS status ( PCOS vs. controls ) and weight-class ( obese vs. lean ) on MIF and other parameters . MIF levels were significantly ( p<0.001 ) higher in women with PCOS ( lean : 37.7+/-10.6 ng/ml ; obese : 54.6+/-15.2 ng/ml ) compared to controls ( lean : 4.8+/-0.6 ng/ml ; obese : 17.5+/-8.0 ng/ml ) regardless of weight-class . CRP levels were significantly ( p<0.001 ) higher in obese subjects ( PCOS : 6.2+/-1.9 mg/l ; controls : 6.7+/-1.4 mg/l ) compared to lean subjects ( PCOS : 0.9+/-0.4 mg/l ; controls : 0.2+/-01 mg/l ) after controlling for PCOS status . MIF levels directly correlated with % truncal fat ( r=0.41 , p<0.05 ) , and plasma levels of CRP ( r=0.42 , p=0.05 ) , LH ( r=0.45 , p=0.04 ) , testosterone ( r=0.53 , p<0.008 ) , and rostendione ( r=0.58 , p<0.005 ) . IS(OGTT ) inversely correlated with plasma levels of MIF ( r=-0.51 , p<0.02 ) and CRP ( r=-0.73 , p<0.001 ) . Circulating MIF is elevated in PCOS independent of obesity , but both PCOS and obesity contribute to a proatherogenic state . In PCOS , abdominal adiposity and hyper and rogenism may exacerbate the risk of atherosclerosis 
    Output:
    
Women with PCOS on average tend to experience mildly elevated anxiety and depression , significantly more than women without PCOS .
Women with PCOS with lower BMI tended to have slightly lower anxiety and depression scores , suggesting that having a lower BMI reduces anxiety and depression .