Paul Hardiman

University College London, Londinium, England, United Kingdom

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Publications (37)233.22 Total impact

  • John A Barry · Eileen Moran · Michael Thomas · Paul J Hardiman
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    ABSTRACT: The aim of this systematic review and meta-analysis was to assess any difference in the self-ratings of hostility in mentally healthy women with different levels of prolactin (PRL). Electronic databases (PubMed, MEDLINE, EMBASE and the Cochrane Library) were searched up to 2nd July 2012 for published literature comparing hostility levels in women with different levels of PRL. Keyword pairs (‘prolactin’ and ‘aggression’, ‘prolactin’ and ‘hostil*’, ‘prolactin’ and ‘anger’, and ‘prolactin’ and ‘angry’) were entered simultaneously. From 1065 resulting titles, and one unpublished study, 214 articles underwent full-text review by authors JB and EM. Studies were selected based on clinical relevance. Eight comparative studies consisting of 242 female patients with high PRL levels, 207 female patients with normal PRL levels and 127 healthy controls with normal PRL levels were included. Data were analysed using the inverse variance method with a random-effects model. Analysis revealed significantly higher hostility in patients with high PRL compared with that in healthy control women (Z = 1.94, p < 0.05; Hedges’ g = 0.72; 95% confidence interval [CI]: −0.01–1.45), significantly higher hostility in patient controls compared with that in healthy controls (Z = 1.94, p < 0.05; Hedges’ g = 0.47; 95% CI: 0.00–0.94) and non-significantly higher hostility levels in patients with high PRL compared with that in patients with normal PRL levels (Z = 1.45, p < 0.15; Hedges’ g = 0.38; 95% CI: −0.13–0.89). In this meta-analysis, hostility appears to be accounted for partly by PRL levels and also partly by patient status, perhaps due to the stress of being a patient. Methodological considerations and implications for patient care are discussed.
    No preview · Article · Aug 2014 · Journal of Obstetrics and Gynaecology
  • John A Barry · Mallika M Azizia · Paul J Hardiman

    No preview · Article · Jun 2014 · Human Reproduction Update
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    Sarah A. Anderson · John A. Barry · Paul J. Hardiman

    Preview · Article · Jun 2014 · International Journal of Cardiology
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    John A Barry · Mallika M Azizia · Paul J Hardiman
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    ABSTRACT: BACKGROUND Polycystic ovary syndrome (PCOS) is a common condition affecting ∼8% of women. The objective of the present study was to quantify separately the risk of endometrial cancer, ovarian cancer and breast cancer in women with PCOS compared with non-PCOS controls, and quantify separately the risk to women of all ages as well as the risk to premenopausal women.METHODS We conducted a systematic review and meta-analysis of observational studies. Studies were eligible for inclusion if they compared women with PCOS to non-PCOS groups for fatal or non-fatal gynaecological cancers. Studies listed in MEDLINE and EMBASE published up to 7 October 2013 in any language were identified, and relevant papers were also searched by hand. Relevant data (for example, study design, source of control data, diagnostic criteria) were extracted and tabulated.RESULTSFrom 698 references, 11 studies (5 of endometrial cancer and 3 each of ovarian and breast cancer) met the inclusion criteria for the meta-analysis (919 women with PCOS and 72054 non-PCOS controls). Using the Mantel-Haenszel method, with fixed or random effects model as appropriate, women with PCOS were at a significantly increased risk of endometrial cancer (odds ratio (OR), 2.79; 95% confidence interval (CI), 1.31-5.95, P < 0.008), but the risk of ovarian and breast cancers was not significantly increased (OR, 1.41; 95% CI, 0.93-2.15, P < 0.11 and OR, 0.95; 95% CI, 0.64-1.39, P < 0.78, respectively). However when studies which included women aged over 54 years were excluded from the analysis, the risk for women with PCOS increased further for endometrial cancer (OR, 4.05; 95% CI, 2.42-6.76, P < 0.00001), became significantly increased for ovarian cancer (OR, 2.52; 95% CI, 1.08-5.89, P < 0.03), but remained non-significant for breast cancer (OR, 0.78; 95% CI, 0.46-1.32, P < 0.35).CONCLUSIONS This is the first meta-analysis to examine gynaecological cancers in women with PCOS younger than 54 years of age compared with controls of similar age. Current data suggest that women of all ages with PCOS are at an increased risk of endometrial cancer but the risk of ovarian and breast cancer was not significantly increased overall. These results highlight the potential risk of gynaecological cancer morbidities associated with PCOS. However, the available evidence is far from robust and variation in diagnostic criteria for PCOS, associated risk factors (particularly obesity), and selection bias in the studies may have resulted in an exaggeration of the increased risk. Furthermore, women who have PCOS should also be made aware that any increased risk for endometrial cancer must be judged in the context of its relatively low incidence in the general population. A large well-controlled prospective study is required in order to gain a more accurate estimate of the risk of gynaecological cancers in women with PCOS.PROSPERO CRD REGISTRATION NUMBERCRD42012003500.
    Preview · Article · Mar 2014 · Human Reproduction Update
  • John A Barry · Andrzej R Kuczmierczyk · Paul J Hardiman

    No preview · Article · Mar 2014 · Journal of Sexual Medicine
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    J A Barry · H S K Parekh · P J Hardiman
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    ABSTRACT: Are women with polycystic ovary syndrome (PCOS) better at three-dimensional mental rotation than other women? Women with PCOS scored significantly higher on a mental rotation task than a female control group. PCOS is a condition characterized by elevated testosterone levels. Some researches have found that three-dimensional mental rotation task performance is positively correlated with testosterone levels. This cross-sectional study was conducted between June 2006 and January 2009. The participants were 69 women with PCOS and 41 controls recruited from five gynaecology clinics in London. The control group consisted of non-PCOS women of comparable subfertility to PCOS group. These groups sizes gave roughly 80% power to detect moderate effect sizes for the main statistical test. Participants were recruited at London gynaecology clinics. The women were aged between 18 and 43. PCOS was diagnosed based on the Rotterdam criteria. Controls were women who experienced some degree of subfertility. Blood samples from participants were frozen for up to 4 months until being assayed by direct electrochemiluminescence. The mental rotation task was undertaken electronically. Some questionnaires and other tasks were completed as control measures. Women with PCOS scored significantly higher than controls: median (range) 3.00 (0-9) and 2.00 (0-8), respectively (U = 1147.500, N1 = 69, N2 = 41, P < 0.047). Within the PCOS group, circulating levels of testosterone were significantly positively correlated with three-dimensional scoring (rs = 0.376, n = 56, P < 0.002), whereas estradiol was significantly negatively correlated with three-dimensional scoring (rs = -0.473, n = 29, P < 0.010). In the control group, the relationship between sex hormones and mental rotation was non-significant. Other factors, including general intelligence and social class, did not account for these findings. A subgroup analysis comparing hyperandrogenic PCOS cases, non-hyperandrogenic PCOS cases and controls, in which age and body mass index were controlled for using ANCOVA, found a non-significant difference in three-dimensional scoring between the three groups (F = 1.062, d.f. = 1, 73, P < 0.351). The small number of women in the control group meant that correlations were underpowered in this group. This study is the first to find a benefit of PCOS in visuospatial cognition, and the first to find a link between visuospatial cognition and sex hormones in PCOS. The fact that the correlations went in the opposite direction in the PCOS group compared with the controls might suggest the influence of increased prenatal exposure to androgen in PCOS. The assays for this study were funded by the Department of Psychology, City University London. All authors report no conflicts of interest.
    Preview · Article · Aug 2013 · Human Reproduction
  • Hu S · Ho TK · Barry JA · Seifalian A · Hardiman PJ

    No preview · Article · Sep 2012 · Fertility and Sterility
  • JA Barry · P J Hardiman · M R Siddiqui · M Thomas
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    ABSTRACT: This meta-analysis reviewed published literature comparing human male and female umbilical cord total testosterone (T) levels. A total of 18 studies using 1,229 samples from 602 male and 627 female newborns were analysed using the RevMan 5 statistical package. Analysis using the inverse variance method based on a random-effects model revealed significantly higher cord T in boys than girls at a moderate effect size (Hedges' g = 0.57). There was significant heterogeneity between the 18 studies, although the five studies using direct assays showed no heterogeneity. For studies using extraction and chromatography, those that combined T from arterial and venous cord blood found a larger sex difference than those using only cord venous samples (Hedges' g = 0.94 vs 0.32); this suggests umbilical cord venous T is of maternal/placental origin and arterial T is of fetal origin. The wide range of T values between studies suggests high cross-reactivity in the assay methods reviewed.
    No preview · Article · Nov 2011 · Journal of Obstetrics and Gynaecology

  • No preview · Article · Aug 2011 · Human Reproduction
  • K Lakhani · AR Kay · J Leiper · JA Barry · P J Hardiman
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    ABSTRACT: Polycystic ovary syndrome (PCOS) is associated with endothelial dysfunction, which may be caused by elevated levels of asymmetric dimethylarginine (ADMA). ADMA reduces nitric oxide production in diabetes mellitus, hypertension and renal failure. Symmetric dimethylarginine (SDMA) is a stereoisomer produced alongside ADMA, and has recently been described as a risk factor for cardiovascular events. In this cross-sectional study based in a teaching hospital, 16 women with PCOS were recruited alongside 15 healthy controls, and fasting venous blood samples were obtained. Renal function was measured, and ADMA and SDMA were analysed using a high-performance liquid chromatography method. After controlling for BMI, mean ADMA and SDMA levels in women with PCOS were higher than in controls (p = 0.036 and p = 0.030, respectively). Renal function was not different between the two groups (p = 0.152). Women with PCOS have raised levels of SDMA, a molecule implicated in endothelial dysfunction and long-term cardiovascular risk.
    No preview · Article · Jul 2011 · Journal of Obstetrics and Gynaecology
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    J.A. Barry · A.R. Kuczmierczyk · P.J. Hardiman
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    ABSTRACT: Our aim was to assess differences in anxiety and depression between women with and without (controls) polycystic ovary syndrome (PCOS). We conducted a systematic review and meta-analysis of published literature comparing women with PCOS to control groups on anxiety and depression. Electronic databases were searched up to 17 December 2010. The inverse variance method based, as appropriate, on a random- or fixed-effects model in Review Manager, Version 5 was used to analyse the data. Twelve comparative studies were included; all studies assessed depression (910 women with PCOS and 1347 controls) and six also assessed anxiety (208 women with PCOS and 169 controls). Analysis revealed higher depression (Z = 17.92, P < 0.00001; Hedges' g = 0.82; 95% CI 0.73-0.92) and anxiety (Z = 5.03, P < 0.00001; Hedges' g = 0.54; 95% CI 0.33-0.75) scores in the participants with, than without, PCOS. Studies controlling for BMI showed a smaller difference between women with PCOS and controls on anxiety and depression scores than studies not controlling for BMI. 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. Future studies might consider (i) controlling for BMI, (ii) stratifying by medication use in order to control for any anti-androgenic effects of medication and (iii) excluding women with polycystic ovaries from control groups.
    Preview · Article · Jul 2011 · Human Reproduction
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    ABSTRACT: Women with polycystic ovarian syndrome (PCOS) have been found to suffer from fertility problems and mood dysfunction. To control for any effect of fertility problems, the present study compared mood dysfunction in women with PCOS to non-PCOS women with fertility problems. Seventy-six women with PCOS and 49 subfertile controls reported their anxiety, depression and aggression levels, and the relationship between mood and testosterone (T) was assessed. Controlling for age and BMI using MANCOVA, women with PCOS were significantly more neurotic (had difficulty coping with stress) than controls, had more anger symptoms, were significantly more likely to withhold feelings of anger and had more quality of life problems related to the symptoms of their condition (acne, hirsutism, menstrual problems and emotions). In a subgroup of 30 women matched on age, BMI and ethnicity, it was found that women with PCOS were significantly more anxious and depressed than controls. T was not generally correlated with mood states. This is the first study to identify problems with neuroticism and withholding anger in women with PCOS. These mood problems appear to be mainly attributable to PCOS symptoms, though other factors, such as hypoglycaemia, cannot be ruled out.
    No preview · Article · Jun 2011 · Journal of Psychosomatic Obstetrics & Gynecology
  • John A Barry · Pierre Bouloux · Paul J Hardiman
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    ABSTRACT: The idea that diet can affect mood and behavior in women with polycystic ovary syndrome (PCOS) by altering blood glucose levels has become popular in recent years. This paper describes an online survey (N=462) of 24 women with PCOS, 299 healthy control women, 47 women who possibly had undiagnosed PCOS, and 92 men. The groups were compared for symptoms of mood and behavioral symptoms typical of reactive (postprandial) hypoglycemia. The outcome measures were two questionnaires that measure states associated with hypoglycemia: the Hypoglycemia Symptom Checklist-7 (HSC-7), which measures behavioral symptoms and the Mood Adjective Checklist (MACL), which measures emotional states. Controlling for age and body mass index (BMI) using between-groups analysis of covariance (ANCOVA), the women with PCOS scored significantly higher than the other three groups (p<0.001) on the outcome measures. These differences remained statistically significant in a subset of twelve women with PCOS compared to twelve healthy control women closely matched for age, BMI, and eating behavior. The findings are suggestive of hypoglycemia-related mood and behavioral problems in PCOS. Future research should test whether blood glucose levels correlate with these symptoms in PCOS, and whether a low glycemic index ('low-GI') diet improves the symptoms.
    No preview · Article · Mar 2011 · Appetite
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    ABSTRACT: The aetiology of polycystic ovary syndrome (PCOS) is poorly understood, but an intrauterine hyperandrogenic environment has been implicated. This study was designed to assess whether the female offspring of mothers with PCOS are exposed to raised levels of testosterone (T) in utero. In this case-control study, three groups of pregnant women were recruited from the labour ward: PCOS women with a female baby (n = 10, PCOS girls); control women with a female baby (n = 20, control girls) and control women with a male baby (n = 10, control boys). Maternal and umbilical vein (UV) blood was assayed for T levels. UV T in PCOS girls was significantly raised, compared with control girls (p < 0.012). The difference in UV T between PCOS girls and control boys was not significant (p < 0.254). This is the first demonstration of a hyperandrogenic in utero environment in PCOS pregnancies; UV T in female infants is raised to male levels.
    No preview · Article · Jul 2010 · Journal of Obstetrics and Gynaecology
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    ABSTRACT: The objective of this study was to determine whether the relationship between antioxidant capacity of follicular fluid and early reproductive outcomes is influenced by the cause of infertility, polycystic ovarian morphology, age and smoking. This was a prospective, cross-sectional study performed in an assisted conception unit and a teaching hospital. The study cohort was 34 women undergoing IVF treatment. Interventions included total antioxidant capacity (TAC) measured using ferric reducing/antioxidant power assay in 303 follicular fluid samples. The main outcome measures were follicular fluid TAC, percentage TAC loss after 72 h and early reproductive outcomes. Follicular TAC was elevated in women with infertility of 'unexplained' (UE) or tubal factor (TF) aetiology, relative to those with male factor (MF) infertility, when reproductive outcomes were positive but not when they were negative. In the TF and UE groups, low TAC was associated with ovum fertilization incompetence, whereas TAC was comparable irrespective of embryo viability. Unexplained infertility was associated with significantly elevated follicular TAC. Among women with polycystic ovaries, fertilization incompetence was associated with elevated TAC; the opposite was true in women with normal ovaries. Follicular fluid 72-h TAC consumption > 20% was associated with poorer reproductive performance. The follicular fluid pro-oxidant-antioxidant balance required for conception in women undergoing IVF is related to the aetiology of infertility, age, the presence of polycystic ovary morphology and smoking.
    No preview · Article · Oct 2009 · Redox report: communications in free radical research
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    ABSTRACT: ObjectiveFeasibility of a clinical-trial comparing a low-glycaemic diet with a low-calorie healthy eating approach at achieving weight loss and reducing the risk of endometrial cancer in women with PCOS.DesignA pilot Randomised-Controlled-Trial using different recruitment strategies.SettingA University Hospital in the United Kingdom.PatientsWomen seen at specialist gynaecology clinics over a 12 month period in one University Hospital, and women self identified through a website and posters.InterventionsPotential recruits were assessed for eligibility, gave informed consent, randomised, treated and assessed as in the definitive trial.Main outcome measuresEligibility and recruitment rates, compliance with the allocated diet for 6 months and with clinical assessments, blood tests, pelvic ultrasound scans and endometrial biopsies.Results1433 new and 2598 follow up patients were seen in 153 gynaecology clinics for over 12 months. 441 (11%) potentially eligible women were identified, 19 (0.4%) of whom met the trial entry criteria. Eleven consented to take part, of which 8 (73%) completed the study.ConclusionsPlanned future trials on over-weight women with PCOS should be multicentre and should incorporate primary care. This data will help other researchers plan and calculate the sample size and potential recruitment rates in future clinical trials in PCOS. The results will also be useful for inclusion in future meta-analyses.
    No preview · Article · Sep 2009 · Contemporary clinical trials
  • Maria Andrikoula · Paul Hardiman · Gordana Prelevic
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    ABSTRACT: Hot flush is one of the most commonly reported symptoms during menopause; however, it is not experienced by all menopausal women, for reasons that remain unclear. In this review, we present current evidence that link hot flushes with cardiovascular disease, suggesting that the persistence of hot flushes many years after the menopause may represent a marker of an underlying disorder that increases the risk for cardiovascular disease.
    No preview · Article · Jul 2009 · Gynecological Endocrinology
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    ABSTRACT: An association between polycystic ovary syndrome (PCOS) and endometrial carcinoma was first suggested in 1949. Since then, several studies have been published that appear to support this association, and it is common practice among gynecologists and physicians to prescribe hormonal treatment to reduce this perceived risk, although there is no consensus as to the subgroup of PCOS in whom this is required. The mechanism(s) underlying any association are also unclear, but it is again widely assumed that chronic anovulation, which results in continuous estrogen stimulation of the endometrium unopposed by progesterone, is a major factor. However, obesity, hyperinsulinemia, and hyperandrogenism, which are also features of PCOS, are risk factors for endometrial carcinoma, but it does not necessarily follow that the incidence or mortality from endometrial cancer is increased in women with the syndrome. Potential strategies to prevent endometrial cancer in PCOS women are discussed.
    No preview · Article · Feb 2008 · Seminars in Reproductive Medicine
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    Shan Hu · Andrew Leonard · Alex Seifalian · Paul Hardiman
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    ABSTRACT: An association has been proposed between polycystic ovary syndrome (PCOS) and pregnancy-induced hypertensive disorders. Ambulatory blood pressure and carotid artery elasticity were therefore prospectively investigated in matched PCOS and control pregnancies. Twenty-two PCOS-control subject pairs with singleton pregnancies, matched for age, body mass index, parity and ethnicity, were recruited in the first trimester (T1, 11-13 weeks). Ambulatory blood pressure recording for 24 h and carotid artery ultrasound for elasticity estimation were performed in T1 and in the second (T2, 22-24 weeks) and third (T3, 32-34 weeks) trimesters. At nearly all time points during gestation, ambulatory systolic, diastolic and mean arterial pressures were elevated in PCOS versus control pregnancies. Carotid artery stiffness index was greater and compliance was less in PCOS pregnancies compared with controls. Differences in night-time systolic pressure and carotid artery elasticity were greatest in T3. PCOS also increased the incidence of pregnancy-induced hypertension (6 of 22 cases versus 0 of 22 in controls; P = 0.011). Pregnant women with PCOS have higher baseline ambulatory blood pressure and impaired arterial elasticity, suggestive of disturbed vascular adaptation to pregnancy.
    Full-text · Article · Jul 2007 · Human Reproduction
  • A Wong · A B Maclean · S J Furrows · G L Ridgway · P J Hardiman · C W Perrett
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    ABSTRACT: Epithelial ovarian cancer (EOC) is the leading cause of death from gynaecological malignancy in the UK. The pathogenesis of this disease is poorly understood. Our hypothesis was that chlamydial infection might play a role in the pathogenesis of EOC. 122 serum samples of patients undergoing surgery for benign or malignant gynaecological conditions were analysed. There was a total of 41 patients with EOC (33.6%), 27 with benign cystadenomas (22.1%) and 54 with normal ovaries (44.3%). There was a higher incidence of IgA seropositivity and lower incidence of IgG seropositivity in the EOC group compared with the other groups; however, this was not statistically significant. There was no statistical difference in the serum IgM antibodies to chlamydia in the three different groups. Although chronic infection and persistent inflammation may contribute to the pathogenesis of EOC, and chlamydia is a common genital tract pathogen, our study did not find an association between chlamydia and EOC.
    No preview · Article · Feb 2007 · European journal of gynaecological oncology

Publication Stats

852 Citations
233.22 Total Impact Points


  • 2006-2011
    • University College London
      • • Institute for Women's Health
      • • Royal Free Hospital
      Londinium, England, United Kingdom
  • 1992-2009
    • Royal Free London NHS Foundation Trust
      • Department of Endocrinology
      Londinium, England, United Kingdom
    • Royal National Orthopaedic Hospital NHS Trust
      Londinium, England, United Kingdom
  • 2002
    • Middlesex Hospital
      मिडलटाउन, Connecticut, United States
  • 1996
    • University of Toronto
      • Department of Obstetrics and Gynaecology
      Toronto, Ontario, Canada