Dr. Apostolos Kampagiannis

Advanced Practitioner in Gynaecological Endocrinology.

ISGE (International Society of Gynaecological Endocrinology).

"PCOS, Obesity, Metabolic Syndrome".

ISGE Certified Practitioner.

"Menstrual Cycle Disorders".

ISGE Certified Practitioner.

"Amenorrhea".

ISGE Certified Practitioner.

"Hormonal Contraception".

ISGE Certified Practitioner.

"Hormonal Therapies for Menopause and Healthy Aging".

ISGE Certified Practitioner.

Για κάθε 1% αύξηση της παχυσαρκίας στον γενικό πληθυσμό, υπάρχει μία αύξηση 0.4% στο Σύνδρομο Πολυκυστικων Ωοθηκών. Ένα εντυπωσιακό στοιχείο που εξηγεί την αυξητική τάση του Συνδρόμου. Οι γυναίκες έχουν περισσότερα κιλά, μένουν έγκυες με περισσότερα κιλά, παίρνουν πολλά κιλά στην εγκυμοσύνη, γεννούν παιδιά με αντίσταση στην ινσουλίνη (είτε πρωτογενώς μέσω ενός αυξημένου βάρους γέννησης, είτε δευτερογενώς μέσω μιας μορφής catch up growth), η ενηλικίωση σχετίζεται με αύξηση του σωματικού βάρους, οι σύγχρονες κοινωνίες-μέσω του υπερκαταναλωτισμού-προωθούν την παχυσαρκία, και κάπως έτσι έχουμε φτάσει σήμερα σε ένα ποσοστό 15-25% του Συνδρομου Πολυκυστικων Ωοθηκών.

Τα καινούργια δεδομένα είναι ακόμα πιο εντυπωσιακά. Στην εφηβεία, μπορείς να περιορίσεις την εκδήλωση του Συνδρόμου στο μέλλον. Είναι μια πληροφορία που έδινα σε πολλές γυναίκες, είτε για να τονίσω την σημασία της έγκαιρης παρέμβασης, είτε για να ενημερώσω για την μη αναστρεψιμοτητα κάποιων καταστάσεων, αλλά ήταν μια γνώση που είχα αποκτήσει από την κλινική μου πράξη. Τώρα γνωρίζουμε πως το Σύνδρομο μπορεί να αναχαιτιστεί.

Είναι μια δύσκολη διαδικασία. Η εφηβεία έχει απαιτήσεις. Πρέπει να αναγνωρίσεις το Σύνδρομο (εξαιρετικά πολύπλοκο, αφενός λόγω των πολλών διαφορετικών μορφών του Συνδρόμου, αφετέρου λόγω των αλληλεπιδράσεων πολλών συμπτωμάτων με φυσιολογικές καταστάσεις στην εφηβεία), να μην παρέμβεις στην διαδικασία της ανάπτυξης (κάθε φάρμακο που χορηγείται ενδέχεται να έχει αρνητικές επιπτώσεις στο μέλλον), να ακούσεις μία νεαρή κοπέλα και να μπορέσεις να καταλάβεις τα προβλήματα της, για να τα συζητήσεις με τους γονείς. Οι γονείς πρέπει να είναι έτοιμοι να ενημερωθούν και να συνεργαστούν.

Αν όλα αυτά βασιστούν σε μια αμφίδρομη σχέση κατανόησης της πολυπλοκότητας του Συνδρομου και στην ανάγκη προάσπισης της υγείας στο μέλλον (χωρίς βέβαια να κλείνουμε τα μάτια στο παρόν), θα μπορέσουμε να ελέγξουμε το Σύνδρομο και να δώσουμε μια ζωή με τα λιγότερα προβλήματα.

Απόστολος Καμπαγιαννης
Πιστοποιημένος Ιατρός για το Σύνδρομο Πολυκυστικων Ωοθηκών, την Παχυσαρκία και το Μεταβολικό Σύνδρομο (Διεθνής Ένωση Γυναικολογικής Ενδοκρινολογίας)

Die gynäkologische Endokrinologie konzentriert sich auf Frauen jeden Alters und betrachtet ihre Gesundheit ganzheitlich, zunächst auf hormoneller und reproduktiver Ebene, anschließend auf metabolischer, kardiovaskulärer, psychologischer und ästhetischer Ebene.

Probleme mit denen wir uns befassen:

Diagnostischer Ansatz und Behandlung im gesamten Spektrum des polyzystischen Ovarialsyndroms.

Regulierung von Menstruationsproblemen bei Frauen im reproduktiven Alter (Zyklusunregelmäßigkeiten, Verzögerung oder Ausbleiben der Menstruation, Menstruationsschmerzen, prämenstruelles Syndrom, Zwischenblutungen und Blutungen während der Periode). Aufklärung über Verhütung und Familienplanung.

Behandlung hormoneller und metabolischer Störungen bei Frauen, die sich mit Freizeit- und Leistungssport beschäftigen, durch Untersuchung und Behandlung insbesondere des Spektrums der funktionellen hypothalamischen Amenorrhoe.

Behandlung von Endometriose mit Medikamenten als Alternative zu chirurgischen Eingriffen.

Behandlung von Störungen während der Adoleszenz, einschließlich der Untersuchung von früher Menarche (frühzeitiger Beginn der Menstruation), später Menarche oder Ausbleiben der Menstruation (Amenorrhoe) und der Behandlung von Zyklusstörungen oder Menstruationssymptomen bei jungen Mädchen.
Umgang mit Problemen der Perimenopause und Menopause.

Telemedizin ist der moderne Weg, chronische hormonelle Probleme zu behandeln. Jede Frau hat die Möglichkeit, sich von überall auf der Welt mit dem spezialisierten Arzt in Verbindung zu setzen, ohne physisch in der Klinik anwesend sein zu müssen, und sich valide und zuverlässig über ihre Gesundheit informieren zu lassen. Wir freuen uns darauf Sie kennenzulernen und Ihnen bei der Lösung Ihres Problems zu helfen.

"Intermittent energy restriction (IER) and continuous energy restriction (CER) reduced body mass index (BMI) in adolescents with obesity after 52 weeks, with no major differences found in body composition or cardiometabolic outcomes."

"These findings suggest that for adolescents with obesity-associated complications, IER can be incorporated into a behavioral weight management program, providing an option in addition to CER and offering participants more choice".

For female teens, weight control is extremely important, as obesity could lead to Polycystic O***y Syndrome (PCOS) and a self-perpetuating vicious cycle with long term consequenses.

Apostolos Kampagiannis
Gynaecologist - Doctor of Gynaecological Endocrinology.
Advanced Practitioner (International Society of Gynaecological Endocrinology - ISGE).
Certified practitioner for Polycystic O***y, Obesity and Metabolic Syndrome (ISGE).

Intermittent Fasting: A New Approach for Obese Teens Intermittent and continuous energy restriction are equally effective in reducing BMI in adolescents with obesity.

"Women with polycystic o***y syndrome (PCOS) face an increased risk for type 2 diabetes (T2D), metabolic dysfunction–associated steatotic liver disease (MASLD), and cardiovascular disease (CVD), although these risks vary depending on PCOS phenotype.

More careful characterization of PCOS phenotype, specifically addressing clinical and biochemical androgen status, with tailored surveillance based on the phenotype-specific differential risk is needed."

The early identification of the specific phenotype of PCOS is crucial for the prevention and management of the complications of the Syndrome.

https://www.medscape.com/viewarticle/polycystic-o***y-syndrome-hidden-risk-metabolic-and-2024a1000ffe

Apostolos Kampagiannis
Gynecologist - Doctor of Gynaecological Endocrinology.
Advanced Practitioner (International Society of Gynaecological Endocrinology - ISGE).
Certified Practitioner for Polycystic O***y, Obesity and Metabolic Syndrome (ISGE).

PCOS Linked to Higher Risk for Cardiometabolic Diseases Women with polycystic o***y syndrome showed an increased risk for cardiometabolic diseases, with the risk varying according to phenotype.

For every woman, there is one contraceptive method suitable to her needs. Except from their contraceptive efficacy, hormonal contraceptive methods have numerous non-contraceptive benefits that improve total quality of life.

Apostolos Kampagiannis
Gynaecologist - Doctor of Gynaecological Endocrinology.
Advanced Practitioner ( International Society of Gynaecological Endocrinology - ISGE)

Endometriosis can increase the risk of ovarian cancer.

The most severe the endometriosis, the higher the ovarian cancer risk. Risk is highest with endometriomas and deep - infiltrating endometriosis.

The risk of ovarian cancer is low in the general population. So the increased risk due to endometriosis is not significant overall. But the association exists.

We don't have to push women to perform unnecessary examinations for the early detection of ovarian cancer. But we need to inform them about the need of regular gynaecological examination.

And we must try to use the hormonal therapies properly. Oral combined contraceptive pills can decrease the incidence of ovarian cancer. Hormonal Replacement Therapy can increase the relative risk of certain types of ovarian cancer, or increase the chance of recurrence of endometriosis in menopause. Every decision we take must be properly balanced, after thorough information and discussion with the patient.

Endometriosis, Especially Severe Types, Boosts Ovarian Cancer Risk Endometriosis patients overall had a more than fourfold higher risk for any type of ovarian cancer.

The challenging future of Polycystic O***y Syndrome. The pharmaceutical technology trying to decode the genetics and epigenetics of the disease.

The present is easier to understand. Identification of the specific clinical form of the disease, personalized treatment to improve the overall quality of life, prevention of complications in the future.

Apostolos Kampagiannis
Gynaecologist - Doctor of Gynaecological Endocrinology.
Advanced Practitioner (International Society of Gynaecological Endocrinology - ISGE).
Certified Practitioner for Polycystic O***y Syndrome (ISGE).

We improve quality of life.
We take care for your future.

Apostolos Kampagiannis
Gynaecologist - Doctor of Gynaecological Endocrinology.
Advanced Practitioner (International Society of Gynaecological Endocrinology - ISGE).
Certified Practitioner for Hormone Therapies for the Menopause and Healthy Ageing (ISGE).

Adenomyosis and endometriosis.

Two conditions with a common, but also a distinct origin.

The early diagnosis will prevent the serious reproductive and non- reproductive complications of the diseases.

Adolescence is a critical period for the early detection and treatment.

The new data regarding acute and chronic pain, with the central desensitisation and the dramatic deterioration of quality of life, must be taken into consideration in every consultation.

Women who have used GLP-1 agonists to lose weight, regain their weight during pregnancy, and to a higher extent. This poses a threat for them and for their babies, during and after pregnancy.

Ofcourse. This medication acts centrally. In most cases, long-standing obesity has triggered inflammatory cascades within the organism. The rapid loss of weight, without taking into consideration the specific hormonal and metabolic milleau of each woman, will backfire when the internal environment is under stress, as it happens in (the demanding period of) pregnancy.

GLP-1 agonists, a true masterpiece for dealing with obesity, will create a new population of people with iatrogenic problems.

Especially for women with hormonal problems, like women with PCOS, the administration of GLP-1 agonists as a panacea to treat the physical, but mainly the psychological effects of obesity, without approaching the disease as it is (a complex, chronic inflammatory condition with hormonal and metabolic imbalances), will create enormous problems in the future.

Weight Gain From Discontinuing GLP-1s a Concern in Pregnancy Women are recommended to discontinue the weight loss/type 2 diabetes drugs months before conceiving, but that places them in a rebound mode of weight gain and reversal of glycemic benefits.

"Women with PCOS are burdened with multimorbidity and higher medication use, independent of BMI and other confounders. Accordingly, preventive strategies are needed to alleviate the disease burden and improve the health outcomes of women with PCOS".

Polycystic o***y syndrome presents as a multimorbid condition by age 50: birth cohort linkage to national register data AbstractObjective. This population-based follow-up study investigated register-based disease diagnoses and medication use up till age of 50 years among wom

Polycystic O***y Syndrome (PCOS) and mental health.

Women with PCOS have an increased incidence of anxiety, depression and major psychiatric diseases. The reasons are genetic, epigenetic, hormonal, metabolic, inflammatory, autoimmune, environmental, iatrogenic, social, personal and many more. For every special PCOS woman, there can be a special reason.

Women with PCOS must be approached with a holistic attitude, taking care both their physical and their psychological health.

PCOS and endometriosis.

The most common chronic diseases in women of reproductive age.

Two complex, heterogeneous diseases, causing frustration and deterioration in quality of life.

These two diseases could be described as opposites, they can coexist and they compete for their domination in different time periods during reproductive life.

Wrong approach could lead to decreased life expectancy, due to the several consequences of both diseases.

30% of women with PCOS present a functional adrenal hyperandrogenemia. There is a hypersecretion of the adrenal androgens, either alone, or together with an increased secretion of the ovarian androgens.

Due to the more neutral (or even beneficial) effect of adrenal androgens, the clinical picture of PCOS is, usually, mild. We must never forget that the expression of androgens differs from organism to organism, and even within the different receptors of the same organism, so it is difficult to predict the clinical form of PCOS. But the majority of women with PCOS have the third phenotype of the disease, a milder form than the full-blown form of the disease, and usually they are not obese. The "lean - PCOS" is usually connected to adrenal PCOS.

Women with adrenal PCOS could have the consequences of the disease, especially reproductive and hormonal consequences. Metabolic consequences are not common and the progression from an adrenal PCOS to a Metabolic Syndrome, should be viewed as a rather negative result.

Adrenal PCOS is a great example of evidence - based Medicine and individualisation in practice. We have to treat, only when the benefits outweigh the costs, with our primary interest to the future. We must avoid the change of this phenotype to a different form, something common when we give medications without taking into consideration their effect later in life. And we aim for a good family planning. Adrenal PCOS can be linked to reproductive problems.

Finally, excessive diet, strenuous physical activity, or both, could lead to a very interesting progression of a third phenotype of PCOS to Functional Hypothalamic Amenorrhea. The milder forms of PCOS could be the most difficult, because they are underdiagnosed, or underestimated.

Hormone Replacement Therapy can be an important tool for the health of most women.

The individualision in Medicine has created two different therapeutic approaches. The manufacturer - based treatment and the physician - based treatment. This is why the leaflet that we find inside every pharmaceutical compound has, nowadays, less medical value and it serves mostly for legal issues.

The worldwide problem in the drug supply, further increases the difference between the two approaches. And this makes every hormonal choice a tough challenge.

If we don't have the proper medications, we do not subscribe what we find available in the market. Specialised doctors can provide alternatives to hormone therapy, if necessary.

One of the most common questions we have to answer in our daily practice is the following: How long should I take the medications?

This is a complex question and there is no definite answer. Dealing with hormonal problems is difficult. There is no cure for the condition. There can be improvement for the symptoms. And most importantly, certain medications could lead to a decrease in health problems later in life. So, we have to set the goals. What are we aiming, in order to make an initial plan for the duration of the treatment

We must have a thorough and sincere discussion with every woman. We must break the myths. Medications are important, when the benefits outweigh the costs. Medications are needed, as long as they can provide health, both in the short and in the long term. Denying a medical treatment, in order to support a natural approach, without evidence, with the sole purpose to satisfy an anti-medication movement, could be as dangerous as prescribing an unnecessary medication with the goal to keep the patient coming to the office. We have to follow certain rules.

The years to come, we will be forced to understand the meaning of evidence - based, individualised Medicine. A very difficult way to practice Medicine, requiring responsibility from both sides, which makes it-at the moment-impossible to be applied. But this is the immediate future. Hopefully, it will not be late. And, as it happens everywhere in life, there is no black or white. There are many colours and many shades. We must find the best colour that suits to our life. We must aim for the shiny smile. Individualized and personalised information, guided by evidence, will be the key to our success.

Apostolos Kampagiannis
Gynecologist - Doctor of Gynecological Endocrinology
Advanced Practitioner (International Society of Gynecological Endocrinology)

Good news for women taking GLP-1 agonists. Their use is not linked to birth defects or pregnancy losses.

It was something known, from preliminary studies. And we must state here the problems arising from "Google-Medicine". Women should know that the medical knowledge shared in internet, at least the vast majority of it, is probably outdated. Medicine progresses fast and, unfortunately, limited or past knowledge is as dangerous as no knowledge. There is a time gap between the knowledge we know and the knowledge we share, either through guidelines, or in our consultation with the patients.

The universal advise for postponing pregnancy at least two months after the cessation of treatment with GLP-1 seems to have no scientific evidence. We hope that women receiving these important medications should be informed correctly and, most important, learn the significance of family planning and contraception during their therapy, very important issues for women with obesity or diabetes.

GLP1 Drugs Not Tied to Pregnancy Loss, Birth Defects Recipients of GLP1 receptor agonists were compared with two reference groups in one of the first studies of its kind.

New Guidelines regarding Vitamin D: Don't screen for Vitamin D, don't give supplements for Vitamin D in the general population.

These guidelines are in compliance with the former guidelines, which, unfortunately, failed to produce any change in clinical practice. The "Vitamin-D" industry is extremely profitable and it will be difficult for the medical societies to reverse the results they caused, with their hesitance to take proper actions.

The progression of medicine and the increasingly negative effect of the environment to human health, apply an increased financial burden to our societies. We must follow guidelines. We must adjust guidelines to the population. We must educate our population about the complexity of Medicine. We must say no to the "Vitamin-D" Medicine.

https://www.medscape.com/viewarticle/dont-screen-vitamin-d-new-endo-society-guideline-2024a1000aez

Medical care becomes challenging and complicated. In the era of health - care privatisation, therapeutic approach must be individualised and evidence - based, in order to be cost - effective. Chronic, hormonal problems require expertise and any delay could cause severe physical and psychological distress.

Telemedicine gives the opportunity to a medical consultation with the specialists for people all around the world, without the need of the physical presence in the office. With Telemedicine, the primary, secondary and tertiary level of medical care work together, providing the optimal treatment, under a multidisciplinary approach.

Consultations are available in English, German and Greek. I am looking forward to meeting you!

Combined oral contraceptive pills and Polycystic O***y Syndrome (PCOS).

What used to be the gold standard of treatment for the symptoms of the Syndrome (irregular periods, excessive hair, acne), should be taken now under serious consideration.

The different clinical forms of the disease and the different hormonal preparations, make the correct choice of contraceptive pills quite challenging.

Wrong application of contraceptive pills could deteriorate the Syndrome and cause-potentially-irreversible situations.

PCOS is the most common cause of infertility in women. A large proportion of women with PCOS will need assistance, in order to achieve a pregnancy.

Each of the various phenotypes of PCOS could have a different reproductive potential, thus explaining the difference in the reproductive outcome among women, with or without the assistance of Assisted Reproduction Technology. We should never forget that PCOS is an heterogeneous disease and every woman with PCOS is different from the others, regarding her hormonal, reproductive, metabolic and psychological environment.

Early diagnosis of PCOS and the proper identification of the clinical form of the disease, will increase the chances of a pregnancy without complications and the birth of a healthy baby.

50% of women have severe hot flushes up to 10 years after the final mentrual period.

25% of women have severe hot flushes forever.

The presence of hot flashes, the age of onset and the severity of them, are predictive of serious health implications in the future.

Hot flashes are linked to increased cardiovascular risks, increased risk of dementia and increased risk of cognitive impairment later in life.

The management of hot flashes should be directed towards the improvement of quality of life, as well as the prevention of future problems.

Every approach, whether it is behavioral or pharmaceutical, whether it is hormonal or non-hormonal, should be evidence-based and take all aspects in consideration.

Modern women will spend nearly half of their lifes in oestrogen-depleted conditions. The presence of hot flushes must be thorough investigated and treated by the specialists.

Apostolos Kampagiannis
Gynecologist - Doctor of Gynecological Endocrinology
Advanced Practitioner (International Society of Gynecological Endocrinology - ISGE)

Functional Hypothalamic Amenorrhea. One of the most common causes of amenorrhea (lack of period). The negative action of environment (restrictive eating habits/diets, strenuous physical activity) and stress, on the axis regulating the female hormonal mileau.

The spectrum of Functional Hypothalamic Amenorrhea extends from subclinical forms of a luteal phase insufficiency, with mild irregularities in menstrual period, to the complete cessation of menstrual period. Sometimes, women report an absence of menstrual period for more than six months or one year. The symptoms, as shown below, affect both physical and mental health.

The treatment is necessary and should be individualised. The proper and close cooperation and communication between specialised health professionals, will provide quality of life and will prevent the future complications of the disease.

Apostolos Kampagiannis
Advanced Practitioner (International Society of Gynecological Endocrinology - ISGE).
Certified Practitioner for Amenorrhea (ISGE).

Perimenopause. The period of transition from the reproductive years to menopause.

According to the timing hypothesis, perimenopause is the window of opportunity for the majority of women, to decrease mortality for all causes in menopause. Perimenopause is the window of vulnerability for the cognitive functions in the future.

Gynecological Endocrinology offers the chance for a better quality of life, with the least health problems. Modern, evidence - based Medicine, with a person - oriented holistic approach, can provide health and safety.

Apostolos Kampagiannis
Advanced Practitioner (International Society of Gynecological Endocrinology - ISGE).
Certified Practitioner for Hormonal Therapy in Menopause and Healthy Aging (ISGE).