Characteristics of different phenotypes of polycystic ovary syndrome in a Bulgarian population

Pre-polycystic ovary syndrome and polymenorrhoea as new facets of polycystic ovary syndrome (PCOS): Evidences from a single centre data set

OBJECTIVE

Polycystic ovary syndrome (PCOS) is a complex disorder with diverse metabolic implications. Diagnosis typically relies on oligo-amenorrhoea (OA), hyperandrogenism (HA), and polycystic ovarian morphology (PCOM). However, the role of polymenorrhoea in PCOS remains understudied. Additionally, limited information exists regarding metabolic disturbances in women with partial PCOS phenotypes that do not meet diagnostic criteria. This extensive database aims to provide substantial evidence on the metabolic implications of polymenorrhoea and partial PCOS phenotypes.

DESIGN

Prospective observational study.

PATIENTS AND MEASUREMENTS

In this single-centre study, 6463 women with PCOS-like characteristics and 3142 age-matched healthy women were included. The study compared clinical (anthropometry, modified Ferriman Gallwey [mFG] score), hormonal (serum testosterone), and metabolic (plasma glucose, serum lipids, insulin) characteristics between women diagnosed with PCOS, those with partial PCOS phenotypes, and the healthy control group RESULTS: In all, 5174 women met Rotterdam criteria for PCOS diagnosis, while 737 were classified as Pre-PCOS, including HA (n = 538), OA (n = 121), or PCOM (n = 78). Common clinical features included oligomenorrhoea (75.5%), hirsutism (82.9%), obesity (27.2%), hypertension (1.6%), metabolic syndrome (19.6%), and diabetes mellitus (5.6%). Women diagnosed with PCOS, HA only, and OA only exhibited higher average body mass index, plasma glucose levels (both fasting and 2 h after the oral glucose tolerance test), and lipid fractions in comparison to those with PCOM and the healthy controls. However, indices of insulin resistance were similar among women with PCOS, HA, PCOM, and OA, albeit higher than in the healthy controls. The polymenorrhoea subgroup (5.9%) had lower BMI and serum testosterone, but similar mFG score, plasma glucose, insulin, and lipid levels as the oligomenorrhoea subgroup.

CONCLUSION

The metabolic disturbances observed in Pre-PCOS women highlight the need to reassess diagnostic criteria. Including the polymenorrhoea subcategory in PCOS criteria is recommended due to similar metabolic dysfunctions as the oligomenorrhoea group.

Sexuality and psychological well-being in different polycystic ovary syndrome phenotypes compared with healthy controls: a cross-sectional study

Introduction

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. The present study aimed to compare the women with different PCOS phenotypes with the healty group in terms of sexual function, depression, anxiety and quality of life scale.

Materials and methods

The present cross-sectional study was carried out on 192 women with PCOS (classified on the basis of Rotterdam criteria into four categories) and 50 healthy controls. All participants were asked to fill out the valid and reliable questionnaires of FSFI (Female Sexual Function Index), HADS (Hospital Depression and Anxiety Scale) and SF-12.

Results

In the HADS questionnaire, phenotype B achieved the highest mean score in anxiety and depression domains, whereas, phenotype B had the lowest mean score in the FSFI and SF-12 quassionnaires. Furthermore, there was a significant difference between the women with PCOS phenotypes and the control grroup in arousal, lubrication, pain, and mean total score of FSFI (P < 0.05). In regression logistic analysis, age, infertility and depression were predictors of sexual dysfunction (P < 0.05).

Conclusion

The results indicated significant differences in terms of sexual dysfunction, depression, anxiety and quality of life in the women suffering from different phenotypes of PCOS compared with the healthy group. These results provide evidence that care and recommendations for improving women’s QoL and sexual function should be considered according to the relevant PCOS phenotypes.

Is there a Relationship between Serum IGF-1 and Thyroid Nodule, Thyroid or Ovarian Volume in Polycystic Ovarian Syndrome?

Context

Studies investigating the association between serum IGF-1, and thyroid nodule, ovarian or thyroid volume in polycystic ovarian syndrome (PCOS) are limited.

Objective

We aimed to analyze the association between serum IGF-1 level, and ovarian or thyroid volume, or thyroid nodule in PCOS.

Design

The study was performed between June 2017 and August 2019 as prospective design.

Subjects and Methods

Adult females with new-onset PCOS were included. The patients having comorbid illness, or using medication were excluded. Basic tests, thyroid and ovarian sonography were performed. The patients were grouped according to thyroid nodule(absent/present) and ovarian volume (<10mL/≥10mL). We planned to find a positive association between IGF-1, and thyroid nodule, thyroid or ovarian volume in PCOS.

Results

Of total 118 patients, 11(9%) had thyroid nodule. The patients with thyroid nodule had a higher ovarian volume (p=0.006). No correlation was found between GH or IGF-1, and thyroid or ovarian volume. IGF-1 was not a predictor for thyroid nodule or higher ovarian volume. Thyroid nodule was a significant predictor for higher ovarian volume.

Conclusion

Our study is the first to analyze the association between IGF-1 and thyroid nodule in PCOS. We found that thyroid nodule was associated with thyroid and ovarian volume, but IGF-1 was not associated with thyroid nodule, thyroid or ovarian volume.

The Effect of Free Androgen Index on the Quality of Life of Women With Polycystic Ovary Syndrome: A Cross-Sectional Study

Purpose: Free androgen index (FAI) and anti-Mullerian hormone (AMH) are independently associated with polycystic ovary syndrome (PCOS). This study aimed to describe the relationship between these two markers and health-related quality of life (HR-QoL) in women with PCOS. Methods: This cross-sectional study consisted of 81 women in the Hull PCOS biobank, who fulfilled the Rotterdam consensus criteria for the diagnosis of PCOS. The primary outcome was to measure the various domains of the QoL in the modified polycystic ovary syndrome questionnaire (MPCOSQ). Results: Mean age of the study participants was 28 ± 6.0 years, mean body mass index (BMI) 33.5 ± 7.8 kg/m², mean FAI (6 ± 5.5), free testosterone (2.99 ± 0.75) and mean AMH (3.5 ± 0.8 units). In linear regression analysis, the FAI was associated with overall mean MPCOSQ score (Beta = 0.53, P-value = 0.0002), and with depression (Beta = 0.45, P-value = 0.01), hirsutism (Beta = 0.99, P-value = 0.0002) and menstrual irregularity (Beta = 0.31, P-value = 0.04). However, with adjustment for age and BMI, FAI was only associated with the hirsutism domain (Beta = 0.94, P-value = 0.001) of the MPCOSQ. FAI was also associated with the weight domain (Beta = 0.63 P-value = 0.005) of MPCOSQ. However, AMH was not associated with the overall mean MPCOSQ score or with any of its domains. Conclusion: FAI but not AMH was associated with QoL in women with PCOS, and this effect was mediated by BMI.

Natural Molecules in the Management of Polycystic Ovary Syndrome (PCOS): An Analytical Review

Polycystic ovary syndrome (PCOS) is a heterogenous disorder characterized by chronic ovulation dysfunction and hyperandrogenism. It is considered the most common endocrinological disorder, affecting up to 25% of women of reproductive age, and associated with long-term metabolic abnormalities predisposing to cardiovascular risk, such as insulin resistance (IR), dyslipidemia, endothelial dysfunction, and systemic inflammation. PCOS is also characterized by elevated serum levels of luteinizing hormone (LH), causing a condition of hyperandrogenism and a consequent altered ratio between LH and the follicle stimulating hormone (FSH). Over the years, several different approaches have been proposed to alleviate PCOS symptoms. Supplementation with natural molecules such as inositols, resveratrol, flavonoids and flavones, vitamin C, vitamin E and vitamin D, and omega-3 fatty acids may contribute to overcoming PCOS pathological features, including the presence of immature oocyte, IR, hyperandrogenism, oxidative stress and inflammation. This review provides a comprehensive overview of the current knowledge about the efficacy of natural molecule supplementation in the management of PCOS.

Health related quality of life and psychological parameters in different polycystic ovary syndrome phenotypes: a comparative cross-sectional study

Background

Polycystic Ovary Syndrome (PCOS) is associated with high levels of phsychological implications and detriments to Quality of Life (QoL). The aim of this study was to assess Health- Related Quality of Life (HRQoL), depression, and anxiety in Iranian women with different PCOS phenotypes.

Methods

The present observational, cross-sectional study was carried out on 239 PCOS women who were classified on the basis of Rotterdam criteria into four categories: A (n = 77), B (n = 38), C (n = 68), and D (n = 56). They asked to fill out three questionnaires, namely, HRQoL, SF-12, and HADS.

Results

No significant differences were observed between the four PCOS phenotypes for anxiety, depression and QoL, as well as HRQoL domains related to infertiliy, weight and emotional problems (P > 0.05). Phenotypes A and B had worse HRQoL related to hirsutism (13.98 ± 5.22, 14.13 ± 6.23, P < 0.001). In addition, no significant differences were observed between them for HRQoL domains. While the score of acne in phenotype D (19.60 ± 5.12, P = 0.003) and menstrual score in phenotype C were significantly higher comparing to the other PCOS groups (16.82 ± 3.87, P < 0.001).

Conclusion

Presenting similar psychological profiles in all phenotypes unveils the importance of pychological well-being screening, even in milder reproductive phenotypes.

Divergences in Clinical, Anthropometric, Metabolic, and Hormonal Parameters among Different Phenotypes of Polycystic Ovary Syndrome Presenting at Endocrinology Outpatient Departments: A Multicenter Study from Bangladesh

Background

Polycystic ovary syndrome (PCOS) is a heterogeneous androgen-excess disorder. Data comparing the PCOS phenotypes in Bangladesh are scarce.

Objectives

The objective of this study was to find out the distribution of Rotterdam classified PCOS phenotypes and to compare the phenotypes concerning clinical, anthropometric, metabolic, and hormonal parameters.

Subjects and Methods

In this cross-sectional study, 370 PCOS cases in the age group of 20-45 years diagnosed by the Rotterdam consensus criteria were recruited from the endocrinology outpatient departments of several tertiary hospitals of Bangladesh. Metabolic syndrome (MetS) was diagnosed using the International Diabetes Federation criteria.

Results

The prevalence of phenotypes A, B, C, and D were 59.2%, 14.1%, 11.9%, and 14.9%, respectively. More than one-third (34.6%) of the women had pre-hypertension (pre-HTN)/hypertension (HTN), 34.1% had abnormal glucose intolerance (AGT), 93.0% had dyslipidemia, and 57.0% had MetS. The hyperandrogenic phenotypes (A, B, and C) had higher prevalence of pre-HTN/HTN, AGT, dyslipidemia, and MetS compared to the normoandrogenic phenotype D, though the differences were statistically insignificant. The clinical and biochemical markers of hyperandrogenism (Ferriman-Gallwey score, hirsutism, acne, and serum testosterone levels) did not differ among the hyperandrogenic phenotypes. The serum prolactin level was highest in phenotype C. No differences were observed in most other clinical, anthropometric, metabolic, and hormonal parameters among the four phenotypes.

Conclusion

Phenotype A is the most prevalent phenotype of PCOS in our setting. The prevalence of MetS was considerably high. Most of the clinical, anthropometric, and metabolic parameters were similar across the four PCOS phenotypes in this study.

Prevalence of metabolic syndrome in four phenotypes of PCOS and its relationship with androgenic components among Iranian women: A cross-sectional study

BACKGROUND

Polycystic ovary syndrome (PCOS) increases the risk of metabolic syndrome (MetS). Insulin resistance (IR) plays a major role in the pathophysiology of both PCOS and MetS.

OBJECTIVE

This study was designed to compare the prevalence of MetS among different phenotypes of PCOS and its relationship with androgenic components.

MATERIALS AND METHODS

182 participants eligible for this five-group comparative study were selected by convenience sampling method. They were classified according to the Rotterdam criteria: clinical and/or biochemical hyperandrogenism (H) + PCOS on ultrasound (P) + ovulation disorders (O) (n = 41), clinical and/or biochemical H + PCOS on P (n = 33), PCOS on P + O (n = 40), clinical and/or biochemical H + O (n = 37), and control (without PCOS) (n = 31). MetS was measured based on the National Cholesterol Education Program Adult Treatment Panel III criteria. Androgenic components included free-androgen-index (FAI), total-testosterone (TT) level and sex-hormone-binding-globulin (SHBG).

RESULTS

A significant difference was observed between the study groups in terms of MetS prevalence (p = 0.01). In phenotype H+P+O, there was a statistically significant positive association between TG and TT, and a significant negative association between SBP and DBP with SHBG. In phenotype O+P, WC was inversely associated with SHBG. In phenotype H+O, FBS and TG were positively associated with FAI but HDL was inversely associated with FAI. Moreover, WC and DBP were positively associated with TT in phenotype H+O. No associations were detected between MetS parameters and androgenic components in other PCOS subjects (phenotype H+P) and in the control group. TT was significantly higher in the PCOS group suffering from MetS (p = 0.04).

CONCLUSION

According to the research results, hyperandrogenic components are potent predictors of metabolic disorders. Thus, we suggest that MetS screening is required for the prevention of MetS and its related complications in PCOS women.

Changes in clinical and biochemical characteristics of polycystic ovary syndrome with advancing age

OBJECTIVE

To verify whether aging can modify the clinical and biochemical characteristics of women with polycystic ovary syndrome (PCOS).

MATERIAL AND METHODS

This observational cross-sectional study was conducted at the reproductive endocrinology clinics of Julio Muller University Hospital and Tropical Institute of Reproductive Medicine in Cuiabá, MT, Brazil, between 2003 and 2017. Both, 796 PCOS and 444 non-PCOS normal cycling women underwent the same examination. PCOS was diagnosed using the Rotterdam criteria as recommended for adolescent and adult subjects. Anthropometric, metabolic, and endocrinological modifications with aging were initially examined in the two groups: control and PCOS. Further analyses were performed after a 5-year age stratification of data throughout the reproductive period. All participants signed a consent form approved by the local ethical committee.

RESULTS

Biomarkers of adiposity were more remarkable in African descendant PCOS women. Body weight, waist/hip ratio, fat mass, and BMI were higher in PCOS women and tended to increase at all 5 age-strata, between ≤19 and 35 years of age. Serum androgen levels decreased with aging, markedly in PCOS subjects (P < 0.01 for all age-strata comparisons), but remained elevated when compared with the levels found in controls. Carbohydrate markers, triglycerides, and total cholesterol tended to increase over time in PCOS (P < 0.01 for all age-strata comparisons). Total cholesterol also tended to increase with age in non-PCOS women (P = 0.041).

CONCLUSION

The present study has shown that the advancing age influences many features of PCOS women. Biochemical hyperandrogenism, the core criterion recommended in the current systems to define the syndrome, showed statistically significant tendencies to decrease with aging progression but did not normalize. The use of age-adjusted features for the diagnosis of PCOS are recommended.

Increased MicroRNA Levels in Women With Polycystic Ovarian Syndrome but Without Insulin Resistance: A Pilot Prospective Study

BACKGROUND

Small noncoding microRNA (miRNA) have regulatory functions in polycystic ovary syndrome (PCOS) that differ to those in women without PCOS. However, little is known about miRNA expression in women with PCOS who are not insulin resistant (IR).

METHODS

Circulating miRNAs were measured using quantitative polymerase chain reaction (qPCR) in 24 non-obese BMI and age matched women with PCOS and 24 control women. A miRNA data set was used to determine miRNA levels.

RESULTS

Women with PCOS showed a higher free androgen index (FAI) and anti-mullerian hormone (AMH) but IR did not differ. Four miRNAs (miR-1260a, miR-18b-5p, miR-424-5p, and miR let-7b-3p) differed between control and PCOS women that passed the false discovery rate (FDR) out of a total of 177 circulating miRNAs that were detected. MiRNA let-7b-3p correlated with AMH in PCOS (p < 0.05). When the groups were combined, miR-1260a correlated with FAI and let-7b-3p correlated with body mass index (BMI) (p < 0.05). There was no correlation to androgen levels. Ingenuity pathway analysis showed that nine of the top 10 miRNAs reported were associated with inflammatory pathways.

CONCLUSION

When IR did not differ between PCOS and control women, only four miRNA differed significantly suggesting that IR may be a driver for many of the miRNA changes reported. Let-7b-3p was related to AMH in PCOS, and to BMI as a group, whilst miR-1260a correlated with FAI. Androgen levels, however, had no effect upon circulating miRNA profiles. The expressed miRNAs were associated with the inflammatory pathway involving TNF and IL6.

Changes in Resting-State Cerebral Activity in Women With Polycystic Ovary Syndrome: A Functional MR Imaging Study

BACKGROUND

Previous studies have found that women with polycystic ovary syndrome (PCOS) have some degree of brain function change as well as cognitive function and emotions, such as poor executive functioning and memory, anxiety and depressive symptoms. However, the neurobiological mechanisms underlying these alterations have not yet been clarified.

METHOD

Fasting serum hormone testing, neuropsychological testing and resting-state magnetic resonance imaging (rs-fMRI) were performed in 41 women with newly diagnosed PCOS and 41 healthy controls matched by age and education during their 2-5 days of menstrual period. Analysis of the amplitude of low-frequency fluctuation (ALFF) was used to calculate the seed points. Then, the functional connectivity (FC) values between these abnormal seed points and other voxels in the whole brain were calculated. Finally, the correlations among clinical indexes, neuropsychological evaluation scores, and neuroimaging data were analyzed.

RESULTS

Compared with the control group, the PCOS group showed higher luteinizing hormone (LH) and serum insulin levels, worse sleep quality, increased depressive and anxiety state scores, and memory and executive function impairments. Pearson's correlation analysis showed that the decreased ALFF value in the left middle frontal gyrus (MFG.L), which is related to poor executive performance and depressive disorders, was negatively correlated with the plasma insulin level in subjects with insulin resistance. Furthermore, the increased FC strength between the MFG.L and left inferior frontal gyrus (IFG.L) was positively correlated with the serum testosterone level. The enhanced FC strength between the left posterior cingulate gyrus (PCG.L) and triangular part of the left inferior frontal gyrus (IFGtriang.L) was negatively correlated with the plasma LH level. When use the right middle occipital gyrus (MOG.R) as the seed point, the FC strength with the right inferior occipital gyrus (IOG.R), which is associated with impaired memory, was decreased.

CONCLUSION

The ALFF and FC results elucidated brain functional abnormalities at the regional and network levels in women with PCOS, while correlation analyses simultaneously demonstrated that these alterations were associated with serum hormones and cognitive function. These results may provide useful information regarding the potential mechanisms of cognitive impairment and emotional changes in this population.

Phenotype and genotype of polycystic ovary syndrome in Asia: Ethnic differences

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in reproductive-aged women, and ethnic diversity has been reported in its manifestation. This review addressed phenotype and genetic studies in Asian women with PCOS. Generally, East Asians are less hirsute, and the hirsutism score cutoff is lower than the Caucasian counterpart. It is not clear whether there are any significant differences in the prevalence or severity of irregular menstruation (IM) or characteristics of polycystic ovary (PCO) across ethnicities. Interestingly, the IM/PCO subgroup is a relatively common phenotype in East Asian patients but not in Caucasian patients. The prevalence of insulin resistance in PCOS patients varies depending on the index used and the cutoff, but women with PCOS showed a higher degree of insulin resistance than those of controls across ethnicities. Lower body mass index (BMI) and lower prevalence of metabolic syndrome were reported in East Asian patients, but despite lower BMI, a comparative study reported that Asian women with PCOS were more likely to have diabetes compared with Caucasian patients, suggesting they also have metabolic complications. Unlike East Asian patients, South Asian patients showed an increased degree of hirsutism, early onset of symptoms, and severe insulin resistance and metabolic risks compared with Caucasians. Genetic components play important roles in the pathogenesis of PCOS, and genome-wide association studies of PCOS suggest that similar genetic risk factors exist between Asian and Caucasian patients. Continuous comparative studies are needed to standardize the diagnosis and management of PCOS across different ethnicities.

Comparison of the Different PCOS Phenotypes Based on Clinical Metabolic, and Hormonal Profile, and their Response to Clomiphene

OBJECTIVE

To compare the different polycystic ovarian syndrome (PCOS) phenotypes based on their clinical, metabolic, hormonal profile, and their differential response to clomiphene.

DESIGN

Prospective observational study.

SETTING

Infertility clinic, a government hospital.

SAMPLE SIZE

164 women with PCOS-related infertility.

MATERIALS AND METHODS

Sample population was divided into four phenotypes based on the NIH (National Institute of Health) consensus panel criteria. The incremental dose of clomiphene from 50 to 150 mg/day over three cycles was given.

OUTCOME MEASURES

Clinical history, metabolic, hormonal profile, and ultrasound features of each phenotype. Also, the response to clomiphene citrate was studied as presence or absence of ovulation.

RESULTS

The prevalence of phenotypes A, B, C, and D were 67.7%, 11%, 17.7%, and 3.6%, respectively. Phenotype A had significantly higher weight, body mass index, clinical, and biochemical hyperandrogenism, menstrual irregularities, ovarian reserve parameters, fasting insulin, HOMA-IR, and more deranged lipid profile (P < 0.05). Clomiphene resistance was significantly more common in phenotype A (P < 0.05). No significant differences were noted in the waist circumference, waist-hip ratio, blood pressure and blood sugar values (fasting, 1-hour postprandial, 2-hour postprandial). Also, the Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), LH-FSH ratio, 17-hydroxyprogesterone, and vitamin D levels were not significantly different among various PCOS phenotypes.

CONCLUSION

Full-blown PCOS (phenotype A) is at a higher risk of adverse metabolic and cardiovascular outcomes as compared with the others, and phenotype D is the least severe phenotype. Thus, the phenotypic division of patients with PCOS-related infertility can help in prognosticating the patients about the severity of the disease and the fertility outcome.

Metabolic risk assessment of Indian women with polycystic ovarian syndrome in relation to four Rotterdam criteria based phenotypes

OBJECTIVES

Though polycystic ovarian syndrome (PCOS) is associated with multiple metabolic abnormalities, the metabolic risk profile of various PCOS phenotypes is still debated. Here we sought to compare the clinical, biochemical and metabolic parameters among the different PCOS phenotypes and controls.

STUDY DESIGN

A total of 394 newly diagnosed PCOS women and 108 controls were enrolled consecutively. PCOS women were divided into four phenotypes based on the presence of two of the following Rotterdam criteria: oligo/anovulation (O), hyperandrogenism (H), and polycystic ovaries (P): A (O + H + P), B (O + H), C (H + P), D (O + P).

RESULTS

Phenotype A (55.8%) was the most common phenotype in the PCOS cohort. Prevalence of metabolic syndrome was highest in phenotype A and B compared to other two phenotypes and controls. The clinical, biochemical and metabolic characteristics, of phenotypes A and B, were similar, but phenotype A had higher hirsutism score and androgen level. Phenotype C had intermediate metabolic characteristics between A and controls whereas phenotype D had the mildest metabolic abnormalities among the four phenotypes. Significant predictors for metabolic syndrome within the PCOS cohort are waist circumference >80 cm, hypertension, fasting glucose >100 mg/dL, HDL-cholesterol <50 mg/dL and triglyceride >150 mg/dL (p < 0.001).

CONCLUSIONS

Indian PCOS women with Phenotype A and B lie at increased metabolic risk compared to other phenotypes. Phenotypic classification of PCOS women may facilitate more effective application of screening and treatment strategies for high-risk metabolic phenotypes.

Gestational Diabetes Mellitus and Metabolic Disorder Among the Different Phenotypes of Polycystic Ovary Syndrome

OBJECTIVES

Polycystic ovary syndrome (PCOS) is a common endocrine disorder related to several metabolic consequences. However, there remains uncertainty regarding the metabolic features of various phenotypes. The aim of this study was to explore the relationship between the prevalence of gestational diabetes mellitus (GDM) and metabolic disorders among the four different phenotypes of PCOS.

METHODS

A cross-sectional study was performed in Royan Institute including 208 pregnant women with a history of infertility and PCOS. Using the diagnostic criteria of the American Diabetes Association (ADA), pregnant women with a documented diagnoses of PCOS were further categorized into four different phenotypes (A, B, C, and D) as defined by the Rotterdam criteria.

RESULTS

The prevalence of GDM failed to demonstrate a significant relationship among the four phenotypes of PCOS. The mean levels of fasting blood sugar, plasma glucose concentrations at three hours (following the 100 g oral glucose tolerance test) and triglyceride levels were significantly higher in phenotype B compared to the remaining phenotypes (p < 0.050). There was a statistically significant difference between the mean free testosterone level and phenotypes A and C groups (1.8±1.6 vs. 1.1±1.0, p = 0.003).

CONCLUSIONS

Women with a known diagnosis of PCOS who exhibited oligo/anovulation and hyperandrogenism demonstrated an increase of metabolic disorders. These results suggest that metabolic screening, before conception or in the early stages of pregnancy, can be beneficial particularly in women with PCOS phenotypes A and B. Early screening and identification may justify enhanced maternal fetal surveillance to improve maternal and fetal morbidity among women affected with PCOS.

Lipid accumulation product as a marker of cardiometabolic susceptibility in women with different phenotypes of polycystic ovary syndrome

OBJECTIVE

There are limited data on cardiometabolic risk factors and the prevalence of metabolic syndrome (MetS) across the different PCOS phenotypes in Caucasian population. Lipid accumulation product (LAP) is a clinical surrogate marker that could be used for evaluation of MetS in clinical practice. The aim of the study was to analyze metabolic characteristics and the ability of LAP to predict MetS in different PCOS phenotypes.

DESIGN

Cross-sectional clinical study analyzing 365 women with PCOS divided into four phenotypes according to the ESHRE/ASRM criteria, and 125 healthy BMI-matched controls.

METHODS

In all subjects, LAP was determined and MetS was diagnosed according to the National Cholesterol Education Program/Adult Treatment Panel III (NCEP-ATP III), the International Diabetes Federation (IDF) and the Joint Interim Statement (JIS) criteria. Logistic regression and ROC curve analyses were used to determine predictors of MetS in each PCOS phenotype. All analyses were performed with age and BMI adjustment.

RESULTS

All PCOS phenotypes in comparison to controls had higher prevalence of MetS assessed by NCEP-ATP III criteria, and only classic phenotypes when IDF and JIS criteria were used. All phenotypes had the same prevalence of MetS irrespective of used definition. LAP and exhibited the highest diagnostic accuracy and was an independent predictor of MetS in all phenotypes.

CONCLUSION

LAP is an independent and accurate clinical determinant of MetS in all PCOS phenotypes in our Caucasian population. All PCOS phenotypes, including non-classic ones, are metabolically challenged and with cardiovascular risk, particularly phenotype B.

Metabolic syndrome, diet and exercise

Polycystic ovary syndrome (PCOS) is associated with a range of metabolic complications including insulin resistance (IR), obesity, dyslipidaemia, hypertension, obstructive sleep apnoea (OSA) and non-alcoholic fatty liver disease. These compound risks result in a high prevalence of metabolic syndrome and possibly increased cardiovascular (CV) disease. As the cardiometabolic risk of PCOS is shared amongst the different diagnostic systems, all women with PCOS should undergo metabolic surveillance though the precise approach differs between guidelines. Lifestyle interventions consisting of increased physical activity and caloric restriction have been shown to improve both metabolic and reproductive outcomes. Pharmacotherapy and bariatric surgery may be considered in resistant metabolic disease. Issues requiring further research include the natural history of PCOS-associated metabolic disease, absolute CV risk and comparative efficacy of lifestyle interventions.

Metabolic aspects of different phenotypes of polycystic ovary syndrome: Iranian PCOS Prevalence Study

OBJECTIVE

To compare insulin resistance (IR) and metabolic characteristics of different phenotypes of polycystic ovary syndrome (PCOS) and healthy controls in a representative sample of reproductive-aged Iranian women.

DESIGN

Cross-sectional community-based study.

PATIENTS

Of 915 participants, 136 met Rotterdam criteria for PCOS and were divided in four subgroups: ovulatory dysfunction with polycystic ovaries (Anovu + PCO), hyperandrogenism with PCO (HA + PCO), hyperandrogenism with ovulatory dysfunction (HA + Anovu) and full Rotterdam (HA + Anovu + PCO). Also 423 subjects served as normal controls, and the rest of participants were analysed as isolated HA, Anovu or PCO subgroups.

MEASUREMENTS

Anthropometric measures, biochemical parameters and IR were compared between different groups. IR was defined using the homeostatic model assessment-IR (HOMA-IR).

RESULTS

Overall prevalence of IR in PCOS and normal women were 26·5% and 23·9%, respectively (P = 0·03). After age and BMI adjustment, there was no difference regarding metabolic characteristics between different PCOS phenotypes. Also metabolic characteristics, fasting insulin and HOMA-IR were comparable in PCOS subjects with hyperandrogenism and the nonhyperandrogenic phenotype (Anovu + PCO). In regression analysis, only overweight and obesity (BMI ≥ 25 kg/m(2) ) had an independent association with IR (OR: 2·49, CI: 1·06-5·82, P = 0·03).

CONCLUSIONS

In a representative sample of an Iranian PCOS population, there is no significant difference between different PCOS phenotypes or between PCOS women and normal subjects regarding their metabolic characteristics. These findings suggest that overall metabolic screening may not always be required for all women diagnosed with PCOS. Larger-scale population-based studies are needed to further assess these issues.

Prevalence of Polycystic Ovary Syndrome Phenotypes Using Updated Criteria for Polycystic Ovarian Morphology: An Assessment of Over 100 Consecutive Women Self-reporting Features of Polycystic Ovary Syndrome

The prevalence of polycystic ovary syndrome (PCOS) and its distinct clinical phenotypes were assessed using 3 sets of international diagnostic criteria in women self-reporting concerns over outward features of PCOS. Revised ultrasonographic criteria for polycystic ovaries (PCO) based on modern ultrasound technology were used. Of the participants, 53%, 62%, and 70% were diagnosed with PCOS using National Institutes of Health, Androgen Excess and PCOS Society, and Rotterdam criteria, respectively. Prevalence of Frank, Ovulatory, Normoandrogenic, and Non-PCO PCOS were 66%, 13%, 11%, and 9%, respectively. Frank PCOS was associated with the severest metabolic disturbances whereas metabolic profiles in Normoandrogenic PCOS did not differ from controls, supporting reduced health risks in women without androgen excess. Metabolic disturbances and hyperandrogenism were linked to excess adiposity across all the groups. Using updated criteria for PCO, the prevalence of Non-PCO PCOS and PCO alone in healthy women recruited from the general population was reduced compared to the previous reports.

Comparing classic and newer phenotypes in Greek PCOS women: the prevalence of metabolic syndrome and their association with insulin resistance

OBJECTIVE

Recently, it has been debated whether the new polycystic ovary syndrome (PCOS) phenotypes, according to the Rotterdam criteria, share the same metabolic risk with the classic ones (National Institutes of Health 1990). Our study sought to compare the prevalence of metabolic syndrome (MS) and glucose homeostasis disorders in Greek women with classic and new PCOS phenotypes.

MATERIALS AND METHODS

Two hundred and sixty-six Greek PCOS women were recruited and divided into groups according to two of the three Rotterdam criteria that they fulfilled. Two subgroups were formed; the first represented the classic phenotypes and the second the new phenotypes. The clinical, biochemical, and ultrasound characteristics of both groups were explored. All subjects were evaluated for MS and underwent a 2-h glucose tolerance test to assess insulin resistance (IR) as measured by the homeostasis model assessment (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), and MATSUDA indices.

RESULTS

62.4% of PCOS women were classified as classic NIH phenotypes of which 32 women had MS (prevalence 19.6%). Only 4 patients categorized in the newer phenotypic groups had MS (prevalence 4.1%). Among the subjects with classic phenotypes, 11.7% exhibited impaired glucose tolerance (3-fold higher percentage compared to patients with newer phenotypes). Regarding IR indices, HOMA-IR was significantly higher and QUICKI significantly lower for classic phenotypes.

CONCLUSIONS

Greek PCOS women with classic phenotypes are at increased risk for MS and impaired glucose homeostasis compared to women with newer phenotypes. A subclassification of PCOS permits the earlier recognition and closer surveillance of women whose metabolic profile indicates potential risks for adverse health outcomes.

Phenotype and metabolic disorders in polycystic ovary syndrome

The polycystic ovary syndrome (PCOS) is one of the most frequent endocrinopathies in women. Its incidence is assessed at 6–8% of the female population in the reproductive age. It is characterised by oligomenorrhea (Oligo), hyperandrogenism (HA), and the presence of polycystic ovaries (PCOs). Carbohydrate and lipid metabolism is being disturbed in many women with PCOS. The pathogenesis of PCOS is still unexplained. Following the main criteria of diagnosis (Rotterdam Consensus 2003), Dewailly, Welt and Pehlivanov divided the patients with PCOS into 4 phenotype groups: A, B, C, and D. In our studies of 93 patients with PCOS, we found (1) the most frequent appearance (60,2%) of the phenotype A [Oligo + HA + PCO]; (2) an increased androstenedione concentration in a group with HA (A, B, C); (3) an increased HOMA-β and insulin concentration after 30 min an oral 75 g glucose tolerance test (OGTT) in a group of obese women with BMI > 30 kg/m²; (4) high levels of total testosterone, total cholesterol, and LDL cholesterol concentrations in a group A with classic phenotype of PCOS: Oligo + HA + PCO—increasing the risk of development of cardiovascular diseases, type 2 diabetes, or metabolic syndrome. The average androstenedione concentrations could be a good diagnostic and prognostic parameter.

Phenotype and metabolic profile of South Asian women with polycystic ovary syndrome (PCOS): results of a large database from a specialist Endocrine Clinic

BACKGROUND

Compared with other populations, South Asians have a greater propensity to insulin resistance and the metabolic syndrome (MetS). This is the first study to determine the distribution of phenotypes of polycystic ovary syndrome (PCOS) and their relationship to the MetS among indigenous South Asians.

METHOD

An evaluation of the phenotype and metabolic characteristics of PCOS was conducted by recruiting consecutive women diagnosed by Rotterdam consensus criteria from an Endocrine clinic in Colombo, Sri Lanka. Prevalence of MetS was determined, in relation to the phenotypic subgroup of PCOS and compared with ethnically matched, BMI- and age-adjusted controls (n =231).

RESULTS

Acanthosis nigricans (AN) occurred in 64.6% of women with PCOS (n= 469). MetS occurred in 30.6% of the PCOS group compared with 6.34% of controls (P = 0.0001). Those with PCOS and MetS had significantly higher median BMI, blood pressure (BP), fasting plasma glucose, insulin and triglycerides and lower high-density lipoprotein and sex hormone-binding globulin (SHBG), but similar testosterone concentrations compared with those with PCOS alone. Prevalence of MetS was similar in the four PCOS phenotypes, although oligomenorrhoeic women were more obese compared with the normal cycling hyperandrogenic group. Multivariate logistic regression confirmed age ≥35 years, BMI ≥25 kg/m(2) and AN as significant predictors of MetS in PCOS. Case-control comparisons showed that the presence of PCOS results in higher odds of having the MetS, a high waist circumference, elevated diastolic BP, abnormal fasting lipids and high fasting insulin and plasma testosterone concentrations.

CONCLUSIONS

Young indigenous South Asians with PCOS have greater odds of being centrally obese, with a third having the MetS that bears no relationship to the androgenic phenotype. Significant predictors for MetS within the PCOS cohort are advancing age, obesity determined by the Asian cut off (BMI >25 kg/m(2)) and AN, while family history of diabetes, hyperandrogenism and elevated SHBG have no predictive value.

Ovarian function and obesity--interrelationship, impact on women's reproductive lifespan and treatment options

Insulin resistance (IR) is a consequence of obesity, and in women it is often inextricably linked with ovarian function leading to clinical reproductive manifestations such as early menarche onset, subfertility and polycystic ovary syndrome (PCOS). Likewise, the dramatic fall in oestrogen production after menopause may contribute to weight gain and changes in adipose tissue distribution. Overall, women who are obese, especially those with reproductive complications including PCOS, have been identified as specific high risk subgroups for further progression through to prediabetes, type 2 diabetes mellitus (T2DM) and potentially cardiovascular disease (CVD). This review focuses on the interrelationship between the ovarian function and obesity as well as its treatment strategies.