Abstract
BackgroundA diagnosis of Polycystic Ovary Syndrome (PCOS) and its related phenotypic features including increased hair growth can affect a woman’s social and emotional well-being. We aim to determine firstly, if excess body weight affects menstrual cycle length, excessive hair growth and other phenotypic features in healthy women without PCOS and secondly, whether having PCOS exacerbates the effects of high body mass index (BMI).MethodsA prospective cross-sectional study involving healthy women (21–45 years) recruited at an annual health screen for hospital staff and volunteers from the university community, and PCOS cases referred to tertiary gynecological clinics in Singapore. To dissect the independent and/or combinatorial effects of PCOS and BMI on the phenotypic features, subjects were divided into four categories: non-PCOS (normal BMI), non-PCOS (high BMI), PCOS (normal BMI), and PCOS (high BMI). General linear modelling was performed to compare clinical, ovarian, hormonal and metabolic parameters across these four categories.ResultsOf 389 participants, 134 (34.4%) were classified as PCOS and the remaining 255 (65.6%), as the non-PCOS population. Overall 45.2% of women had high BMI (≥ 23). Compared to non-PCOS subjects, women with PCOS had a higher BMI (mean (SD): 25.14 ± 6.46 vs 23.08 ± 4.36, p < 0.001). Women with PCOS and high BMI had increased hair growth with modified Ferriman-Gallwey (mFG) scores that were 2.96-fold higher versus healthy-normal BMI women (mean difference; 1.85, 95% CI 0.80–2.90). Compared to healthy-high BMI women, PCOS women with high BMI had significantly higher mean differences in mFG scores (1.79, 95% CI 0.64–2.93). In PCOS women, having high BMI also significantly increased mFG scores by 1.85-fold (mean difference; 1.82. 95% CI 0.52–3.12). This effect was mirrored by the additive effect of BMI and PCOS on free androgen index. No independent effect of high BMI on rates of oligomenorrhoea, antral follicle count, ovarian volume or serum androgens were observed.ConclusionsWe observed an additive effect of body weight to increase hair growth in women with PCOS. Maximum mFG scores were present in PCOS women with high BMI. Such increases in mFG score may affect the self-esteem of women with PCOS.
Highlights
A diagnosis of Polycystic Ovary Syndrome (PCOS) and its related phenotypic features including increased hair growth can affect a woman’s social and emotional well-being
The syndrome is a heterogenous condition characterized by three canonical features; oligomenorrhea/anovulation; hyperandrogenism as demonstrated by elevated serum androgens and/or hirsutism; and polycystic ovarian morphology characterized by abnormally high antral follicle counts (AFC) or increased ovarian volume
We examined the effects of body mass index (BMI) on individual clinical, ovarian, hormonal and metabolic features associated with PCOS in women with, and without, the syndrome
Summary
A diagnosis of Polycystic Ovary Syndrome (PCOS) and its related phenotypic features including increased hair growth can affect a woman’s social and emotional well-being. A diagnosis of Polycystic Ovary Syndrome (PCOS) and its related phenotypic features including hirsutism and oligomenorrhea [1] can affect a woman’s social and emotional well-being [2] and physical perception of herself [3], causing great distress and leading to a diminished quality of life [4, 5]. Raised body-mass index (BMI) is a known risk factor for diabetes mellitus, coronary artery disease and strokes [7, 8] Reproductive problems such as menstrual irregularity and infertility are more prevalent in overweight and obese women [9, 10]. The presence of two of these three features is sufficient for a diagnosis of PCOS according to the Rotterdam 2003 criteria [12]
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