Endocrine Indices of PCOS in Women with Polycystic Ovaries but without Diagnostic Features of PCOS: A Study of an Infertility Clinic Population

Eleni Kousta,Desmond G Johnston,Davinia M White,Stephen Franks

doi:10.4236/ojog.2020.1020024

Eleni Kousta, Desmond G Johnston + Show 2 more

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https://doi.org/10.4236/ojog.2020.1020024

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Abstract

Background: The presence of polycystic ovarian morphology (PCO) without the other characteristics of the polycystic ovarian syndrome (PCOS) is insufficient for the diagnosis of PCOS and there is little justification for follow up in endocrine clinics for women with PCO morphology alone. A few studies have been reported regarding the endocrine features of asymptomatic women with PCO with conflicting data about endocrine profiling. The aim of this study was to assess whether women with PCO, but who have no symptoms of PCOS differ, endocrinologically, from women with normal ovaries. Methods: We analysed the results of ultrasound and endocrine investigations in 576 consecutive women who attended the infertility clinic between 1993 and 1995 at the Reproductive Medicine Unit of St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK. Results: Three hundred and twenty eight women had PCO and 248 had normal ovaries. Among the 328 women with PCO, 169 (51.5%) had PCOS according to Rotterdam criteria. The remaining women with PCO had no symptoms of the syndrome (n = 159); they had a history of regular menses, had proven ovulatory cycles and had neither clinical nor biochemical evidence of hyperandrogenism. However, these women had higher timed LH [median (IQR) 5.3 (4.2) IU/l vs 4.8 (3.4) IU/l, respectively; p = 0.044] and testosterone [2.0 (0.8) nmol/l vs 1.8 (0.8), respectively; p = 0.009] compared with women with normal ovaries (although by definition within the normal range). There was no difference in BMI or FSH between the two groups. Among the 169 women with PCOS, 45.0% (n = 76) were anovulatory without hyperandrogenism, 34.3% (n = 58) fulfilled the NIH criteria and 20.7% (n = 35) were ovulatory with hyperandrogenism. The proportion of hyperandrogenism among anovulatory women with PCO is 43.3% (58 out of 134). Conclusions: Women with PCO, but no symptoms of the syndrome, differ endocrinologically compared with women with normal ovaries: they had higher timed LH and testosterone (although by definition within the normal range). These data suggest that despite the lack of symptoms of PCOS, women presenting to an infertility clinic with PCO represent a milder phenotype of those with overt PCOS, but fall on the same spectrum.

Highlights

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder to affect women of reproductive age
The remaining women with polycystic ovarian morphology (PCO) had no symptoms of the syndrome (n = 159); they had a history of regular menses, had proven ovulatory cycles and had neither clinical nor biochemical evidence of hyperandrogenism
Among the 328 women with PCO morphology, 159 (48.5%) had PCO morphology without fulfilling the diagnostic criteria for polycystic ovarian syndrome (PCOS) i.e. they had a history of regular menses, had proven ovulatory cycles and had neither clinical nor biochemical evidence of hyperandrogenism; 169 (51.5%) had PCOS according to Rotterdam criteria, including 58 (17.7%) who had PCOS according to the NIH criteria (Table 2)

Summary

Introduction

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder to affect women of reproductive age. The remaining women with PCO had no symptoms of the syndrome (n = 159); they had a history of regular menses, had proven ovulatory cycles and had neither clinical nor biochemical evidence of hyperandrogenism. These women had higher timed LH [median (IQR) 5.3 (4.2) IU/l vs 4.8 (3.4) IU/l, respectively; p = 0.044] and testosterone [2.0 (0.8) nmol/l vs 1.8 (0.8), respectively; p = 0.009] compared with women with normal ovaries ( by definition within the normal range).

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