Abstract
Background: Women with polycystic ovary syndrome (PCOS) are at higher risk of developing endometrial hyperplasia (EH). This study determined the prevalence of EH among women with infertility due to PCOS and assessed the predictive value of endometrial thickness (ET) measurement by trans-vaginal scan (TVS). Study Type & Population: This was a prospective study on infertile women with and without PCOS in which clinical data, hormonal profile, ET and endometrial biopsy (EB) for histopathological examination were collected. Methods: Thirty-seven women with PCOS and 23 women without PCOS presenting with infertility and/or abnormal uterine bleeding underwent TVS, hysteroscopy, laparoscopy and EB. Results: The overall prevalence of EH was 23.3 % while in PCOS group: 18.3 %. The mean ET (14.8 mm) was significantly higher in patients with EH (t = -2.74, P value = 0.009). The lower value of ET among women with EH was 10 mm. A cut-off point of 9.5 mm was set. An ET of >9.5 mm had 92.9% sensitivity and 51.85% specificity for the presence of EH. Women with ET ≥ 9.5 mm were 1.28 times more at risk of EH than women with ET 9.5 mm. Women with oligomenorrhea and irregular cycles were 5.5 and 13.7 times more at risk of EH compared to those with regular cycles, respectively. ET was positively correlated with insulin resistance (r = 0.439, P = 0.007). Conclusion: ET ≥ 9.5 mm predicts EH in infertile women with PCOS, with a high degree of sensitivity and a moderate degree of specificity. In PCOS patients with oligomenorrhea or irregular cycles, the risk of EH is higher than women with regular cycles.
Highlights
Polycystic ovary syndrome (PCOS) is the most common multisystem endocrine disorder affecting 5% - 10% of women during their reproductive age [1]
Our results showed that the prevalence of endometrial hyperplasia among infertile patients with PCOS is 18.3%
We propose a new threshold value of 9.5 mm of endometrial thickness measured by vaginal U/S, which had a sensitivity of 92.9%, specificity of 51.85% positive predictive value of 47.8%, and negative predictive value of 100%
Summary
Polycystic ovary syndrome (PCOS) is the most common multisystem endocrine disorder affecting 5% - 10% of women during their reproductive age [1]. The endometrium of PCOS patients has high levels of insulin-like growth factor-1 (IGF-1) activity [7], decreased concentrations of sex hormonebinding globulin (SHBG) [8], up-regulation of endometrial aromatase, hyperandrogenemia and hyperinsulinemia. Those molecular changes increase the potential for neoplastic changes within the endometrium [9]. Anovulation is common among women with PCOS, the progesterone levels are within suboptimal or absent effects over the endometrium, and the tissue is in a state of a relative over-response to the proliferative effects of estrogen (E2), where its levels were found to be comparable to the follicular phase levels [10] These relatively high levels of E2 prohibit the endometrium from enduring the sequential changes in gene expression and its associated endocrine processes. In PCOS patients with oligomenorrhea or irregular cycles, the risk of EH is higher than women with regular cycles
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