Exploring the natural history of polycystic ovary syndrome: still a long road to traverse.

Abstract

I read with keen interest the systematic review by Kiconco et al. (2022) that makes a sincere effort to throw light on the understanding of the natural history of polycystic ovary syndrome (PCOS). The authors found that there was consistent evidence, though from limited studies, that the level of total testosterone and dehydroepiandrosterone sulfate declined to a greater degree and the risk of gestational diabetes was higher in women with PCOS as compared to those without it. However, the evidence was found to be conflicting or insufficient for the other outcomes which are more likely to have practical long-term implications in the lives of women with PCOS. In the process of the selection of articles for the review, the participants were females of any age group and weight with a diagnosis of PCOS. The fact of extreme heterogeneity among the studies notwithstanding, it is conceptually imprecise to include women with PCOS of all age and weight categories in one common group. The international evidence-based guidelines on the assessment and management of PCOS recommends to assess the BMI in all patients and also the prevention of excess weight gain (Teede et al., 2018). Visceral adiposity is known to result in an increase in insulin resistance as well as aggravation of reproductive and metabolic features in PCOS. Obesity is significantly associated with menstrual irregularity, hyperandrogenemia and hirsutism (Rosenfield and Ehrmann, 2016). PCOS in the adolescent age group presents diagnostic challenges due to a considerable overlap of physiological features of the pubertal transition phase with the diagnostic criteria of adult PCOS (Peña et al., 2020). A meta-analysis of differentially expressed genes across various tissue types in PCOS indicated that the etiology, genetic contributors, and expression profile of genes from similar cell types are different in the obese and the lean phenotypes (Idicula-Thomas et al., 2020). Consequently, it is of paramount importance to understand the natural history of this chronic disease according to its different phenotypes.