Prevalence of Polycystic Ovarian Syndrome (PCOS) Like Symptoms in the General Practice of an Obstetrics and Gynecological Office on the Island of Tobago: A Retrospective Chart Analysis

Abstract

Introduction: Polycystic ovarian syndrome (PCOS) is one of the most common endocrinopathies found in reproductive age women. It is characterized by anovulatory infertility, menstrual dysfunction, and hirsutism. It is thought to be associated with an increased risk of metabolic aberrations, including insulin resistance, hyperinsulinism and type 2 diabetes mellitus (T2D). Due to the racial disparities associated with insulin resistance and T2D, we hypothesized that the prevalence of PCOS like symptoms would be increased on the island of Tobago where women were predominantly of Afro-Caribbean descent. Study Design: A retrospective chart review of 1000 women seen in an obstetrics and gynecological office over a 7-year period was conducted. Inclusion criteria included race, body mass index (BMI)<50, and no diagnosis of a co-morbid endocrinopathy. Of the 1000 women, 884 Afro-Caribbean women were included in the analysis. PCOS diagnosis was made based on clinical signs and symptoms verified on ultrasound. The diagnosis was considered if a patient presented with ≥2 of the following signs and symptoms: infertility after >1yr of unprotected sex; irregular menses with periods >35 d, <21 d or <6/yr; overweight/ obese (BMI>25); hirsutism; and acne. Results: Within the study population, 15.7% of participants had irregular menses, 9.2% had infertility, 4.0% had hirsutism and 0.4% developed acne. The prevalence of PCOS based on clinical diagnoses and ultrasonographic evidence was 19.7%. No statistical difference (p<0.05) was found between the two groups with regards to BMI, age and parity. When stratified by age, differences in infertility were found in the 20-24 and 35-39 year old age groups with rates at 10.5 v 18.9% and 15.4 v. 30.2%, respectively. The incidence of irregular menses also differed among age groups, with PCOS patients reporting significantly higher percentages between 30-50%. Conclusion: PCOS appears to be a common disorder on the island of Tobago with a prevalence of 19.7%. This prevalence is higher than in North American studies but is in line with data excluding biochemical analysis. As PCOS is a heterogeneous disorder with diverse phenotypes and probable ethno-genetic variations, the next step would be to further characterize the characteristics of PCOS in the Tobago population. This includes obtaining a full battery of biochemical profiles of women diagnosed with PCOS-like symptoms and the consideration of gene environment interactions including exposure to endocrine disruptors thought to be involved in the etiology of PCOS.