Self-Selected Women With Polycystic Ovary Syndrome Are Reproductively and Metabolically Abnormal and Undertreated

Abstract

There is at present no uniformly agreed upon definition of polycystic ovary syndrome (PCOS), and variation in the diagnostic criteria used has limited the development of effective interventions. This study, carried out in44 women who identified themselves as having PCOS and 80 control women, was aimed at determining the prevalence of hyperandrogenemia, menstrual irregularity, and insulin resistance in the former group. Hormonal and other medications were continued during the study, but the participants fasted. The control and study groups were matched for age, body weight, ethnicity, and lack of a personal or family history of hypertension and diabetes. PCOS had been most often diagnosed from ovarian morphology as determined by ultrasonography or laparoscopy, followed by blood tests, the history, and physical factors. Fasting levels of 17a-hydroxyprogesterone were normal except for a woman with atypical congenital adrenal hyperplasia. All study women had normal prolactin levels. Women in the PCOS group had significantly elevated blood pressures and increased waist-hip ratios compared with control women, and they were twice as likely to have a history of irregular menses. Nulliparity also was more prevalent in the women with self-selected PCOS, and they had used fertility measures more often in an attempt to conceive a child. Study women were relatively hyperandrogenemic and also had significantly elevated levels of luteinizing hormone (but not follicle-stimulating hormone). Multiple metabolic abnormalities noted in study women included increases in fasting insulin, total cholesterol, and low-density lipoprotein cholesterol as well as a decrease in fasting high-density lipoprotein cholesterol. None of the women were receiving treatment specific for these metabolic abnormalities. Women who claim to have PCOS are highly likely to have appropriate symptoms and signs, and they deserve a full workup for the reproductive and metabolic alterations associated with this condition.