Polycystic Ovarian Syndrome (Polyendocrine Metabolic Ovarian Syndrome)

The family history of patients with polycystic ovarian syndrome (PCOS; renamed polyendocrine metabolic ovarian syndrome) may include the following: Menstrual disorders Adrenal enzyme deficiencies Hirsutism Infertility Obesity and metabolic syndrome Diabetes Menstrual abnormalities Patients with PCOS have abnormal menstruation patterns attributed to chronic anovulation. The patient usually has a history of menstrual disturbance dating back to menarche. Some women have oligomenorrhea (ie, menstrual bleeding that occurs at intervals of 35 days to 6 months, with < 9 menstrual periods per year) or secondary amenorrhea (an absence of menstruation for 6 months). Dysfunctional uterine bleeding and infertility are the other consequences of anovulatory menstrual cycles. The menstrual irregularities in PCOS usually present around the time of menarche. A retrospective study by Maslyanskaya et al reported that PCOS was the most common etiology seen in adolescent patients hospitalized for abnormal uterine bleeding (accounting for 33% of 125 hospital admissions). Hyperandrogenism Hyperandrogenism clinically manifests as excess terminal body hair in a male distribution pattern. Hair is commonly seen on the upper lip, on the chin, around the nipples, and along the linea alba of the lower abdomen. Some patients have acne and/or male-pattern hair loss (androgenic alopecia). Other signs of hyperandrogenism (eg, clitoromegaly, increased muscle mass, voice deepening) are more characteristic of an extreme form of PCOS termed hyperthecosis. These signs and symptoms could also be consistent with androgen-producing tumors, exogenous androgen administration, or virilizing congenital adrenal hyperplasia. Premature adrenarche is a common occurrence and, in some cases, may represent a precursor to PCOS. Hirsutism and obesity may be present in premenarchal adolescent girls with PCOS. The American College of Obstetricians and Gynecologists (ACOG) recommends screening with 17-hydroxyprogesterone levels in women with suspected PCOS who are at increased risk for nonclassical congenital adrenal hyperplasia. Infertility A subset of women with PCOS is infertile. Most women with PCOS ovulate intermittently. Conception may take longer than in other women, or women with PCOS may have fewer children than they had planned. In addition, the rate of miscarriage is also higher in affected women. Obesity, metabolic syndrome, and atherosclerosis Nearly half of all women with PCOS are clinically obese. A study comparing the body mass index (BMI) in American and Italian women with PCOS showed that American women had a BMI higher than that of their Italian counterparts. [39] Women with PCOS should be assessed for their cardiovascular risk by evaluating their BMI, fasting lipid and lipoprotein levels, and risk factors for metabolic syndrome. Many patients with PCOS have characteristics of metabolic syndrome; one study showed a 43% prevalence of metabolic syndrome in women with PCOS. [23] In women, metabolic syndrome is characterized by abdominal obesity (waist circumference >35 in), dyslipidemia (triglyceride level >150 mg/dL, high-density lipoprotein cholesterol [HDL-C] level < 50 mg/dL), elevated blood pressure, a proinflammatory state characterized by an elevated C-reactive protein level, and a prothrombotic state characterized by elevated plasminogen activator inhibitor-1 (PAI-1) and fibrinogen levels. Women with PCOS have a significantly higher prevalence of subclinical atherosclerosis, as evidenced by increased coronary artery calcification and carotid intima-media thickness, than women without the syndrome. Diabetes mellitus ACOG recommends screening for type 2 diabetes mellitus and impaired glucose tolerance in women with PCOS by obtaining a fasting glucose level and then a 2-hour glucose level after a 75-g glucose load. [38] Approximately 10% of women with PCOS have type 2 diabetes mellitus, and 30-40% of women with PCOS have impaired glucose tolerance by 40 years of age. Sleep apnea Many women with PCOS have obstructive sleep apnea syndrome (OSAS), which is an independent risk factor for cardiovascular disease. Ask these patients and/or their partners about excessive daytime somnolence; individuals with obstructive sleep apnea experience apnea/hypopnea episodes during sleep. [43] For women with PCOS with suspected OSAS, there should be a low threshold for referral for sleep assessment. Patients may also be screened for OSAS in the clinic using such tools as the Epworth sleepiness score. Depression and anxiety disorders International evidence-based guidelines recommend screening for depression and anxiety disorders among patients with PCOS. [1] A prospective case-control study showed that women with PCOS have significantly higher levels of psychological symptoms, including depression, anxiety, and elevated perceived stress, compared to women without PCOS eMedicine Logo