Clinical manifestations of polycystic ovary syndrome: a modern view

Abstract

INTRODUCTION: Polycystic ovary syndrome (PCOS) is one of the urgent problems of gynecological endocrinology. The main signs of PCOS include a violation of menstrual and/or ovulatory function and clinical and/or biochemical hyperandrogenism, as well as polycystic ovarian morphology according to the ultrasound results. PCOS leads to infertility, obesity, and cardiovascular system diseases. PCOS is an important symptom complex in the diagnosis, which directly affects the reproductive function of females, hence the percentage of fertility. This study aimed to analyze the features of clinical, laboratory, and instrumental parameters in females with a previously established PCOS diagnosis referred for surgical treatment. The obtained results were studied from the point of view of the clinical guidelines of the American Society for Reproductive Medicine and the European Society of Human Reproduction and Embryology (2003), International PCOS Network (2018), and the Ministry of Health of the Russian Federation (2021).

MATERIALS AND METHODS: The study included 121 females who were admitted to hospitals in Moscow for surgical treatment. Among the gynecological surgical hospitals, the following medical institutions were allocated: the city clinical hospital, the research center, and the commercial clinic we conditionally divided into three levels.

The city clinical hospital had 54 females (1^st group) aged 21–37 years, the research center with 48 females (2^nd group) aged 22–42 years, and the commercial clinic with 19 females (3^rd group) aged 25–41. Before the ovarian surgery for PCOS, all patients underwent an additional examination, including the collection of anamnesis, particularly, features of menstrual and generative function, anthropometric indicators, body weight, and height study. Based on these parameters, the body mass index (BMI) was calculated, the clinical signs of hyperandrogenism (acne, excessive hair growth on the body and face, and the degree of hirsutism) were assessed, and the hormonal profile was determined to detect biochemical hyperandrogenism (free testosterone). Additionally, the level of glucose and insulin in the blood plasma was determined in all patients, and a pelvic ultrasound examination (ultrasound) was performed.

RESULTS: Menstrual irregularities were revealed, of which complaints were presented by a total of 49.5% of patients. The results of the preliminary selection of patients with PCOS for surgical treatment revealed that 108 (89.2%) had primary and secondary infertility, of whom 64 (52.9%) had BMI within the normative values, 29 (23.9%) were overweight, and 25 (20.6%) were obese. Clinical manifestations of hyperandrogenism were present in 61 (50.4%) patients included in the study. The level of free testosterone above the normative values (>2.85 pg/ml) was diagnosed only in 9 (7.4%) patients out of 121 who are included in the study. Additionally, this parameter was within the upper limit of the norm (average value of 2.78±0.36 pg/ml) in 112 females but was combined with clinical manifestations of hyperandrogenism. Black acanthosis was noted in 6 (5.0%) patients with free testosterone levels in 3.01–3.64 pg/ml. Increased blood glucose levels were combined with obesity in 3 (5.5%) patients of 1^st group and 1 (2.1%) in 2^nd group. Insulin levels significantly exceeded the upper limit of the norm in 6 (5.0%) patients. The ultrasound result in all patients (n=121) revealed the presence of echographic signs of PCOS in PCOS was confirmed by ultrasound in 54 females in 1^st group, 48 females in 2^nd group, and 19 females in 3^rd group.

CONCLUSION: Our results suggest an unreasonably broad interpretation of PCOS diagnosis. Therefore, PCOS diagnosis should be primarily remembered as a diagnosis-exception. Only repeated, extended, thorough, and comprehensive examination of patients with a presumed PCOS diagnosis will allow you to better navigate the individual characteristics of patients and offer adequate methods for correcting the symptom complex to improve the overall health, fertility, and quality of life.

Keywords

polycystic ovary syndrome / menstrual disorders / hyperandrogenism / infertility / body mass index / insulin / free testosterone / ultrasound signs of polycystic ovaries

References

[1] Kurzrocka R, Cohen PhR. Polycystic ovary syndrome in men: Stein–Leventhal syndrome revisited. Medical Hypotheses. 2007;68(3):480–483. doi: 10.1016/j.mehy.2006.03.057

[2] Kurzrocka R., Cohen Ph.R. Polycystic ovary syndrome in men: Stein–Leventhal syndrome revisited // Medical Hypotheses. 2007. Vol. 68, Iss. 3. P. 480–483. doi: 10.1016/j.mehy.2006.03.057

[3] Umarova SS, Nabiyeva FS, Ibragimova NS. Early diagnostics of echinococcosis in children. European research: innovation in science, education and technology. P. 81–83. January 9–10, 2020; London, UK. Available from: https://internationalconference.ru/images/PDF/2020/59/EUROPEAN-RESEARCH-1-59-ISBN-A.pdf

[4] Umarova S.S., Nabiyeva F.S., Ibragimova N.S. Early diagnostics of echinococcosis in children // European Research: Innovation in Science, Education and Technology. P. 81–83. January 9–10, 2020; London, UK. Режим доступа: https://internationalconference.ru/images/PDF/2020/59/EUROPEAN-RESEARCH-1-59-ISBN-A.pdf

[5] Carmina E, Guastella E, Longo RA. Advances in the Diagnosis and Treatment of PCOS. Curr Pharm Des. 2016;22(36):5508–5514. doi: 10.2174/1381612822666160719105808

[6] Carmina E., Guastella E., Longo R.A. Advances in the Diagnosis and Treatment of PCOS // Curr Pharm Des. 2016. Vol. 22, N 36. P. 5508–5514. doi: 10.2174/1381612822666160719105808

[7] Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19(1):41–47. doi: 10.1093/humrep/deh098

[8] Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS) // Hum Reprod. 2004. Vol. 19, N 1. P. 41–47. doi: 10.1093/humrep/deh098

[9] Teede HJ, Misso ML, Costello MF, et al.; International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril. 2018;110(3):364–379. doi: 10.1016/j.fertnstert.2018.05.004

[10] Teede H.J., Misso M.L., Costello M.F., et al.; International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome // Fertil Steril. 2018. Vol. 110, N 3. P. 364–379. doi: 10.1016/j.fertnstert.2018.05.004

[11] Neven ACH, Laven J, Teede HJ, Boyle JA. A Summary on Polycystic Ovary Syndrome: Diagnostic Criteria, Prevalence, Clinical Manifestations, and Management According to the Latest International Guidelines. Semin Reprod Med. 2018;36(1):5–12. doi: 10.1055/s-0038-1668085

[12] Neven A.C.H., Laven J., Teede H.J., Boyle J.A. A Summary on Polycystic Ovary Syndrome: Diagnostic Criteria, Prevalence, Clinical Manifestations, and Management According to the Latest International Guidelines // Semin Reprod Med. 2018. Vol. 36, N 1. P. 5–12. doi: 10.1055/s-0038-1668085

[13] Suturina LV. Polycystic ovarian syndrome in the 21st century. Obstetrics and Gynecology. 2017;(3):86–92. (In Russ).

[14] Сутурина Л.В. Синдром поликистозных яичников в XXI веке //Акушерство и гинекология. Новости. Мнения. Обучение. 2017. № 3. С. 86–91.

[15] Russian Society of Obstetricians and Gynecologists, Russian Association of Endocrinologists. Polycystic ovary syndrome. Clinical recommendations. Ministry of Health of the Russian Federation; 2021. (In Russ).

[16] Российское общество акушеров-гинекологов, Российская ассоциация эндокринологов. Синдром поликистозных яичников. Клинические рекомендации. Министерство здравоохранения Российской Федерации, 2021.

[17] Tannus S, Tan J, Son WY, Dahan MH. Prevalence, clinical characteristics, and reproductive outcomes of polycystic ovary syndrome in older women referred for tertiary fertility care. Arch Gynecol Obstet. 2018;297(4):1037–1042. doi: 10.1007/s00404-017-4642-z

[18] Tannus S., Tan J., Son W.Y., Dahan M.H. Prevalence, clinical characteristics, and reproductive outcomes of polycystic ovary syndrome in older women referred for tertiary fertility care // Arch Gynecol Obstet. 2018. Vol. 297, N 4. P. 1037–1042. doi: 10.1007/s00404-017-4642-z

[19] Nazarenko TA, Sotnikova EI, Durinyan ER. Principles and schemes of ovulation stimulation in infertility caused by disorders of the hypothalamic-pituitary system. Obstetrics and Gynecology. 1996;(5):46–50. (In Russ).

[20] Назаренко Т.А., Сотникова Е.И., Дуринян Э.Р. Принципы и схемы стимуляции овуляции при бесплодии, обусловленном нарушениями функции гипоталамо-гипофизарной системы // Акушерство и гинекология. 1996. № 5. С. 46–50.

[21] Baillargeon JP, Iuorno MJ, Nestler JE. Insulin sensitizers for polycystic ovary syndrome. Clin Obstet Gynecol. 2003;46(2):325–340. doi: 10.1097/00003081-200306000-00011

[22] Baillargeon J.P., Iuorno M.J., Nestler J.E. Insulin sensitizers for polycystic ovary syndrome // Clin Obstet Gynecol. 2003. Vol. 46, N 2. P. 325–340. doi: 10.1097/00003081-200306000-00011

[23] Catrall FR, Healy DL. Long-term metabolic, cardiovascular and neoplastic risks with polycystic ovary syndrome. Best Pract Res Clin Obstet Gynecol. 2004;18(5):803–812. doi: 10.1016/j.bpobgyn.2004.05.005

[24] Catrall F.R., Healy D.L. Long-term metabolic, cardiovascular and neoplastic risks with polycystic ovary syndrome // Best Pract Res Clin Obstet Gynecol. 2004. Vol. 18, N 5. P. 803–812. doi: 10.1016/j.bpobgyn.2004.05.005

[25] Klein DA, Paradise SL, Reeder RM. Amenorrhea: A Systematic Approach to Diagnosis and Management. Am Fam Physician. 2019;100(1):39–48.

[26] Klein D.A., Paradise S.L., Reeder R.M. Amenorrhea: A Systematic Approach to Diagnosis and Management //Am Fam Physician. 2019. Vol. 100, N 1. P. 39–48.

[27] Hickey M, Balen A. Menstrual disorders in adolescence: investigation and management. Hum Reprod Update. 2003;9(5):493–504. doi: 10.1093/humupd/dmg038

[28] Hickey M., Balen A. Menstrual disorders in adolescence: investigation and management // Hum Reprod Update. 2003. Vol. 9, N 5. P. 493–504. doi: 10.1093/humupd/dmg038

[29] Chittenden BG, Fullerton G, Maheshwari A., et al. Polycystic ovary syndrome and the risk of gynaecological cancer: a systematic review. Reprod Biomed Online. 2009;19(3):398–405. doi: 10.1016/s1472-6483(10)60175-7

[30] Chittenden B.G., Fullerton G., Maheshwari A., et al. Polycystic ovary syndrome and the risk of gynaecological cancer: a systematic review // Reprod Biomed Online. 2009. Vol. 19, N 3. P. 398–405. doi: 10.1016/s1472-6483(10)60175-7

[31] World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894: i–xii, 1–253.

[32] World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation // World Health Organ Tech Rep Ser. 2000. Vol. 894. P. i–xii, 1–253.

[33] Lause M, Kamboj A, Fernandez Faith E. Dermatologic manifestations of endocrine disorders. Transl Pediatr. 2017;6(4):300–312. doi: 10.21037/tp.2017.09.08

[34] Lause M., Kamboj A., Fernandez Faith E. Dermatologic manifestations of endocrine disorders // Transl Pediatr. 2017. Vol. 6, N 4. P. 300–312. doi: 10.21037/tp.2017.09.08

[35] Moran LJ, Misso ML, Wild RA, Norman RJ. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2010;16(4):347–363. doi: 10.1093/humupd/dmq001

[36] Moran L.J., Misso M.L., Wild R.A., Norman R.J. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis // Hum Reprod Update. 2010. Vol. 16, N 4. P. 347–363. doi: 10.1093/humupd/dmq001

[37] Wild RA, Carmina E, Diamanti-Kandarakis E, et al. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab. 2010;95(5):2038–2049. doi: 10.1210/jc.2009-2724

[38] Wild R.A., Carmina E., Diamanti-Kandarakis E., et al. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society // J Clin Endocrinol Metab. 2010. Vol. 95, N 5. P. 2038–2049. doi: 10.1210/jc.2009-2724

[39] Andersen M, Glintborg D. Diagnosis and follow-up of type 2 diabetes in women with PCOS: a role for OGTT? Eur J Endocrinol. 2018;179(3):D1–D14. doi: 10.1530/EJE-18-0237

[40] Andersen M., Glintborg D. Diagnosis and follow-up of type 2 diabetes in women with PCOS: a role for OGTT? // Eur J Endocrinol. 2018. Vol. 179, N 3. P. D1–D14. doi: 10.1530/EJE-18-0237

RIGHTS & PERMISSIONS

Sosnova E.A., Gracheva T.S., Pesegova S.V.