A group of experts have highlighted the need to update current diagnostic criteria and to improve the monitoring of PCOS
A team of specialists from various hospitals who make up the Reproductive Endocrinology Unit of the Spanish Fertility Society conducted an extensive review of the available scientific literature on the potential impact of polycystic ovary syndrome (PCOS) on health from early life to old age. While the clinical manifestations of this syndrome generally emerge during adolescence, it is thought that PCOS may begin in utero, during foetal development.
The authors, who include Dr. Francisca Martínez from Dexeus Mujer, point out that the criteria on which the diagnosis is based are grouped into different classifications, and that up to 16 different phenotypes have been described, with different clinical manifestations at the metabolic and reproductive level. However, some of these classification criteria, such as those listed in the Rotterdam consensus (ESHRE/ASRM) are more than ten years old and there is no global consensus, so that they should be updated. On the other hand, the authors have highlighted that the criteria for defining infrequent ovulation are inadequate, and that a new biological definition of hyperandrogenism (excess levels of androgens, i.e. male hormones) should be established. In addition, the characterisation of polycystic ovarian morphology has been rendered obsolete by new ultrasound equipment, and new markers of PCOS have recently emerged such as blood levels of Anti-Müllerian hormone (AMH).
The study also suggests that the prevalence of PCOS in women of childbearing age ranges from 1-9% depending on the geographical area, which could be due to genetic and environmental factors. It is also thought that the presence of certain environmental factors during critical stages of foetal development, such as a restrictive maternal diet or placental insufficiency, could increase the production of glucocorticoids and increase the predisposition to develop the syndrome.
Although the clinical manifestations of this syndrome and the disorders it causes vary throughout the different stages of life, the authors suggest that menstrual and fertility problems often cause metabolic complications in later life, since the insulin resistance commonly associated with PCOS increases the risk of developing type 2 diabetes and obesity, which in turn promotes the development of cardiovascular disorders. The risk of endometrial cancer is also increased.
Therefore, once the diagnosis has been confirmed, close monitoring of these patients is essential, with regular blood pressure, body mass index and lipid profile determinations, and glucose tolerance tests. Patients also need to be counselled on the potential associated risks.
This extensive review led to the conclusion that, for all these reasons, accurate diagnosis is essential, especially at the extremes of reproductive age. The diagnostic procedure should take into account that there are different phenotypes, as each case may differ in terms of treatment requirements and clinical course.
In general, the adoption of a healthy lifestyle is the first step recommended when treating PCOS, especially in cases where the syndrome is accompanied by excess weight. Drug treatment may help to control the clinical manifestations associated with the different stages of PCOS (hirsutism in adolescence, and fertility problems, metabolic disorders and increased risk of certain cancers in adulthood). Nevertheless, the authors stress that advances in the investigation of the disorder are likely to include an analysis of the different phenotypes as completely separate entities. The findings of the study were published in the Journal of Assisted Reproduction and Genetics.
Polycystic ovary syndrome throughout a woman's life
Bellver J, Rodríguez-Tabernero L, Robles A, Muñoz E, Martínez F, Landeras J, García-Velasco J, Fontes J, Álvarez M, Álvarez C, Acevedo B; Group of interest in Reproductive Endocrinology (GIER) of the Spanish Fertility Society (SEF).
J Assist Reprod Genet. 2017 Sep 27. doi: 10.1007/s10815-017-1047-7