Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls

AbstractPolycystic ovary syndrome (PCOS) is a heterogeneous disorder characterized by hyperandrogenism and chronic anovulation. Depending on diagnostic criteria, 6% to 20% of reproductive aged women are affected. Symptoms of PCOS arise during the early pubertal years. Both normal female pubertal development and PCOS are characterized by irregular menstrual cycles, anovulation, and acne. Owing to the complicated interwoven pathophysiology, discerning the inciting causes is challenging. Most available clinical data communicate findings and outcomes in adult women. Whereas the Rotterdam criteria are accepted for adult women, different diagnostic criteria for PCOS in adolescent girls have been delineated. Diagnostic features for adolescent girls are menstrual irregularity, clinical hyperandrogenism, and/or hyperandrogenemia. Pelvic ultrasound findings are not needed for the diagnosis of PCOS in adolescent girls. Even before definitive diagnosis of PCOS, adolescents with clinical signs of androgen excess and oligomenorrhea/amenorrhea, features of PCOS, can be regarded as being “at risk for PCOS.” Management of both those at risk for PCOS and those with a confirmed PCOS diagnosis includes education, healthy lifestyle interventions, and therapeutic interventions targeting their symptoms. Interventions can include metformin, combined oral contraceptive pills, spironolactone, and local treatments for hirsutism and acne. In addition to ascertaining for associated comorbidities, management should also include regular follow-up visits and planned transition to adult care providers. Comprehensive knowledge regarding the pathogenesis of PCOS will enable earlier identification of girls with high propensity to develop PCOS. Timely implementation of individualized therapeutic interventions will improve overall management of PCOS during adolescence, prevent associated comorbidities, and improve quality of life.

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POLYCYSTIC OVARY SYNDROME (ARTAVA KSHAYA): GENETIC AND NONGENETIC ETIOPATHOLOGY AND DIAGNOSIS: AN AYURVEDIC NARRATIVE REVIEW

International Journal of Research in Ayurveda and Pharmacy ◽

10.7897/2277-4343.1204127 ◽

2021 ◽

Vol 12 (4) ◽

pp. 161-165

Author(s):

Rakhi Sahu ◽

Awanish Jaiswal ◽

Anurag Pandey ◽

Ramanand Tiwari

Keyword(s):

Polycystic Ovary Syndrome ◽

Adolescent Girls ◽

Polycystic Ovary ◽

Clinical Manifestations ◽

Signs And Symptoms ◽

Reproductive Age ◽

Therapeutic Interventions ◽

Adult Women ◽

Ovary Syndrome ◽

Diagnostic Features

Polycystic ovary syndrome (PCOS) is a common heterogeneous endocrine disorder and about 6% to 20% of women are affected in their reproductive age. Clinical manifestations arise during the early pubertal years, and it’s characterized by irregular menstrual cycles, anovulation, acne, Oligomenorrhea/Amenorrhea, Hirsutism, and frequently infertility. Despite recent advancements in technologies in the scientific world pathophysiology of PCOS is still challenging and initially, most available clinical data communicated findings and outcomes is only in adult women. After that, the Rotterdam criteria are most accepted for adult women and adolescent girls. The diagnostic features for adolescent girls are based on classical tried e.g., menstrual irregularity, clinical hyperandrogenism, and/or hyperandrogenemia. Whereas findings of pelvic ultrasound are significant in adult women but least significant in adolescent girls. Mental health disorders including depression, anxiety, bipolar disorder also occur more frequently in both adolescent girls and women with PCOS. Ayurveda gives prime importance to maintain the healthiness of women and literature provides many references related to signs and symptoms of PCOS in the same way and hence PCOS correlated with Artava kshaya. This review aims to display comprehensive knowledge regarding the pathogenesis of PCOS and Artava Kshaya. The efforts made here will enable earlier identification of girls and adult women with a high propensity to develop PCOS. The timely implementation of individualized therapeutic interventions will improve the overall management of PCOS, prevent associated comorbidities, and improve quality of life. This review emphasizes the various etiological aspects and screening recommendations currently in use to prevent and manages PCOS.

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Promotion of reproductive and metabolic health - current trends in the treatment and prevention of polycystic ovary syndrome in different periods of life

Kwartalnik Naukowy Fides et Ratio ◽

10.34766/fetr.v47i3.895 ◽

2021 ◽

Vol 47 (3) ◽

pp. 130-149

Author(s):

Joanna Smyczyńska

Keyword(s):

Insulin Resistance ◽

Polycystic Ovary Syndrome ◽

Diagnostic Criteria ◽

Polycystic Ovary ◽

Hormonal Contraception ◽

Reproductive Age ◽

Metabolic Effects ◽

Adult Women ◽

Ovary Syndrome ◽

Treatment And Prevention

Polycystic ovary syndrome (PCOS) is one of the most common hormonal disorders and causes of infertility in women in reproductive age. Diagnostic criteria of PCOS in adult women include: ovulation disorders, hyperandrogenism and polycystic ovaries. According to most recommendations, 2 out of these 3 criteria are confirm the diagnosis of PCOS. In girls during puberty and in the first years after menarche, different diagnostic criteria of menstrual disorders should be taken into account (variable length of menstrual cycles, monophasic cycles) and the limited usefulness of ultrasound examination for PCOS diagnosis within 8 years after menarche. Fairly extensive differential diagnosis is also necessary, especially – exclusion of adrenal hyperandrogenism. Moreover, the diagnostic criteria of PCOS do not take into account the metabolic disorders found in most patients (obesity, insulin resistance, type 2 diabetes), which should be diagnosed as early as possible and treated appropriately. This is especially true for teenagers, in whom the unequivocal diagnosis of PCOS or its exclusion may be very difficult. Current recommendations regard hormonal contraception as the first-line therapy in PCOS, in both adult women and adolescents. Together with its beneficial effect on the reduction of hyperandrogenism and obtaining regular bleeding (which in fact are not menstruations), the unfavorable metabolic effects of hormonal contraception are emphasized, as well as the inadequacy of its use if it is expected to achieve or restore ovulation and fertility. The latest reports indicate the legitimacy of treatment aimed at correcting disorders of carbohydrate metabolism and its greater effectiveness compared to the use of oral contraceptives in both adult women and girls with PCOS. In the pharmacotherapy of insulin resistance, metformin is of fundamental importance, the use of pioglitazone, GLP-1 receptor agonists or inositols is also proposed. Adequate lifestyle and dietary modification are of major importance in the treatment and prevention of PCOS. The mechanisms of "inheritance" of PCOS and insulin resistance with the participation of epigenetic modifications are still better understood, taking into account the effects of exposure to androgen excess in utero, intrauterine growth retardation, and maternal obesity and hyperalimentation. This creates new possibilities for PCOS prophylaxis.

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Spectrum of metabolic dysfunction in relationship with hyperandrogenemia in obese adolescent girls with polycystic ovary syndrome

Acta Endocrinologica ◽

10.1530/eje-10-0205 ◽

2010 ◽

Vol 162 (6) ◽

pp. 1093-1099 ◽

Cited By ~ 27

Author(s):

Ramin Alemzadeh ◽

Jessica Kichler ◽

Mariaelena Calhoun

Keyword(s):

Insulin Resistance ◽

At Risk ◽

Polycystic Ovary Syndrome ◽

Adolescent Girls ◽

Polycystic Ovary ◽

Assessment Model ◽

Metabolic Dysfunction ◽

Ovary Syndrome ◽

Obese Adolescent ◽

Hs Crp

ObjectivePolycystic ovary syndrome (PCOS) in adult women is associated with increased risk of metabolic syndrome (MS) and atherosclerosis. We evaluated the spectrum of metabolic dysfunction in relationship with hyperandrogenemia (HA) in adolescent girls with PCOS.Materials and methodsOvulatory function, acne, hirsutism (HS), body mass index (BMI), body composition, fasting lipids, glucose, insulin, free testosterone (FT), high-sensitivity C-reactive protein (hs-CRP), and HbA1c were evaluated in 103 girls. The homeostatic assessment model equations (HOMA-IR and HOMA-%B) were used for determination of insulin resistance and β-cell function respectively.ResultsThe oligo-ovulation (Oligo)+HA+HS (n=44), Oligo+HA (n=28), and Oligo+HS (n=31) phenotypes had similar BMI. However, hyperandrogenemic phenotypes had higher prevalence of acanthosis nigricans (AN) and acne (P<0.01) and higher insulin, HOMA-IR, HOMA-%B, HbA1c, and hs-CRP levels than Oligo+HS group (P<0.01). Serum FT was correlated with HOMA-IR (r=0.38,P<0.01), HOMA-%B (r=0.49,P<0.01), hs-CRP (r=0.42,P<0.01), AN (r=0.39,P<0.01), and HbA1c (r=0.27,P<0.01). Furthermore, 34% of girls met diagnostic criteria for MS displaying higher BMI, FT, HOMA-%B, HOMA-IR, hs-CRP, and HbA1c than subjects without MS (P<0.01). Using combined HOMA-IR≥4.0 and hs-CRP>3.0 cut-off values, 71.4% of MS versus 23.5% non-MS group were considered at risk of diabetes and atherosclerosis (P<0.0001).ConclusionsHyperandrogenemic PCOS phenotypes have greatest degree of insulin resistance and inflammation. The use of insulin resistance and inflammatory markers may help identify adolescent girls with PCOS at risk of cardiometabolic syndrome.

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Diagnostic difficulties of polycystic ovarian syndrome in adolescent girls

Orvosi Hetilap ◽

10.1556/oh.2013.29527 ◽

2013 ◽

Vol 154 (4) ◽

pp. 136-142 ◽

Cited By ~ 1

Author(s):

László Ságodi ◽

László Barkai

Keyword(s):

Polycystic Ovary Syndrome ◽

Adolescent Girls ◽

Polycystic Ovary ◽

Reproductive Age ◽

Adult Women ◽

Ovary Syndrome ◽

Female Population ◽

Ovulatory Dysfunction ◽

Diagnostic Difficulties ◽

Diagnostic Work

Polycystic ovary syndrome is a heterogeneous disorder characterized by chronic ovulatory dysfunction and hyperandrogenism. It occurs in 6–8% of the female population in the reproductive age. The syndrome may be associated with various metabolic disorders which may impair the quality of life and life expectancy of patients. The diagnosis in adults is usually established by the presence of three criteria. Polycystic ovary syndrome can be also identified in adolescent girls. Although the clinical, hormonal and metabolic features are similar to those found in adult women, it may be difficult to distinguish normal adolescents from those with polycystic ovary syndrome. Irregular menstruation, anovulatory cycles, and acne are not uncommon in adolescents, and polycystic ovary syndrome may mimic physiological anovulation in adolescents. There is a high probability of polycystic ovary syndrome if anovulatory cycles persist for more than 2 years. The diagnosis of polycystic ovary syndrome in adolescents may require a unique set of criteria, however, there are no generally accepted recommendations for the diagnostic work-up. The authors propose that hyperandrogenemia is often the most reliable finding in this age group, and it may be prudent to define adolescent polycystic ovary syndrome according to the Rotterdam consensus criteria. Obesity in adolescent girls may increase the severity of symptoms of polycystic ovary syndrome and this underlines the importance of early diagnosis and treatment. Orv. Hetil., 2013, 154, 136–142.

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17-Hydroxyprogesterone responses to human chorionic gonadotropin are not associated with serum anti-Mullerian hormone levels among adolescent girls with polycystic ovary syndrome

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2015-0461 ◽

2016 ◽

Vol 29 (7) ◽

Cited By ~ 1

Author(s):

Jingwen Hou ◽

Heidi Cook-Andersen ◽

H. Irene Su ◽

Rana Shayya ◽

Kevin H. Maas ◽

...

Keyword(s):

Polycystic Ovary Syndrome ◽

Adolescent Girls ◽

Chorionic Gonadotropin ◽

Human Chorionic Gonadotropin ◽

Polycystic Ovary ◽

Adult Women ◽

Ovary Syndrome ◽

17 Hydroxyprogesterone ◽

A Prospective Study ◽

Normal Controls

AbstractIn adult women with polycystic ovary syndrome (PCOS) 17-OHP responses to human chorionic gonadotropin (hCG) stimulation are highly variable and inversely correlated with serum anti-Mullerian hormone (AMH) levels. The objective of this study was to determine whether adolescents with PCOS exhibit similar variable 17-OHP responsiveness to hCG and whether these responses are correlated to AMH levels.In a prospective study, adolescent PCOS (n=14) and normal controls (n=10) received 25 μg of hCG, intravenously. Blood samples were obtained before and 24 h afterwards for measurement of 17-OHP and basal AMH.Variable 17-OHP responses to hCG were observed among PCOS girls similar to that observed in adults. There was no correlation between AMH and 17-OHP responses to hCG.Among adult and adolescent individuals with PCOS variable 17-OHP production appears to be characteristic of the disorder. In adolescent PCOS, 17-OHP responsiveness to hCG is not correlated to AMH.

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Is polycystic ovary syndrome appropriately diagnosed by obstetricians and gynaecologists across China: a nationwide survey

Journal of Ovarian Research ◽

10.1186/s13048-021-00780-6 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Deng Yan ◽

Wang Yan-Fang ◽

Zhu Shi-Yang ◽

Ma Rui-Lin ◽

Ding Xue-Song ◽

...

Keyword(s):

Polycystic Ovary Syndrome ◽

Diagnostic Criteria ◽

Polycystic Ovary ◽

Final Analysis ◽

Nationwide Survey ◽

Care Quality ◽

Cross Sectional Survey ◽

Ovary Syndrome ◽

Cross Sectional ◽

Rotterdam Criteria

Abstract Background To describe the diagnostic criteria used and their application accuracy in the practice of polycystic ovary syndrome (PCOS) caring among obstetricians and gynaecologists across China. Methods This was an Online cross-sectional survey of Obstetricians and gynecologists involved in PCOS caring conducted via the largest continuing education platform of obstetrics and gynecology across China from September 2019 to November 2019. Results A total of 2,328 respondents were eligible for the final analysis. Of these, 94.5 % were general obstetricians and gynaecologists (Ge-ObGyn), and 5.5 % were reproductive endocrinologists (Re-ObGyn). Overall, the most frequently used criteria were the Androgen Excess and Polycystic Ovary Syndrome Society (AE-PCOS) criteria (48.2 %), followed by the Rotterdam criteria (35.7 %) and NIH criteria (12.1 %). Of the respondents, 31.3 % used their diagnostic criteria in their clinical practice. More respondents who chose the Rotterdam criteria could accurately apply the diagnostic criteria than those who chose the AE-PCOS criteria (41.2 % vs. 32.1 %, P < 0.001). Compared with Ge-ObGyn, Re-ObGyn were less likely to use the AE-PCOS criteria (adjusted odds ratio, 0.513; 95 % CI, 0.328–0.802; P < 0.05) and 1.492 times more likely to accurately use their criteria (95 % CI, 1.014–2.196; P < 0.05). Conclusions Less than one-third of obstetricians and gynaecologists across China could accurately use the diagnostic criteria they choose to diagnose PCOS. There is an urgent need to train obstetricians and gynaecologists on PCOS diagnosis in an effort to improve the medical care quality of patients with PCOS.

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Ovarian imaging by magnetic resonance in obese adolescent girls with polycystic ovary syndrome: a pilot study

Fertility and Sterility ◽

10.1016/j.fertnstert.2005.04.039 ◽

2005 ◽

Vol 84 (4) ◽

pp. 985-995 ◽

Cited By ~ 36

Author(s):

R YOO ◽

C SIRLIN ◽

M GOTTSCHALK ◽

R CHANG

Keyword(s):

Pilot Study ◽

Magnetic Resonance ◽

Polycystic Ovary Syndrome ◽

Adolescent Girls ◽

Polycystic Ovary ◽

Ovary Syndrome ◽

Obese Adolescent

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Understanding and supporting women with polycystic ovary syndrome: a qualitative study in an ethnically diverse UK sample

Endocrine Connections ◽

10.1530/ec-17-0053 ◽

2017 ◽

Vol 6 (5) ◽

pp. 323-330 ◽

Cited By ~ 8

Author(s):

Michelle Hadjiconstantinou ◽

Hamidreza Mani ◽

Naina Patel ◽

Miles Levy ◽

Melanie Davies ◽

...

Keyword(s):

Psychological Distress ◽

Polycystic Ovary Syndrome ◽

Health Care Providers ◽

Polycystic Ovary ◽

Ethnically Diverse ◽

Comparative Approach ◽

Care Providers ◽

Structured Interviews ◽

Ovary Syndrome ◽

Group Education

Objective Polycystic ovary syndrome (PCOS) is a lifelong condition. Its symptoms have been linked with psychological consequences, but less attention has been given to the daily implications of living with PCOS. We aimed to explore women’s experiences living with PCOS, and the potential acceptability of group education sessions for this target group. Methods Women with PCOS were recruited from an ethnically diverse UK community. Twelve semi-structured interviews were conducted. Analysis was underpinned by the constant comparative approach and involved the identification and exploration of key themes. Results Participants reported a range of symptoms linked with PCOS, including problems relating to menstruation and weight difficulties. Hirsutism was reported as the most distressing symptom. Emergent themes included perceptions about symptoms and delays in receiving a diagnosis; psychological distress; practical implications of living with the condition; coping with PCOS and perceived support needs. Some findings were specific to cultural backgrounds. Participants were supportive of the idea of group education for women with PCOS and suggested a need to provide education within the community and health care providers. Discussion Women with PCOS experience high psychological distress and difficulties with coping with their condition. Suggested strategies to reduce the negative psychological impact include education at various levels.

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The Molecular-Genetic Basis of Functional Hyperandrogenism and the Polycystic Ovary Syndrome

Endocrine Reviews ◽

10.1210/er.2004-0004 ◽

2005 ◽

Vol 26 (2) ◽

pp. 251-282 ◽

Cited By ~ 231

Author(s):

Héctor F. Escobar-Morreale ◽

Manuel Luque-Ramírez ◽

José L. San Millán

Keyword(s):

Environmental Factors ◽

Polycystic Ovary Syndrome ◽

Diagnostic Criteria ◽

Genetic Basis ◽

Polycystic Ovary ◽

Molecular Genetic ◽

Ovary Syndrome ◽

The Metabolic Syndrome ◽

Molecular Genetic Basis ◽

Functional Hyperandrogenism

The genetic mechanisms underlying functional hyperandrogenism and the polycystic ovary syndrome (PCOS) remain largely unknown. Given the large number of genetic variants found in association with these disorders, the emerging picture is that of a complex multigenic trait in which environmental influences play an important role in the expression of the hyperandrogenic phenotype. Among others, genomic variants in genes related to the regulation of androgen biosynthesis and function, insulin resistance, and the metabolic syndrome, and proinflammatory genotypes may be involved in the genetic predisposition to functional hyperandrogenism and PCOS. The elucidation of the molecular genetic basis of these disorders has been burdened by the heterogeneity in the diagnostic criteria used to define PCOS, the limited sample size of the studies conducted to date, and the lack of precision in the identification of ethnic and environmental factors that trigger the development of hyperandrogenic disorders. Progress in this area requires adequately sized multicenter collaborative studies after standardization of the diagnostic criteria used to classify hyperandrogenic patients, in whom modifying environmental factors such as ethnicity, diet, and lifestyle are identified with precision. In addition to classic molecular genetic techniques such as linkage analysis in the form of a whole-genome scan and large case-control studies, promising genomic and proteomic approaches will be paramount to our understanding of the pathogenesis of functional hyperandrogenism and PCOS, allowing a more precise prevention, diagnosis, and treatment of these prevalent disorders.

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