Polycystic ovary syndrome: 1 in 15 women affected worldwide and burden likely to increase

The diverse and complex female endocrine disorder polycystic ovary syndrome (PCOS), which affects 1 in 15 women worldwide, is a major economic health burden that is likely to expand together with obesity, conclude authors of a Seminar in this week’s edition of The Lancet. Dr Theresa Hickey and Prof Robert Norman, University of Adelaide, Australia, and colleagues, reviewed published literature on PCOS up to November 2006 to prepare the Seminar.

Many body systems are affected in PCOS, resulting in several health complications, including menstrual dysfunction, infertility, hirsutism (excessive body hair growth), acne, obesity, and metabolic syndrome. Principal symptoms of PCOS are polycystic ovaries shown by ultrasonography, irregular ovulation, and excessive amounts or activity of male hormones (hyperandrogenism). Type 2 diabetes is also more common in women with PCOS. Two differing definitions of PCOS, one from 1990 and the other from 2003, lead to differing statistics and consequences for studies depending on which definition is selected.

The cause of PCOS remains unknown, although both environmental and genetic factors are implicated. Research is focussing on whether the primary cause of the syndrome is due to a defect within the ovary, the hypothalamic-pituitary axis, or is primarily due to abnormal insulin activity. Obesity is a major risk factor for PCOS, and as such realistic and achievable weight loss can be sufficient to restore regular ovulation and improve fertility in obese women with this disorder.

The authors say: “Skin and hair disorders can be substantial in women with PCOS, and are physically and psychologically very damaging.” Abnormal body hair growth and acne are usually combated with oral contraceptives, which have the advantage of both regulating the menstrual cycle and providing contraception.

The connection between PCOS and infertility is discussed in detail, as is the so called “gold standard” treatment of clomifene, which simulates follicle growth and ovulation. Complications of infertility treatment for women with PCOS include multiple pregnancy after ovulation induction, ovarian hyperstimulation syndrome (which can be life-threatening) and in-vitro fertilisation cycle cancellation. For pregnant women, PCOS can cause early pregnancy loss, gestational diabetes, pregnancy-induced high blood pressure, pre-eclampsia, and a higher risk of delivery by caesarean section.

The authors conclude that the burden of PCOS is likely to expand, saying: “Future priorities in relation to PCOS include the development of evidence-based criteria for diagnosis and treatment, and determination of the natural history, cause, long-term consequences and prevention of the disorder.”

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