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Cited by 528Ovarian function and disordersEndometriosis Research and TreatmentGenetic and Kidney Cyst Diseases

Polycystic Ovary Syndrome (PCOS): Arguably the Most Common Endocrinopathy Is Associated with Significant Morbidity in Women

Carmina, Enrico, Lobo, Rogerio A.·1999·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jcem.84.6.5803
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Abstract

Women’s health is about the prevention, screening, diagnosis, and treatment of disorders that are unique to women. Polycystic ovary syndrome (PCOS) is extremely prevalent and probably constitutes the most frequently encountered endocrinopathy in women of reproductive age. Primary care providers do not commonly appreciate that the syndrome is associated with significant morbidity in terms of both reproductive and nonreproductive events. Having the disorder may significantly impact the quality of life of women during the reproductive years, and it contributes to morbidity and mortality by the time of menopause. A cohort of women with PCOS who were followed for many years after wedge resection (1) revealed several important findings by the time they reached the age of menopause. Their symptoms of PCOS had persisted over this time, they had a later menopause, and they had experienced a higher hysterectomy rate. Most importantly, there was a high prevalence of diabetes (16%) and hypertension (40%). A uniform definition of PCOS does not exist, in large part because of its diverse and heterogeneous nature. It is clear to us, however, that the disorder is an endocrinopathy, and that it should be referred to as PCOS, a syndrome, rather than a disease (2). At a meeting held at the National Institutes of Health 10 years ago, there was no consensus but a general agreement that hyperandrogenism and chronic anovulation are the principal facets of the syndrome and that once other disorders (CAH, tumors) were ruled out, the diagnosis of PCOS may be presumed. In the literature, this general definition is quoted as the“ NIH Consensus Statement.” Indeed, this was not a consensus conference, and there was no consensus. For the purpose of these comments we refer to PCOS using this most widely accepted definition, and we wish to bring attention to the fact that the diagnosis carries with it significant health risks for women. PCOS is extremely prevalent and is estimated to be present in 5–7% of reproductive-age women if we consider the diagnosis to be based on hyperandrogenism and anovulation (3, 4). However, the spectrum of the syndrome is wider still. We have recently became convinced that there is a mild form of PCOS that includes women who have hyperandrogenism and polycystic ovaries but who’s ovulatory function is maintained (5). However, it is clear that the syndrome is milder and the hyperandrogenism is not as pronounced. These women have many of the same risks as women with more classic PCOS, which will be described below. While PCOS occurs in at least 5% of the population, the isolated finding of polycystic-appearing ovaries (PAO), which meets the classic ultrasonographic criteria, occurs in 16–25% of the normal population (6). PAO or PCO (referring only to the ovarian morphology) is known to occur in hypothalamic amenorrhea and in CAH, where its prevalence is virtually 100% (7). Normal ovulatory women with PAO cannot be considered to have PCOS although many clinicians have based the diagnosis on ultrasound findings. Nevertheless, it is curious that there is this high prevalence of PAO in the normal population, and yet there is a much smaller percentage of women who have PCOS. We have formulated a hypothesis that relates the polycystic ovary (PAO/PCO) to PCOS. It is known that PAOs may appear in childhood before any hormonal changes occur at puberty, and they probably arise from genetic and/or environmental influences. We have proposed that various “insults” need to come into play after puberty for women with PAO to develop PCOS (8). Usually more than one factor may be involved, and the list of these “insults” is long (for instance: insulin resistance, obesity, stress, and dopaminergic dysregulation). Simultaneously, various individual adaptive or compensatory mechanisms are probably opposing these insults, either to attenuate the expression of PCOS, or to prevent its development altogether. Thus, these adaptive factors may allow a woman never to develop PCOS despite having PAO, or to develop some form of the syndrome later than usual in reproductive life. With our hypothesis, while PCOS is defined by characteristic findings, a larger group of women with PAO are susceptible to developing the syndrome as well. Thus, these women may also be subject to the increased morbidity described below. Indeed, we have demonstrated that some normal women with PAO may have subtle metabolic abnormalities. The majority of women with PCOS have anovulation. With this comes infertility as well as problems of dysfunctional bleeding. Chronic unopposed estrogen leads to endometrial hyperplasia and, potentially, to cancer, as will be discussed below. Heavy persistent bleeding often leads to anemia. Infertility due to anovulation may be treated effectively but may not be a simple manner. Clomiphene citrate is the mainstay of therapy. However, up to 10% of women may have clomiphene resistance and will fail to respond to doses as high as 150 mg d

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Authors
Carmina, E., & Lobo, R. A.
Affiliations
Columbia University Irving Medical Center (US)
ORCID
Carmina, Enrico
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
1999-06
Volume
84
Issue
6
Pages
1897-1899
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jcem.84.6.5803
OpenAlex
W2114250093
Cited by
528
References
24
Citations by year
2026: 9 · 2025: 15 · 2024: 18 · 2023: 22 · 2022: 30 · 2021: 17 · 2020: 22 · 2019: 24 · 2018: 19 · 2017: 18 · 2016: 14 · 2015: 20 · 2014: 28 · 2013: 18 · 2012: 19
FWCI
11.31
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic and Kidney Cyst Diseases
Keywords
polycystic ovary syndrome, hyperandrogenism, anovulation, PCOS diagnosis, diabetes mellitus, hypertension, menopause, hysterectomy, quality of life, PCOS prevalence, PCOS phenotypes, PCOS treatment, PCOS screening, PCOS prevention
MeSH terms
Female, Humans, Polycystic Ovary Syndrome, Reproduction

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