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Observational Study
. 2023 Dec;99(6):566-578.
doi: 10.1111/cen.14964. Epub 2023 Sep 1.

Pre-polycystic ovary syndrome and polymenorrhoea as new facets of polycystic ovary syndrome (PCOS): Evidences from a single centre data set

Mohd Ashraf Ganie  1   2 , Aafia Rashid  2 , Mohammad Salem Baba  1 , Mohd Afzal Zargar  3 , Imtiyaz Ahmad Wani  2 , Sobia Nisar  4 , Ishfaq Ahmad Wani  2 , Syed Douhath  2 , Mukesh Sriwastawa  5 , Mohd Ishaq Geer  6 , Mir Mohd Asrar  2 , Rintu Kutum  7   8 , Saqib Hassan  9 , Shahid Khan  10 , Wajid Rafi  11 , Dil Afroz Bhat  12 , Wasia Showkat  2 , Tajali Sahar  2 , Naseer Ahmad Choh  13 , Rabia Khurshid  14 , Syed Mudassar  12 , Zafar Amin Shah  15 , Iram Shabir  16 , Sanjeed Ahmad Sofi  13 , Nandita Gupta  11 , Imran Hafeez  17 , Vishnubatla Sreenivas  18
Affiliations
Observational Study

Pre-polycystic ovary syndrome and polymenorrhoea as new facets of polycystic ovary syndrome (PCOS): Evidences from a single centre data set

Mohd Ashraf Ganie et al. Clin Endocrinol (Oxf). 2023 Dec.

Abstract

Objective: Polycystic ovary syndrome (PCOS) is a complex disorder with diverse metabolic implications. Diagnosis typically relies on oligo-amenorrhoea (OA), hyperandrogenism (HA), and polycystic ovarian morphology (PCOM). However, the role of polymenorrhoea in PCOS remains understudied. Additionally, limited information exists regarding metabolic disturbances in women with partial PCOS phenotypes that do not meet diagnostic criteria. This extensive database aims to provide substantial evidence on the metabolic implications of polymenorrhoea and partial PCOS phenotypes.

Design: Prospective observational study.

Patients and measurements: In this single-centre study, 6463 women with PCOS-like characteristics and 3142 age-matched healthy women were included. The study compared clinical (anthropometry, modified Ferriman Gallwey [mFG] score), hormonal (serum testosterone), and metabolic (plasma glucose, serum lipids, insulin) characteristics between women diagnosed with PCOS, those with partial PCOS phenotypes, and the healthy control group RESULTS: In all, 5174 women met Rotterdam criteria for PCOS diagnosis, while 737 were classified as Pre-PCOS, including HA (n = 538), OA (n = 121), or PCOM (n = 78). Common clinical features included oligomenorrhoea (75.5%), hirsutism (82.9%), obesity (27.2%), hypertension (1.6%), metabolic syndrome (19.6%), and diabetes mellitus (5.6%). Women diagnosed with PCOS, HA only, and OA only exhibited higher average body mass index, plasma glucose levels (both fasting and 2 h after the oral glucose tolerance test), and lipid fractions in comparison to those with PCOM and the healthy controls. However, indices of insulin resistance were similar among women with PCOS, HA, PCOM, and OA, albeit higher than in the healthy controls. The polymenorrhoea subgroup (5.9%) had lower BMI and serum testosterone, but similar mFG score, plasma glucose, insulin, and lipid levels as the oligomenorrhoea subgroup.

Conclusion: The metabolic disturbances observed in Pre-PCOS women highlight the need to reassess diagnostic criteria. Including the polymenorrhoea subcategory in PCOS criteria is recommended due to similar metabolic dysfunctions as the oligomenorrhoea group.

Keywords: India; PCOS; Pre-PCOS; metabolism; oligomenorrhoea; phenotype; polymenorrhoea.

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References

REFERENCES

    1. Joham AE, Norman RJ, Stener-Victorin E, et al. Polycystic ovary syndrome. Lancet Diabetes Endocrinol. 2022;10(9):668-680.
    1. Ganie MA, Khurana ML, Eunice M, Gulati M, Dwivedi SN, Ammini AC. Comparison of efficacy of spironolactone with metformin in the management of polycystic ovary syndrome: an open-labeled study. J Clin Endocrinol Metab. 2004;89(6):2756-2762.
    1. Ganie MA, Khurana ML, Nisar S, et al. Improved efficacy of low-dose spironolactone and metformin combination than either drug alone in the management of women with polycystic ovary syndrome (PCOS): a six-month, open-label randomized study. J Clin Endocrinol Metab. 2013;98(9):3599-3607.
    1. Ganie MA, Dhingra A, Nisar S, et al. Oral glucose tolerance test significantly impacts the prevalence of abnormal glucose tolerance among Indian women with polycystic ovary syndrome: lessons from a large database of two tertiary care centers on the Indian subcontinent. Fertil Steril. 2016;105(1):194-201.e3.
    1. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81(1):19-25.

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