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A review of 300 consecutive cases of Polycystic ovarian syndrome: clinical presentation and management


MOJ Women's Health
Maryam Modarres,1 Kunal Rathod,1 Prashant Purohit,1 Vicky Minns,1 Bassam Nusair,1 Kuga Vigneswaran,1 Phoebe Howells,1 Mike Savvas,2 Haitham Hamoda2

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Abstract

Background: Polycystic ovary syndrome (PCOS) is a common heterogeneous endocrine disorder. The prevalence of PCOS varies depending on which criteria are used to make the diagnosis, but can be as high as 15%–20%. Aim and objectives: To review the demographic details, presenting symptoms, biochemical features and management in women with PCOS and differentiate patients who have polycystic ovarian morphology (PCOM) and have hypothalamic amenorrhoea. Method: Retrospective observational study of 300 consecutive new cases with suspected PCOS were referred to the reproductive endocrinology clinic in a tertiary referral hospital (Kings college hospital, London) from 2008-2015. Electronic medical records were reviewed and Microsoft Excel software was used for data collection and analysis. Inclusion and exclusion criteria’s: All patients with suspected PCOS fulfilling Rotterdam criteria were included in the study. Phenotypically similar androgen excess disorders like congenital adrenal hyperplasia (CAH), androgen secreting-tumor and Cushing’s syndrome were excluded. Results: The mean (+/-SD) age was 30 (+/-6.7) years [range 14-49].

A total of 213 (71%) had oligomenorrhoea, 61 (20.3%) had amenorrhoea, while 26 (8.6%)had regular cycles. 135 (45%) presented with subfertility, while 93 (31%) had hirsutism. Mean (+/-SD) FSH and LH were 5.5 IU/L (+/- 2.8) and 17.8 IU/L (+/-7.9), respectively, while mean (+/-SD) estradiol level was 253.4 pmol/L (+/-267.1). 27/61 (44.2%) women with amenorrhoea, had low estradiol [mean (+/-SD) <176 pmol/l (123.8+/-30.8 )]. Mean (+/-SD) anti-Mullerian hormone (AMH) was 44.6 pmol/L (+/-33.1). 39/45 (87%) had elevated AMH while 6/45 (13%) had normal AMH levels. Mean (+/-SD) testosterone level was 2.0nmol/L (+/-1.5) and 36 (16%) patients had elevated total testosterone levels. Mean (+/-SD) Sex Hormone Binding Globulin (SHBG) and Free Androgen Index (FAI) were 45.9 (+/- 29.4) and 5.8 (+/- 6.6). 20/43 (47% of women assessed) had elevated androstenedione levels with a Mean (+/-SD) of 13.06 (+/- 7.5). Elevated triglycerides and/or total cholesterol was noted in 13/44 (29.5% of women assessed). 13/28 (46.4% of women assessed) had raised HbA1C. In a total of six (2%) patients, the ovaries did not appear polycystic. Conclusion: A significant proportion of women with hypothalamic amenorrhea with PCOM were classed as PCOS.

Keywords

polycystic ovarian syndrome, polycystic ovarian morphology, Amenorrhea, Oligomenorrhea, Hyperandrogenism, testosterone

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