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Title: Ovulatory Polycystic Ovary Syndrome A New Disorder

URL: http://obgyn.pdr.net/be_core/MVC?mag=g&action=viewArticle&y=2003&m=07&d=01&articl
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Contemporary OB/GYN Archive 2003;48:53-64. "Diagnosing PCOS in women who menstruate regularly"
07/25/2003 03:33:22 PM
By Guy Furness

Polycystic ovary syndrome (PCOS) can be diagnosed in anovulatory women with normal menses, particularly when hyperandrogenism is also present, experts suggest; however, the authors of two recent commentaries are not in complete accord about the existence of PCOS in ovulatory women. Enrico Carmina, MD, professor of endocrinology, University of Palermo, Italy, notes that, of hyperandrogenic women with normal menses, 15-21% "have to be considered as having PCOS." In such patients, states Dr. Carmina, the presence of anovulation (shown by low serum progesterone levels over two or more cycles) and hyperandrogenism (shown by increased testosterone levels) is sufficient for a diagnosis of PCOS. Dr. Carmina also notes that 45-50% of ovulatory hyperandrogenic women had clinical characteristics of PCOS, including polycystic ovaries on ultrasound. Furthermore, these patients also had endocrine characteristics consistent with PCOS, such as mild insulin resistance. Thus, Dr Carmina believes that there is no reason to limit the diagnosis of PCOS to anovulatory women. In ovulatory hyperandrogenic women, the existence of polycystic ovaries is sufficient for a diagnosis, he concludes. A second commentary, by Ricardo Azziz, MD, Cedars-Sinai Medical Center, Los Angeles, California, United States, takes a different view. "It is premature to begin to define a new disorder, namely 'ovulatory PCOS,'" states Dr. Azziz. Dr Azziz points out that, in one study, Dr. Carmina's group reports that women with ovulatory PCOS generally had lesser degrees of insulin resistance than those with frank PCOS. Thus, rather than having PCOS, he suggests that ovulatory women with hyperandrogenism might represent an "intermediate stable phenotype between idiopathic hirsutism and PCOS" -- an early form of PCOS, or perhaps a distinct disorder. Although the opinions are somewhat contradictory, two points between the two commentaries are clear: PCOS is a highly heterogeneous disorder; and further studies are required to define its full spectrum, the clinical implications and preventative strategies.

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