Human Reproduction Update Advance Access originally published online on March 11, 2009
Human Reproduction Update 2009 15(4):477-488; doi:10.1093/humupd/dmp008
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Metabolic features of the reproductive phenotypes of polycystic ovary syndrome
1 The Jean Hailes Foundation for Women's Health Research Unit, Monash Institute of Health Services Research, Monash University, Locked Bag 29, Clayton, VIC 3168, Australia 2 Diabetes Unit, Southern Health, Clayton, VIC 3168, Australia
3 Correspondence address. Tel: +61-3-9594-7592; Fax: +61-3-9594-7550; E-mail: lisa.moran{at}med.monash.edu.au
BACKGROUND: Polycystic ovary syndrome (PCOS) is a common condition in women of reproductive age with well established metabolic abnormalities. There are numerous diagnostic criteria generating several reproductive diagnostic phenotypes [National Institute of Health (NIH) hyperandrogenic anovulatory PCOS and non-NIH PCOS including hyperandrogenic ovulatory or non-hyperandrogenic anovulatory PCOS]. There is ongoing debate regarding the optimal diagnostic criteria for PCOS and on the metabolic implications of newer non-NIH PCOS phenotypes.
METHODS: We reviewed the literature on the presence of risk factors for type 2 diabetes (DM2) and cardiovascular disease (CVD) across the reproductive diagnostic phenotypes of PCOS with the aims of comparing the metabolic features of the NIH and non-NIH groups and identifying potential high metabolic risk phenotypes of PCOS.
RESULTS: NIH PCOS patients present with greater obesity, abdominal obesity, insulin resistance (IR) and risk factors for DM2 and CVD compared with non-NIH ovulatory and non-hyperandrogenic PCOS patients. Where differences in metabolic features exist between the phenotypes, they are generally related to the degree of total and abdominal obesity. There is emerging evidence suggesting ovulatory and non-hyperandrogenic PCOS have greater metabolic abnormalities than controls primarily linked to abdominal adiposity. There is currently no evidence that non-hyperandrogenic PCOS is associated with a less adverse metabolic profile than ovulatory PCOS.
CONCLUSIONS: Current metabolic evidence appears to justify the inclusion of both non-NIH PCOS groups (ovulatory and non-hyperandrogenic) as PCOS subgroups. NIH PCOS is associated with a more adverse metabolic profile including greater total and abdominal obesity, IR and risk factors for CVD and DM2 than non-NIH phenotypes.
Key words: polycystic ovary syndrome / diagnostic criteria / insulin resistance / hyperandrogenism
L.M. and H.T. both contributed to article conception, design, drafting, manuscript writing, critical revision and final approval of version to be published. Received on August 8, 2008; revised January 29, 2009; accepted on February 3, 2009