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The Polycystic Ovary Syndrome (PCOS)

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Female Reproductive Dysfunction

Part of the book series: Endocrinology ((ENDOCR))

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Abstract

PCOS is the commonest endocrine abnormality in women of reproductive age. It represents the major cause of anovulatory infertility and is also associated with hirsutism and acne. The typical biochemical features are elevated serum levels of testosterone and luteinizing hormone (LH) along with metabolic disturbances including insulin resistance and abnormalities of energy expenditure. PCOS is now recognized as a major risk factor for the development of type 2 diabetes (T2DM) and cardiovascular disease in later life. At least in part, this reflects the strong associations between PCOS and obesity, with the latter being an amplifier of PCOS.

The etiology of PCOS is unclear, and it seems to be a complex disease resulting from a complex interplay between genetic and environmental factors. Moreover, there is evidence for familial clustering of endocrine and metabolic features of PCOS. Environmental factors such as diet and obesity might similarly contribute to the phenotype. Due to its heterogeneous nature, there have been historical disagreements about the definitions and how to diagnose PCOS.

Treatment should be tailored to the complaints and needs of the patient and involve restoring fertility, treatment of metabolic complaints, treatment of androgen excess, and providing endometrial protection.

The complexity of the disorder, and the impact on quality of life, requires timely diagnosis, screening for complications, and management strategies of the long-term health issues associated with PCOS. The syndrome remains underdiagnosed, and women experience significant delays to diagnosis.

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References

  • Abu Hashim H, Foda O, El Rakhawy M. Unilateral or bilateral laparoscopic ovarian drilling in polycystic ovary syndrome: a meta-analysis of randomized trials. Arch Gynecol Obstet. 2018;297(4):859–70.

    Article  PubMed  CAS  Google Scholar 

  • Azziz R, Carmina E, Chen Z, Dunaif A, Laven JS, Legro RS, et al. Polycystic ovary syndrome. Nat Rev Dis Primers. 2016;2:16057.

    Article  PubMed  Google Scholar 

  • Balen AH, Laven JS, Tan SL, Dewailly D. Ultrasound assessment of the polycystic ovary: international consensus definitions. Hum Reprod Update. 2003;9(6):505–14.

    Article  PubMed  Google Scholar 

  • Barry JA, Kuczmierczyk AR, Hardiman PJ. Anxiety and depression in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. 2011;26(9):2442–51.

    Article  PubMed  CAS  Google Scholar 

  • Barry JA, Azizia MM, Hardiman PJ. Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2014;20(5):748–58.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brassard M, AinMelk Y, Baillargeon JP. Basic infertility including polycystic ovary syndrome. Med Clin North Am. 2008;92(5):1163–92.. xi

    Article  PubMed  CAS  Google Scholar 

  • Brown ZA, Louwers YV, Fong SL, Valkenburg O, Birnie E, de Jong FH, et al. The phenotype of polycystic ovary syndrome ameliorates with aging. Fertil Steril. 2011;96(5):1259–65.

    Article  PubMed  Google Scholar 

  • Burgers JA, Fong SL, Louwers YV, Valkenburg O, de Jong FH, Fauser BC, et al. Oligoovulatory and anovulatory cycles in women with polycystic ovary syndrome (PCOS): what’s the difference? J Clin Endocrinol Metab. 2010;95(12):E485–9.

    Article  PubMed  CAS  Google Scholar 

  • Burt Solorzano CM, Beller JP, Abshire MY, Collins JS, McCartney CR, Marshall JC. Neuroendocrine dysfunction in polycystic ovary syndrome. Steroids. 2012;77(4):332–7.

    Article  PubMed  CAS  Google Scholar 

  • Cassar S, Misso ML, Hopkins WG, Shaw CS, Teede HJ, Stepto NK. Insulin resistance in polycystic ovary syndrome: a systematic review and meta-analysis of euglycaemic-hyperinsulinaemic clamp studies. Hum Reprod. 2016;31(11):2619–31.

    Article  PubMed  CAS  Google Scholar 

  • Cesta CE, Mansson M, Palm C, Lichtenstein P, Iliadou AN, Landen M. Polycystic ovary syndrome and psychiatric disorders: co-morbidity and heritability in a nationwide Swedish cohort. Psychoneuroendocrinology. 2016;73:196–203.

    Article  PubMed  Google Scholar 

  • Cesta CE, Kuja-Halkola R, Lehto K, Iliadou AN, Landen M. Polycystic ovary syndrome, personality, and depression: a twin study. Psychoneuroendocrinology. 2017;85:63–8.

    Article  PubMed  Google Scholar 

  • Chen ZJ, Zhao H, He L, Shi Y, Qin Y, Shi Y, et al. Genome-wide association study identifies susceptibility loci for polycystic ovary syndrome on chromosome 2p16.3, 2p21 and 9q33.3. Nat Genet. 2011;43(1):55–9.

    Article  PubMed  CAS  Google Scholar 

  • Christ JP, Gunning MN, Meun C, Eijkemans MJC, van Rijn BB, Bonsel GJ, et al. Pre-conception characteristics predict obstetrical and neonatal outcomes in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2019;104(3):809–18.

    Article  PubMed  Google Scholar 

  • Cimino I, Casoni F, Liu X, Messina A, Parkash J, Jamin SP, et al. Novel role for anti-Mullerian hormone in the regulation of GnRH neuron excitability and hormone secretion. Nat Commun. 2016;7:10055.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Cooney LG, Dokras A. Depression and anxiety in polycystic ovary syndrome: etiology and treatment. Curr Psychiatry Rep. 2017;19(11):83.

    Article  PubMed  Google Scholar 

  • Cooney LG, Lee I, Sammel MD, Dokras A. High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. 2017;32(5):1075–91.

    Article  PubMed  Google Scholar 

  • Day FR, Hinds DA, Tung JY, Stolk L, Styrkarsdottir U, Saxena R, et al. Causal mechanisms and balancing selection inferred from genetic associations with polycystic ovary syndrome. Nat Commun. 2015;6:8464.

    Article  PubMed  CAS  Google Scholar 

  • Day F, Karaderi T, Jones MR, Meun C, He C, Drong A, et al. Large-scale genome-wide meta-analysis of polycystic ovary syndrome suggests shared genetic architecture for different diagnosis criteria. PLoS Genet. 2018;14(12):e1007813.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • de Groot PC, Dekkers OM, Romijn JA, Dieben SW, Helmerhorst FM. PCOS, coronary heart disease, stroke and the influence of obesity: a systematic review and meta-analysis. Hum Reprod Update. 2011;17(4):495–500.

    Article  PubMed  Google Scholar 

  • de Wilde MA, Veltman-Verhulst SM, Goverde AJ, Lambalk CB, Laven JS, Franx A, et al. Preconception predictors of gestational diabetes: a multicentre prospective cohort study on the predominant complication of pregnancy in polycystic ovary syndrome. Hum Reprod. 2014;29(6):1327–36.

    Article  PubMed  CAS  Google Scholar 

  • de Wilde MA, Lamain-de Ruiter M, Veltman-Verhulst SM, Kwee A, Laven JS, Lambalk CB, et al. Increased rates of complications in singleton pregnancies of women previously diagnosed with polycystic ovary syndrome predominantly in the hyperandrogenic phenotype. Fertil Steril. 2017;108(2):333–40.

    Article  PubMed  Google Scholar 

  • Dokras A, Clifton S, Futterweit W, Wild R. Increased risk for abnormal depression scores in women with polycystic ovary syndrome: a systematic review and meta-analysis. Obstet Gynecol. 2011;117(1):145–52.

    Article  PubMed  Google Scholar 

  • Dokras A, Clifton S, Futterweit W, Wild R. Increased prevalence of anxiety symptoms in women with polycystic ovary syndrome: systematic review and meta-analysis. Fertil Steril. 2012;97(1):225–30. e2.

    Article  PubMed  Google Scholar 

  • Dumesic DA, Oberfield SE, Stener-Victorin E, Marshall JC, Laven JS, Legro RS. Scientific statement on the diagnostic criteria, epidemiology, pathophysiology, and molecular genetics of polycystic ovary syndrome. Endocr Rev. 2015;36(5):487–525.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Elting MW, Kwee J, Korsen TJ, Rekers-Mombarg LT, Schoemaker J. Aging women with polycystic ovary syndrome who achieve regular menstrual cycles have a smaller follicle cohort than those who continue to have irregular cycles. Fertil Steril. 2003;79(5):1154–60.

    Article  PubMed  Google Scholar 

  • Escobar-Morreale HF, Santacruz E, Luque-Ramirez M, Botella Carretero JI. Prevalence of ‘obesity-associated gonadal dysfunction’ in severely obese men and women and its resolution after bariatric surgery: a systematic review and meta-analysis. Hum Reprod Update. 2017;23(4):390–408.

    Article  PubMed  CAS  Google Scholar 

  • Franik S, Eltrop SM, Kremer JA, Kiesel L, Farquhar C. Aromatase inhibitors (letrozole) for subfertile women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2018;5:CD010287.

    PubMed  Google Scholar 

  • Gambineri A, Patton L, Altieri P, Pagotto U, Pizzi C, Manzoli L, et al. Polycystic ovary syndrome is a risk factor for type 2 diabetes: results from a long-term prospective study. Diabetes. 2012;61(9):2369–74.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Gateva A, Unfer V, Kamenov Z. The use of inositol(s) isomers in the management of polycystic ovary syndrome: a comprehensive review. Gynecol Endocrinol. 2018;34(7):545–50.

    Article  PubMed  CAS  Google Scholar 

  • George JT, Kakkar R, Marshall J, Scott ML, Finkelman RD, Ho TW, et al. Neurokinin B receptor antagonism in women with polycystic ovary syndrome: a randomized, placebo-controlled trial. J Clin Endocrinol Metab. 2016;101(11):4313–21.

    Article  PubMed  CAS  Google Scholar 

  • Glintborg D, Rubin KH, Nybo M, Abrahamsen B, Andersen M. Cardiovascular disease in a nationwide population of Danish women with polycystic ovary syndrome. Cardiovasc Diabetol. 2018;17(1):37.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Glueck CJ, Goldenberg N. Characteristics of obesity in polycystic ovary syndrome: etiology, treatment, and genetics. Metab Clin Exp. 2019;92:108–120.

    Article  PubMed  CAS  Google Scholar 

  • Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E, et al. American association of clinical endocrinologists, American college of endocrinology, and androgen excess and Pcos society disease state clinical review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome – part 2. Endocr Pract. 2015;21(12):1415–26.

    Article  PubMed  Google Scholar 

  • Harris HR, Terry KL. Polycystic ovary syndrome and risk of endometrial, ovarian, and breast cancer: a systematic review. Fertil Res Pract. 2016;2:14.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hart R, Doherty DA. The potential implications of a PCOS diagnosis on a woman’s long-term health using data linkage. J Clin Endocrinol Metab. 2015;100(3):911–9.

    Article  PubMed  CAS  Google Scholar 

  • Hayes MG, Urbanek M, Ehrmann DA, Armstrong LL, Lee JY, Sisk R, et al. Genome-wide association of polycystic ovary syndrome implicates alterations in gonadotropin secretion in European ancestry populations. Nat Commun. 2015;6:7502.

    Article  PubMed  CAS  Google Scholar 

  • Heida KY, Bots ML, de Groot CJ, van Dunne FM, Hammoud NM, Hoek A, et al. Cardiovascular risk management after reproductive and pregnancy-related disorders: a Dutch multidisciplinary evidence-based guideline. Eur J Prev Cardiol. 2016;23(17):1863–79.

    Article  PubMed  Google Scholar 

  • Hudecova M, Holte J, Olovsson M, Larsson A, Berne C, Poromaa IS. Diabetes and impaired glucose tolerance in patients with polycystic ovary syndrome–a long term follow-up. Hum Reprod. 2011;26(6):1462–8.

    Article  PubMed  CAS  Google Scholar 

  • Joham AE, Teede HJ, Ranasinha S, Zoungas S, Boyle J. Prevalence of infertility and use of fertility treatment in women with polycystic ovary syndrome: data from a large community-based cohort study. J Womens Health (Larchmt). 2015;24(4):299–307.

    Article  Google Scholar 

  • Laven JSE. Family ties. Fertil Steril. 2018;109(2):254–5.

    Article  PubMed  Google Scholar 

  • Laven JSE. Follicle stimulating hormone receptor (FSHR) polymorphisms and polycystic ovary syndrome (PCOS). Front Endocrinol. 2019;10:23.

    Article  Google Scholar 

  • Lee I, Cooney LG, Saini S, Sammel MD, Allison KC, Dokras A. Increased odds of disordered eating in polycystic ovary syndrome: a systematic review and meta-analysis. Eat Weight Disord. 2018;24(5):787–797.

    Article  Google Scholar 

  • Legro RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab. 1999;84(1):165–9.

    PubMed  CAS  Google Scholar 

  • Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013;98(12):4565–92.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Lepine S, Jo J, Metwally M, Cheong YC. Ovarian surgery for symptom relief in women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2017;11:CD009526.

    PubMed  Google Scholar 

  • Lizneva D, Kirubakaran R, Mykhalchenko K, Suturina L, Chernukha G, Diamond MP, et al. Phenotypes and body mass in women with polycystic ovary syndrome identified in referral versus unselected populations: systematic review and meta-analysis. Fertil Steril. 2016;106(6):1510–20.e2.

    Article  PubMed  Google Scholar 

  • Lujan ME, Jarrett BY, Brooks ED, Reines JK, Peppin AK, Muhn N, et al. Updated ultrasound criteria for polycystic ovary syndrome: reliable thresholds for elevated follicle population and ovarian volume. Hum Reprod. 2013;28(5):1361–8.

    Article  PubMed  Google Scholar 

  • Macut D, Tziomalos K, Bozic-Antic I, Bjekic-Macut J, Katsikis I, Papadakis E, et al. Non-alcoholic fatty liver disease is associated with insulin resistance and lipid accumulation product in women with polycystic ovary syndrome. Hum Reprod. 2016;31(6):1347–53.

    Article  PubMed  CAS  Google Scholar 

  • McAllister JM, Legro RS, Modi BP, Strauss JF 3rd. Functional genomics of PCOS: from GWAS to molecular mechanisms. Trends Endocrinol Metab. 2015;26(3):118–24.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Meun C, Franco OH, Dhana K, Jaspers L, Muka T, Louwers Y, et al. High androgens in postmenopausal women and the risk for atherosclerosis and cardiovascular disease: the Rotterdam study. J Clin Endocrinol Metab. 2018;103(4):1622–30.

    Article  PubMed  Google Scholar 

  • Mokhlesi B, Scoccia B, Mazzone T, Sam S. Risk of obstructive sleep apnea in obese and nonobese women with polycystic ovary syndrome and healthy reproductively normal women. Fertil Steril. 2012;97(3):786–91.

    Article  PubMed  PubMed Central  Google Scholar 

  • Moran LJ, Pasquali R, Teede HJ, Hoeger KM, Norman RJ. Treatment of obesity in polycystic ovary syndrome: a position statement of the androgen excess and polycystic ovary syndrome society. Fertil Steril. 2009;92(6):1966–82.

    Article  PubMed  Google Scholar 

  • Moran LJ, Hutchison SK, Norman RJ, Teede HJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2011;2:CD007506.

    Google Scholar 

  • Mulders AG, Laven JS, Eijkemans MJ, de Jong FH, Themmen AP, Fauser BC. Changes in anti-Mullerian hormone serum concentrations over time suggest delayed ovarian ageing in normogonadotrophic anovulatory infertility. Hum Reprod. 2004;19(9):2036–42.

    Article  PubMed  CAS  Google Scholar 

  • Mykhalchenko K, Lizneva D, Trofimova T, Walker W, Suturina L, Diamond MP, et al. Genetics of polycystic ovary syndrome. Expert Rev Mol Diagn. 2017;17(7):723–33.

    Article  PubMed  CAS  Google Scholar 

  • Naderpoor N, Shorakae S, de Courten B, Misso ML, Moran LJ, Teede HJ. Metformin and lifestyle modification in polycystic ovary syndrome: systematic review and meta-analysis. Hum Reprod Update. 2015;21(5):560–74.

    Article  PubMed  CAS  Google Scholar 

  • Neven ACH, Laven J, Teede HJ, Boyle JAA. Summary on polycystic ovary syndrome: diagnostic criteria, prevalence, clinical manifestations, and management according to the latest international guidelines. Semin Reprod Med. 2018;36(1):5–12.

    Article  PubMed  Google Scholar 

  • Norman RJ, Masters L, Milner CR, Wang JX, Davies MJ. Relative risk of conversion from normoglycaemia to impaired glucose tolerance or non-insulin dependent diabetes mellitus in polycystic ovarian syndrome. Hum Reprod. 2001;16(9):1995–8.

    Article  PubMed  CAS  Google Scholar 

  • Panidis D, Tziomalos K, Misichronis G, Papadakis E, Betsas G, Katsikis I, et al. Insulin resistance and endocrine characteristics of the different phenotypes of polycystic ovary syndrome: a prospective study. Hum Reprod. 2012;27(2):541–9.

    Article  PubMed  CAS  Google Scholar 

  • Pastoor H, Timman R, de Klerk C, W MB, Laan ET, Laven JS. Sexual function in women with polycystic ovary syndrome: a systematic review and meta-analysis. Reprod Biomed Online. 2018;37(6):750–60.

    Article  PubMed  Google Scholar 

  • Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19(1):41–7.

    Article  Google Scholar 

  • Schmidt J, Landin-Wilhelmsen K, Brannstrom M, Dahlgren E. Cardiovascular disease and risk factors in PCOS women of postmenopausal age: a 21-year controlled follow-up study. J Clin Endocrinol Metab. 2011;96(12):3794–803.

    Article  PubMed  CAS  Google Scholar 

  • Tasali E, Chapotot F, Leproult R, Whitmore H, Ehrmann DA. Treatment of obstructive sleep apnea improves cardiometabolic function in young obese women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2011;96(2):365–74.

    Article  PubMed  CAS  Google Scholar 

  • Tata B, Mimouni NEH, Barbotin AL, Malone SA, Loyens A, Pigny P, et al. Elevated prenatal anti-Mullerian hormone reprograms the fetus and induces polycystic ovary syndrome in adulthood. Nat Med. 2018;24(6):834–46.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod. 2018;33(9):1602–18.

    Article  PubMed  PubMed Central  Google Scholar 

  • The Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Consensus on infertility treatment related to polycystic ovary syndrome. Hum Reprod. 2008;23(3):462–77.

    Article  Google Scholar 

  • Valkenburg O, van Santbrink EJ, Konig TE, Themmen AP, Uitterlinden AG, Fauser BC, et al. Follicle-stimulating hormone receptor polymorphism affects the outcome of ovulation induction in normogonadotropic (World Health Organization class 2) anovulatory subfertility. Fertil Steril. 2015;103(4):1081–8.e3.

    Article  PubMed  CAS  Google Scholar 

  • Veltman-Verhulst SM, Boivin J, Eijkemans MJ, Fauser BJ. Emotional distress is a common risk in women with polycystic ovary syndrome: a systematic review and meta-analysis of 28 studies. Hum Reprod Update. 2012;18(6):638–51.

    Article  PubMed  Google Scholar 

  • Victoria M, Labrosse J, Krief F, Cedrin-Durnerin I, Comtet M, Grynberg M. Anti Mullerian Hormone: more than a biomarker of female reproductive function. J Gynecol Obstet Hum Reprod. 2019;48(1):19–24.

    Article  PubMed  Google Scholar 

  • Wang R, Kim BV, van Wely M, Johnson NP, Costello MF, Zhang H, et al. Treatment strategies for women with WHO group II anovulation: systematic review and network meta-analysis. BMJ (Clin Res Ed). 2017;356:j138.

    Article  Google Scholar 

  • Wing RR, Papandonatos G, Fava JL, Gorin AA, Phelan S, McCaffery J, et al. Maintaining large weight losses: the role of behavioral and psychological factors. J Consult Clin Psychol. 2008;76(6):1015–21.

    Article  PubMed  PubMed Central  Google Scholar 

  • Yilmaz B, Vellanki P, Ata B, Yildiz BO. Metabolic syndrome, hypertension, and hyperlipidemia in mothers, fathers, sisters, and brothers of women with polycystic ovary syndrome: a systematic review and meta-analysis. Fertil Steril. 2018;109(2):356–64.e32.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Erasmus University Medical Centre, Rotterdam, The Netherlands

    Yvonne V. Louwers & Joop S. E. Laven

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  1. Yvonne V. Louwers
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  2. Joop S. E. Laven
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Correspondence to Joop S. E. Laven .

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  1. Deaprtment of Obstatrics and Gynecology, Azienda Ospedaliero-Universitaria Caregg, Firenze, Italy

    Felice Petraglia

  2. Obstetrics and Gynecology, Utrecht University, Utrecht, Utrecht, The Netherlands

    Bart CJM Fauser

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Louwers, Y.V., Laven, J.S.E. (2020). The Polycystic Ovary Syndrome (PCOS). In: Petraglia, F., Fauser, B. (eds) Female Reproductive Dysfunction . Endocrinology. Springer, Cham. https://doi.org/10.1007/978-3-030-03594-5_3-1

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