Age related endocrine patterns observed in polycystic ovary syndrome patients vs. ovulatory controls: descriptive data from a university based infertility center

Abstract

Objective: To compare serum anti-Müllerian hormone (AMH) and other endocrine parameters between patients diagnosed with polycystic ovary syndrome (PCOS) and age-matched ovulatory women. Materials and methods: AMH, DHEAS, FSH, LH, PRL, TSH and total testosterone (TT) were prospectively measured in oligo-ovulatory PCOS patients (n = 595) and in ovulatory non-PCOS women (n = 157) referred to a tertiary infertility center. Mean BMI was similar across the two study populations and there were no smokers in the sample. Patients in both groups were further classified into three categories by age: < 25 yrs, 25-34 yrs, and ≥ 35 yrs. Selected clinical and demographic characteristics were tabulated for each group. Results: Serum AMH was significantly higher among PCOS patients compared to non-PCOS controls in the non-stratified sample (7.54 ± 5.8 vs. 2.49 ± 2.0 ng/mL, respectively; p < 0.0001), while serum FSH, DHEAS, TSH and prolactin were similar for both groups (p > 0.05). As expected, mean (total) testosterone levels were notably different between PCOS vs. non-PCOS controls (0.84 ± 0.76 vs. 0.43 ± 0.38 ng/mL, respectively; p < 0.001), and mean AMH level was significantly lower in the oldest age category (> 35 yrs) compared to both younger control groups (p < 0.0001). Both DHEAS and total testosterone decreased with age among PCOS patients, although mean serum DHEAS for women age > 35 yrs was significantly lower than DHEAS measured in younger women with PCOS (p < 0.02). For PCOS patients, AMH remained relatively stable irrespective of age. Conclusion: Although AMH can serve as a satisfactory marker of ovarian reserve, for PCOS patients the expected decline in AMH associated with reproductive aging appears attenuated despite ovarian senescence. In contrast, mean DHEAS levels were markedly lower among older PCOS women (> 35 yrs) compared to younger PCOS patients. Arch Endocrinol Metab. 2016;60(5):486-91

Adrenal hyperandrogenism does not deteriorate insulin resistance and lipid profile in women with PCOS

“…Given that low SHBG concentrations are associated with insulin resistance ( 27 ), the elevated DHEA-S concentrations could reflect an adaptive mechanism to this metabolic disturbance, implying further complexity in the interplay between hormones and energy homeostasis ( 28 ). Furthermore, the negative correlation between adrenal androgens with age demonstrated in the present study is in accordance with previous findings of an age-related reduction in DHEA-S concentrations in the general population ( 29 ) as well as in women with PCOS ( 30 ).…”

Changes in clinical and biochemical characteristics of polycystic ovary syndrome with advancing age

“…In PCOS women, testosterone decreased in 20%, from 20 to 24 year strata, what is not different from the decrease of 25% reported in a longitudinal study including women between 22 years and 43 years of age (5). In general, without normalization, a decline in testosterone levels in PCOS patients ranging from 20 and 50% have been reported, markedly after 30 years of age (3,5,6,8,16,18,19,21,24,66,67,68). This fact shows that the biochemical hyperandrogenism, as a parameter to diagnose PCOS, becomes weak with age and may hamper the diagnosis of PCOS after 30 years of age.…”

“…This fact shows that the biochemical hyperandrogenism, as a parameter to diagnose PCOS, becomes weak with age and may hamper the diagnosis of PCOS after 30 years of age. Despite these findings, two prospective studies did not show significant changes in testosterone levels in PCOS women with advancing age (67,69). In addition, a small number of cross-sectional studies also did not report any decrease in testosterone 9:2 levels in PCOS women either younger or older than 30 years (70,71).…”

Age‐stratified thresholds of anti‐Müllerian hormone improve prediction of polycystic ovary syndrome over a population‐based threshold

“…Additionally, the role of age in determining normal ranges for AMH levels has been overlooked in the PCOS literature despite a clearly established decline in AMH over the lifespan in large cohorts of normal women . While several recent publications have depicted AMH values by age group in controls and patients with PCOS, no statistical analysis proposing age‐specific thresholds for distinguishing between groups was been performed, thereby limiting clinical utility . In providing age category‐stratified thresholds of AMH, we acknowledge the inverse relationship between serum AMH concentration and chronologic age.…”