Polycystic ovary morphology: age-based ultrasound criteria

Abstract

Objective To determine age-based criteria for polycystic ovary morphology. Design The study was a cross sectional, case-control design. Setting The study took place in an outpatient setting. Subjects Women with PCOS defined by hyperandrogenism and irregular menses (n=544) and controls with regular menses and no evidence of hyperandrogenism (n=666) participated. Parameters were tested in a second cohort of women with PCOS (n=105) and controls (n=32) meeting the same criteria. Interventions Subjects underwent a pelvic ultrasound documenting ovarian volume and maximum follicle number in a single plane. Main Outcome Measures A receiver operating characteristic curve was constructed to determine the ovarian volume and follicle number with the best sensitivity and specificity to define PCOS for age groups at approximately 5 year intervals from age 18 to >44 years. Results The best sensitivity and specificity were obtained using a threshold volume of 12 mL and 13 follicles age ≤24 yrs, 10 mL and 14 follicles age 25–29 yrs, 9 mL and 10 follicles age 30–34 yrs, 8 mL and 10 follicles age 35–39 yrs, 10 mL and 9 follicles for age 40–44 yrs and 6 mL and 7 follicles for age >44 years. Data from a second cohort confirmed the need to decrease volume and follicle number with increasing age to diagnose PCOS. Polycystic ovary morphology was most accurate at predicting the PCOS diagnosis for women aged 30 to 39 years. Conclusion The ovarian volume and follicle number threshold to define polycystic ovary morphology should be lowered starting at age 30 years.

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

“…Does it really matter? When the data from Quinn et al's study are well observed, the decrease in the diagnostic threshold is relatively small between the 25‐30 and 30‐35 age groups, as recently reported by others for AMH and AFC, whereas it becomes much sharper for the group between 35 and 40 years. The same is true for interquartile range (IQR), whose width after age adjustment is much larger in the latter group than in the other two.…”

Polycystic ovary syndrome and the risk of cardiometabolic complications in longitudinal studies

“…Moreover, PCOM in the diagnosis of PCOS continues to be a matter of debate because the presence of PCOM appears to be age related . Kim et al described that the ovarian volume and follicle number threshold to define PCOM should be lowered starting at age 30 . Furthermore, the identification of PCOS following menopause remains problematic, because there are no established diagnostic criteria of serum androgens levels or intensity of hirsutism in elderly women and the ovarian morphology changes dramatically.…”

Vascular compliance in women with polycystic ovary syndrome treated with spironolactone

“…Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age in the United States, with research showing that about 5% to 18% of females between 18 and 44 affected with the disorder . PCOS involves defects in the hypothalamic‐pituitary axis, insulin secretion and action, and ovarian function, which can lead to elevated androgen levels, menstrual irregularities, and/or increased follicular number and volume in one or both ovaries . Increased insulin levels cause ovarian overproduction of androgens, leading to anovulation …”

“…1,2 PCOS involves defects in the hypothalamic-pituitary axis, insulin secretion and action, and ovarian function, which can lead to elevated androgen levels, menstrual irregularities, and/or increased follicular number and volume in one or both ovaries. 1,3,4 Increased insulin levels cause ovarian overproduction of androgens, leading to anovulation. 1,5 Women with PCOS are predisposed to higher rates of cardiovascular disease, obesity, dyslipidemia, hypertension, impaired glucose tolerance, type 2 diabetes mellitus, and endometrial cancer.…”