Polycystic ovary syndrome

Abstract

Introduction 1.1 Definition Polycystic ovary syndrome (PCOS) is a remarkably common disorder of premenopausal women with a prevalence of 5-10%. Besides reproductive endocrine abnormalities, including amenorrhea or oligomenorrhea, hyperandrogenism and infertility, patients with PCOS often show an insulin resistance and beta-cell dysfunction (1). 1.2 Diagnostic criteria The condition was described by Stein and Leventhal in 1935. There is a considerable controversy on the optimal criteria for PCOS. Although the NIH (National Institute of Health) criteria as hyperandrogenic anovulatory PCOS were proposed in 1992, these have now expanded to non NIH criteria including hyperandrogenic ovulatory to nonhyperandrogenic anovulatory PCOS (2). After a meeting between ESHRE (European Society for Human Reproduction and Embryology) and ASRM (American Society for Reproductive Medicine) in Rotterdam in 2003, a new set of criteria for PCOS was proposed, commonly refered to as Rotterdam criteria: 1. irregular/no ovulations, 2. clinical/paraclinical hyperandrogenemia and 3. polycystic ovaries. Two out of the three criteria need to be fulfilled and other causes of hyperandrogenemia should by excluded. The Rotterdam criteria are curently debated because they introduced two new fenotypes (3). It is known that the metabolic disturbances of PCOS are more pronounced in hyperandrogen patients compared to patients with no hyperandrogenemia in genetic studies. In 2006 AES (Androgen Excess Society) published a position statement which suggested that androgen excess is the key component of PCOS related to clinical symptoms and long-term morbidity. According to AES, diagnostic criteria should be modified to include only those with hyperandrogenism and polycystic ovary or ovarian dysfunction (2). This definition excluded the phenotype subset of polycystic ovary and ovarian dysfunction without hyperandrogenism. NIH criteria covered first two phenotypes: A and B, Rotterdam criteria covered all four phenotypes (including non hyperandrogenic anovulatory polycystic ovary) and finally AES criteria excluded non-hyperandrogenic phenotype Table 1 (2). These criteria recognize that PCOS is a functional disorder in which ovarian hyperandrogenism can occur in the presence or absence of ovarian morphologic changes. However, according to Rotterdam criteria or AES criteria, polycystic ovaries need not to be www.intechopen.com Amenorrhea 46 present to make a diagnosis of PCOS and controversely their presence alone does not establish the diagnosis of PCOS (2).