Prevalence of polycystic ovaries in women with androgenic alopecia

Abstract

Objective: Although androgenic alopecia is recognised to be a symptom of polycystic ovary syndrome (PCOS), it is not known whether polycystic ovaries (PCO) and associated endocrine abnormalities are present in patients who present with alopecia as a primary complaint. We therefore set out to determine the strength of the association between androgenic alopecia and PCO. We examined the prevalence of ultrasound-based polycystic ovarian morphology and associated clinical and biochemical features in a large multiethnic group of women whose presenting complaint was of alopecia, and in a control group. Subjects and methods: We studied 89 women of mixed ethnic origin with androgenic alopecia and compared them to 73 control women. A detailed history was taken, anthropometry was performed and assessment of body-hair distribution was made. The presence of PCO was established by pelvic ultrasound scan. Serum gonadotrophins, testosterone, androstenedione, dihydrotestosterone and sex hormone binding globulin concentrations were measured. Results: Women with alopecia had a higher prevalence of PCO and hirsutism than the control population (PCO: 67% vs 27%, P , 0.00001; hirsutism: 21% vs 4%, P ¼ 0.003). Women with alopecia (with or without PCO) had higher testosterone, androstenedione and free androgen index than controls, even though few had frankly abnormal androgens. Conclusions: These findings confirm an association between androgenic alopecia and PCO, and other symptoms of hyperandrogenaemia. Thus most women who present with androgenic alopecia as their primary complaint also have PCO and have indices of abnormal androgen production. Since PCO is a well known risk factor for development of type 2 diabetes, this association has important implications for long-term management.

Diagnostic Criteria for Polycystic Ovary Syndrome: Pitfalls and Controversies

“…3 In the years that followed, it became apparent that the clinical presentation of PCOS was much more variable than that described by the NICHD criteria, and that polycystic morphology of the ovaries was a consistent finding in women demonstrating biochemical and clinical evidence of the syndrome. 11,[21][22][23] In 2003, the European Society for Human Reproduction and Embryology and the American Society for Reproductive Medicine amended the consensus criteria to include polycystic ovaries as a third diagnostic marker and to allow for a diagnosis of PCOS if two of three criteria were met (Table 1). These "Rotterdam criteria" were intended to broaden the phenotypic expression of the syndrome and to redefine PCOS as primarily a syndrome of ovarian dysfunction (i.e., one that occurs in the presence of anovulation and/or ovarian dysmorphology).…”

“…Historically, alopecia was recognized as a symptom of PCOS because it is an androgen-mediated process 51 ; however, it is a poor predictor of biochemical hyperandrogenemia, and low serum iron levels and aging are more common causes of hair loss in women. 24,35 While the actual prevalence of alopecia in women with PCOS is relatively low compared with other androgenic symptoms (approximately 5% 24 ), an association with polycystic ovaries has been reported, 22 and this observation merits an investigation of whether alopecia is actually increased in prevalence or severity in women with PCOS.…”

Hirsutism, Acne, and Hair Loss: Management of Hyperandrogenic Cutaneous Manifestations of Polycystic Ovary Syndrome

“…The Ludwig scale and Sinclair scale have been used in clinical grading of female-pattern hair loss. There are conflicting results in the literature where some but not all studies have reported higher levels of serum androgens in women with androgenic alopecia (72,73).…”

El ovario poliquístico y las enfermedades dermatológicas

“…Se caracteriza por ser una alopecia no cicatricial, que suele respetar la zona occipital y frontal. Los andrógenos -fundamentalmente, la DHT, que se ha generado a partir de la testosterona por efecto de la 5α-reductasa a nivel cutáneo-estimulan la conversión del folículo terminal en vello y disminuye el número de folículos en anágeno 10 .…”