Polycystic Ovarian Syndrome

Biography

M A Hasanat holds an MPhil and MD degree in Endocrinology and is currently working as Professor and Chairman in the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. He has more than 50 original articles published in reputed national and international journals. His major research areas are Diabetes (special fascination in gestational diabetes mellitus—GDM and diabetes of young), PCOS and Infertility, Thyroid Autoimmunity and Childhood Obesity. He is also working as an Editor (American Research Journal of Endocrinology, International Journal of Diabetes, and Diabetes & Obesity International Journal of different open access journals.

 

Abstract

The polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphologic features. PCOS affects 6 to 10% of women of reproductive age. Marked controversy surrounds the pathophysiology and management issues of PCOS. One school proposes it to be a reproductive disorder while other one considers it as an endocrine disorder. In fact PCOS is an endocrine disorder with adverse reproductive outcome and associated with cardiometabolic abnormalities like impaired glucose tolerance, type 2 DM, dyslipidemia, subclinical vascular disease and an increased risk of cardiovascular disease. Controversies exist on the prevalence of insulin resistance and metabolic derangement among different PCOS phenotypes. In our studies, women with phenotype A and B have been found to have worse metabolic profiles and higher prevalence of cardiovascular risk factors compared with phenotype C and D. Similarly, amenorrhoea and oligo-amenorrhoea were found to have worst metabolic profile and insulin resistance compared with eumenorrhoea. Although serum antimüllerian hormone levels and prostate specific antigen correlate with the sonographically determined antral follicle count and ovarian volume, the diagnostic usefulness of these in women with PCOS is uncertain. Similarly, no definitive association could be ascertained from our studies. Biochemical parameters of hyperandrogenemia, including total testosterone, free androgen index and testosterone dihydrotestosterone ratio were studied, and have been found to significantly correlate with clinical parameters. There is controversy regarding thresholds for diagnosis in adolescents and peri-menopausal women and the most appropriate therapeutic approaches for these patients. Metformin is found to have significant role in the management as insulin resistance is the key etiopathogenic factor in PCOS, which was also evidenced in our randomized control trial. PCOS lies at the crossroad of metabolic and reproductive disorder and a multi-systemic approach with involvement of the concerned specialties is required for successful outcome.