European Journal of Cardiovascular Medicine

Polycystic ovarian syndrome affects 5–10% of women in the reproductive age range[1]. According to the National Institutes of Health Office of Disease Prevention, detecting and treating polycystic ovarian syndrome costs around $4 billion annually for the 5 million women of reproductive age who have the condition[2]. Polycystic ovarian syndrome, or PCOS is a diverse disorder that can manifest as infertility, hirsutism, acne, abnormal uterine haemorrhage, tiny cysts in one or both ovaries, etc. Insulin resistance, persistent anovulation, and increased testosterone levels are all part of the pathogenesis[3].The hypothalamic-pituitary axis, insulin secretion and action, and ovarian function are the main areas affected. Anovulation, monthly irregularities, microcysts in the ovaries, and suppression of follicular growth are all consequences of hyperandrogenism. It is one of polycystic ovarian syndrome 's clinical characteristics.

Hyperinsulinemia is linked to insulin resistance, which raises gonadotropin-releasing hormone (GnRH), reverses the luteinizing hormone/follicular-stimulating hormone (LH/FSH) ratio, raises testosterone levels, and lowers sex hormone-binding globulin (SHBG) production[4].

The polycystic ovaries, oligo ovulation or anovulation, and hyperandrogenism are widely recognised as the diagnostic standards for polycystic ovarian syndrome. The polycystic ovarian syndrome is associated with increased rates of endometrial cancer, cardiovascular disease, dyslipidaemia, and type 2 diabetes mellitus, a proper diagnosis is essential for both accurate treatment and the evaluation of any additional consequences[5]. The present study aimed to identify the clinical characteristics of polycystic ovarian syndrome and determine the gonadotropin hormones and body mass index relate to polycystic ovarian syndrome in the Kurnool population.

A total of 120 patients attending the gynaecology outpatient department and diagnosed with polycystic ovarian syndrome were included. The study was conducted by the Department of Physiology, Kurnool Medical College, Kurnool. The age of the patients ranges from 18-40 years included with informed consent.

The patients with endocrine disorders like thyroid and pituitary disorders, diabetes, and cardiovascular diseases were excluded from the study.

The detailed clinical history and systemic examination of the patients were evaluated. PCOS was diagnosed by clinical, laboratory, and radiological investigations. Polycystic ovarian syndrome patients were suggested to undergo hormonal analysis of gonadotropins and BMI was calculated as weight (kg)/height squared (m2). The score of Hirsutism was assessed by Ferriman Gallwey scoring system and recorded in the present study.

The mean patient waist-hip ratio (WHR) was 0.73 ± 0.031, FSH was 6.21 ± 2.74, LH was 8.92 ± 4.68, LH/FSH was 1.56 ± 1.21, and the patient mean age was 23.28 ± 4.13, BMI was 25.12 ± 5.86 noted in our study[Table 1 ; Graph 1].

Table 1: Various parameters in the present study

Graph -1:Various parameters in the present study

The women with PCOS, 109(91.0%) had polycystic ovaries, 106(88.3%) had oligomenorrhea,71(59.16%) had hirsutism, and 53(44.16%) had acne and patients with clinical presentations in relation with high parameters were noted [Table 2; Graph 2].

Table 2: Incidence of various parameter

Graph 2: Incidence of various parameter

The patients with oligomenorrhea (62), acne(30), hirsutism(43), and polycystic ovaries(68) had LH/FSH ratio >2/1. The patients with oligomenorrhea(21), acne(11), hirsutism(36), and polycystic ovaries(32) had FSH ratio >7.

The patients with oligomenorrhea(29), acne(29), hirsutism(31), and polycystic ovaries(41) had FSH ratio >10. Around 58% of patients with polycystic ovaries had Body mass index value of 25.0 in the current study was noted[Table 3].

Table 3: Various parameter with clinical features

Polycystic ovarian syndrome is associated with endometrial, ovarian, and breast cancers, this may be due to multiple ovulations, long time exposure to oestrogen, hyperinsulinemia, hyperandrogenism, and obesity[6]. The higher BMI in polycystic ovarian syndrome women was 31.9 ± 6.4, the mean age of patient was 35.9 ± 5.0 and noted 77.4% of oligomenorrhea[7]. The mean age of patient as 27.9 ± 2.13, BMI 24.04 ± 3.4, and LH/FSH 1.5 ± 0.8 was observed [8].It was observed that 94% of polycystic ovarian syndrome women had polycystic ovaries [9]. It was noted 92% of oligomenorrhea, 31.4% acne, 78.9% hirsutism, and 89.1% polycystic ovaries[10].The findings in our study are in mere agreement with previous literature[9,10]. An increased LH/FSH ratio (>1.5) was seen in women with polycystic ovarian syndrome compared with control women and found a higher hyperandrogenism in women with high BMI[11,12]. There was  increase in LH/FSH ratio among polycystic ovarian syndrome women and reported that 75% of PCOS patients had elevated LH and 94% had elevated LH-to-FSH ratio[13,14]. The women with higher BMI have higher age of menarche, abortion, menstrual disturbance, hyperandrogenism, and acanthosis nigricans with a statistically significant[15]. The mean levels of metabolic and sex hormones were also shown significantly higher in obese polycystic ovarian syndrome women. The  LH/FSH and total testosterone were significantly increased in polycystic ovarian syndrome cases, whereas FSH, SHBG, and progesterone were significantly decreased in polycystic ovarian syndrome patients[10]. The hormonal parameters in the present study agree with previous literature[11,12,15]. The women with polycystic ovarian syndrome prone to higher risk of preeclampsia or pregnancy-induced hypertension, gestational diabetes mellitus, and preterm deliveries[16]. Majority of our findings are similar with previous studies and the incidence of polycystic ovaries and other variables were higher in our study compared with other studies [9,12,14].The current study acknowledges the importance of body mass index, gonadotropin hormonal assessment in understanding the management of polycystic ovarian syndrome. 

The polycystic ovaries and oligomenorrhea were present in most of the patients. There was a  substantial correlation between the LH/FSH ratio, LH, and FSH levels and the feature of polycystic ovaries noted in the present study. A multidisciplinary approach is used to diagnose polycystic ovarian syndrome, and radiological studies, hormonal assessments, and clinical aspects should be considered.

Acknowledgement 

The authors are also grateful to authors, editors, and publishers of all those articles, journals, and books from where the literature for this article has been reviewed and discussed.  

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