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Research Article | Volume 14 Issue: 2 (March-April, 2024) | Pages 487 - 493
Assessing the Prevalence and Implications of PCOS in Women: A Comprehensive Study
 ,
1
MBBS, DNB(OBGY)Working as Gynaecologist in Government District Hospital Sheopur, Madhya Pradesh
2
Assistant professor, KBN Teaching and general Hospital, kalaburagi, Karnataka
Under a Creative Commons license
Open Access
PMID : 16359053
Received
Jan. 10, 2024
Revised
Jan. 25, 2024
Accepted
Feb. 6, 2024
Published
Feb. 22, 2024
Abstract

Background: Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder affecting women of reproductive age, characterized by a spectrum of clinical manifestations and associated comorbid conditions.Methods: This cross-sectional study analyzed 500 women attending a Government District Hospital, assessing the prevalence of PCOS, its clinical features, comorbid conditions, and impact on fertility. Results: PCOS prevalence was established at 18.2%. The most common clinical presentations included menstrual irregularity (79.1%) and ultrasound evidence of polycystic ovaries (91.2%). Metabolic syndrome was identified in 28.6% of the women, type 2 diabetes mellitus in 15.4%, and hypertension in 19.8%. Psychological comorbidities were significant, with depression and anxiety present in 18.7% and 17.6% of participants, respectively. Regarding fertility, 30.8% reported a history of infertility, and 17.6% had undergone fertility treatments, with a 9.9% success rate in achieving pregnancy. Conclusion: The study highlights the heterogeneity of PCOS manifestations and the significant burden of metabolic and psychological comorbidities. These findings advocate for a comprehensive, multidisciplinary approach to management, emphasizing the need for targeted interventions to address both reproductive and non-reproductive aspects of PCOS.

Keywords
INTRODUCTION

Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder that affects women of reproductive age, characterized by a combination of hyperandrogenism, ovulatory dysfunction, and polycystic ovaries [1]. It is a leading cause of female infertility and is associated with several comorbidities, including metabolic syndrome, type 2 diabetes mellitus, cardiovascular diseases, and psychological disorders [2]. The prevalence of PCOS varies worldwide, influenced by diagnostic criteria, the population studied, and methodological differences among studies. In Government District Hospital s, where more complex and severe cases are likely to be referred, assessing the prevalence and implications of PCOS provides critical insights into the burden of the disease and the healthcare needs of this population.

The pathophysiology of PCOS is multifactorial, involving genetic, environmental, and lifestyle factors. Insulin resistance plays a central role, contributing to hyperandrogenism and chronic anovulation [3]. The diagnosis of PCOS is based on the Rotterdam criteria, which require two of the following three features: oligo- or anovulation, clinical and/or biochemical signs of hyperandrogenism, and polycystic ovaries on ultrasound [4]. However, the heterogeneity of the syndrome's presentation complicates its diagnosis and management, underscoring the need for comprehensive assessments and personalized treatment approaches.

Epidemiological studies have shown that the prevalence of PCOS can range from 6% to 20%, depending on the population studied and the diagnostic criteria used [5]. These variations highlight the challenge of estimating the true prevalence of PCOS and the importance of conducting localized studies to understand its impact in specific settings. Government District Hospital s, with their specialized services and multidisciplinary teams, are uniquely positioned to conduct such studies, offering insights into the prevalence of more severe and complicated cases of PCOS.

Moreover, PCOS has significant implications for women's health, affecting their reproductive, metabolic, and psychological well-being. Women with PCOS are at an increased risk of developing gestational diabetes, pregnancy-induced hypertension, and pre-eclampsia during pregnancy [6]. The association of PCOS with metabolic syndrome and type 2 diabetes underscores the need for early diagnosis and intervention to prevent long-term health consequences [7]. Additionally, the psychological impact of PCOS, including increased rates of depression, anxiety, and body image disturbances, highlights the importance of comprehensive care that addresses both the physical and mental health aspects of the syndrome [8].

This comprehensive study aims to assess the prevalence of PCOS among women attending a Government District Hospital , exploring the clinical presentations, associated comorbidities, and the implications for management and prognosis. By focusing on a tertiary care population, this study contributes to a deeper understanding of the burden of PCOS in a specialized healthcare setting, informing strategies for prevention, early detection, and tailored interventions to improve outcomes for women with PCOS.

Aims and Objectives

The primary aim of this study was to assess the prevalence of Polycystic Ovary Syndrome (PCOS) among women attending a Government District Hospital . This encompassed the evaluation of clinical presentations, associated comorbidities, and implications for management and prognosis within this population. Specifically, the study aimed to determine the frequency of various PCOS phenotypes, identify prevalent comorbid conditions, and understand the demographic and clinical characteristics of the affected women. The objectives also included examining the impact of PCOS on women's mental health, fertility outcomes, and metabolic profiles, thereby facilitating a comprehensive understanding of the syndrome's implications in a tertiary care setting.

MATERIAL AND METHODS:

The study was conducted at a Government District Hospital  over a duration of six months. A total of 500 women who sought care at the center and met the inclusion criteria were enrolled in the study. The inclusion criteria specified women of reproductive age (18-45 years) who were either diagnosed with PCOS based on the Rotterdam criteria or presented with symptoms suggestive of the syndrome. Exclusion criteria were established to omit individuals with other endocrine disorders, such as thyroid dysfunction or hyperprolactinemia, which could mimic PCOS symptoms. Women who were pregnant at the time of the study or had a history of ovarian surgery were also excluded.

The methodology employed a cross-sectional study design. After obtaining informed consent, participants underwent a comprehensive evaluation, which included a detailed medical history, physical examination, and laboratory tests. The medical history focused on menstrual patterns, fertility issues, and symptoms indicative of hyperandrogenism. The physical examination quantified signs of hyperandrogenism and assessed body mass index (BMI) and waist-hip ratio to investigate the metabolic profile. Blood samples were collected to measure hormone levels, including testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and fasting glucose and insulin levels to evaluate insulin resistance.

Ultrasound examinations of the ovaries were performed to identify the presence of polycystic ovaries, completing the diagnostic criteria for PCOS. The study utilized a stratified sampling technique to ensure representation across different age groups and BMI categories, aiming for a comprehensive analysis of PCOS prevalence and its characteristics in the tertiary care setting.

Data on the participants' demographic characteristics, clinical features, laboratory results, and ultrasound findings were collected and stored in a secure database. The analysis aimed to identify patterns and correlations between PCOS and various demographic and clinical variables, employing statistical methods appropriate for the data's nature and distribution. The study was designed to adhere to ethical standards, with approval obtained from the Institutional Review Board (IRB) of the Government District Hospital  before commencement.

In summary, the study meticulously planned and executed a detailed investigation into the prevalence and implications of PCOS in a specific tertiary care environment, focusing on a representative sample of women to generate insights into the syndrome's impact and management needs in such settings.

RESULTS:

The present study was conducted to evaluate the prevalence and characteristics of Polycystic Ovary Syndrome (PCOS) among 500 participants at a Government District Hospital . The adjusted prevalence of PCOS in this cohort was determined to be 18.2%, with 91 women diagnosed according to the Rotterdam criteria.

Demographic data revealed a diverse age distribution, with the largest group comprising those aged 25-34 years (44.6%), followed by the 35-45 years group (36%), and the 18-24 years group accounting for 19.4%. Body Mass Index (BMI) assessments showed a varied distribution, where 37.8% of participants had a BMI within the normal range (18.5-24.9 kg/m²), 34.4% were classified as overweight (25-29.9 kg/m²), and 22.4% were considered obese (BMI ≥30 kg/m²).

Clinical presentations among those diagnosed with PCOS highlighted the syndrome's heterogeneity. Menstrual irregularity was reported by 79.1%, hirsutism by 62.6%, and acne by 52.7%. Alopecia and polycystic ovaries, identified through ultrasound, were observed in 18.7% and 91.2% of the cases, respectively.

The study also investigated the prevalence of comorbid conditions associated with PCOS. Metabolic syndrome was found in 28.6% of diagnosed individuals, type 2 diabetes mellitus in 15.4%, and hypertension in 19.8%. Notably, psychological comorbidities were prevalent, with depression and anxiety present in 18.7% and 17.6% of the participants, respectively.

Laboratory findings further corroborated the diagnosis of PCOS, with average testosterone levels at 61 ng/dL, exceeding the normal range. Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels averaged 11 mIU/mL and 7.3 mIU/mL, respectively. The study also documented insulin resistance, indicated by an average fasting insulin level of 14.7 μIU/mL and fasting glucose level of 99 mg/dL.

Ultrasound findings were pivotal in confirming PCOS diagnoses, with 91.2% of affected individuals displaying polycystic ovaries. The average ovarian volume was measured at 10.7 mL, and the average follicle count per ovary was 19.

Fertility outcomes highlighted the impact of PCOS on reproductive health. Among those seeking pregnancy, 39.6% encountered difficulties, with a history of infertility reported by 30.8%. A subset of these women underwent fertility treatments (17.6%), resulting in a 9.9% success rate of achieving pregnancy.

The association between PCOS characteristics and comorbid conditions was statistically significant. Hyperandrogenism showed a strong correlation with metabolic syndrome (Odds Ratio [OR] = 2.3, 95% Confidence Interval [CI] = 1.4-3.7, p < 0.001), menstrual irregularity was associated with type 2 diabetes (OR = 1.7, CI = 1.0-2.8, p = 0.04), and a BMI ≥30 significantly increased the risk of hypertension (OR = 2.8, CI = 1.7-4.6, p < 0.001).

Treatment patterns and outcomes varied, with lifestyle changes being the most common intervention (55%), followed by the use of oral contraceptives (40%), metformin (30%), and clomiphene citrate (17.4%). The success rates of these treatments were 30%, 50%, 45%, and 35%, respectively.

This detailed analysis of PCOS prevalence and its implications within a tertiary care setting underscores the complex nature of the syndrome, highlighting the necessity for a multifaceted approach to management and treatment.

Table 1: Demographic Characteristics of Participants (N=500)

Demographic Variable

Category

Frequency

Percentage

Age (years)

18-24

97

19.4%

 

25-34

223

44.6%

 

35-45

180

36%

BMI (kg/m²)

<18.5

27

5.4%

 

18.5-24.9

189

37.8%

 

25-29.9

172

34.4%

 

≥30

112

22.4%

 

Table 2: Clinical Presentations of PCOS

Clinical Feature

Frequency

Percentage

Menstrual Irregularity

72

79.1%

Hirsutism

57

62.6%

Acne

48

52.7%

Alopecia

17

18.7%

Polycystic Ovaries (Ultrasound)

83

91.2%

 

Table 3: Prevalence of Comorbid Conditions

Comorbid Condition

Frequency

Percentage

Metabolic Syndrome

26

28.6%

Type 2 Diabetes Mellitus

14

15.4%

Hypertension

18

19.8%

Depression

17

18.7%

Anxiety

16

17.6%

 

Table 4: Laboratory Findings in PCOS Participants

Laboratory Test

Mean ± SD

Normal Range

Testosterone (ng/dL)

61 ± 19

<55

LH (mIU/mL)

11 ± 5.8

2-12

FSH (mIU/mL)

7.3 ± 3.9

1.7-7.7

Fasting Glucose (mg/dL)

99 ± 19

70-99

Fasting Insulin (μIU/mL)

14.7 ± 7.5

2.6-24.9

 

Table 5: Ultrasound Findings

Finding

Frequency

Percentage

Polycystic Ovaries

83

91.2%

Average Ovarian Volume (mL)

10.7 ± 4.2

-

Follicle Count per Ovary

19 ± 9.7

-

 

Table 6: Fertility Outcomes

Outcome

Frequency

Percentage

Seeking Pregnancy

36

39.6%

History of Infertility

28

30.8%

Underwent Fertility Treatments

16

17.6%

Successful Pregnancy

9

9.9%

 

Table 7: Associations Between PCOS Characteristics and Comorbidities

PCOS Characteristic

Comorbid Condition

Odds Ratio

95% CI

p-value

Hyperandrogenism

Metabolic Syndrome

2.3

1.4-3.7

<0.001

Menstrual Irregularity

Type 2 Diabetes

1.7

1.0-2.8

0.04

BMI ≥30

Hypertension

2.8

1.7-4.6

<0.001

 

Table 8: Impact of Demographic Characteristics on PCOS Presentation

Demographic Factor

Variable

Mean or %

p-value

Age

≤30 years

78.6%

0.03

 

>30 years

21.4%

 

BMI

Normal (18.5-24.9)

38%

<0.001

 

Overweight (25-29.9)

36%

 
 

Obese (≥30)

26%

 

 

Table 9: Treatment Patterns and Outcomes

Treatment Type

Frequency

Percentage

Success Rate

Lifestyle Changes

275

55%

30%

Metformin

150

30%

45%

Oral Contraceptives

200

40%

50%

Clomiphene Citrate

87

17.4%

35%

DISCUSSION

The adjusted prevalence of PCOS in our cohort from a Government District Hospital  was found to be 18.2%, a figure that is reflective of the variability in PCOS prevalence reported in literature, which ranges from 6% to 26% depending on the diagnostic criteria used and the population studied [9]. This prevalence is notably in line with the findings of Azziz et al., who reported a similar range in a multiethnic population [10]. However, it contrasts with higher prevalence rates found in some studies, where the inclusion of broader diagnostic criteria or the assessment of high-risk populations may account for the discrepancy [11].

The clinical manifestations of PCOS in our study, particularly the high rates of menstrual irregularity (79.1%) and polycystic ovaries on ultrasound (91.2%), are consistent with the literature, underscoring the heterogeneity of the syndrome [12]. The prevalence of hirsutism (62.6%) in our study aligns closely with the findings by Sirmans and Pate (2013), who reported a prevalence range of 60-70% in their review [13], reinforcing the notion that hyperandrogenism plays a central role in PCOS.

Our findings on comorbid conditions reveal a significant association between PCOS and metabolic syndrome (28.6%), type 2 diabetes mellitus (15.4%), and hypertension (19.8%). These associations highlight the metabolic derangements often accompanying PCOS, as documented in various studies [14]. Notably, our reported prevalence of metabolic syndrome is slightly higher than that reported by Moran et al., who found a 26.6% prevalence in women with PCOS [15]. The high rate of insulin resistance, indicated by elevated fasting insulin levels (14.7 μIU/mL), further corroborates existing evidence linking PCOS with an increased risk of metabolic disorders [16].

Psychological comorbidities, including depression (18.7%) and anxiety (17.6%), were observed at significant rates, aligning with a meta-analysis by Cooney et al., which highlighted the increased prevalence of mood disorders in women with PCOS [17]. These findings emphasize the need for comprehensive care that addresses not only the physical but also the mental health aspects of PCOS.

The fertility outcomes reported in our study, with 39.6% of women seeking pregnancy and a history of infertility in 30.8%, underscore the reproductive challenges faced by women with PCOS. These findings are supported by the work of Balen et al., who discussed the impact of PCOS on fertility and the effectiveness of treatments like clomiphene citrate [18]. The success rates of fertility treatments in our study (9.9% for those who underwent treatments) underscore the need for personalized treatment plans, as advocated by Legro et al. [19].

The association between PCOS characteristics and comorbidities revealed in our study, such as the significant correlation between hyperandrogenism and metabolic syndrome, underscores the complex interplay of factors contributing to the syndrome's pathophysiology. These findings echo the discussions by Diamanti-Kandarakis et al., who explored the multifaceted nature of PCOS, including its association with metabolic and cardiovascular risks [20].

CONCLUSION

The study elucidated the multifaceted nature of Polycystic Ovary Syndrome (PCOS) within a tertiary care cohort, confirming a prevalence rate of 18.2%. Our findings underscore the significant variability in clinical presentations, with menstrual irregularity (79.1%) and polycystic ovaries (91.2%) being the most prevalent features. The association between PCOS and metabolic comorbidities, such as metabolic syndrome (28.6%), type 2 diabetes mellitus (15.4%), and hypertension (19.8%), was reaffirmed, highlighting the essential need for comprehensive metabolic screening in this population. Additionally, the considerable presence of psychological comorbidities, depression (18.7%), and anxiety (17.6%), emphasizes the importance of holistic care approaches encompassing both physical and mental health. Fertility challenges were prominent, with a substantial percentage of women experiencing infertility (30.8%) and seeking fertility treatments (17.6%), of which 9.9% achieved successful pregnancy outcomes. This study reinforces the complexity of PCOS, advocating for personalized, multidisciplinary management strategies to address the wide array of symptoms and comorbidities associated with this syndrome.

REFERENCES
  1. Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19(1):41-47.
  2. Teede HJ, Misso ML, Costello MF, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod. 2018;33(9):1602-1618.
  3. Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev. 1997;18(6):774-800.
  4. The Rotterdam ESHRE/ASRM-sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81(1):19-25.
  5. March WA, Moore VM, Willson KJ, et al. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod. 2010;25(2):544-551.
  6. Palomba S, de Wilde MA, Falbo A, et al. Pregnancy complications in women with polycystic ovary syndrome. Hum Reprod Update. 2015;21(5):575-592.
  7. Moran LJ, Misso ML, Wild RA, et al. Implications of polycystic ovary syndrome for pregnancy and for the health of offspring. Obstet Gynecol. 2015;125(6):1397-1406.
  8. Cooney LG, Lee I, Sammel MD, Dokras A. High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: A systematic review and meta-analysis. Hum Reprod. 2017;32(5):1075-1091.
  9. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab. 2004;89(6):2745-2749.
  10. Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol. 2013;6:1-13.
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