European Journal of Cardiovascular Medicine

A hormonal condition known as polycystic ovarian syndrome, or PCOS, is highly prevalent in women who are fertile. Numerous studies have demonstrated that overweight PCOS participants are more seriously impacted than those with the same BMI without PCOS, and that slim women with PCOS exhibit insulin resistance.¹ There is a substantial correlation between the rising average BMI and inclination toward central obesity and risk factors for conditions like osteoarthritis, cardiovascular disease, sleep apnea, breast and uterine cancer, and reproductive system abnormalities.^1,2 Individuals with PCOS who are overweight have a lower chance of becoming pregnant on their own or with medical help.³ The goal of PCOS treatment must be to normalize anovulation as well as hyper- and rogenism. The primary focus in the management of type 2 diabetes mellitus and impaired glucose tolerance (IGT) is lowering metabolic consequences. Pharmacological intervention or, better yet, lifestyle adjustment, can accomplish this. Important treatment approaches include losing all of the weight and a significant portion of the abdominal fat. The effects of weight loss on metabolism and reproduction stem from lower levels of circulating insulin. Promising metabolic and clinical outcomes have been observed with the initial usage of insulin-sensitizing medications, such as metformin and thiazolidinedione.⁴ Also regularly reported are the positive effects of weight loss on the biochemical and clinical signs of PCOS.⁵

Studies on short-term (four to eight week) weight loss interventions have shown a decrease in abdominal fat. Although moderate to severe calorie restriction can effectively lead to short-term weight loss, it is unlikely to result in maintained long-term weight loss. The recurrence of PCOS symptoms and the corresponding long-term morbidity and mortality concerns is likely to occur during weight gain. Achievable and sustainable goals are crucial for the long-term treatment of overweight and obesity, according to NIH guidelines. One such aim is combining behavior therapy, physical activity, and nutrition change.⁶ These principles align with those that have been investigated in a long-term diabetic population. According to a systematic review and meta-analysis conducted by Liza Haqq, James McFarlane, and colleagues at the University of New England, modifying one's diet and exercising can raise one's levels of rostenedione, FSH, SHBG, and total testosterone. All of these outcomes—aside from LH—were enhanced by exercise alone. Exercise or a lifestyle change by itself demonstrated a noticeably positive increase in hirsutism. These results are consistent with other research indicating that exercise and a change in lifestyle can reduce hirsutism.⁷

For women with PCOS, anovulation is the primary cause of infertility. Numerous routines have developed over time to trigger ovulation. There is mounting evidence in the last several years that excessive LH secretion is harmful to fertility and pregnancy outcomes. Anovulatory infertility is most frequently caused by polycystic ovarian syndrome. Age and elevated BMI can also lead to infertility; therefore, women should get counseling regarding the significance of preserving a healthy weight (BMI<30 kg/m2) and the ideal time to start a family.⁸ A portion of the population, women with PCOS, would presumably benefit most from regular exercise. Exercise improves insulin sensitivity through its direct effects on muscle metabolism as well as its indirect effects on weight managemen.⁹ Furthermore, a significant change in body weight or apparent body shape may not be indicative of the positive effects of exercise. It is crucial to stress that even little adjustments in energy expenditure or weight loss can have a substantial positive impac.¹⁰ The population being evaluated determines the estimation of PCOS prevalence since the clinical and biochemical characteristics of PCOS vary among ethnic group.¹¹ As many as 30% of women with secondary amenorrhea, 40% of infertile women, 75% of oligomenorrhea women, and 90% of hirsutism women have PCO.¹² PCOS is a prevalent endocrine condition that affects 5% to 10% of the general population and is often met by clinicians in women of reproductive age.¹³

This aim of this study was to determine the prevalence and phenotypes of PCOS among women attending a teaching hospital of eastern India.

This present prospective cross-sectional study was carried out in gynecology out-patient department of Gynae and Obstetrics, Calcutta National Medical College, Kolkata, West Bengal, India between April 2023 to December 2023.

Study population and sampling technique : According to statistical calculation a total of 50 PCOS patients were selected as study population following selection criteria

Inclusion criteria : Women who were diagnosed as PCOS in reproductive age (15-35) group attended at the gynecology OPD of Calcutta National Medical College, Kolkata were enrolled in this study.

Exclusion criteria : Women who were not interested in the study were excluded.

Pre designed, pre tested schedule was used to collect the data. The questionnaire was given only

after a proper informed and written consent was obtained. Then results were analyzed at the end of data collection.

Sample was selected by consecutive, convenient sampling technique. Normal females without PCOS, pregnant, age >35 or <15, patients with symptomatic diseases (liver, kidney, heart or other symptomatic diseases) were excluded from study. Informed written consent was taken from each participant prior to enrollment in study. All study participants were evaluated by history, clinical examination and investigation

Data Analysis plan- The data was tabulated in Microsoft Excel software and analysed with SPSS V.20 software. An alpha level of 5% has been taken that is if any p value is <0.05, it was considered as significant.

Table 1: Socio-demographic characteristics of the study population (n=50)

Mean age of the patients was 23.2±5.32 and majority of the patients belonged to the age group between 21-25 years (42%). The mean BMI was 22.48±5.64 where 18 (36%) were overweight and 42 (84%) of the patients were Hindu. (Table 1)

Table 2: Clinical profile of 100 PCOS patients (n=100).

Almost all were detected to have PCOS in ultrasonography. FLP was done of all patients. In present study among 50 PCOS patients, hirsutism was present in 28 (56%). Androgenic features like acne were present in 20 (40%) of the patients, acanthosis nigricans in 10 (20%) of the patients and androgenic alopecia was present in 26 (52%) of patients. (Table 2)

Table 3: Hormonal profile of study population (n=50).

Table 3 demonstrates biochemical and hormonal profile of PCOS patients. Metabolic syndrome diagnosis was made according to NCEP ATP 3 criteria. The prevalence of metabolic syndrome was calculated and it is found to be 18.0%

The prevalence of PCOS using Rotterdam criteria in our study was 5.42% among gynecological out-patient visits. In different parts of India like Andhra Pradesh prevalence of PCOS among adolescents is 9.13%.¹⁴ In Lucknow, U.P., India 3.7% females 18-25 years of age are found to have PCOS.¹⁵ In the neighboring countries like Pakistan, around 21.9% females are infertile of the total population, among which 38.5% of the infertility is due to PCOS.¹⁶ In Bangladesh, a study was conducted on 16700 infertile females among which 31.7% of the female population is suffering from PCOS.¹⁷ The rate of female population having PCOS in Myanmar is 5%.¹⁶ The rate of prevalence of PCOS in Sri Lanka is found to be 6.3%.¹⁸ The prevalence of PCOS among infertile women in our study was 38.46%, accounting to one third of the patients. Couzin estimated that 40% of infertile women have PCOS.¹⁹ A recent assessment of the frequency of PCOS in North India was 3.7% in women aged between 18 and 25 years.⁴⁰ In a study done by Muralidhara et al in KMC Mangalore in 2012 mean age among PCOS patients was 27±7.1.²¹

In present study among 50 PCOS patients, hirsutism was present in 28 (56%). Androgenic features like acne were present in 20 (40%) of the patients, acanthosis nigricans in 10 (20%) of the patients and androgenic alopecia was present in 26 (52%) of patients.

In a study done by Ramanand et al at Kohlapur, Maharashtra found that oligomenorrhea was present in 65% patients.²²

In present study waist circumference was >88 cm in 22 (44%) of the patients and WHR >0.8 was seen in 20 (40%) of the patients.

In present study metabolic syndrome diagnosis was made according to NCEP ATP 3 criteria. The prevalence of metabolic syndrome was calculated and it is found to be 18.0%.

In a study done in 2008 showed that all PCOS subgroups were more associated with metabolic syndrome than the control group (p<0.05).²³

Presenting with oligomenorrhea was the most typical. Because of their more severe ovulatory dysfunction, obese women with PCOS require additional care to ensure proper management.

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