Racial and Ethnic Differences in Physiology and Clinical Symptoms of Polycystic Ovary Syndrome

 

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Abstract

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders and affects approximately 5 to 10% of women of reproductive age. There exists substantial variation of physical stigmata and clinical symptoms among women, but PCOS has been known to be associated with irregular periods, infertility, increased pregnancy complications, as well as nonreproductive health problems arising from its association with the metabolic syndrome. Over the years, there have been various consensus statements regarding the diagnostic criteria, but the varying pronouncements suggest that the underlying cause is still not well understood and may be multifaceted. Importantly, the interaction of genetic predisposition and local environment is possibly responsible for the heterogeneity of phenotypes seen; it has been demonstrated that there is substantial ethnic and racial variation in the clinical presentations among PCOS patients and related individuals may vary in appearance based on nutritional and other aspects of locale. The differences in phenotype and clinical symptoms of PCOS related to the clinical, hormonal, and metabolic characteristics among various ethnic backgrounds, including Hispanics, African Americans, Asians, and Indians, need to be considered when assessing and treating these individuals. Future research must address the importance of interactions between genotype and the environment.

• References

• 1 Neel JV. Diabetes mellitus: a “thrifty” genotype rendered detrimental by “progress”?. Am J Hum Genet 1962; 14: 353-362
  PubMedGoogle Scholar
• 2 National Institutes of Health Evidence-based Methodology Workshop on Polycystic Ovarian Syndrome (PCOS). Available from: http://www.nichd.nih.gov/about/meetings/2012/Pages/120512.aspx
  PubMedGoogle Scholar
• 3 Stein I, Leventhal M. Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol 1935; 29: 181
  PubMedGoogle Scholar
• 4 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
  PubMedGoogle Scholar
• 5 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
  CrossrefPubMedGoogle Scholar
• 6 Azziz R, Carmina E, Dewailly D , et al; Androgen Excess Society. Positions statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. J Clin Endocrinol Metab 2006; 91 (11) 4237-4245
  Google Scholar
• 7 Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev 1997; 18 (6) 774-800
  CrossrefPubMedGoogle Scholar
• 8 Moran LJ, Misso ML, Wild RA, Norman RJ. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update 2010; 16 (4) 347-363
  CrossrefPubMedGoogle Scholar
• 9 Park YW, Zhu S, Palaniappan L, Heshka S, Carnethon MR, Heymsfield SB. The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988-1994. Arch Intern Med 2003; 163 (4) 427-436
  CrossrefPubMedGoogle Scholar
• 10 Solomon CG, Hu FB, Dunaif A , et al. Long or highly irregular menstrual cycles as a marker for risk of type 2 diabetes mellitus. JAMA 2001; 286 (19) 2421-2426
  CrossrefPubMedGoogle Scholar
• 11 Boomsma CM, Eijkemans MJ, Hughes EG, Visser GH, Fauser BC, Macklon NS. A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Hum Reprod Update 2006; 12 (6) 673-683
  CrossrefPubMedGoogle Scholar
• 12 Legro RS, Chiu P, Kunselman AR, Bentley CM, Dodson WC, Dunaif A. Polycystic ovaries are common in women with hyperandrogenic chronic anovulation but do not predict metabolic or reproductive phenotype. J Clin Endocrinol Metab 2005; 90 (5) 2571-2579
  CrossrefPubMedGoogle Scholar
• 13 Goodarzi MO, Quiñones MJ, Azziz R, Rotter JI, Hsueh WA, Yang H. Polycystic ovary syndrome in Mexican-Americans: prevalence and association with the severity of insulin resistance. Fertil Steril 2005; 84 (3) 766-769
  CrossrefPubMedGoogle Scholar
• 14 Moran C, Tena G, Moran S, Ruiz P, Reyna R, Duque X. Prevalence of polycystic ovary syndrome and related disorders in Mexican women. Gynecol Obstet Invest 2010; 69 (4) 274-280
  CrossrefPubMedGoogle Scholar
• 15 Lo JC, Feigenbaum SL, Yang J, Pressman AR, Selby JV, Go AS. Epidemiology and adverse cardiovascular risk profile of diagnosed polycystic ovary syndrome. J Clin Endocrinol Metab 2006; 91 (4) 1357-1363
  CrossrefPubMedGoogle Scholar
• 16 Coney P, Ladson G, Sweet S, Legro RS. Does polycystic ovary syndrome increase the disparity in metabolic syndrome and cardiovascular-related health for African-American women?. Semin Reprod Med 2008; 26 (1) 35-38
  Article in Thieme ConnectPubMedGoogle Scholar
• 17 Nidhi R, Padmalatha V, Nagarathna R, Amritanshu R. Prevalence of polycystic ovarian syndrome in Indian adolescents. J Pediatr Adolesc Gynecol 2011; 24 (4) 223-227
  CrossrefPubMedGoogle Scholar
• 18 Chen X, Yang D, Mo Y, Li L, Chen Y, Huang Y. Prevalence of polycystic ovary syndrome in unselected women from southern China. Eur J Obstet Gynecol Reprod Biol 2008; 139 (1) 59-64
  CrossrefPubMedGoogle Scholar
• 19 Kumarapeli V, Seneviratne Rde A, Wijeyaratne CN, Yapa RM, Dodampahala SH. A simple screening approach for assessing community prevalence and phenotype of polycystic ovary syndrome in a semi-urban population in Sri Lanka. Am J Epidemiol 2008; 168 (3) 321-328
  CrossrefPubMedGoogle Scholar
• 20 Kalra P, Bansal B, Nag P , et al. Abdominal fat distribution and insulin resistance in Indian women with polycystic ovarian syndrome. Fertil Steril 2009; 91 (4, Suppl): 1437-1440
  CrossrefPubMedGoogle Scholar
• 21 Wijeyaratne CN, Seneviratne Rde A, Dahanayake S , et al. Phenotype and metabolic profile of South Asian women with polycystic ovary syndrome (PCOS): results of a large database from a specialist Endocrine Clinic. Hum Reprod 2011; 26 (1) 202-213
  CrossrefPubMedGoogle Scholar
• 22 Yu Ng EH, Ho PC. Polycystic ovary syndrome in Asian women. Semin Reprod Med 2008; 26 (1) 14-21
  Article in Thieme ConnectPubMedGoogle Scholar
• 23 Li L, Yang D, Chen X, Chen Y, Feng S, Wang L. Clinical and metabolic features of polycystic ovary syndrome. Int J Gynaecol Obstet 2007; 97 (2) 129-134
  CrossrefPubMedGoogle Scholar
• 24 Nestler JE, Jakubowicz DJ. Decreases in ovarian cytochrome P450c17 alpha activity and serum free testosterone after reduction of insulin secretion in polycystic ovary syndrome. N Engl J Med 1996; 335 (9) 617-623
  CrossrefPubMedGoogle Scholar
• 25 Nestler JE, Jakubowicz DJ, Evans WS, Pasquali R. Effects of metformin on spontaneous and clomiphene-induced ovulation in the polycystic ovary syndrome. N Engl J Med 1998; 338 (26) 1876-1880
  CrossrefPubMedGoogle Scholar
• 26 Lord JM, Flight IH, Norman RJ. Metformin in polycystic ovary syndrome: systematic review and meta-analysis. BMJ 2003; 327 (7421) 951-953
  CrossrefPubMedGoogle Scholar
• 27 Legro RS, Barnhart HX, Schlaff WD , et al; Cooperative Multicenter Reproductive Medicine Network. Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome. N Engl J Med 2007; 356 (6) 551-566
  CrossrefPubMedGoogle Scholar
• 28 Seifer DB, Frazier LM, Grainger DA. Disparity in assisted reproductive technologies outcomes in black women compared with white women. Fertil Steril 2008; 90 (5) 1701-1710
  CrossrefPubMedGoogle Scholar
• 29 Wellons MF, Fujimoto VY, Baker VL , et al. Race matters: a systematic review of racial/ethnic disparity in Society for Assisted Reproductive Technology reported outcomes. Fertil Steril 2012; 98 (2) 406-409
  CrossrefPubMedGoogle Scholar
• 30 Baker VL, Luke B, Brown MB , et al. Multivariate analysis of factors affecting probability of pregnancy and live birth with in vitro fertilization: an analysis of the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System. Fertil Steril 2010; 94 (4) 1410-1416
  CrossrefPubMedGoogle Scholar
• 31 DeUgarte CM, Bartolucci AA, Azziz R. Prevalence of insulin resistance in the polycystic ovary syndrome using the homeostasis model assessment. Fertil Steril 2005; 83 (5) 1454-1460
  CrossrefPubMedGoogle Scholar
• 32 Mathur R, Alexander CJ, Yano J, Trivax B, Azziz R. Use of metformin in polycystic ovary syndrome. Am J Obstet Gynecol 2008; 199 (6) 596-609
  CrossrefPubMedGoogle Scholar
• 33 Knowler WC, Barrett-Connor E, Fowler SE , et al; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346 (6) 393-403
  CrossrefPubMedGoogle Scholar
• 34 Marshall JC, Dunaif A. Should all women with PCOS be treated for insulin resistance?. Fertil Steril 2012; 97 (1) 18-22
  CrossrefPubMedGoogle Scholar