Clinical manifestations of polycystic ovary syndrome: a modern view

INTRODUCTION: Polycystic ovary syndrome (PCOS) is one of the urgent problems of gynecological endocrinology. The main signs of PCOS include a violation of menstrual and/or ovulatory function and clinical and/or biochemical hyperandrogenism, as well as polycystic ovarian morphology according to the ultrasound results. PCOS leads to infertility, obesity, and cardiovascular system diseases. PCOS is an important symptom complex in the diagnosis, which directly affects the reproductive function of females, hence the percentage of fertility. This study aimed to analyze the features of clinical, laboratory, and instrumental parameters in females with a previously established PCOS diagnosis referred for surgical treatment. The obtained results were studied from the point of view of the clinical guidelines of the American Society for Reproductive Medicine and the European Society of Human Reproduction and Embryology (2003), International PCOS Network (2018), and the Ministry of Health of the Russian Federation (2021).

MATERIALS AND METHODS: The study included 121 females who were admitted to hospitals in Moscow for surgical treatment. Among the gynecological surgical hospitals, the following medical institutions were allocated: the city clinical hospital, the research center, and the commercial clinic we conditionally divided into three levels.

The city clinical hospital had 54 females (1^st group) aged 21–37 years, the research center with 48 females (2^nd group) aged 22–42 years, and the commercial clinic with 19 females (3^rd group) aged 25–41. Before the ovarian surgery for PCOS, all patients underwent an additional examination, including the collection of anamnesis, particularly, features of menstrual and generative function, anthropometric indicators, body weight, and height study. Based on these parameters, the body mass index (BMI) was calculated, the clinical signs of hyperandrogenism (acne, excessive hair growth on the body and face, and the degree of hirsutism) were assessed, and the hormonal profile was determined to detect biochemical hyperandrogenism (free testosterone). Additionally, the level of glucose and insulin in the blood plasma was determined in all patients, and a pelvic ultrasound examination (ultrasound) was performed.

RESULTS: Menstrual irregularities were revealed, of which complaints were presented by a total of 49.5% of patients. The results of the preliminary selection of patients with PCOS for surgical treatment revealed that 108 (89.2%) had primary and secondary infertility, of whom 64 (52.9%) had BMI within the normative values, 29 (23.9%) were overweight, and 25 (20.6%) were obese. Clinical manifestations of hyperandrogenism were present in 61 (50.4%) patients included in the study. The level of free testosterone above the normative values (>2.85 pg/ml) was diagnosed only in 9 (7.4%) patients out of 121 who are included in the study. Additionally, this parameter was within the upper limit of the norm (average value of 2.78±0.36 pg/ml) in 112 females but was combined with clinical manifestations of hyperandrogenism. Black acanthosis was noted in 6 (5.0%) patients with free testosterone levels in 3.01–3.64 pg/ml. Increased blood glucose levels were combined with obesity in 3 (5.5%) patients of 1^st group and 1 (2.1%) in 2^nd group. Insulin levels significantly exceeded the upper limit of the norm in 6 (5.0%) patients. The ultrasound result in all patients (n=121) revealed the presence of echographic signs of PCOS in PCOS was confirmed by ultrasound in 54 females in 1^st group, 48 females in 2^nd group, and 19 females in 3^rd group.

CONCLUSION: Our results suggest an unreasonably broad interpretation of PCOS diagnosis. Therefore, PCOS diagnosis should be primarily remembered as a diagnosis-exception. Only repeated, extended, thorough, and comprehensive examination of patients with a presumed PCOS diagnosis will allow you to better navigate the individual characteristics of patients and offer adequate methods for correcting the symptom complex to improve the overall health, fertility, and quality of life.