Clinical features of polycystic ovary syndrome phenotypes in women with normogonadotropic anovulation in reproductive age

Hypothesis/aims of study. Polycystic ovary syndrome (PCOS) is a common disease, the frequency of which ranges from 8 to 13% in women of reproductive age. PCOS is a complex polygenic endocrine disorder with reproductive, metabolic, and psychological features. Currently, four PCOS phenotypes are identified that are associated with metabolic disorders, insulin resistance, impaired glucose tolerance (IGT), diabetes mellitus, and an increase in the number of risk factors for cardiovascular diseases. The aim of this study was to investigate the clinical features of PCOS phenotypes in women with normogonadotropic anovulation in reproductive age.

Study design, materials, and methods. The study included 60 women of reproductive age from 24 to 37 years (mean age 28 ± 4 years) with PCOS and normogogonadotropic, normoprolactinemic anovulation. We studied the levels of anti-mullerian, follicle-stimulating, luteinizing hormone, prolactin, estradiol, and androgens from days 2 to 5 of the menstrual cycle. The serum progesterone level was studied by ELISA using test systems manufactured by Alkor Bio Ltd. (Russia) on days 20–23 of the menstrual cycle for three consecutive cycles. The average level of progesterone in the blood on days 20–23 of the menstrual cycle was 3.1 ± 1.5 nM. Echographic methods for diagnosing polycystic ovaries were used. All women included in the study underwent hysteroscopy on days 18–22 of the menstrual cycle, followed by a histological and immunohistochemical study of the endometrium.

Results. In women with anovulatory PCOS phenotypes, phenotype A (classical) was detected in 32 (53.3%) women; phenotype B (anovulatory) in 18 (30%) women; phenotype D (non-androgenic) in 10 (16.7%) women with. In 32 (53.3%) patients, changes in carbohydrate metabolism (IGT) were found. Clinical and biochemical manifestations of androgen-dependent dermopathy (acne, oily seborrhea, and hirsutism) were significantly (p < 0.05) more often observed in PCOS patients with phenotypes A (84.4%) and B (88.9%) than in women with phenotype D (30%). In the majority (93.8%) of patients with IGT, the androgenic-anovulatory PCOS phenotypes were detected: phenotype A in 20 (62.5%) women and phenotype B in 10 (31.3%) women. Phenotype D (non-androgenic) was present only in two women with PCOS and IGT. As a result of complex histological and immunohistochemical studies of endometrial biopsy specimens, chronic endometritis was detected in 44 (73.3%) examined women with PCOS and simple glandular endometrial hyperplasia was diagnosed in 13 (21.7%) PCOS patients. The incidence of chronic endometritis and simple glandular endometrial hyperplasia in women with normogonadotropic anovulation and PCOS directly depended (r = 0.35; p < 0.05) on disorders of carbohydrate metabolism and was detected more often in patients with PCOS and IGT.

Conclusion. The differential approach to the examination of patients with various PCOS phenotypes allows personalizing the therapy of this disease and determining the complex of preventive measures to improve the quality of life of women of reproductive age.