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A Multifaceted Disease from Adolescence to Adult Age
a Endocrinology Unit, Department of Internal Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
Key Words: polycystic ovary syndrome (PCOS) • hyperandrogenism • hyperinsulinemia • infertility • obesity
Address for correspondence: Renato Pasquali. U.O. di Endocrinologia, Dipt. Medicina Interna, Osp. S.Orsola-Malpighi, via Massarenti 9, 40138 Bologna, Italy. Voice: 0039-0-51-6364147; fax: 0039-0-51-6363080. e-mail: renato.pasquali{at}unibo.it
Polycystic ovary syndrome (PCOS), one of the most common causes of ovulatory infertility, affects 4–7% of women. Although it was considered that PCOS may have some genetic component and that clinical features of this disorder may change throughout a life span, starting from adolescence to postmenopausal age, no effort has been made to define differences in the phenotype and clinical presentation according to age. Indeed, it has been widely recognized in the last decade that several features of metabolic syndrome (MS), particularly insulin resistance and hyperinsulinemia, are inconsistently present in the majority of women with PCOS. This represents an important factor in the evaluation of PCOS throughout life, which implies that PCOS by itself may not be a hyperandrogenic disorder exclusively related to young and fertile-aged women, but may also have some health implications later in life. In young women with PCOS, hyperandrogenism, menses irregularities, and insulin resistance may occur together, emphasizing the pathophysiological role of excess androgen and insulin on PCOS. Hyperandrogenism and infertility represent the major complaints of PCOS in adult fertile age. In addition, obesity and MS may affect more than half these women. Later in life, it becomes clear that the association of obesity (particularly the abdominal phenotype) and PCOS renders affected women more susceptible to develop type 2 diabetes mellitus (T2DM), with some difference in the prevalence rates among countries, suggesting that environmental factors are important in determining individual susceptibility. Little is known about ovarian morphology and androgen production in women with PCOS after menopause. Some studies found that morphological ultrasonographic features consistent with polycystic ovaries are very common in postmenopausal women, and that these features are associated with higher than normal testosterone levels and metabolic alterations. There is an obvious need for further research in this area. Identification of major complaints and features of PCOS during the different ages of an affected woman may help, in fact, to plan individual therapeutic strategies, and, possibly, prevent long-term chronic metabolic diseases.
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