Carmina, E., & Lobo, R. A. (1999). Do hyperandrogenic women with normal menses have polycystic ovary syndrome? Fertility and Sterility, 71(2), 319-322. https://doi.org/10.1016/s0015-0282(98)00455-5
Carmina E, Lobo RA. Do hyperandrogenic women with normal menses have polycystic ovary syndrome? Fertil Steril. 1999;71(2):319-322. doi:10.1016/s0015-0282(98)00455-5
Carmina, Enrico, and Rogerio A. Lobo. "Do hyperandrogenic women with normal menses have polycystic ovary syndrome?" Fertility and Sterility, vol. 71, no. 2, 1999, pp. 319-322.
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Hyperandrogenic women with normal periods may still have PCOS
In 58 women with high androgen levels and self-reported normal periods, 43 could be considered to have PCOS. Twelve of the women were not ovulating, found on progesterone testing. Of the 46 who were ovulating, 31 had PCOS-like ovaries or hormone responses. PCOS is also called PMOS (polyendocrine metabolic ovarian syndrome).
About 7 in 10 women with high androgen levels and normal periods could be considered to have PCOS. Source: Carmina E et al., 1999, PMID 9988405.Study at a glance, prospective study of 58 new patients: Hyperandrogenic women with normal periods may still have PCOS. Source: Carmina E et al., 1999, PMID 9988405.
Key Findings
Twelve of 58 women (20.7%) did not ovulate across two consecutive cycles, even though they reported normal menses.
Polycystic ovaries on ultrasound appeared in 11 of the 12 women who were not ovulating (91%) and in 19 of the 46 who were ovulating (42%).
An exaggerated 17-hydroxyprogesterone response to a leuprolide acetate test appeared in 10 of 12 women not ovulating (83%) and 24 of 46 ovulating (52%).
Of the 46 ovulating women, 31 (67%) had polycystic ovaries, an exaggerated hormone response, or both. Fifteen (33%) had neither.
Counting both groups, 43 of 58 women (74%) could be considered to have PCOS.
Interpretation
This prospective study followed 58 new patients at one practice in 1996 and 1997. All had high androgen levels and reported normal menses. Progesterone tests, repeated in the next cycle when low, checked ovulation. The authors found that 74% of these women could be considered to have PCOS. The count combined the women with no ovulation and the ovulating women who had polycystic ovaries or an exaggerated hormone response. High androgens plus chronic lack of ovulation remain the usual criteria for the diagnosis. The authors note the cause of high androgens in the other ovulating women could not be established at this time. The findings support larger studies of hyperandrogenic women who report normal menses.
RRM Context
Regular bleeding can happen without ovulation. Twelve of these 58 women had normal menses and did not ovulate on progesterone testing. Restorative reproductive medicine asks whether a woman is ovulating and why her androgen levels are high.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To determine the prevalence of polycystic ovary syndrome (PCOS) among hyperandrogenic women who report normal menses.
Design
Prospective observational study.
Setting
Academic practice in reproductive endocrinology.
Patients
Fifty-eight consecutively seen new patients with hyperandrogenism who reported normal menses.
Interventions
Ovulatory status was assessed with timed serum progesterone measurements. The following tests also were carried out: vaginal ultrasound examination; measurement of the ovarian response of 17-hydroxyprogesterone (17-OHP) after the administration of leuprolide acetate, 1 mg SC; and determination of fasting serum LH, FSH, E2, 17-OHP, insulin, and androgen levels.
Main Outcome Measures
Determination of ovulatory status, polycystic appearance of ovaries, and increased response of 17-OHP to leuprolide acetate.
Results
Twelve (20.7%) of the hyperandrogenic women were anovulatory and met the usual criteria for the diagnosis of PCOS. The ovulatory patients had lower serum total and unbound testosterone levels. Thirty-one (53.4%) of the ovulatory women had polycystic ovaries on ultrasound examination and/or an increased 17-OHP response to leuprolide acetate, suggesting the diagnosis of PCOS despite the presence of ovulation. Considering both the anovulatory and ovulatory patients, 74% of the hyperandrogenic women studied could have PCOS.
Conclusions
The data suggest that most (74%) hyperandrogenic women who report normal menses have evidence for the diagnosis of PCOS.
PMOS / PCOS has four diagnostic phenotypes and distinct metabolic, reproductive, and mental health implications. How RRM-trained clinicians approach diagnosis and treatment differently.
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