Joshi, A. (2024). PCOS stratification for precision diagnostics and treatment. Frontiers in Cell and Developmental Biology, 12. https://doi.org/10.3389/fcell.2024.1358755
Joshi A. PCOS stratification for precision diagnostics and treatment. Front. Cell Dev. Biol. 2024;12. doi:10.3389/fcell.2024.1358755
Joshi, Anagha. "PCOS stratification for precision diagnostics and treatment." Frontiers in Cell and Developmental Biology, vol. 12, 2024.
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PCOS is likely several disorders, so subtyping could guide care
A 2024 review of the science argues that PCOS is a group of overlapping disorders, and sorting them into subtypes could guide diagnosis and treatment. The author covers diagnosis, causes, weight and related conditions. One cited study found two subtypes, reproductive and metabolic. The review asks for large, varied datasets.
Key Findings
The review puts PCOS at 5%–20% of women in their reproductive years.
Counting PCOS by the Rotterdam definition gives a prevalence of up to 20%, against 6% by the NIH definition. Rotterdam also yields four phenotypes.
One study separated a reproductive subtype, with comparatively low BMI and insulin, from a metabolic subtype, with higher BMI, glucose and insulin.
The review reports shares of overweight or obese women with PCOS ranging from 38% to 88%.
A meta-analysis of forty studies found type 2 diabetes and impaired glucose tolerance three-fold more prevalent in women with PCOS.
Interpretation
The paper is a narrative review. The author summarizes selected studies, describes no search method and pools no data. The subtype evidence rests on one cited study, and many women fit neither subtype. Links found in population studies, such as those with environmental factors, lack proven biological mechanisms, the review says. One cited genetic study found weak evidence that obesity causes PCOS. Subtype-guided care remains a proposal awaiting data from diverse ages and ethnicities.
RRM Context
PCOS is now also called polyendocrine metabolic ovarian syndrome (PMOS). Restorative reproductive medicine looks for the cause before treating, so sorting PCOS by its drivers fits that principle. The review lists birth control pills among usual treatments. Birth control pills are suppressive medications that override the cycle.
Our editorial summary of this paper, not the article's abstract.
Abstract
Globally, polycystic ovarian syndrome (PCOS) affects approximately 10% of fertile women, leading to great health and economic burden. PCOS is a heterogenous illness that can cause infertility, irregular menstrual cycles, acne, and hirsutism, among other symptoms. The clinical diagnosis is primarily a diagnosis of exclusion if one or more of the three primary symptoms, namely, oligo- or anovulation, hyperandrogenism, and polycystic ovarian morphology, are present. Obesity and PCOS are often coexisting disorders that may be bidirectionally causally related. Phenotypic heterogeneity throughout the reproductive lifespan, such as the overlap of PCOS symptoms with regular fluctuations in a woman’s menstrual cycle and metabolism during the menarche and menopausal transition, further complicates diagnosis. PCOS etiology is mostly unknown and complex, likely due to the fact that it is a group of disorders with overlapping metabolic and reproductive problems. Evidence-based, common, standardized guidelines for PCOS diagnosis and treatment are urgently needed. Genomics and clinical data from populations across diverse ages and ethnicities are urgently needed to build efficient machine learning models for the stratification of PCOS. PCOS subtype-specific strategies for early screening, an accurate diagnosis, and management throughout life will optimize healthcare resources and reduce unnecessary testing. This will pave the way for women to be able to take the best possible care of their own health using the latest clinical expertise combined with their unique needs and preferences.
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