PCOS spans a spectrum of ovarian, cycle and hormone findings
A 1989 review of London ultrasound and hormone data finds that women with polycystic ovaries differ widely. Polycystic ovaries appeared in 22% of 257 volunteers who saw themselves as normal.
Key Findings
Pelvic ultrasound found polycystic ovaries in 32% of 100 clinic patients with no periods, 87% of 75 with infrequent periods and 87% of 46 with hirsutism and regular ovulatory cycles.
Among 158 volunteers not taking the oral contraceptive, 36 (23%) had polycystic ovaries, and 75% of the women with polycystic ovaries had irregular cycles.
Among women with polycystic ovaries on ultrasound who did not ovulate or had hirsutism, 85% had at least one raised marker: luteinizing hormone, testosterone or androstenedione.
A random basal luteinizing hormone level was above the normal range in 51% of women with polycystic ovaries, and 6 of 33 non-ovulating women (18%) had a normal 8-hour mean.
Overweight women with polycystic ovaries were more often hirsute (73% against 56% of lean women) and less often had regular cycles (12% against 28%).
Interpretation
The paper is a review that combines published studies with the authors' own ultrasound and hormone tests, mostly single blood samples. The data come from women attending a London endocrine clinic and from volunteers who included hospital staff. Women with high-prolactin amenorrhea were analyzed separately in the clinic figures. The authors note that the volunteer group was relatively small and could include an unrepresentative share of women with irregular cycles. They cite population studies in which up to 20% of women have irregular cycles. Their ideas about cause, including a familial and ovarian origin in most cases, are suggestions.
RRM Context
The review defines polycystic ovaries by follicle number and an increased amount of stroma. A 2026 Lancet consensus gave the condition a new name: polyendocrine metabolic ovarian syndrome (PMOS), formerly polycystic ovary syndrome (PCOS). The old name implied ovarian cysts and obscured the endocrine and metabolic features, and a transition period to the new name is under way. Restorative reproductive medicine looks for the cause of ovulation problems in each woman before treating. The wide range of patterns in this review fits that approach.
Our editorial summary of this paper, not the article's abstract.
Abstract
Few subjects have provoked such controversy in the field of reproductive endocrinology as polycystic ovary syndrome (PCOS). It is characterized by heterogeneous clinical and endocrine features and this has led to considerable debate about its definition. The controversy has been fuelled by uncertainty about the aetiology of the syndrome. It seems probable that there are several causes of the typical ovarian appearance although, as will be discussed later, a familial basis for the disorder appears to be the most common of these. Traditionally, since the classic description of the syndrome by Stein and Leventhal in 1935, the diagnosis has rested primarily on the typical appearance of bilateral sclerocystic ovaries in women presenting with anovulation or hirsutism (or both). But the results from subsequent publications indicated that there could be a wide variety of clinical presentations in women who had evidence of polycystic ovaries (PCO) at ovarian biopsy (Goldzieher & Axelrod, 1963; Goldzicher & Green, 1962; Jeffcoate, 1963; Smith et al.. 1965; Givens, 1977, 1984; Yen, 1980). Although most of the women had menstrual disorders or hirsutism, there were also those who had evidence of ovulatory cycles and others who were non-hirsute. McArthur, Ingersoll and Worcester (1958) made the important observation that women with bilateral PCO characteristically had elevated urinary excretion of luteinizing hormone (LH). When radioimmunoassay became widely available in the early 1970s the emphasis changed from diagnosis by histology to use of biochemical markers of the syndrome. The typical endocrine abnormalities in PCS were raised serum concentrations of LH and testosterone (and/or androstenedione) to which could be added, in later studies, evidence of hypersecretion of adrenal androgens and abnormalities of estrogen secretion, particularly estrone (Yen et al., 1970; Gambrell et al., 1973; Rebar et al., 1976; Baird et al.. 1977; Kandeel et al.. 1978; Yen, 1980). So great was the reliance on biochemical diagnosis that, in some studies, the appearance of the ovaries was considered to be of secondary importance. One problem has been that there has seldom been total agreement as to the biochemical definition of PCOS. Some groups, for example, have taken a raised serum LH to be important for the diagnosis (Lobo, 1985; Waldstreicher et al.. 1988). However, it was clear from early biochemical studies that some women with all the other clinical and biochemical features of PCOS had normal serum LH concentra- tions (Givens et al., 1976; Rebar er al., 1976).
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