The University of Adelaide, Discipline of Obstetrics & Gynaecology, Adelaide, South Australia, Australia.
The University of Adelaide, School of Public Health, Adelaide, South Australia, Australia.
Hum Reprod. 2021 Jul 19;36(8):2275-2284. doi: 10.1093/humrep/deab101.
Are reproductive, metabolic or psychological health profiles of women with clinically diagnosed polycystic ovary syndrome (PCOS) different from those with undiagnosed PCOS?
Obtaining a clinical diagnosis of PCOS is strongly linked to the experience of fertility problems, but not clinical depression or poor metabolic health, although these were highly prevalent in women with PCOS irrespective of when they were diagnosed.
PCOS is an endocrine disorder that is relative common, but heterogeneous in presentation. This may impact on the pathways to diagnosis and timely treatment.
STUDY DESIGN, SIZE, DURATION: A cross-sectional analysis of a community-based cohort of 974 women, established retrospectively when women were around 30 years of age.
PARTICIPANTS/MATERIALS, SETTING, METHODS: In this cohort of women born in Adelaide, South Australia, half of women who met the Rotterdam criteria for PCOS were previously undiagnosed. We compared women with prior clinical diagnosis of PCOS, those diagnosed through participation in this research, and the remainder in the cohort. Sociodemographic characteristics, reproductive, metabolic and psychological health, including medical conditions and medications were considered. Logistic regression was undertaken to identify independent predictors of prior clinical diagnosis.
There were 56 women with a prior clinical diagnosis of PCOS (5.7%) and a further 64 (6.6%) were undiagnosed until study entry. The great majority of women with a prior diagnosis of PCOS reported having had problems with periods (95%) and excess body hair (63%). Corresponding proportions for women undiagnosed until study participation were slightly lower (81% and 45%, respectively). Although the proportion of women attempting or achieving pregnancy was similar across all groups, those with a prior diagnosis of PCOS were four times more likely to have reported difficulties becoming pregnant than those undiagnosed (odds ratio = 4.05, 95% CI 1.74-9.45) and frequently sought medical assistance. Metabolic problems were higher in both PCOS groups compared to women without PCOS. In both PCOS groups, the prevalence of clinical depression was 50% higher than in those with no PCOS (P = 0.021).
LIMITATIONS, REASONS FOR CAUTION: The number of women who were diagnosed with PCOS both prior to and during the study limited statistical power available to detect modest differences between the PCOS groups. Some women in the group classified as not having PCOS may have remained undiagnosed, but any bias from this source would contribute to more conservative findings.
Findings reinforce the need for early detection of PCOS symptoms from adolescence, ensuring timely diagnosis and appropriate health care. The high prevalence of depression among clinically diagnosed and undiagnosed women with PCOS suggests this is a feature of the condition and supports recent recommendations in the international PCOS guidelines to screen all women with PCOS for depression and anxiety.
STUDY FUNDING/COMPETING INTEREST(S): This work was supported by a project grant (2017) from the National Health and Medical Research Council of Australia (NHMRC) Centre for Research Excellence in Polycystic Ovary Syndrome (Grant ID APP1078444). R.C.F. and J.C.A. were supported by Robinson Research Institute Lloyd Cox Career Development Fellowships (2018). Establishment of the cohort was funded by an NHMRC Strategic Award No. 465455, a Career Development Award in Population Health (No. 349548) and the Australian Research Council (Future Fellowship FT100101018) awarded to M.J.D. All authors declared no conflict of interest.
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患有临床诊断多囊卵巢综合征（PCOS）的女性与未经诊断的 PCOS 女性在生殖、代谢或心理健康方面的特征是否不同？
获得 PCOS 的临床诊断与生育问题的经历密切相关，但与临床抑郁症或代谢健康问题无关，尽管这些问题在患有 PCOS 的女性中非常普遍，无论她们何时被诊断。
PCOS 是一种内分泌紊乱疾病，相对常见，但表现形式多样。这可能会影响到诊断和及时治疗的途径。
研究设计、规模、持续时间：对阿德莱德 974 名女性的社区队列进行了回顾性横断面分析，这些女性在大约 30 岁时建立了队列。
参与者/材料、设置、方法：在南澳大利亚阿德莱德出生的这组女性中，符合 Rotterdam 标准的 PCOS 患者中有一半以前未被诊断。我们比较了有先前临床诊断的 PCOS 患者、通过参与本研究诊断的患者以及队列中的其余患者。考虑了社会人口统计学特征、生殖、代谢和心理健康，包括医疗状况和药物治疗。采用逻辑回归确定先前临床诊断的独立预测因素。
有 56 名女性有先前的临床诊断为 PCOS（5.7%），另有 64 名（6.6%）直到研究开始时才被诊断。绝大多数有先前诊断的 PCOS 患者报告有月经问题（95%）和过多的体毛（63%）。相应的比例对于那些直到参与研究才被诊断的女性略低（分别为 81%和 45%）。尽管所有组中试图或实现怀孕的女性比例相似，但有先前诊断的 PCOS 患者报告怀孕困难的可能性是未被诊断的四倍（比值比=4.05，95%CI 1.74-9.45），并且经常寻求医疗帮助。与没有 PCOS 的女性相比，两组 PCOS 患者的代谢问题都更高。在两组 PCOS 患者中，临床抑郁症的患病率比没有 PCOS 的女性高 50%（P=0.021）。
局限性、谨慎的原因：在研究之前和期间被诊断为 PCOS 的女性数量限制了可用于检测 PCOS 组之间细微差异的统计能力。一些被归类为没有 PCOS 的女性可能仍然未被诊断，但任何来自这一来源的偏见都会导致更保守的发现。
研究结果强调需要从青春期开始早期发现 PCOS 症状，以确保及时诊断和适当的医疗保健。在有临床诊断和未经诊断的 PCOS 女性中，抑郁症的高患病率表明这是该疾病的一个特征，并支持国际 PCOS 指南中的最新建议，即对所有 PCOS 女性进行抑郁症和焦虑症筛查。
研究资助/利益冲突：这项工作得到了澳大利亚国家健康与医学研究委员会（NHMRC）多囊卵巢综合征研究卓越中心（Grant ID APP1078444）项目资助（2017 年）。R.C.F. 和 J.C.A. 得到了罗宾逊研究所 Lloyd Cox 职业发展奖学金（2018 年）的支持。该队列的建立得到了 NHMRC 战略奖（No. 465455）、人口健康职业发展奖（No. 349548）和澳大利亚研究委员会（未来奖学金 FT100101018）的资助，该奖学金授予 M.J.D. 所有作者均声明无利益冲突。
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