Skip to main content Accessibility help
×
Home
  • Print publication year: 2007
  • Online publication date: September 2009

18 - Polycystic ovary syndrome in Asian women

Summary

Introduction

Polycystic ovary syndrome (PCOS) is the commonest endocrine disorder in women of reproductive age as this syndrome may affect 5–10% of premenopausal women in Western countries (Franks 1995). Women with this syndrome may present with one, all, or any combination of menstrual irregularities, chronic anovulation, infertility, obesity, and hyperandrogenism. There is substantial heterogeneity of symptoms and signs among women with PCOS and different criteria have been used to confirm the diagnosis. Ultrasound assessment of ovarian morphology is considered to be essential and the gold standard for defining polycystic ovaries in Europe (Adams et al. 1986, Balen 1999). Characteristic ovarian morphology is not required in the American definition, which states that PCOS is the association of hyperandrogenism with chronic anovulation in women without specific underlying diseases of the adrenal or pituitary glands (Dunaif 1997).

Recently, a revised definition of PCOS was agreed and required the presence of two from the following three diagnostic criteria: (1) oligo- and/or anovulation; (2) clinical and/or biochemical features of hyperandrogenism; and (3) the presence of polycystic ovary (PCO) morphology (The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group 2004). In recent years, transvaginal ultrasound has become the most commonly used diagnostic method for the identification of PCO. In order to make a diagnosis of PCO, >10 follicles of 2–10 mm in diameter and increased density of ovarian stroma (Adams et al. 1986) are required.

REFERENCES
Aboulghar, M. A. and Mansour, R. T. (2003) Ovarian hyperstimulation syndrome: classifications and critical analysis of preventive measures. Hum. Reprod. Update 9:275–289.
Adams, J., Polson, D. W., and Franks, S. (1986) Prevalence of polycystic ovaries in women with anovulation and idiopathic hirsutism. Br. Med. J. 293:355–359.
Agrawal, R., Sladkevicius, P., Engmann, L., et al. (1998) Serum vascular endothelial growth factor concentrations and ovarian stromal blood flow are increased in women with polycystic ovaries. Hum. Reprod. 13:651–655.
Andoh, K., Mizunuma, H., Liu, X., et al. (1998) A comparative study of fixed-dose, step-down, and low-dose step-up regimens of human menopausal gonadotropin for patients with polycystic ovary syndrome. Fertil. Steril. 70:840–846.
Balen, A. (1999) Pathogenesis of polycystic ovary syndrome: the enigma unravels?Lancet 354:966–967.
Balen, A. H., Laven, J. S. E., Tan, S. L., and Dewailly, D. (2003) Ultrasound assessment of the polycystic ovary: international consensus definitions. Hum. Reprod. Update 9:505–514.
Carmina, E., Koyama, T., Chang, L., Stanczyk, F. Z., and Lobo, R. A. (1992) Does ethnicity influence the prevalence of adrenal hyperandrogenism and insulin resistance in polycystic ovary syndrome?Am. J. Obstet. Gynecol. 167:1807–1812.
Chan C. C. W., Ng E. H. Y., Tang O. S., Lee C. P., and Ho P. C. (2006a) The prevalence of polycystic ovary in Chinese women with a history of gestational diabetes. Gynecol. Endocrinol. (In press.)
Chan, C. C. W., Koo, M. W. L., Ng, E. H. Y., et al. (2006b) Effects of Chinese green tea on weight, hormonal and biochemical profiles in obese patients with polycystic ovary syndrome: a randomized placebo controlled trial. J. Soc. Gynaecol. Invest. 13:63–68.
Chantre, P. and Lairon, D. (2002) Recent findings of green tea extract AR25 (Exolise) and its activity for the treatment of obesity. Phytomedicine 9:3–8.
Dulloo, A. G., Duret, C., Rohrer, D., et al. (1999) Efficacy of a green tea extract rich in catechin polyphenols and caffeine in increasing 24-h energy expenditure and fat oxidation in humans. Am. J. Clin. Nutr. 70:1040–1045.
Dunaif, A. (1995) Hyperandrogenic anovulation (PCOS): a unique disorder of insulin action associated with an increased risk of non-insulin-dependent diabetes mellitus. Am. J. Med. 98(Suppl. 1A):33S–39S.
Dunaif, A. (1997) Insulin resistance and the polycystic ovary syndrome: mechanisms and implication for pathogenesis. Endocr. Rev. 18:774–800.
Farquhar, C., Lilford, R. J., Maroribanks, J., and Vandekerckhove, P. (2005) Laparoscopic “drilling” by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome. Cochrane Database Syst. Rev. 3:CD001122.
Franks, S. (1995) Polycystic ovary syndrome. N. Engl. J. Med. 333:853–861.
Järvelä, I. Y., Mason, H. D., Sladkevicius, P., et al. (2002) Characterization of normal and polycystic ovaries using three-dimensional power Doppler ultrasonography. J. Assist. Reprod. Genet. 19:582–590.
Han, L. K., Takaku, T., Li, J., Kimura, Y., and Okuda, H. (1999) Anti-obesity action of oolong tea. Int. J. Obes. Relat. Metab. Disord. 23:98–105.
Hasegawa, I., Murakawa, H., Suzuki, M., et al. (1999) Effect of troglitazone on endocrine and ovulatory performance in women with insulin resistance-related polycystic ovary syndrome. Fertil. Steril. 71:323–327.
Imai, K., Suga, K., and Nakachi, K. (1997) Cancer-preventive effects of drinking green tea among a Japanese population. Prev. Med. 26:769–775.
Kao, Y. H., Hiipakka, R. A., and Liao, S. (2000) Modulation of endocrine systems and food intake by green tea epigallocatechin gallate. Endocrinology 141:980–987.
Kiddy, D. S., Hamilton-Fairley, D., Bush, A., et al. (1992) Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin. Endocrinol. (Oxf.) 36:105–111.
Kondoh, Y., Uemura, T., Ishikawa, M., Yokoi, N., and Hirahara, F. (1999) Classification of polycystic ovary syndrome into three types according to response to human corticotropin-releasing hormone. Fertil. Steril. 72:15–20.
Lord, J. M., Flight, I. H. K., and Norman, R. J. (2003) Metformin in polycystic ovary syndrome: systematic review and meta-analysis. Br. Med. J. 327:951–953.
Ng, E. H. Y., Tang, O. S., and Ho, P. C. (2000) The significance of the number of antral follicles prior to stimulation in predicting ovarian responses in an in-vitro fertilization programme. Hum. Reprod. 15:1937–1942.
Ng, E. H. Y., Wat, W. M. S., and Ho, P. C. (2001) Effects of metformin on ovulation rate, hormonal and metabolic profiles in women with clomiphene resistant polycystic ovaries: a randomized, double-blinded placebo-controlled trial. Hum. Reprod. 16:1625–1631.
Ng, E. H. Y., Fong, D. Y. T., Yeung, W. S. B., and Ho, P. C. (2003) Effects of age on hormonal and ultrasound markers of ovarian reserve in Chinese women with proven fertility. Hum. Reprod. 18:2169–2174.
Ng, E. H. Y., Chan, C. C. W., Yeung, W. S. B., and Ho, P. C. (2004) Effect of age on ovarian stromal flow measured by three-dimensional ultrasound with power Doppler in Chinese women with proven fertility. Hum. Reprod. 19:2132–2137.
Ng, E. H. Y., Chan, C. C. W., Yeung, W. S. B., and Ho, P. C. (2005a) Antral follicle count and follicle stimulating hormone concentration after clomiphene citrate challenge test in the prediction of ovarian response during in vitro fertilization treatment. Hum. Reprod. 20:1647–1654
Ng, E. H. Y., Chan, C. C. W., Yeung, W. S. B., and Ho, P. C. (2005b) Comparison of ovarian stromal flow measured by three-dimensional power Doppler ultrasound between fertile women with normal ovaries and infertile women with polycystic ovary syndrome. Hum. Reprod. 20:1881–1886.
Norman, R. J., Mahabeer, S., and Masters, S. (1995) Ethnic differences in insulin and glucose response to glucose between white and Indian women with polycystic ovary syndrome. Fertil. Steril. 63:58–62.
Pairleitner, H., Steiner, H., Hasenoehrl, G., and Staudach, A. (1999) Three-dimensional power Doppler sonography: imaging and quantifying blood flow and vascularization. Ultrasound Obstet. Gynecol. 14:139–143.
Pan, H. A., Wu, M. H., Cheng, Y. C., Li, C. H., and Chang, F. M. (2002) Quantification of Doppler signal in polycystic ovary syndrome using three-dimensional power Doppler ultrasonography: a possible new marker for diagnosis. Hum. Reprod. 17:201–206.
Pirwany, I. R., Yates, R. W. S., Cameron, I. T., and Fleming, R. (1999) Effects of the insulin sensitizing drug metformin on ovarian function, follicular growth and ovulation rate in obese women with oligomenorrhea. Hum. Reprod. 14:2963–2968.
Polson, D. W., Wadsworth, J., Adams, J., and Franks, S. (1988) Polycystic ovaries: a common finding in normal women. Lancet i:870–872.
Robinson, S., Kiddy, D., Gelding, S. V., et al. (1993) The relationship of insulin insensitivity to menstrual pattern in women with hyperandrogenism and polycystic ovaries. Clin. Endocrinol. (Oxf.) 39:351–355.
Rodin, D. A., Bano, G., Bland, J. M., Taylor, K., and Nussey, S. S. (1998) Polycystic ovaries and associated metabolic abnormalities in Indian subcontinent Asian women. Clin. Endocrinol. (Oxf.) 49:91–99.
Sakai, A., Kondo, Z., Kamei, K., Izumi, S., and Sumi, K. (1999) Induction of ovulation by Sairei-to for polycystic ovary syndrome patients. Endocr. J. 46:217–220.
Takahashi, K. and Kitao, M. (1994) Effect of TJ-68 (shakuyaku-kanzo-to) on polycystic ovarian disease. Int. J. Fertil. Menopausal Stud. 39:69–76.
Takahashi, K., Uchida, A., Yamasaki, H., Ozaki, T., and Kitao, M. (1994) Transvaginal ultrasonic assessment of the response to clomiphene citrate in polycystic ovarian syndrome. Fertil. Steril. 62:48–53.
The ESHRE Capri Workshop (1997) Female infertility: treatment options for complicated cases. Hum. Reprod. 12:1191–1196.
The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Hum. Reprod. 19:41–47.
Ushiroyama, T., Ikeda, A., Sakai, M., et al. (2001) Effects of unkei-to, an herbal medicine, on endocrine function and ovulation in women with high basal levels of luteinizing hormone secretion. J. Reprod. Med. 6:451–456.
Wang, D. Z., Wang, Z. Q., and Shi, L. Y. (1988) Treatment of polycystic ovary syndrome with Chinese drug longdan xiegan tang. J. Tradit. Chin. Med. 8:117–119.
Wijeyaratne, C. N., Balen, A. H., Barth, J. H., and Belchetz, P. E. (2002) Clinical manifestations and insulin resistance (IR) in polycystic ovary syndrome PCOS) among South Asians and Caucasians: is there a difference?Clin. Endocrinol. (Oxf.) 57:343–350.
Wu, X. K., Su, Y. H., and Zhang, Z. X. (1996) Wedge resection to improve insulin resistance in polycystic ovary syndrome: a study among Chinese women. Br. J. Obstet. Gynaecol. 103:822–825.
Xiao, B. (2003) Chinese traditional medicine for induction of ovulation. J. Reprod. Med. 12(Suppl. 1):1–8.
Yang, T. T. C. and Koo, M. W. L. (1997) Hypocholesterolemic effects of Chinese tea. Pharmacol. Res. 35:505–512.
Zaidi, J., Campbell, S., Pittrof, R., et al. (1995) Ovarian stromal blood flow in women with polycystic ovaries: a possible new marker for diagnosis?Hum. Reprod. 10:1992–1996.