Researchers at Cedars-Sinai Medical Center and the University of Alabama, Birmingham, have found that a complex hormonal disorder affecting the reproductive and metabolic function of premenopausal women may be considerably more common in the United States than previously believed from earlier, smaller studies.
“This is the single largest study concerning the prevalence of the Polycystic Ovary Syndrome in this country, and the data support the concept that PCOS is the most common endocrine abnormality of reproductive-aged women,” said Ricardo Azziz, MD, MPH, MBA, Chair of Cedars-Sinai’s Department of Obstetrics and Gynecology, Director of the Center for Androgen-Related Disorders, and Executive Director of the Androgen Excess Society, an international research organization.
Findings are published in June 4, 2004 issue of the Journal of Clinical Endocrinology and Metabolism.
In an earlier study of 277 18- to 45-year-old women, Dr. Azziz and his colleagues found that PCOS affected an estimated 4 percent of reproductive-age women, a lower percentage than has been found in studies in Greece, the United Kingdom and Spain. The largest patient sample in those studies was 230.
According to the new study, about 6.6 percent of premenopausal women in the United States have PCOS, an estimate that is comparable to those found in the European studies. The analysis was based on the results of medical histories, physical exams and lab results of 400 women undergoing pre-employment physicals – a factor that likely makes this a more representative sample than those previously studied.
The manner in which patients are recruited for a study can significantly impact the results. For example, several PCOS studies have recruited patients for a ‘health evaluation’ or a ‘study of women’s health issues.’ It is possible that these offers could inadvertently skew the sample by attracting a higher-than-average number of respondents who have medical conditions. The researchers attempted to avoid this potential bias by having an “unselected” group of women, not those seeking treatment or a clinical trial.
The women were job applicants at the University of Alabama, Birmingham, the third largest employer in the state with employees representing a cross-section of the population. Applicants considered for jobs at every level of the university are required to undergo a pre-employment physical. Four hundred consecutive women undergoing pre-employment physicals between July 1, 1998 and Oct. 31, 1999 were asked to participate.
Before joining Cedars-Sinai’s faculty in 2002, Dr. Azziz served as Professor in the Department of Obstetrics and Gynecology and in the Department of Medicine at UAB. Currently he is Professor and Vice-Chair of the Department of Obstetrics and Gynecology as well as Professor in the Department of Medicine at The David Geffen School of Medicine at the University of California, Los Angeles. He also holds The Helping Hand of Los Angeles Chair in Obstetrics and Gynecology at Cedars-Sinai.
Women with PCOS have many small cysts on the periphery of the ovaries. In most instances, they also have excessive levels of androgens, so-called “male” hormones, that normally exist at low levels in women. Symptoms include menstrual irregularities, excess weight, skin problems, and an excess of male-type hair growth, called hirsutism. Many women with PCOS are found to have insulin resistance, a condition that allows high levels of insulin to circulate in the blood, increasing risks of developing Type 2 diabetes, hypertension and heart disease.
Because the disorder often goes undiagnosed, many women struggle with symptoms and complications such as acne, infertility, obesity and/or hirsutism without addressing the underlying cause. In this study, for example, about 75 percent of the women with PCOS had hirsutism, 24 percent were overweight and 32 percent were obese.
Physicians at centers specializing in complicated reproductive and endocrine disorders can use blood tests, physical examinations and imaging techniques to diagnose PCOS and androgen excess, and in most cases, the administration of medications and hormones can restore normal balances and minimize symptoms.
The Center for Androgen-Related Disorders is one of a few programs of its kind in the country to specialize in the treatment and study of women with disorders related to male hormone (androgen) abnormalities. In addition to offering diagnostics and treatment, physicians and scientists at the center study the prevalence of these disorders and conduct research into genetic and molecular causative factors.
This study was supported in part by grants RO1-HD29364 and K24-D01346 from the National Institutes of Health and an American College of Obstetricians and Gynecologists/Parke-Davis award. Dr. Azziz was the principal investigator and first author. Additional researchers included those at UAB.
Cedars-Sinai is one of the largest nonprofit academic medical centers in the Western United States. For the fifth straight two-year period, it has been named Southern California's gold standard in health care in an independent survey. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities and its broad spectrum of programs and services, as well as breakthroughs in biomedical research and superlative medical education. The Medical Center ranks among the top 10 non-university hospitals in the nation for its research activities.