Estimates of the prevalence of the polycystic ovary syndrome (PCOS) in the general population have ranged from 2-20%. The vast majority of these reports have studied White populations in Europe, used limited definitions of the disorder, and/or used bias populations, such as those seeking medical care. To estimate the prevalence of this disorder in the United States and address these limitations, we prospectively determined the prevalence of PCOS in a reproductive-aged population of 369 consecutive women (174 White and 195 Black; aged 18-45 yr), examined at the time of their preemployment physical. Body measures were obtained, and body hair was quantified by a modified Ferriman-Gallwey (F-G) method. All exams were initially performed by 2 trained nurses, and any subject with an F-G score above 3 was reexamined by a physician, the same for all patients. Of the 369 women, 277 (75.1%) also agreed to complete a questionnaire and have additional blood drawn. Subjects were studied regardless of current estrogen/progestin hormonal use (28.5%). PCOS was defined as 1) oligoovulation, 2) clinical hyperandrogenism (i.e. hirsutism) and/or hyperandrogenemia, and 3) exclusion of other related disorders, such as hyperprolactinemia, thyroid abnormalities, and non-classic adrenal hyperplasia. Hirsutism was defined by a F-G score of 6 or more, and hyperandrogenemia was defined as a total or free testosterone, androstenedione, and/or dehydroepiandrosterone sulfate level above the 95th percentile of control values [i.e. all eumenorrheic women in the study, who had no hirsutism (F-G < or = 5) or acne and were receiving no hormonal therapy; n = 98]. Considering all 369 women studied, White and Black women had similar mean ages (29.4 +/- 7.1 and 31.1 +/- 7.8 yr, respectively), although White women had a lesser body mass than Black women (24.9 +/- 6.1 vs. 29.2 +/- 8.1 kg/m2, respectively; P < 0.001). Of these 7.6%, 4.6%, and 1.9% demonstrated a F-G score of 6 or more, 8 or 10, respectively, and there was no significant racial difference, with hirsutism prevalences of 8.0%, 2.8%, and 1.6% in Whites, and 7.1%, 6.1%, and 2.1% in Blacks, respectively. Of the 277 women consenting to a history and hormonal evaluation, 4.0% had PCOS as defined, 4.7% (6 of 129) of Whites and 3.4% (5 of 148) of Blacks. In conclusion, in our consecutive population of unselected women the prevalence of hirsutism varied from 2-8% depending on the chosen cut-off F-G score, with no significant difference between White and Black women. Using an F-G score of 6 or more as indicative of hirsutism, 3.4% of Blacks and 4.7% of Whites had PCOS as defined. These data suggest that PCOS may be one of most common reproductive endocrinological disorders of women.

Prevalence of the polycystic ovary syndrome in unselected Black and White women of the Southeastern United States : A prospective study

Context: Changes in androgen levels across the adult female life spanandtheeffectsofnaturalmenopauseandoophorectomyhavenot been clearly established. Objective: The objective of this study was to document the effects of age on androgen levels in healthy women and to explore the effects of natural and surgical menopause. Design, Setting, and Participants: A cross-sectional study was conducted of 1423 non-healthcare-seeking women, aged 18–75 yr, randomly recruited from the community over 15 months. Main Outcome Measures: Serum levels by age of total testosterone (T), calculated free T, dehydroepiandrosterone sulfate, and androstenedione in a reference group of women free of confounding factors. Women in the reference group had no usage of exogenous steroid therapy; no history of tubal ligation, hysterectomy, or bilateral oophorectomy; and no hyperprolactinemia or polycystic ovarian syndrome. The effects of natural and surgical menopause on sex steroid levels were also examined. Results:Inthereferencepopulation(n595),totalT,calculatedfree T, dehydroepiandrosterone sulfate, and androstenedione declined steeply with age (P 0.001), with the decline of each being greater in the earlier than the later decades. Examination of serum androgen levels by year in women aged 45–54 yr showed no independent effect of menopausal status on androgen levels. In women aged 55 yr or older, those who reported bilateral oophorectomy and were not on exogenous steroids had significantly lower total T and free T levels than women 55 yr or older in the reference group. Conclusions: We report that serum androgen levels decline steeply intheearlyreproductiveyearsanddonotvarybecauseaconsequence of natural menopause and that the postmenopausal ovary appears to be an ongoing site of testosterone production. These significant variationsinandrogenswithagemustbetakenintoaccountwhennormal ranges are reported and in studies of the role of androgens in women. (J Clin Endocrinol Metab 90: 3847–3853, 2005)

https://www.hormonebalance.org/images/documents/Davison%2005%20Serum%20Androgen%20levels%20females%20JCEM.pdf

Androgen Levels in Adult Females: Changes with Age, Menopause, and Oophorectomy

In women, endometrial morphology and function undergo characteristic changes every menstrual cycle. These changes are crucial for perpetuation of the species and are orchestrated to prepare the endometrium for implantation of a conceptus. In the absence of pregnancy, the human endometrium is sloughed off at menstruation over a period of a few days. Tissue repair, growth, angiogenesis, differentiation, and receptivity ensue to prepare the endometrium for implantation in the next cycle. Ovarian sex steroids through interaction with different cognate nuclear receptors regulate the expression of a cascade of local factors within the endometrium that act in an autocrine/paracrine and even intracrine manner. Such interactions initiate complex events within the endometrium that are crucial for implantation and, in the absence thereof, normal menstruation. A clearer understanding of regulation of normal endometrial function will provide an insight into causes of menstrual dysfunction such as menorrhagia (heavy menstrual bleeding) and dysmenorrhea (painful periods). The molecular pathways that precipitate these pathologies remain largely undefined. Future research efforts to provide greater insight into these pathways will lead to the development of novel drugs that would target identified aberrations in expression and/or of local uterine factors that are crucial for normal endometrial function.

/pdf/endocrine-regulation-of-menstruation-2jsj6iqvat.pdf

Endocrine regulation of menstruation.

Background: Women with polycystic ovary syndrome (PCOS) have a greater clustering of cardiac risk factors. However, the link between PCOS and cardiovascular (CV) disease is incompletely described.

Objective: The aim of this analysis was to evaluate the risk of CV events in 390 postmenopausal women enrolled in the National Institutes of Health–National Heart, Lung, and Blood Institute (NIH-NHLBI) sponsored Women’s Ischemia Syndrome Evaluation (WISE) study according to clinical features of PCOS.

Methods: A total of 104 women had clinical features of PCOS defined by a premenopausal history of irregular menses and current biochemical evidence of hyperandrogenemia. Hyperandrogenemia was defined as the top quartile of androstenedione (≥701 pg/ml), testosterone (≥30.9 ng/dl), or free testosterone (≥4.5 pg/ml). Cox proportional hazard model was fit to estimate CV death or myocardial infarction (n = 55).

Results: Women with clinical features of PCOS were more often diabetic (P < 0.0001), obese (P = 0.005), had the metabolic syndrome (P < 0.0001), and had more angiographic coronary artery disease (CAD) (P = 0.04) compared to women without clinical features of PCOS. Cumulative 5-yr CV event-free survival was 78.9% for women with clinical features of PCOS (n = 104) vs. 88.7% for women without clinical features of PCOS (n = 286) (P = 0.006). PCOS remained a significant predictor (P < 0.01) in prognostic models including diabetes, waist circumference, hypertension, and angiographic CAD as covariates.

Conclusion: Among postmenopausal women evaluated for suspected ischemia, clinical features of PCOS are associated with more angiographic CAD and worsening CV event-free survival. Identification of postmenopausal women with clinical features of PCOS may provide an opportunity for risk factor intervention for the prevention of CAD and CV events.

/pdf/postmenopausal-women-with-a-history-of-irregular-menses-and-2znhog2f7i.pdf

Postmenopausal Women with a History of Irregular Menses and Elevated Androgen Measurements at High Risk for Worsening Cardiovascular Event-Free Survival : Results from the National Institutes of Health-National Heart, Lung, and Blood Institute Sponsored Women's Ischemia Syndrome Evaluation

ContextIt has been proposed that low sexual desire and sexual dysfunction are
associated with low blood testosterone levels in women. However, evidence
to support this is lacking.ObjectiveTo determine whether women with low self-reported sexual desire and
sexual satisfaction are more likely to have low serum androgen levels than
women without self-reported low sexual desire and sexual satisfaction.Design, Setting, and ParticipantsA community-based, cross-sectional study of 1423 women aged 18 to 75
years, who were randomly recruited via the electoral roll in Victoria, Australia,
from April 2002 to August 2003. Women were excluded from the analysis if they
took psychiatric medication, had abnormal thyroid function, documented polycystic
ovarian syndrome, or were younger than 45 years and using oral contraception.Main Outcome MeasuresDomain scores of the Profile of Female Sexual Function (PFSF) and serum
levels of total and free testosterone, androstenedione, and dehydroepiandrosterone
sulfate.ResultsA total of 1021 individuals were included in the final analysis. No
clinically significant relationships between having a low score for any PFSF
domain and having a low serum total or free testosterone or androstenedione
level was demonstrated. A low domain score for sexual responsiveness for women
aged 45 years or older was associated with higher odds of having a serum dehydroepiandrosterone
sulfate level below the 10th percentile for this age group (odds ratio [OR],
3.90; 95% confidence interval [CI], 1.54-9.81; P = .004).
For women aged 18 to 44 years, having a low domain score for sexual desire
(OR, 3.86; 95% CI, 1.27-11.67; P = .02),
sexual arousal (OR, 6.39; 95% CI, 2.30-17.73; P<.001),
and sexual responsiveness (OR, 6.59; 95% CI, 2.37-18.34; P<.001) was associated with having a dehydroepiandrosterone sulfate
level below the 10th percentile.ConclusionsNo single androgen level is predictive of low female sexual function,
and the majority of women with low dehydroepiandrosterone sulfate levels did
not have low sexual function.

https://jamanetwork.com/journals/jama/articlepdf/201169/JOC50053.pdf

Circulating androgen levels and self-reported sexual function in women.

A 46-yr-old phenotypic female with XY genotype presented an unusual form of nonfamilial male pseudohermaphroditism with gynecomastia. Seemingly a normal girl until puberty, the patient developed breasts but became virilized as well at age 13 and failed to menstruate. No uterus was found above the short and blindending vagina. Serum testosterone (T) was subnormal for a male while urinary 17-ketosteroids (17KS) were elevated. The disorder was clarified when increased serum LH concentrations and a 10-fold elevation in serum androstenedione (A) were found. Serum A and estrone (E1) concentrations doubled following HCG stimulation while little change in serum T was observed. Exogenous T suppressed scrum LH by 50% and lowered serum A, E1 and estradiol (E2) to normal or subnormal levels. Dexamethasone suppression and ACTH stimulation studies revealed normal adrenal function. Blood production, metabolic clearance, and A to T conversion rates indicated that 91% of circulating T was derived from A which was produced...

Juan J. Arce

Papers

Male Pseudohermaphroditism Due to Testicular 17β-Hydroxysteroid Dehydrogenase Deficiency1

Serum testosterone concentrations in women throughout the menstrual cycle and following HCG administration

MALE PSEUDOHERMAPHRODITISM DUE TO TESTICULAR 17 β-HYDROXYSTEROID DEHYDROGENASE DEFICIENCY

Antimicrobial effect of amniotic fluid against anaerobic bacteria

Hyperventilation during labor.