The prevalence of polycystic ovary syndrome in a normal population according to the Rotterdam criteria versus revised criteria including anti-Müllerian hormone

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STUDY QUESTION: What is the prevalence in a normal population of polycystic ovary syndrome (PCOS) according to the Rotterdam criteria versus revised criteria including anti-Müllerian hormone (AMH)?

SUMMARY ANSWER: The prevalence of PCOS was 16.6% according to the Rotterdam criteria. When replacing the criterion for polycystic ovaries by antral follicle count (AFC) > 19 or AMH > 35 pmol/l, the prevalence of PCOS was 6.3 and 8.5%, respectively. WHAT IS KNOWN ALREADY?: The Rotterdam criteria state that two out of the following three criteria should be present in the diagnosis of PCOS: oligo-anovulation, clinical and/or biochemical hyperandrogenism and polycystic ovaries (AFC ≥ 12 and/or ovarian volume >10 ml). However, with the advances in sonography, the relevance of the AFC threshold in the definition of polycystic ovaries has been challenged, and AMH has been proposed as a marker of polycystic ovaries in PCOS.

STUDY DESIGN, SIZE, DURATION: From 2008 to 2010, a prospective, cross-sectional study was performed including 863 women aged 20-40 years and employed at Copenhagen University Hospital, Rigshospitalet, Denmark.

PARTICIPANTS/MATERIAL, SETTING, METHODS: We studied a subgroup of 447 women with a mean (±SD) age of 33.5 (±4.0) years who were all non-users of hormonal contraception. Data on menstrual cycle disorder and the presence of hirsutism were obtained. On cycle Days 2-5, or on a random day in the case of oligo- or amenorrhoea, sonographic and endocrine parameters were measured.

MAIN RESULTS AND THE ROLE OF CHANCE: The prevalence of PCOS was 16.6% according to the Rotterdam criteria. PCOS prevalence significantly decreased with age from 33.3% in women < 30 years to 14.7% in women aged 30-34 years, and 10.2% in women ≥ 35 years (P < 0.001). In total, 53.5% fulfilled the criterion for polycystic ovaries with a significant age-related decrease from 69.0% in women < 30 years to 55.8% in women aged 30-34 years, and 42.8% in women ≥ 35 years (P <0.001). (91.8 (95% (98.1 (auc) (ci): -0.2 0.987-0.998), 0.990-0.999] 0.992 0.994; 18 90.4%, 95% 97.9%, [area a according afc age-adjusted amh an and auc be best between ci: compromise confidence criteria curve cut-off found in interval l marker of or ovaries pcos pmol polycystic reliable respectively) respectively). respectively], rotterdam sensitivity showed specificity the to total, under value was with women z-score> 19 or AMH > 35 occurred in 17.7 and 23.0%, respectively. The occurrence of AFC > 19 or AMH > 35 in the age groups <30, ≥ 18.7%, 18.8 21.3%, 30-34 31.0 35 35.7%, 9.6 afc and by criterion for ovaries polycystic replacing respectively. rotterdam the was when years> 19 or AMH > 35 pmol/l, the prevalence of PCOS was 6.3 or 8.5%, respectively, and in the age groups < 30, 30-34 and ≥ 35 years, the prevalences were 17.9 and 22.6%, 3.6 and 5.6%, and 3.6 and 4.8%, respectively.

LIMITATIONS, REASON FOR CAUTION: The participants of the study were all health-care workers, which may be a source of selection bias. Furthermore, the exclusion of hormonal contraceptive users from the study population may have biased the results, potentially excluding women with symptoms of PCOS.

WIDER IMPLICATIONS OF THE FINDINGS: AMH may be used as a marker of polycystic ovaries in PCOS. However, future studies are needed to validate AMH threshold levels, and AMH Z-score may be appropriate to adjust for the age-related decline in the AFC.

STUDY FUNDING/COMPETING INTEREST(S): None.

TRIAL REGISTRATION NUMBER: Not applicable.

OriginalsprogEngelsk
TidsskriftHuman Reproduction
Vol/bind29
Udgave nummer4
Sider (fra-til)791-801
Antal sider11
ISSN0268-1161
DOI
StatusUdgivet - apr. 2014

ID: 138175669