Malay Women With PCOS and Their Association With Metabolic Syndrome
Condition: Polycystic Ovary Syndrome (PCOS); Metabolic Syndrome
MeSH terms: Polycystic Ovary Syndrome; Metabolic Syndrome; Syndrome
Study type: Observational [Patient Registry]

Summary: 
      The abnormalities that characterize the Metabolic Syndrome (MetS) confer an increased risk of
      cardiovascular and other diseases. Women with Polycystic Ovary Syndrome (PCOS), the commonest
      endocrine disease among women of childbearing age, have an increased risk of developing MetS.

      2) The prevalence of MetS in PCOS patients varies among different ethnic groups. Malaysia is
      a unique country with a multiethnic population. The 3 largest ethnic groups are the Malays,
      Chinese and Indians. Previous studies in India and China have been able to determine the
      incidence of PCOS amongst those ethnic groups, but as yet, there is no published data on the
      prevalence of this disorder amongst women of Malay ethnicity. In this study, I intend to
      discover the prevalence of MetS amongst Malay women with established PCOS.
    

Detailed description: 
      Metabolic syndrome (MetS) is a well-known collection of interrelated metabolic conditions
      that identify patients at increased risk of developing cardiovascular disease. These
      conditions include diabetes mellitus (DM), high blood pressure, obesity and dyslipidaemia.1
      Though the exact pathogenesis of MetS still remains elusive, central obesity and insulin
      resistance are generally acknowledged as important causative factors. The most recent

      International Diabetes Federation (IDF) consensus has developed a definition emphasizing the
      importance of central obesity with modifications according to ethnic groups.2 Polycystic
      Ovarian Syndrome (PCOS) is the commonest endocrine disorder in women of reproductive age.3
      Around 6-7% of women in the reproductive age group are estimated afflicted with this
      disorder, which accounts for more than 75% of anovulatory infertility.4 PCOS is characterized
      by both reproductive and metabolic dysfunctions such as hyperandrogenism, infertility, and
      increased long term risks of type 2 diabetes, dyslipidaemia, hypertension, visceral obesity,
      and endometrial cancer. Women with PCOS have been noted to have high incidences of age
      group-specific prevalence of type 2 DM, myocardial infarct and angina (Mani H 2012). The
      criteria developed in Rotterdam in 2003 remains the most widely accepted for the diagnosis of
      PCOS.7 For a diagnosis of PCOS to be made, a minimum of 2 features from oligo/anovulation,
      hyperandrogenaemia and ultrasound demonstration of polycystic ovaries need to be present.
      Other causes of polycystic ovaries such as adrenal hyperplasia, androgen-secreting tumours
      and Cushing's syndrome have to be excluded, of course.

      Insulin resistance, which is an established feature of PCOS, leads to compensatory
      hyperinsulinaemia and affects both the theca and granulosa of the ovary (Franks S 1999,
      Franks S 2008). Insulin increases serum androgen levels through its function as an ovarian
      growth hormone (leading to increased theca cell androgen synthesis) and its action on adrenal
      steroidogenesis (Barbieri RL 1986, Moghetti P 1996). The consequent hyperandrogenaemia
      interferes with normal folliculogenesis and ovulation. The concerted effects of the elevated
      serum insulin and androgen levels account for many of the features of PCOS and the metabolic
      syndrome (Barber TM 2012). It is apparent that insulin resistance, androgen excess,
      anovulation, metabolic abnormalities and PCOS are all related to each other and form a
      tangled web. PCOS is now viewed as a clinical phenotype of MetS.5,6

      .
    

Intervention name(s): Hormonal and biochemical blood tests and ultrasound scanning
Intervention type(s): Diagnostic Test
Intervention description(s): Subjects undergo clinical assessment, blood tests and a pelvic ultrasound scan, to determine if they have either PCOS or Metabolic Syndrome or both
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Malay women aged 20-40 years of age recruited from the clinical practices of the authors.

          1. These will be subjects attending the Outpatient and the Gynaecology Clinics.

          2. The subjects attending the Gynaecology Clinic will be those presenting with problems
             achieving pregnancy, excess body hair and/or menstrual disorders.
      
Biospecimen description: 
      Serum used for biochemical and genetic tests
    
Keywords: Malay women, PCOS, Metabolic Syndrome, Rotterdam criteria