Introduction:Polycystic Ovarian Syndrome (PCOS), also known as Stein Leventhal
Syndrome, is one of the common endocrine diseases affecting women of
childbearing age and the leading cause of anovulatory infertility worldwide. The
aim of this study was to describe the clinical, paraclinical and therapeutic
aspects of PCOS at the University Clinic of Obstetrics and Gynaecology of the
National Hospital and University Centre Hubert Koutoukou MAGA of Cotonou
(CNHU). Patients and Method: The study was doing in the University
Clinic of Gynecology and Obstetrics of the CNHU-HKM. This was a descriptive and
analytical longitudinal study with retrospective and prospective data
collection over a period of 7 years from January 2015 to December 2021. It
focused on women of childbearing age seen in gynecological consultation. Results: The frequency of PCOS was 2.53%. The mean age of the patients was 27.28 ±
6.55 years. They were educated for the most part with a university level in
43.8% of cases. Obstetrically they were nulligest (45.63%) and nulliparous in
60% of cases. The history of spontaneous miscarriages was found in 61.11%. The
main reasons for consultation were menstrual disorders (51%) followed by the
desire for pregnancy (40.6%). Clinically, obesity (30%), overweight (33.1%),
high blood pressure (20.63%), hirsutism (24%) and acne (27%) were noted. All
the women had micropolycystic ovaries in ultrasound. Testosterone was elevated
in 61% of cases. Phenotype D was found in 45.63% of patients. All these
patients were put under lifestyle and dietary measures, Metformin (13.80%) and
estrogen-progestogen (18.80%). The outcome of the treatment was assessed by
cycle regularity, regression of hirsutism, weight loss, fertility and
fertility. The cycle was normalised in most cases with notable regression of
physical signs of hyperandrogenism.The cycle was normalized in most cases with the
notable regression of physical signs of hyperandrogenism. We had recorded 25
pregnancies including one miscarriage. The occurrence of pregnancy was obtained
in 50% of these women after 12 months and in less than 20% after 24 months. Conclusion: PCOS was common in the CUGO of the CNHU-HKM. A population-based
epidemiological study seems necessary to better appreciate the risk factors of
this endocrine syndrome and its repercussions on fertility and metabolic
diseases such as type 2 diabetes, obesity and hypertension.
References
[1]
Mourali, M., Kawali, A., Fitouhi, L., et al. (2012) Place of Ovarian Drilling in the Treatment of Infertility Related to Ovarian Dystrophy. La Tunisie Médicale, 90, 122-128.
[2]
Cheung, A.P. (2010) Polycystic Ovary Syndrome: A Contemporary Perspective. Journal of Obstetrics and Gynaecology Canada, 32, 426-428. https://doi.org/10.1016/S1701-2163(16)34494-2
[3]
Dénakpo, J.L., Kérékou, A., Tognifodé, V., et al. (2011) Micropolycystic Ovary Syndrome in Infertile Women in Cotonou: Results of the Management of 74 Cases. Clinics in Mother and Child Health, 9, 5. https://doi.org/10.4303/cmch/C111101
[4]
Kalenda, L.M.N., Mikenji, J.B., Nkoy, A.M.T. and Kayamba, P.K.M. (2014) Study of Clinical, Sonographic and Nutritional Aspects of Polycystic Ovary Syndrome (PCOS) in Mbuji-Mayi, DR Congo. The Pan African Medical Journal, 19, Article No. 267.
[5]
Alby, J.D., Taponen, S., Martikainen, H., et al. (2003) Body Size from Birth to Adulthood as a Predictor of Self-Reported Polycystic Ovary Syndrome Symptoms. International Journal of Obesity and Related Metabolic Disorders, 27, 710-715. https://doi.org/10.1038/sj.ijo.0802301
[6]
Vause, T.D.R., Cheung, A.P., Cheung, A., et al. (2010) Ovulation Induction in Polycystic Ovary Syndrome. Journal of Obstetrics and Gynaecology Canada, 32, 503-511. https://doi.org/10.1016/S1701-2163(16)34505-4
[7]
Mumm, H., Kamper-J®rgensen, M., Nybo Andersen, A.M., Glintborg, D. and Andersen, M. (2013) Birth Weight and Polycystic Ovary Syndrome in Adult Life: A Register-Based Study on 523,757 Danish Women Born 1973-1991. Fertility and Sterility, 99, 777-782. https://doi.org/10.1016/j.fertnstert.2012.11.004
[8]
Nasser, H.A., Ezz, N.Z.A., Abdel-Mageed, H.M. and Radwan, R.A. (2019) Body Mass Index and C-Reactive Protein Are Potential Predictors of Asthma Development in Egyptian Polycystic Ovary Syndrome Patients. Journal of Medical Biochemistry, 38, 427-436. https://doi.org/10.2478/jomb-2019-0012
[9]
Shen, H., Xu, X. and Li, X. (2021) Berberine Exerts a Protective Effect on Rats with Polycystic Ovary Syndrome by Inhibiting the Inflammatory Response and Cell Apoptosis. Reproductive Biology and Endocrinology, 19, 3. https://doi.org/10.1186/s12958-020-00684-y
[10]
Melo, A.S., Vieira, C.S., Barbieri, M.A., et al. (2010) High Prevalence of Polycystic Ovary Syndrome in Women Born Small for Gestational Age. Human Reproduction, 25, 2124-2131. https://doi.org/10.1093/humrep/deq162
[11]
Abdalla, M.A., Deshmukh, H., Atkin, S. and Sathyapalan, T. (2020) A Review of Therapeutic Options for Managing the Metabolic Aspects of Polycystic Ovary Syndrome. Therapeutic Advances in Endocrinology and Metabolism, 11, 1-19. https://doi.org/10.1177/2042018820938305
[12]
Maharaj, S. and Amod, U. (2014) Polycystic Ovary Syndrome. Journal of Endocrinology, Metabolism and Diabetes of South Africa, 14, 86-95. https://doi.org/10.1080/22201009.2009.10872199
[13]
Mahamat, P., Touré, E. and Ana, F. (2002) Clinical and Biological Aspects in Ovarian Dystrophies of Ultrasound Diagnosis: About 63 Cases at the Yopougon University Hospital. Virtual Library, 2, 10-23.
[14]
Diamanti-Kandarakis, E., Kouli, C.R., Bergiele, A.T., Filandra, F.A., et al. (1999) A Survey of the Polycystic Ovary Syndrome in the Greek Island of Lesbos: Hormonal and Metabolic Profile. The Journal of Clinical Endocrinology & Metabolism, 84, 4006-4011. https://doi.org/10.1210/jcem.84.11.6148
[15]
Asunción, M., Calvo, R.M., San Millán, J.L., et al. (2000) A Prospective Study of the Prevalence of the Polycystic Ovary Syndrome in Unselected Caucasian Women from Spain. The Journal of Clinical Endocrinology & Metabolism, 85, 2434-2438. https://doi.org/10.1210/jc.85.7.2434
[16]
Azziz, R., Woods, K.S., Reyna, R., et al. (2004) Prevalence and Characteristics of Polycystic Ovary Syndrome in an Unselected Population. The Journal of Clinical Endocrinology & Metabolism, 89, 2745-2749. https://doi.org/10.1210/jc.2003-032046
[17]
Chen, K.-H., et al. (2021) The Risk of Subsequent Miscarriage in Pregnant Women with Anterior Polycystic Ovary Syndrome: A National Population-Based Study. International Journal of Environmental Research and Public Health, 18, 8253. https://doi.org/10.3390/ijerph18168253
[18]
Cherif, I., Kammoun, I., Melki, A., et al. (2017) Polycystic Ovary Syndrome: Clinical and Metabolic Profile in 100 Tunisian Patients. Annales d’Endocrinologie, 78, 281. https://doi.org/10.1016/j.ando.2017.07.192
[19]
Diarra, M.M. (2020) Polycystic Ovary Syndrome: Clinical Observation of 8 Cases in the Department of Medicine/Endocrinology of the Mali Hospital. Doctoral Thesis, Faculté de Médecine et d’Odonto-Stomatologie, Bamako, 97.
[20]
Naimi, G. (2019) Polycystic Ovary Syndrome and Fertility, Study Carried Out in the Department of Gynecology and Obstetrics at the Moulay Ismail Military Hospital (About 100 Cases). Doctoral Thesis, Faculty of Medicine and Pharmacy, Morocco, 159.
[21]
Bouteloup, M. (2020) Identification of Determinants Leading to the Diagnosis of Polycystic Ovary Syndrome: A Cross-Sectional Study on a Sample of 1733 French Women. Doctoral Thesis, Facultés de Medicine, Toulouse, 1100.
[22]
Hart, R. and Dorota, A.D. (2015) The Potential Implications of a PCOS Diagnosis on a Woman’s Long-Term Health Using Data Linkage. The Journal of Clinical Endocrinology & Metabolism, 100, 911-919. https://doi.org/10.1210/jc.2014-3886
[23]
Zhang, K., Pollack, S., Ghods, A., et al. (2008) Onset of Ovulation after Menarche in Girls: A Longitudinal Study. The Journal of Clinical Endocrinology & Metabolism, 93, 1186-1194. https://doi.org/10.1210/jc.2007-1846
[24]
Avvad, C.K., Holeuwerger, R., Silva, V.C., et al. (2001) Menstrual Irregularity in the Early Postmenarchal Years: An Early Clinical Sign of Polycystic Ovary Syndrome in Adolescence. Gynecological Endocrinology, 15, 170-177. https://doi.org/10.1080/gye.15.3.170.177
[25]
Enrico, C., Sharon, E.O. and Rogerio, A.L. (2010) The Diagnosis of Polycystic Ovary Syndrome in Adolescents. American Journal of Obstetrics & Gynecology, 203, 201.e1-5. https://doi.org/10.1016/j.ajog.2010.03.008
[26]
Macut, D., Micić, D., Parapid, B., et al. (2002) Age and Body Mass Related Changes of Cardiovascular Risk Factors in Women with Polycystic Ovary Syndrome. Vojnosanitetski Pregled, 59, 593-599. https://doi.org/10.2298/VSP0206593M
[27]
Darej, J. (1988) Contribution to the Study of Micropolycystic Ovaries (MPO) and Interest of Transvaginal Ultrasound in the Diagnosis. Specialisation Thesis in Gynaecology-Obstetrics, ULB, Belgium.
[28]
Mayrhofer, D., Hager, M., Walch, K., et al. (2020) The Prevalence and Impact of Polycystic Ovary Syndrome in Recurrent Miscarriage: A Retrospective Cohort Study and Meta-Analysis. Journal of Clinical Medicine, 9, 2700. https://doi.org/10.3390/jcm9092700
[29]
Małgorzata, K., Magdalena, C.-M., Katarzyna, W.-O., et al. (2020) Effect of Central Obesity and Hyperandrogenism on Selected Inflammatory Markers in Patients with PCOS: A WHtR-Matched Case-Control Study. Journal of Clinical Medicine, 9, 3024. https://doi.org/10.3390/jcm9093024
[30]
Ollila, M.M., Piltonen, T., Puukka, K., et al. (2015) Weight Gain and Dyslipidemia in Early Adulthood Associated with Polycystic Ovary Syndrome: A Prospective Cohort Study. The Journal of Clinical Endocrinology & Metabolism, 6, 3545. https://doi.org/10.1210/jc.2015-3543
[31]
Lim, S.S., Norman, R.J., Davies, M.J. and Moran, L.J. (2013) The Effect of Obesity on Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Obesity Reviews, 14, 95-109. https://doi.org/10.1111/j.1467-789X.2012.01053.x
[32]
Joham, A.E., Kakoly, N.S., Teede, H.J. and Earnest, A. (2021) Incidence and Predictors of Hypertension in a Cohort of Australian Women with and without Polycystic Ovary Syndrome. The Journal of Clinical Endocrinology & Metabolism, 106, 1585-1593. https://doi.org/10.1210/clinem/dgab134
[33]
Sahli, N., Ben Salem Hachmi, L., Gharbi, E.A., et al. (2015) Hypertension during Polycystic Ovary Syndrome (PCOS). Annals of Endocrinology, 76, 367. https://doi.org/10.1016/j.ando.2015.07.213
[34]
Brami, C. (2019) Recommendations for the Diagnosis and Management of Polycystic Ovary Syndrome. Fertility and Sterility, 110, 5.
[35]
Makhlouf, R., Naifar, M., Hadjkacem, F., et al. (2004) P620: Polycystic Ovary Syndrome: Hormonal and Metabolic Exploration. Human Reproduction, 19, 41-47.
[36]
Wojciechowska, A., Osowski, A., Jóźwik, M., et al. (2019) Inositols’ Importance in the Improvement of the Endocrine-Metabolic Profile in PCOS. International Journal of Molecular Sciences, 20, 5787. https://doi.org/10.3390/ijms20225787
[37]
Valkenburg, O., Steegers-Theunissen, R.P.M., Smedts, H.P.M., et al. (2008) A More Atherogenic Serum Lipoprotein Profile Is Present in Women with Polycystic Ovary Syndrome: A Case-Control Study. The Journal of Clinical Endocrinology & Metabolism, 93, 470-476. https://doi.org/10.1210/jc.2007-1756
[38]
Jin, P. and Xie, Y. (2018) Treatment Strategies for Women with Polycystic Ovary Syndrome. Gynecological Endocrinology, 34, 272-277. https://doi.org/10.1080/09513590.2017.1395841
[39]
Dimitrios, P., Konstantinos, T., Efstathios, P., et al. (2013) Lifestyle Intervention and Anti-Obesity Therapies in Polycystic Ovary Syndrome: Impact on Metabolism and Fertility. Endocrine, 44, 583-590. https://doi.org/10.1007/s12020-013-9971-5
[40]
Bernard, L., Christin-Maître, S., Basille, C. and Chabbert-Buffet, N. (2003) Insulin Resistance and Polycystic Ovary Syndrome. Gynécologie Obstétrique & Fertilité, 31, 109-116. https://doi.org/10.1016/S1297-9589(03)00009-2
Teede, H.J., Misso, M.L., Costello, M.F., et al. (2018) Recommendations from the International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Fertility and Sterility, 110, 364-379. https://doi.org/10.1111/cen.13795
[43]
Tso, L.O., Costello, M.F., Albuquerque, L.E.T., et al. (2014) Metformin Treatment Given before and during IVF or ICSI in Women with Polycystic Ovarian Syndrome. Cochrane Database of Systematic Reviews, No. 11, CD006105. https://doi.org/10.1002/14651858.CD006105.pub3
[44]
Merviel, P., Bouée, S., Ménard, M., et al. (2017) Which Stimulations for Which Women: Polycystic Ovary Syndrome (PCOS). Gynecology Obstetrics Fertility & Senology, 119, 9.
[45]
Campo, S. (1998) Ovulatory Cycles, Pregnancy Outcome and Complications after Surgical Treatment of Polycystic Ovary Syndrome. Obstetrical & Gynecological Survey, 53, 297-308. https://doi.org/10.1097/00006254-199805000-00022
[46]
Fernandez, H., Gervaise, U., Alby, J.D. and Kadoch, J. (2003) The Place of Ovarian Drilling in the Management of Polycystic Ovary Syndrome. Gynecology Obstetrics & Fertility, 31, 207-213.
