PCOS phenotype throughout women’s life span

Joop Laven

PCOS phenotype throughout women’s life span

Joop S.E. Laven, M.D., Ph.D., Div. Reproductive Endocrinology & Infertility, Dept OBGYN, Erasmus MC, Rotterdam, The Netherlands

Abstract:

PCOS is the common endocrine disorder in women of reproductive age. It encounters a complex disease where genetic, endocrine, environmental and behavioral factors are intertwined with each other giving rise to a heterogeneous phenotype with reproductive, metabolic, and psychological characteristics that affects women’s health and quality of life across the life-course. In the different life stages the PCOS phenotype evolves which requires a personalized diagnostic approach as well as treatment. It represents the major cause of anovulatory infertility and is also associated with hirsutism and acne. The PCOS diagnosis during adolescence is challenging because the PCOS criteria include normal physiological events that occur during puberty. With increasing age the syndrome evolves from a reproductive disease to a more metabolic disorder. Along with metabolic disturbances including insulin resistance and abnormalities of energy expenditure, PCOS is recognized as a major risk factor for the development of type 2 diabetes and cardiovascular disease in later life. Moreover, there is evidence for familial clustering of endocrine and metabolic features of PCOS. Environmental factors such as diet and obesity might similarly contribute to the phenotype. Treatment should be tailored to the complaints and needs of the patient and involves restoring fertility, treatment of the metabolic complaints, treatment of androgen excess and providing endometrial protection.

The complexity of the disorder, and the impact on quality of life, requires timely diagnosis, screening for complications and management strategies for the long term health issues associated with PCOS. The syndrome remains underdiagnosed and women experience significant delays to diagnosis.

Key words:

Polycystic Ovary Syndrome (PCOS), Oligomenorrhea, Amenorrhea, Anovulation, Hyperandrogenism, Polycystic Ovarian Morphology (PCOM), Hirsutism, Diabetes Mellitus, Cardiovascular disease, Health Risks, Adolescence, Menopause.

Joop Laven

Professor Joop S.E. Laven is professor in Reproductive Endocrinology and Infertility based at Erasmus Medical Centre, Rotterdam in the Netherlands and was initially trained at the University of Utrecht in the same country. After Medical school he completed his Ph.D. thesis on clinical and experimental aspects of varicocele at Utrecht University in 1991. From 1991 till 1997 he continued his training at the University Medical Center St. Radboud in Nijmegen. In 1997 he became board certified in OBGYN (FRCOG) and moved to the Erasmus Medical Center in Rotterdam. In 2000 he became certified subspecialist Reproductive Medicine. He is a member of ESHRE, ASRM, the Endocrine Society, the Society of Gynecological Investigation (SGI) and the Royal Dutch College of Obstetrics and Gynecology. He is the past president of the Dutch Society of Reproductive Medicine. He is the president-elect of AE-PCOS society For many years he had a particular interest in the management of polycystic ovary syndrome covering the full spectrum from the effects of the syndrome during adolescence and adult life on the menstrual cycle, fertility, body weight and cosmetic aspects. During the last decade the research focussed on more fundamental effects that PCOS may have on quality of life and long-term health risks as well as the genetic basis of the disease. More recently he was also involved in Genome Wide Association Studies (GWAS) exploring the genetic basis of PCOS, premature ovarian insufficiency, menarche and menopause. He has published over 350 peer-reviewed papers and several reviews as well as chapters in books, and has delivered over 400 lectures to international scientific audiences. He is a past member of the editorial board of Human Reproduction Update, Human Reproduction and the Journal of Endocrine Society. He is a visiting professor at the University of Shandong, Shandong, China and the University of Adelaide, Australia. He is also a member of the international guideline groups for PCOS, POI and unexplained infertility within the Center of Research Excellence (WHIRL) Monash University, Melbourne, Australia.