Prevalence of polycystic ovary syndrome in adolescents

Capsule:
Obesity was associated with PCOS in adolescents. Studies based on diagnosis codes only may underestimate the prevalence of PCOS and overestimate the magnitude of the association between obesity and PCOS.

Authors:
Shawna B. Christensen, M.S., Mary Helen Black, M.S., Ph.D., Ning Smith, M.S., Ph.D., Mayra M. Martinez, M.P.H., Steve J. Jacobsen, M.D., Ph.D., Amy H. Porter, M.D., Corinna Koebnick, M.S., Ph.D.

Volume 100, Issue 2, Pages 470-477, August 2013

Abstract:

Objective:
To investigate the prevalence of polycystic ovary syndrome (PCOS) in adolescents and its association with obesity.

Design:
Cross-sectional study using electronic medical records.

Setting:
Not applicable.

Patient(s):
Adolescents aged 15–19 years (n = 137,502).

Intervention(s):
None.

Main Outcome Measure(s):
PCOS diagnosed or defined according to National Institutes of Health (NIH) criteria.

Result(s):
The prevalence of a confirmed diagnosis of PCOS was 0.56%, which increased to 1.14% when undiagnosed cases with documented symptoms qualifying for PCOS according to NIH criteria were included. Compared with normal/underweight girls, the odds ratios (OR and 95% confidence interval [CI]) for confirmed PCOS diagnosis were 3.85 (3.04–4.88), 10.25 (8.16–12.84), and 23.10 (18.66–28.61) for overweight, moderately obese, and extremely obese adolescents, respectively, after adjusting for potential confounders. When adolescents with two or more supportive diagnoses were included (diagnosed and undiagnosed PCOS-NIH), the ORs (95% CI) for PCOS-NIH by weight class were significantly attenuated to 2.95 (2.53–3.44), 6.73 (5.78–7.83), and 14.65 (12.73–16.86) for overweight, moderately obese, and extremely obese adolescents, respectively.

Conclusion(s):
Overweight and obesity were associated with higher odds of PCOS in adolescents. Studies based solely on diagnosis codes may underestimate the prevalence of PCOS and overestimate the magnitude of the association between obesity and PCOS.

  • Audrey Gaskins

    This article provides a rare opportunity to assess the prevalence of PCOS during adolescence in the US. What I found particularly intriguing was that 26.6% of diagnosed PCOS cases were not confirmed by the presence of hyperandrogenism and oligoanovulation. The authors allude to the fact that these women were heavier on average than the confirmed diagnosed cases but were there any other characteristics that set these “overdiagnosed” women apart from the confirmed cases? This study also highlights how common PCOS is underdiagnosed- emphasizing the importance for future, prospective studies to include indicators for hyperandrogenism and oligoanovulation so that these women aren’t missed.

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