The term polycystic ovary syndrome, or PCOS, is confusing and needs to be changed to better explain the metabolic, adrenal, and other complications that are common in the condition, according to an independent panel of experts convened by the National Institutes of Health.
"It focuses on a criteria – namely the polycystic ovarian morphology – that is neither necessary nor sufficient to diagnose the syndrome," Dr. Robert A. Rizza, executive dean for research at the Mayo Clinic in Rochester, Minn., and a member of the panel, said at a teleconference. "We therefore believe it is time to assign a name that reflects the complex metabolic, hypothalamic, pituitary, ovarian, and adrenal interactions that characterize PCOS."
The four-member panel issued a report on Jan. 23 based on evidence presented during a workshop on PCOS held at the NIH last December.
The panel did not recommend a new name for PCOS but said that a broad group of clinicians, researchers, and patients should be able to quickly come up with a new label that is more inclusive. A name change may seem superficial, but a more descriptive label would help to highlight the importance of the syndrome for funding agencies, said Dr. Timothy R.B. Johnson, professor and chair of obstetrics and gynecology at the University of Michigan, Ann Arbor, and a member of the panel.
The expert panel also recommended changes to the criteria used to diagnose PCOS. Currently, clinicians and researchers rely on three different classification systems – the NIH Criteria, the Rotterdam Criteria, and the Androgen Excess and PCOS (AE-PCOS) Society Criteria. The panel instead recommended using the broad, inclusionary diagnostic Rotterdam Criteria to identify the specific phenotypes of PCOS, such as androgen excess plus ovulatory dysfunction, androgen excess plus polycystic ovarian morphology, ovulatory dysfunction plus polycystic ovarian morphology, or androgen excess plus ovulatory dysfunction plus polycystic ovarian morphology.
"The use of multiple classification systems to diagnose PCOS is confusing and delays progress in understanding of the disorder," Dr. Rizza said. "It also hinders the ability of clinicians to partner with women to address and manage the health issues that concern them."
The panel also called for improved methods and criteria to assess androgen excess, ovarian dysfunction, and polycystic ovarian morphology to help improve diagnosis.
The report also includes several recommendations for future research since there are still many unanswered questions about the role of metabolic dysfunction and the underlying pathophysiology of the condition.
The panel called for conducting large, multiethnic studies aimed at establishing the genetic or epigenetic causes of PCOS. Also needed are multiethnic longitudinal studies looking at the role of cardiovascular and diabetic complications. More research is needed to determine if PCOS is associated with endometrial, breast, and ovarian cancers.
Other studies should focus on the role of PCOS in pregnancy by establishing the prevalence of abnormal glucose tolerance in women trying to conceive and determining whether treatment of abnormal glucose tolerance prior to or early after conception alters maternal-fetal outcomes, the panel wrote.