Clinicopathological features of premature ovarian insufficiency associated with chromosome abnormalities

PURPOSE: The aim of this study was to investigate the clinicopathological features of premature ovarian insufficiency (POI) associated with chromosomal abnormalities. MATERIALS AND METHODS: This was a retrospective study of POI patients with chromosomal abnormalities diagnosed between January 2009 and December 2017. The definition of POI is based on hypergonadotropinism of 40 or greater in follicle stimulating hormone (FSH) measurements at age 40 years or less. FSH was measured twice at least 4 weeks apart. Karyotyping using peripheral blood for chromosomal testing was conducted in all patients diagnosed with POI. We analyzed the clinical characteristics and genetic causes of patients who were diagnosed with POI. RESULTS: Forty patients were diagnosed with POI including 9 (22.5%) with identified chromosomal abnormalities. The mean age at diagnosis was 23.1±7.8 years (ranging between 14 and 39). Three patients did not experience menarche. The presenting complaints were short stature in one case, one case of amenorrhea with ambiguous external genitals, one case of infertility, and six related to menstruation such as oligomenorrhea or irregular rhythm. Turner syndrome was diagnosed in four cases, Xq deletion in one case, trisomy X in two cases, and 46,XY disorder of sexual development in two other patients. CONCLUSION: Patients diagnosed with POI carrying the same type of chromosomal abnormality manifest different phenotypes. The management protocol also needs to be changed depending on the diagnosis. A karyotype is indicated for accurate diagnosis and proper management of POI in patients, with or without stigmata of chromosomal abnormalities.

Síndrome de Ovarios Poliquísticos / Polycystic ovary syndrome

Resumen El síndrome de ovarios poliquísticos (SOPQ) es la disfunción endocrino- metabólica más frecuente en mujeres de edad reproductiva. El diagnostico de esta patología se basa en la presencia de anovulación, hiperandrogenismo y ovarios poliquísticos. La etiología del SOPQ es compleja y multifactorial; por lo cual el tratamiento se basa en tratar las manifestaciones clínicas y la inducción de la ovulación en el momento que se desee la concepción.

Abstract Polycystic ovary syndrome is the most common endocrinologic and metabolic disfunction in reproductive- aged women. The diagnosis of this pathology is based on the presence of ovulatory dysfunction, hyperandrogenism and polycystic ovaries. Its ethiology is complex and with multiple factors, therefore its treatment is based on fixing the clinical manifestations of the syndrome and in the case of women who would like to conceive, in inducing ovulation.

Amenorrhea as a Side Effect of Low Dose Aripiprazole: An Adolescent Case

Amenorrhea, oligomenorrhea, galactorrhoea, gynecomastia, infertility, and sexual dysfunction may arise as a consequence of hyperprolactinemia. Hyperprolactinemia is one of major side effects of treatment with antipsychotics, but aripiprazole is known as a dopamine stabilizer antipsychotic which can be used to improve hyperprolactinemia. In this report, it was described that an adolescent patient experienced amenorrhea after adding very low dose aripiprazole to ongoing fluoxetine treatment regime for major depressive disorder. Additionally, this case showed that the patient recovered from the amenorrhea with replacement of aripiprazole with quetiapine.

The Association between Oligomenorrhea, Onset of Menopause and Metabolic Syndrome in Thai Postmenopausal Women

OBJECTIVES: This study explored the association between a history of oligomenorrhea and onset of menopause and metabolic parameters. METHODS: The study population was 605 postmenopausal women who were patients at the Menopause Clinic, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand between February 2015 and December 2015. A questionnaire was used to ask all women about their history of oligomenorrhea. The study also collected medical data, including weight, height, waist circumference, blood pressure, and blood glucose and lipid profile. RESULTS: Of the 231 postmenopausal women with a complete data record, 31 had a history of oligomenorrhea and 200 did not. The age of onset of menopause was around 48 years in both groups. Prevalence of metabolic syndrome was 12.1%. More women with a waist circumference larger than 80 cm had a history of oligomenorrhea at the interview than women who had not, but a history of oligomenorrhea did not relate to other metabolic parameters. The adjusted odds ratio of a history of oligomenorrhea to waist circumference was 3.69 (95% confidence interval, 1.17–11.64). CONCLUSIONS: A history of oligomenorrhea did not affect the age at menopause, but was associated with waist circumference during menopause.

Efficacy of Prophylactic Uterine Artery Embolization before Obstetrical Procedures with High Risk for Massive Bleeding

OBJECTIVE: To evaluate the safety and efficacy of prophylactic uterine artery embolization (UAE) before obstetrical procedures with high risk for massive bleeding. MATERIALS AND METHODS: A retrospective review of 29 female patients who underwent prophylactic UAE from June 2009 to February 2014 was performed. Indications for prophylactic UAE were as follows: dilatation and curettage (D&C) associated with ectopic pregnancy (cesarean scar pregnancy, n = 9; cervical pregnancy, n = 6), termination of pregnancy with abnormal placentation (placenta previa, n = 8), D&C for retained placenta with vascularity (n = 5), and D&C for suspected gestational trophoblastic disease (n = 1). Their medical records were reviewed to evaluate the safety and efficacy of UAE. RESULTS: All women received successful bilateral prophylactic UAE followed by D&C with preservation of the uterus. In all patients, UAE followed by obstetrical procedure prevented significant vaginal bleeding on gynecologic examination. There was no major complication related to UAE. Vaginal spotting continued for 3 months in three cases. Although oligomenorrhea continued for six months in one patient, normal menstruation resumed in all patients afterwards. During follow-up, four had subsequent successful natural pregnancies. Spontaneous abortion occurred in one of them during the first trimester. CONCLUSION: Prophylactic UAE before an obstetrical procedure in patients with high risk of bleeding or symptomatic bleeding may be a safe and effective way to manage or prevent serious bleeding, especially for women who wish to preserve their fertility.

Association of Anxiety, Depression, and Somatization with Menstrual Problems among North Korean Women Defectors in South Korea

OBJECTIVE: North Korean women defectors have suffered from anxiety, depression, and somatization after defection. Also they have had many menstrual problems like amenorrhea. This study was done to identify the correlations of anxiety, depression, and somatization to menstrual problems among North Korean woman defectors in South Korea. METHODS: The participants in this study were 126 women from 5 government resettlement centers throughout South Korea. Questionnaires which included State-Trait Anxiety Inventory (STAI), Center for Epidemiological studies-Depression Scale (CED-S), and Symptom Checklist-90-Revised (SCL-90-R) were used to identify anxiety and somatization. Data were collected between June and September, 2012. RESULTS: The women reported the following problems; amenorrhea (9.5%), hypomenorrhea (13.6%), menorrhagia (19.8%), polymenorrhea (13.5%), oligomenorrhea (4.8%), changes in amount of menstrual discharge (4.0%), and changes in amount of blood clot (9.5%). Anxiety (r=0.20, p=0.002), depression (r=0.25, p=0.005), and Somatization (r=0.35, p<0.001) were correlated with number of menstrual problems. CONCLUSION: The results of this study indicate that mental health services need to be taken into account in interventions for North Korean woman defectors to improve their reproductive health including addressing menstrual problems.

Epidemiology and Diagnostic Criteria of Polycystic Ovary Syndrome / 임상당뇨병

Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by oligomenorrhea, hyperandrogenism and polycystic ovaries. The prevalence of PCOS varies between 6% and 10% depending on the diagnostic criteria and the ethnicity. Diagnosis of PCOS relies on a combination of clinical, biological and ultrasound criteria that are used worldwide in different variations. Few studies have extensively examined reproductive and metabolic characteristics and hyperandrogenism in Korean women. Despite the paucity of these studies, they are critical for ascertaining PCOS diagnostic criteria for this population. This review addresses the epidemiology and diagnostic criteria of PCOS specifically for Korean women.

Clinical characteristics in Taiwanese women with polycystic ovary syndrome / 대한생식의학회지

Polycystic ovary syndrome (PCOS) is one of the most common hormonal endocrine disorders in women of reproductive age. It consists of a heterogeneous collection of signs and symptoms that together form a disorder spectrum. The diagnosis of PCOS is principally based on clinical and physical findings. The extent of metabolic abnormalities in women with PCOS varies with phenotype, body weight, age, and ethnicity. For general population, the prevalence of hyperandrogenism and oligomenorrhea decreases with age, while complications such as insulin resistance and other metabolic disturbances increase with age. Obese women with PCOS have a higher risk of developing oligomenorrhea, amenorrhea, hyperandrogenemia, insulin resistance, and lower luteinizing hormone (LH) to follicle stimulation hormone (FSH) ratios than non-obese women with PCOS. The LH to FSH ratio is a valuable diagnostic tool in evaluating Taiwanese women with PCOS, especially in the diagnosis of oligomenorrhea. Overweight/obesity is the major determinant of cardiovascular and metabolic disturbances in women of reproductive age.

Prediction of age at menopause in women of suburban areas in Chennai using a model of FSH over age - a pilot study

The human ovary is characterized by early senescence and the end stage of ovarian activity is termed menopause. The age at which menopause occur is between 45 and 55 years world wide. The objective of this pilot study is to determine the age at menopause by using a model of FSH over age in women of sub urban region around Chennai, India. The subjects include 500 patients of age between 30 and 36 yrs with BMI ranging from 24-28. After recording their general profile and history, blood samples were obtained by venipuncture and hormone FSH was estimated on the day 3 of the menstrual cycle. Based on functional dependence of FSH in the form of exponential relation with age, a model was proposed. Using least square approximation the beta values were calculated. With the help of beta values and using the cut off value of 40 IU/ml for FSH, this predicted model determined the age of menopause as 44.6 yrs in women of sub urban region around Chennai. The age of menopause is different in various region worlds wide. According to this pilot study the suburban women of Chennai, attain menopause at an age of 44.6 years. Further exploration should be done to alleviate the role of diet, life style and ethnic variation on menopausal age and the impact of chronic disease like osteoporosis during the period of menopause

A Clinical Analysis of Patients with Premature Ovarian Failure: Compliance with Hormonal Treatment / 대한폐경학회지

OBJECTIVES: To analyze the clinical features of premature ovarian failure (POF) and patients' compliance with hormonal treatment. METHODS: A retrospective analysis of 126 patients diagnosed with POF was selected between January 2004 and December 2007. The clinical, etiologic features and treatment compliance were evaluated. RESULTS: The mean age of diagnosis was 33.2 +/- 5.2 years. The mean value of follicle stimulating hormone was 78.8 +/- 28.8 IU/L. The most common symptom was amenorrhea or oligomenorrhea (54%). Eighty-eight patients were married and 22 of them visited our clinic due to infertility. The most common etiology was unknown (54.8%) and the second most common cause was iatrogenic (29.4%). Only 61 patients underwent hormonal treatment (48.4%). The remaining 11 patients did not undergo hormonal treatment due to other medical conditions such as breast cancer or liver disease; however, they were followed-up regularly (8.7%). Among the treatment group, only 37 patients were followed-up over a period of 12 months (60.7%). CONCLUSION: About half of the women diagnosed with POF did not accept their own problems and therefore delayed essential treatment. Clinicians should educate the importance of early treatment for preventing degenerative changes.

Relationship of age at menarche on anthropometric index and menstrual irregularity in late adolescent girls in Seoul

PURPOSE: To examine the relationship between menarcheal age and anthropometric indices and menstrual irregularity in late adolescent girls in Seoul. METHODS: We surveyed 4,218 fertile adolescent girls between the ages of 16 and 18 years to determine their anthropometric indices and menarcheal age. Measurements were taken from June 2008 to October 2009 at seven girl's high schools in Seoul, Korea. Participants were offered self-report questionnaire as a survey tool that included questions on anthropometric indices (height, weight, waist circumference), menarcheal age, menstrual pattern, frequency of menstruation per year. RESULTS: The participants were categorized into three groups based on menarcheal age: early menarche group (younger than 2 standard deviations [SD]), mid menarche group (within +/-2 SD), late menarche group (older than 2 SD). The mean age of early menarche group was 9.9+/-0.2 years, mid menarche group 12.5+/-0.9 years, late menarche group 15.1+/-0.3 years (P < 0.001). Heights were recorded as 160.4+/-5.2 cm, 161.8+/-4.9 cm, 162.3+/-4.7 cm in early, mid, and late menarche group, respectively (P = 0.001). Body mass index (BMI) and waist circumference significantly were lager in early menarche group than mid and late menarche ones (P < 0.001). The menarcheal age had a positive correlation with height and negative correlations with weight, BMI, waist circumference (P < 0.001). The prevalence of oligomenorrhea was more frequent in late menarche group than early and mid menarche group. CONCLUSION: The menarcheal age have positive relationship with height and inverse relationship with BMI and waist circumference in late adolescent girls in Seoul. Late menarcheal girls are disposed to have menstrual irregularity compared to early menarcheal girls.

Bone mineral changes and cardiovascular effects among female athletes with chronic menstrual dysfunction

Oligo/amenorrhea, as a part of the Female Athlete Triad has adverse effects on the athlete's bone mineral density [BMD] and cardiovascular system. Hypoestrogenism, due to suppression of hypothalamus-pituitary axis [HPA] as a result of energy imbalance, is the possible cause of the Triad. This study was designed based on following up and reassessment of elite female athletes who were diagnosed as menstrual dysfunction about two years ago. This study was conducted in three phase sections: 1] Reassess the pattern of menstrual cycle among athletes who reported menstrual dysfunction about two years ago; 2] Bone mineral density was measured twice in the same machine and same center with a two-year interval; 3] The laboratory data including blood glucose, lipid profile and inflammatory markers was assessed in phase 3. BMD of athletes did not change significantly after 25.5 months of oligomenorrhea P [spine] = 0.2, P [femur]=0.9. Mean of all cardiovascular factors was in the normal range except for high density lipoprotein [HDL] which was 49.28 [SD=9.18], however, most of the athletes had abnormalities in their lipid profile. Inverse relationship between the increase in the BMD of spine and total cholesterol [r =-0.49, P=0.04], Apolipoprotein A [r = -0.51 P=0.04], and very low density lipoprotein [VLDL] [r =-0.66, P=0.009]. Also correlation between BMD of spine and HbA1C [r =-0.70, P=0.003] were significant. Findings of this study show that negative changes in BMD and cardiovascular biomarkers of female athletes with functional hypothalamic menstrual dysfunction could occur if proper therapeutic intervention [including increase in calorie intake, decrease in exercise load or hormonal replacement] will not consider

Prevalence and pattern of menstrual disorders among Lebanese nursing students

Menstrual disorders frequently affect the quality of life of adolescents and young adult women and can be indicators of serious underlying problems. The objective of this study was to determine the prevalence and pattern of menstrual symptoms among nursing students in Beirut, Lebanon. Of 352 students completinga written questionnaire, the most common menstrual disorders were irregular frequency of menstruation [80.7%] premenstrual syndrome [54.0%], irregular duration of menstruation [43.8%], dysmenorrhoea [38.1%], polymenorrhoea [37.5%] and oligomenorrhoea [19.3%]. On logistic regression analysis, there were significant associations between irregular cycles and marital status [OR 2.18] and menarcheal age [OR 4.76]; oligomenorrhoea and residency [OR 2.06] and menarcheal age [OR 3.17]; abnormal blood loss and menarcheal age [OR 6.92]; dysmenorrhoea and marital status [OR 8.93] and residency [OR 2.04]; and premenstrual syndrome and marital status [OR 2.10]. Dysmenorrhoea and premenstrual symptoms were serious enough to affect daily activities or academic attendance in many cases and this is a concern for policy-makers

Markers of insulin resistance and sedentary lifestyle are predictors of preeclampsia in women with adverse obstetric results

Some thrombophilias and severe preeclampsia may increase the risk for preterm deliveries and fetal death due to placental insufficiency. Our objective was to evaluate clinical and laboratory data as predictors of preeclampsia in a population of mothers with 3rd trimester fetal losses or preterm deliveries. In a longitudinal retrospective study, 54 consecutive women (age range: 16 to 39 years) with normotensive pregnancies were compared to 79 consecutive women with preeclampsia (age range: 16 to 43 years). Weight accrual rate (WAR) was arbitrarily defined as weight gain from age 18 years to the beginning of pregnancy divided by elapsed years. Independent predictors of preeclampsia were past history of oligomenorrhea, WAR >0.8 kg/years, pre-pregnancy or 1st trimester triglyceridemia >150 mg/dL, and elevated acanthosis nigricans in the neck. In a multivariate logistic regression model, two or more predictors conferred an odds ratio of 15 (95 percentCI [5.9-37]; P < 0.001) to develop preeclampsia (85 percent specificity, 73 percent sensitivity, c-statistic of 81 ± 4 percent; P < 0.0001). Clinical markers related to insulin resistance and sedentary lifestyles are strong independent predictors of preeclampsia in mothers with 3rd trimester fetal losses or preterm deliveries due to placental insufficiency. Women at risk for preeclampsia in this particular population might benefit from measures focused on overcoming insulin resistance.

Prevalence of polycystic ovaries among patients with hirsutism and menstrual abnormalities

Polycystic ovaries are considered to be the most frequent cause of hirsutism with its prevalence of 10% of woman of reproductive age group. Polycystic ovarian syndrome [PCOS] reflects multiple potential etiologies and variable clinical presentations. To investigate the prevalence of polycystic ovaries among patients with hirsutism and menstrual abnormalities [oligo- or oligohypomenorrhea] and to correlate presence of hirsutism with BMI, polycystic ovaries, ovarian volume and biochemical markers. All patients who presented with oligo- or oligohypomenorrhea or hirsutism either in outpatient clinic of Obstetrics and Gynecology, Shalamar Hospital or a private laser clinic were enrolled in study. Patients who had hirsutism with normal menstrual cycle were excluded from study. Enrolled patients were categorized into two groups on basis of hirsutism, group 1: oligomenorrhea/oligohypomenorrhea with hirsutism and group 2: oligomenorrhea/oligohypomenorrhea without hirsutism. A detailed clinical history, clinical examination, hormonal profile and abdominopelvic ultrasound were done in all patients. SPSS- version 16 was used for statistical analysis. Out of 90 patients who enrolled in the study, 10 did not report back, so were excluded from study. Out of 80 patients with menstrual problem, 55 [68.7%] had hirsutism [group 1] and 25 [31.3%] had no hirsutism [group 2]. Prevalence of polycystic ovaries was 815% among patients with hirsutism and oligo/oligohypomenorrhea [group 1] as compared to 44% in patients with oligo/oligohypomenorrhea without hirsutism [group 2]. Ovarian volume >10ml and BMI were not statistically significant among both groups. Regarding hormonal profile, serum LH/FSH ratio and testosterone levels were significant among patients with hirsutism as compared to without hirsutism. Prevalence of polycystic ovaries by morphology, FSH/LH ratio and serum testosterone are significantly present among patients with oligo/oligohypomenorrhea and hirsutism as compared to those with oligo/oligohypomennorhea without hirsutism. However Ovarian volume and BMI are not statistically significant among both groups

Long Menstrual Cycle Is Associated with Type 2 Diabetes Mellitus in Korean Women

BACKGROUND: Long menstrual cycle is a risk factor for developing type 2 diabetes and cardiovascular disease in women. We aimed to evaluate the association between existing type 2 diabetes and oligomenorrhea before diagnosis of diabetes, and to observe the differences in this association among obese and non-obese Korean women. METHODS: Patients with type 2 diabetes (n=118) and without any clinical evidence of abnormal glucose regulation (n=258) who attended the outpatient clinic of a university hospital and were over age 30. Patients self-reporting a menstrual cycle over 40 days during their 20s were defined as oligomenorrhea before diagnosis of diabetes. Obesity was defined as having a body mass index (BMI) over 25 kg/m2. RESULTS: The frequency of oligomenorrhea before diagnosis of diabetes was almost two-fold higher in women with type 2 diabetes than in the control group (16.1% vs. 8.5%, P=0.03). Oligomenorrhea was associated with type 2 diabetes after adjusting for age, BMI, systolic blood pressure, triglycerides, and high density lipoprotein cholesterol (odds ratio, 3.89; 95% confidence interval, 1.37 to 11.04). Among women with oligomenorrhea before diagnosis of diabetes, the frequency of type 2 diabetes was significantly higher in obese subjects than in their non-obese counterparts (90.9% vs. 30.0%, P=0.03). CONCLUSION: Having a long menstrual cycle could be a risk factor for the development of type 2 diabetes, especially in obese women.

Forma no clàsica de hiperplasia adrenal congénita en la niñez y adolescencia / Non-classic way of congenital adrenal hyperplasia in childhood and adolescence

INTRODUCCIÓN: la hiperplasia adrenal congénita es un trastorno hereditario de la esteroidogénesis suprarrenal, trasmitido por mutaciones genéticas con carácter autosómico recesivo, las cuales afectan las enzimas que intervienen en la biosíntesis del cortisol. La causa la constituye en 90 a 95 por ciento de los casos la deficiencia de la enzima 21 hidroxilasa. OBJETIVO: exponer la experiencia de los autores de este trabajo en la forma no clásica de esta enfermedad. MÉTODOS: se realizó la caracterización de 7 pacientes diagnosticados en la sala de endocrinología pediátrica del Instituto Nacional de Endocrinología, ubicada en el Hospital Pediátrico del Cerro, durante el período 1998-2008. Todos los pacientes pertenecían al sexo femenino. RESULTADOS: los síntomas se iniciaron a una edad promedio de 8,8 años y más de la mitad de los casos presentaron pubarquia precoz. La menarquia se produjo a una edad media de 10,7 años. Se logró el diagnóstico bioquímico al obtenerse valores elevados de 17 hidroxiprogesterona (en condiciones basales). Se emplearon distintas modalidades de tratamiento según la edad de cada paciente y los síntomas predominantes en cada caso. CONCLUSIONES: se corroboró la mayor frecuencia de diagnóstico de esta enfermedad en el sexo femenino, así como la importancia del estudio y el seguimiento ante un paciente con pubarquia precoz(AU)

INTRODUCTION: the congenital adrenal hyperplasia is an inherited disorder of suprarenal esteroidogenesis, transmitted by genetic mutations with a autosomal recessive character affecting the enzymes intervening in cortisol biosynthesis. In the 90 to 95 percent of cases, the cause is a deficiency of Hydroxylase enzyme 21. OBJECTIVE: to show the current paper authors' experience in the non-classic way of this entity. METHODS: we made a characterization of 7 female patients diagnosed in the Children Endocrinology Ward of the National Institute of Endocrinology located in the Children Hospital, Cerro municipality during 1998-2008. RESULTS: symptoms started at a mean age of 8,8 years and more the a half of cases had an early pubarche. Menarche appeared at a mean age of 19,7 years. We made a biochemical diagnosis achieving higher values of 17 hydroxyprogesterone (in basal conditions). Different treatment modalities were used according to each patient and predominant symptoms in each case. CONCLUSIONS: we verified the great frequency of this entity in female sex, as well as the study and follow-up significance in face of a patient presenting early pubarche(AU)

Common menstrual disorders in adolescents

To assess the knowledge of adolescent females about menstruation, prior to their menarche. To determine the frequency of common menstrual disorders. To determine the number of adolescents taking medical treatment for menstrual disorders. To assess the awareness of adolescent females about the menstrual disorders they are suffering from. It was a descriptive cross sectional study. The study was carried out in a teaching hospital, various schools and colleges and a slum area of North Nazimabad, Karachi. The study included 150 adolescent females on the basis of non probability purposive sampling. A previously prepared questionnaire was filled which included demographical profile, details about the participant's menstrual history and the treatment taken, if any, for the disorders they were suffering from. One hundred and fifty adolescent females participated in our research aged 11 to 19. The girls were non-married, not pregnant and free of co-morbidities. Out of total, 61% participants had menstrual disorders. Out of which 58.6% girls had dysmenorrhea, 12.7% had menorrhagia, 4.7% girls had oligomenorrhea and 2% girls had amenorrhea. 19.3% girls had such severe dysmenorrhea that it affected their school and social life. Only 38% of the suffering girls were aware that they had a menstrual problem. 15.3% of the participants were taking medication for their menstrual problem. 86% girls had prior knowledge of menstrual cycles before menarche. Most of them were taught about normal menstruation by their mothers. So they considered it to be a normal physiological phenomenon. A majority of adolescents in Pakistani society face menstrual disorders after their menarche. There is also a need to teach people about treatment at the community level so the girls can realize and overcome these problems befre the disorders can go into complications like infertility or uterine cancers

Hacia una clasificación racional del síndrome de ovarios poliquísticos / Towards a rational classification of polycystic ovary syndrome

Creemos que existen tres fenotipos clínicos del síndrome de ovarios poliquísticos (SOP) que representan distintas formas del mismo trastorno metabólico y que son el resultado de grados variados de disfunción metabólica. Las pacientes con disfunción neuroendocrina y ciclos irregulares (fenotipo A) tienen los grados más leves de hiperinsulinemia, contrariamente a las pacientes con fenotipo B (ciclos irregulares sin disfunción neuroendocrina), que padecen los grados máximos de hiperinsulinemia. Las mujeres con ciclos regulares y que no manifiestan disfunción neuroendocrina (fenotipo C) parecen tener grados intermedios de hiperandrogenemia y disfunción metabólica. Estos datos sugieren que el fenotipo clínico puede ser útil para decidir sobre la terapia y puede surgir, al menos en parte, de diferencias en el grado de disfunción metabólica.