ASSOCIATION BETWEEN POLYCYSTIC OVARY SYNDROME (PCOS) AND ENDOMETRIAL HYPERPLASIA IN REPRODUCTIVE-AGE WOMEN

Abstract

Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder in women of reproductive age, occurring along with chronic anovulation, obesity, and insulin resistance. These elements lead to extended unopposed estrogen exposure, and with that, a higher risk for hyperplasia of the endometrial lining. Understanding this association is important to inform the implementation of screening and early diagnosis, and to enable the use of preventive interventions in a timely manner.

Objectives:  To find the prevalence of endometrial hyperplasia in women of reproductive age with PCOS and examine the relationships of clinical symptoms and metrics, fasting glucose and insulin, and sex steroid hormones to hyperplasia development.

Methodology

This cross-sectional study was conducted at Hira Hospital, Abbottabad from july 2023 to dec 2023.on women of reproductive age who have been diagnosed with PCOS according to the Rotterdam criteria of having two out of the following three: oligo/anovulation, hyperandrogenism, and polycystic ovarian morphology on ultrasound. Eligible women were subjected to thorough clinical evaluations and clinical records were kept for the following: menstrual history, BMI, waist to hip ratio, and hyperandrogenism. Blood was drawn for laboratories to analyze fasting blood glucose, insulin, profile lipids, LH/FSH ratio, and androgens. Transvaginal ultrasound was done for the measurement of the endometrial thickness. If women had >10–11 mm, or abnormal uterine bleeding, they were counseled for an endometrial biopsy. For the remaining women, a survey with structured questions was administered to find out their demographics, and hormonal and metabolic data. The data was analyzed statistically with SPSS version 24.0. The relationship between endometrial hyperplasia and the assorted risk factors was evaluated with the chi square, independent t, and logistic regression to determine p < 0.05.

 Results: A mean average age of 27.6 ± 5.4 years old, a total of 100 reproductive age women with PCOS were also enrolled. We diagnosed with a histopathological confirmation of endometrial hyperplasia of the remaining 22% of the study cohort. The women with hyperplasia had a higher mean BMI than the women without hyperplasia (31.2 ± 4.1 vs 28.8 ± 4.2; p = 0.01), supporting the contribution of higher body weight to endometrial health risks. As well, the hyperplasia group had higher mean fasting insulin (22.4 ± 7.1 µIU/mL vs 17.5 ± 5.8 µIU/mL; p = 0.01), which also demonstrates the degree of insulin resistance associated with the presence of endometrial disease. As per transvaginal ultrasonography there was a higher mean endometrial thickness which was greater than 11 mm (p = 0.002) associated with hyperplasia. Increase of oligo menorrhea was also prevalent with hyperplasia (81.8% vs 51.3%; p = 0.03), which illustrates the effect of chronic absence of ovulation with unopposed estrogen. We also did not find correlation between serum hyperplasia and androgens which may suggest that the ovulatory dysfunction and metabolic parameters are the greater contributors (p = 0.21). After the diagnosis of endometrial hyperplasia, the women received cyclic progesterone therapy and during follow-up a majority of the study participants had improvement of menstrual regularity, sparing of abnormal uterine bleeding, and improvement of endometrial thickness. Therapy was also noted to be complication free.

Conclusion; Patients with PCOS commonly experience an advanced form of endometrial growth due to an evident exposition of unopposed estrogen, displaying one of its hormonal irregularities. Of these patients, those who have a higher BMI, insulin insensitivity, amenorrhea, and endometrial thickening tend to be more advanced with form os such hyperplasia. Since a good portion of patients with these characteristics may have PCOS, given the various risk factors, it is of utmost importance for these patients to receive early intervention and adequate screening to avert further endometrial growth complications, such as atypical hyperplasia or carcinoma.