Oligoanovulation with polycystic ovaries but not overt hyperandrogenism

By requiring a minimum of two of three items [hyperandrogenism (HA), oligoanovulation (OA), and polycystic ovaries (PCO) at ultrasound], the Rotterdam definition recognizes four PCO syndrome (PCOS) phenotypes: HA+OA+PCO (full-blown syndrome), HA+OA (former National Institutes of Health definition), HA+PCO (ovulatory PCOS), and OA+PCO. However, the latter phenotype is controversial, and it is not known to what extent it shares similarities with the others.

The study was a comparative analysis of hormonal, metabolic, and ultrasound parameters obtained from patients and controls that were consecutively included in a database.

Sixty-six patients having OA+PCO without hirsutism or elevated serum androstenedione and testosterone levels were compared with 118 normally cycling nonhyperandrogenic age-matched women without PCO (controls). These patients (phenotype D) were also compared with patients with HA+OA+PCO (phenotype A, n = 246), HA+OA (phenotype B, n = 27), and HA+PCO (phenotype C, n = 67).

Patients with phenotype D had higher mean values of waist circumference and higher mean levels of serum testosterone, androstenedione, and LH than controls. Conversely, they had lower mean serum levels of FSH and SHBG (P < 0.05 for each parameter). Variance analysis disclosed significant group effects between the different patients' phenotypes for all parameters, except age, BMI, and FSH. After multiple comparisons with post hoc analysis, phenotype D had milder endocrine and metabolic abnormalities than phenotype A, although it did not differ from phenotype C, except for androgen data, by definition. Phenotypes A and B were statistically similar, except for the ultrasound data, by definition.

Oligoanovulatory patients with PCO but without HA have mild endocrine and metabolic features of PCOS.