Polycystic ovary syndrome in Salvador, Brazil: a prevalence study in primary healthcare

Reproductive Biology and Endocrinology

Estela ML Aquino²  Ligia Gabrielli¹ 

[1] Instituto de Saúde Coletiva, Universidade Federal da Bahia, Rua Basílio da Gama, s/n, Campus Universitário do Canela, 40110-040, Salvador, BA, Brazil;MUSA – Programa de Estudos de Gênero e Saúde, Instituto de Saúde Coletiva, Rua Basílio da Gama, s/n, Campus Universitário do Canela, 40110-040, Salvador, BA, Brazil

关键词: Women’s health;    Reproductive medicine;    Polycystic ovary syndrome;    Hyperandrogenism;    Cross-sectional studies;   

Others  :  1149725
DOI  :  10.1186/1477-7827-10-96

 received in 2012-08-15, accepted in 2012-11-08,  发布年份 2012

【 摘 要 】

Background

Polycystic ovary syndrome (PCOS) is a common condition in women of reproductive age. It is characterized by hyperandrogenism, oligomenorrhea/amenorrhea and polycystic ovaries. It is associated with obesity, diabetes, dyslipidemia and cardiovascular disease. No studies have been conducted on the prevalence of PCOS in Brazilian or South American women. Few studies using the Rotterdam criteria have been published. The objective of the present study was to calculate the prevalence of PCOS at primary healthcare level in Salvador, Brazil based on these criteria.

Methods

This was a cross-sectional, two-phase study conducted in a probability sample of women of 18–45 years of age screened for cervical cancer in the primary healthcare network of the city of Salvador, Brazil. In the first phase, interviews were conducted, weight, height, waist circumference, blood pressure and random blood sugar levels were measured, and the presence of acne and hirsutism was investigated. Women with at least one diagnostic criterion were referred for the second phase, which consisted of specialist consultation, pelvic ultrasonography and hormone measurements for differential diagnosis and/or investigation of a second criterion.

Results

Of the 859 women interviewed, 88.5% were black and 58.7% had 11 years of schooling or less. A diagnosis of PCOS was excluded in 84.4%, undetermined in 7.1% and confirmed in 8.5% (95%CI: 6.80–10.56). There were no statistically significant differences between these three groups with respect to weight, body mass index, waist circumference, blood sugar levels or arterial blood pressure. Women with PCOS were younger (p = 0.00), taller (p = 0.04), had fewer children (p = 0.00), were better educated (p = 0.01), and had higher total testosterone levels (p = 0.01) and a higher LH/FSH ratio (p = 0.01).

Conclusion

According to the Rotterdam criteria, the prevalence of PCOS in women seeking primary healthcare in Salvador, Brazil, was 8.5%.

【 授权许可】

   
2012 Gabrielli and Aquino; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Legro RS: Diagnostic criteria in polycystic ovary syndrome. Semin Reprod Med 2003, 21(3):267-275.
• [2]Ehrmann DA: Polycystic ovary syndrome. N Engl J Med 2005, 352(12):1223-1236.
• [3]Speroff LGR, Kase NG: Anovulation and the Polycystic Ovary. In Clinical Gynecologic Endocrinology and Infertility. 7th edition. Edited by Weinberg R. Philadelphia: Lippincott Williams and Wilkins; 2005:465-498.
• [4]Carmina E, Lobo RA: Polycystic ovary syndrome (PCOS): arguably the most common endocrinopathy is associated with significant morbidity in women. J Clin Endocrinol Metabol 1999, 84(6):1897-1899.
• [5]Franks S: Polycystic ovary syndrome. N Engl J Med 2005, 333(13):9.
• [6]Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO: The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metabol 2004, 89(6):2745-2749.
• [7]Legro RS, Kunselman AR, Dodson WC, Dunaif A: Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metabol 1999, 84(1):165-169.
• [8]Krentz AJ, von Muhlen D, Barrett-Connor E: Searching for polycystic ovary syndrome in postmenopausal women: evidence of a dose-effect association with prevalent cardiovascular disease. Menopause 2007, 14(2):284-292.
• [9]Sills ES, Perloe M, Tucker MJ, Kaplan CR, Genton MG, Schattman GL: Diagnostic and treatment characteristics of polycystic ovary syndrome: descriptive measurements of patient perception and awareness from 657 confidential self-reports. BMC Womens Health 2001, 1(1):3. BioMed Central Full Text
• [10]Kumarapeli V, Seneviratne Rde A, Wijeyaratne CN, Yapa RM, Dodampahala SH: A simple screening approach for assessing community prevalence and phenotype of polycystic ovary syndrome in a semi-urban population in Sri Lanka. Am J Epidemiol 2008, 168(3):321-328.
• [11]Group PCW: Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004, 81(1):19-25.
• [12]Chen X, Yang D, Mo Y, Li L, Chen Y, Huang Y: Prevalence of polycystic ovary syndrome in unselected women from southern China. Eur J Obstet Gynecol Reprod Biol 2008, 139(1):59-64.
• [13]Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, Janssen OE, Legro RS, Norman RJ, Taylor AE, et al.: Positions statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. J Clin Endocrinol Metabol 2006, 91(11):4237-4245.
• [14]Lindholm A, Andersson L, Eliasson M, Bixo M, Sundstrom-Poromaa I: Prevalence of symptoms associated with polycystic ovary syndrome. Int J Gynaecol Obstet Offic Organ Int Fed Gynaecol Obstet 2008, 102(1):39-43.
• [15]Knochenhauer ES, Key TJ, Kahsar-Miller M, Waggoner W, Boots LR, Azziz R: Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J Clin Endocrinol Metabol 1998, 83(9):3078-3082.
• [16]Michelmore KF, Balen AH, Dunger DB, Vessey MP: Polycystic ovaries and associated clinical and biochemical features in young women. Clin Endocrinol 1999, 51(6):779-786.
• [17]Diamanti-Kandarakis E, Kouli CR, Bergiele AT, Filandra FA, Tsianateli TC, Spina GG, Zapanti ED, Bartzis MI: A survey of the polycystic ovary syndrome in the Greek island of Lesbos: hormonal and metabolic profile. J Clin Endocrinol Metabol 1999, 84(11):4006-4011.
• [18]Asuncion M, Calvo RM, San Millan JL, Sancho J, Avila S, Escobar-Morreale HF: A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metabol 2000, 85(7):2434-2438.
• [19]Li L, Yang D, Chen X, Chen Y, Feng S, Wang L: Clinical and metabolic features of polycystic ovary syndrome. Int J Gynecol Obstet 2007, 97(2):129-134.
• [20]Moran C, Tena G, Moran S, Ruiz P, Reyna R, Duque X: Prevalence of polycystic ovary syndrome and related disorders in mexican women. Gynecol Obstet Invest 2010, 69(4):274-280.
• [21]Goodarzi MO, Quinones MJ, Azziz R, Rotter JI, Hsueh WA, Yang H: Polycystic ovary syndrome in Mexican-Americans: prevalence and association with the severity of insulin resistance. Fertil Steril 2005, 84(3):766-769.
• [22]Tehrani FR, Simbar M, Tohidi M, Hosseinpanah F, Azizi F: The prevalence of polycystic ovary syndrome in a community sample of Iranian population: Iranian PCOS prevalence study. Reprod Biol Endocrinol 2011, 9:39. BioMed Central Full Text
• [23]Bolfarine HBW: Elementos de Amostragem. 1st edition. São Paulo: Edgard Blucher; 2005.
• [24]Ferriman D, Gallwey JD: Clinical assessment of body hair growth in women. J Clin Endocrinol Metabol 1961, 21:1440-1447.
• [25]Yildiz BO: Diagnosis of hyperandrogenism: clinical criteria. Best Pract Res Clin Endocrinol Metab 2006, 20(2):167-176.
• [26]U.S. Department of Health and Human Services, Food and Drug Administration, Center for Drug Evaluation and Research: Draft Guidance for Industry: Acne Vulgaris: Developing Drugs for Treatment. Clinical/Medical. September 2005. Accessed at http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM071292.pdf webcite
• [27]Agresti ACB: Approximate is better than “Exact” for interval estimation of binomial proportions. Am Statist 1998, 52(2):8.
• [28]Cuzick J: A Wilcoxon-type test for trend. Stat Med 1985, 4(1):87-90.
• [29]Hsu MI, Liou TH, Chou SY, Chang CY, Hsu CS: Diagnostic criteria for polycystic ovary syndrome in Taiwanese Chinese women: comparison between Rotterdam 2003 and NIH 1990. Fertil Steril 2007, 88(3):727-729.
• [30]Broekmans FJ, Knauff EA, Valkenburg O, Laven JS, Eijkemans MJ, Fauser BC: PCOS according to the Rotterdam consensus criteria: Change in prevalence among WHO-II anovulation and association with metabolic factors. BJOG 2006, 113(10):1210-1217.
• [31]Azziz R: Diagnostic criteria for polycystic ovary syndrome: a reappraisal. Fertil Steril 2005, 83(5):1343-1346.
• [32]Diamanti-Kandarakis E, Panidis D: Unravelling the phenotypic map of polycystic ovary syndrome (PCOS): a prospective study of 634 women with PCOS. Clin Endocrinol 2007, 67(5):735-742.
• [33]Carmina E, Koyama T, Chang L, Stanczyk FZ, Lobo RA: Does ethnicity influence the prevalence of adrenal hyperandrogenism and insulin resistance in polycystic ovary syndrome? Am J Obstet Gynecol 1992, 167(6):1807-1812.
• [34]Rodin DA, Bano G, Bland JM, Taylor K, Nussey SS: Polycystic ovaries and associated metabolic abnormalities in Indian subcontinent Asian women. Clin Endocrinol 1998, 49(1):91-99.
• [35]Kac G: Secular height trend: a literature review. Cadernos de saude publica/Ministerio da Saude, Fundacao Oswaldo Cruz, Escola Nacional de Saude Publica 1999, 15(3):451-461.
• [36]Thierry van Dessel HJ, Lee PD, Faessen G, Fauser BC, Giudice LC: Elevated serum levels of free insulin-like growth factor I in polycystic ovary syndrome. J Clin Endocrinol Metabol 1999, 84(9):3030-3035.
• [37]Garcia-Rudaz MC, Ropelato MG, Escobar ME, Veldhuis JD, Barontini M: Amplified and orderly growth hormone secretion characterizes lean adolescents with polycystic ovary syndrome. Eur J Endocrinol/Eur Fed Endocr Soc 2002, 147(2):207-216.
• [38]Prefeitura Municipal de Salvador: Secretaria Municipal de Saúde. Diagnóstico de saúde da população negra de Salvador. Bahia: Salvador; 2006.
• [39]DIEESE. Departamento Intersindical de Estatística e Estudos Socioeconômicos: Anuário da Educação Profissional da Bahia: Indicadores – Região Metropolitana de Salvador. São Paulo; 2010. Accessed at http://dieese.org.br/ped/ssa/pedssa_2010.xml# webcite
• [40]Bozon MHM: Iniciação à sexualidade: modos de socialização, interações de gênero e trajetórias individuais. In O aprendizado da sexualidade: um estudo sobre reprodução e trajetórias sociais de jovens brasileiros. 1st edition. Edited by Heilborn ML AE, Bozon M, Knauth DR. Rio de Janeiro: Fiocruz/Garamond; 2006:156-205.
• [41]Merkin SS, Azziz R, Seeman T, Calderon-Margalit R, Daviglus M, Kiefe C, Matthews K, Sternfeld B, Siscovick D: Socioeconomic status and polycystic ovary syndrome. J Womens Health (Larchmt) 2011, 20(3):413-419.