Objective: To analyse the phenotypic spectrum of polycystic ovary syndrome (PCOS) and determine the association between metabolic, hormonal and new ultrasonographic criteria.
Design: Clinical cross-sectional study.
Setting: University teaching hospital.
Population: A total of 804 Chinese women, among whom 719 cases were diagnosed as PCOS based on the 2003 Rotterdam criteria. Eighty-five women with regular menstrual cycles and without hyperandrogenism were recruited as controls.
Methods: PCOS patients were divided into four subgroups: (i) oligo- and/or anovulation (O), hyperandrogenism (H), and polycystic ovary morphology (P); (ii) O + H; (iii) H + P; and (iv) O + P.
Main outcome measurements: Clinical history, ultrasonographic (ovarian follicle number and volume), hormonal and metabolic parameters.
Results: The composition of the two new phenotypes created by the European Society for Human Reproduction and Embryology/The American Society for Reproductive Medicine (ESHRE/ASRM) 2003 was 65.6% (O + P and H + P). BMI and F-G scores were highest in the O + H + P group and lowest in O + P and controls. Serum testosterone concentrations and insulin resistance were highest in cases with O + H + P and O + H, intermediate in cases with H + P, and lowest in cases with O + P and controls. The prevalence of metabolic syndrome in the five groups was 28.5% (O + H + P), 25.5% (O + H), 8.3% (H + P), 7.2% (O + P) and 3.5% (controls), respectively.
Conclusions: Nonclassic phenotypes for PCOS (O + P, H + P and O + H + P) were more frequent than the classic phenotype (O + H). The nonhyperandrogenic PCOS phenotype (O + P), one of the new phenotypes created by the Rotterdam criteria, may represent a form of PCOS associated with milder metabolic profile compared with the other phenotypes.