The Ontogeny of Distinct Reproductive Phenotypes in Girls at Risk for PCOS During the Postmenarchal Transition.

Context: Daughters of women with PCOS (PCOS-d) and girls with overweight/obesity (OW-g) have hyperandrogenemia (HA) beginning in childhood. However, other features of their early reproductive phenotypes differ, suggesting that there are distinct mechanisms conferring increased risk for PCOS.

Objective: We performed a cross sectional study of adolescent girls during the early postmenarchal transition.

Design, setting, and participants: PCOS-d (n=15), OW-g (n=12) and lean control girls (LC, n=17), were studied within 0.2-1.2 yrs of menarche. Metabolic and reproductive phenotypes were assessed.

Results: SHBG levels were lower (P<0.0001) in PCOS-d and OW-g vs. LC. Free T levels were higher (P=0.02) in OW-g vs. LC. DHEAS levels were higher (P=0.04) in PCOS-d vs. LC, and trended higher in OW-g vs. LC (P=0.07). Morning LH levels were higher in PCOS-d vs. OW-g (P=0.02). LH and FSH responses to GnRH analog were also increased in PCOS-d vs. OW-g (LH AUC P=0.006, FSH AUC P=0.01). The prevalence of HA was similarly increased in PCOS-d and OW-g vs. LC (χ2 P=0.04). The prevalence of ovulatory dysfunction (OD, menses >45 d or <21 d) was increased (χ2 P=0.05) in PCOS-d vs. OW-g and LC.

Conclusions: Both PCOS-d and OW-g had persistent HA during the early postmenarchal transition. However, OD and neuroendocrine abnormalities, elevated basal and stimulated LH responses to GnRH analog, were observed only in PCOS-d. These findings support the existence of distinct developmental trajectories leading to PCOS, with early neuroendocrine dysregulation in PCOS-d and peripheral, likely adiposity-related, androgen excess in OW-g.