Prevalence of endometrial hyperplasia and carcinoma in women with polycystic ovarian syndrome

Objective

To measure the prevalence of EH and EC in women with PCOS.

Design

Prospective, cross-sectional study.

Subjects

208 women diagnosed with PCOS according to the Rotterdam criteria. Patients were excluded if all study variables were not measured/collected, or if they were on hormone treatment within 3 months of diagnosis.

Intervention

All women diagnosed with PCOS underwent an endometrial biopsy in the outpatient setting.

Main Outcome Measures

The primary outcome was the prevalence of a normal endometrium, nonatypical EH (NAEH), atypical EH (endometrial intraepithelial neoplasia (EIN)), or EC on endometrial biopsy.

Results

146 PCOS women (70%) had a normal endometrium, 19 (9%) had NAEH, 31 (15%) had EIN, and 12 (6%) had EC. Compared with women with a normal endometrial biopsy, patients with EC were significantly older (32.1 vs. 28.8 years) and had lower levels of free and total testosterone (5.2 vs. 9.3 pg/mL and 33.9 vs. 60.9 ng/dL, respectively).

Conclusion

There is a high prevalence of EH and EC in PCOS women. The high risk of EIN and EC in an unselected population with PCOS strongly suggests that endometrial biopsy should be a part of the routine evaluation of women >20 years old diagnosed with PCOS.