Structural and hormonal changes in the ovaries of women with polycystic ovary syndrome and healthy controls: a 13-year prospective study in an unselected population.

Background: This study investigates whether ovarian structural and hormonal changes over a 13-year period differ between women diagnosed with polycystic ovary syndrome (PCOS) and healthy controls within an unselected population.

Methods: This prospective nested cohort study followed up on a prevalence study conducted in 2009 in an unselected-population. A total of 41 women with PCOS (≥ 35 years-old, diagnosed using the Rotterdam criteria) and 43 age- and body-mass-index-(BMI)-matched healthy controls were included from this cohort. The relationship between ovarian structure and hormonal profiles was tracked over 13 years. Antral follicle count (AFC) and ovarian volume (OV) were assessed by transvaginal/pelvic ultrasonography. Anti-Mullerian hormone (AMH), total testosterone (TT), sex hormone-binding globulin (SHBG), free androgen index (FAI), and dehydroepiandrosterone sulfate (DHEAS) were measured. The cardiometabolic profile of these aging women in same cohort was reported in a recent study.

Results: The mean age (44.1 ± 6.5 vs. 46.4 ± 4.2 years, p = 0.06), BMI (24.7; IQR:21.9-27.8 vs. 25.2; IQR:23.2-28.9, p = 0.16), and proportion of women in postmenopausal stage (75.6% vs. 62.8%, p = 0.24) were comparable between PCOS and control groups. Ovarian volume and AFC were significantly higher in the aging women with PCOS. At 13 years follow-up, PCOS group experienced a greater decline in AFC, AMH, and TT but retained higher levels of AMH, TT, FAI, and DHEAS than controls. An AMH cutoff of 1.17 ng/mL showed moderate diagnostic reliability for diagnosing PCOS in aging women, with an area under curve of 0.71 (95% CI:0.60-0.83).

Conclusions: Aging women with PCOS show greater declines in AFC, OV, AMH, and TT but maintain higher ovarian and hormonal levels than controls. Serum AMH provides moderate diagnostic utility for diagnosing PCOS in aging women.