Polycystic ovary syndrome and the forgotten uterus

Objective

To review the features of endometrial and uterine aberrations in women with Polycystic ovary syndrome (PCOS).

Evidence Review

PCOS is a common disorder that affects various facets of fertility. Although the ovarian and metabolic aspects of the disease have been well studied, its role in uterine dysfunction is not well understood. A systematic literature search was performed in PubMed, Medline, and the Cochrane Library databases for papers published in English up to March 2020. The following key words were used for the search, alone or in combination: polycystic ovary syndrome, poly cystic ovarian disease, polycystic ovaries, PCOS, PCOD, PCO, PCOM, oligoovulation, anovulation, oligomenorrhea, amenorrhea, and hyperandrogenism, and this was combined with terms such as endometrium, infertility, uterus, progesterone resistance, endometrial hyperplasia, pregnancy outcomes, and preterm delivery.

Results

Result of a comprehensive review show that PCOS affects uterus and leads to various pathologies. Although reported anecdotally in various literature, systematic hypothesis driven investigations are needed to clearly understand the uterine dysfunction.

Conclusion

In this review, we highlight various uterine pathologies that are associated with PCOS and explore its impact on fertility. We also discuss key uterine molecular pathways that are altered in PCOS that may be related to infertility, endometrial hyperplasia, and cancer.