Skip to main content
SpringerLink
Log in

Metabolic and androgen profile in underweight women with polycystic ovary syndrome

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Introduction

Polycystic ovary syndrome (PCOS) is a disorder associated with insulin resistance and obesity. Aim of our study is to clarify the prevalence of underweight in PCOS patients and whether metabolic and androgen profiles of PCOS differ depending on normal or low body weight.

Methods

Out of 1269 consecutive patients with PCOS recruited from the Department of Endocrinology and Metabolism at the University of Duisburg-Essen, 19 patients (1.5%) were underweight and were compared to 375 lean PCOS subjects (29.6%). Clinical and endocrine parameters were evaluated. Insulin resistance was assessed by 3-h oral glucose tolerance test (OGTT).

Results

Prevalence of type 2 diabetes and free androgen index did not differ between the two groups. Total cholesterol and low density lipoprotein levels were significantly lower in the group of underweight patients. While no significant difference was found for the Homeostasis model assessment (HOMA) index at fasting state, the HOMA-M120, calculated 2 h after glucose intake in OGTT, was significantly higher in underweight patients. Underweight patients also showed significantly higher postprandial insulin secretion after glucose intake in OGTT. Six underweight PCOS patients received metformin treatment for oligomenorrhea. An improvement of the menstrual cycle was observed in three cases, while two patients were lost to follow up and one discontinued therapy due to side effects.

Conclusions

The prevalence of underweight in patients with PCOS is very low. Underweight in PCOS is associated with higher postprandial insulin levels. Several of our underweight patients were able to achieve regular menstrual cycle under metformin therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Yildiz BO, Bozdag G, Yapici Z, Esinler I, Yarali H (2012) Prevalence, phenotype and cardiometabolic risk of polycystic ovary syndrome under different diagnostic criteria. Hum Reprod 27(10):3067–3073

    Article  PubMed  Google Scholar 

  2. Lauritsen MP, Bentzen JG, Pinborg A, Loft A, Forman JL, Thuesen LL et al (2014) The prevalence of polycystic ovary syndrome in a normal population according to the Rotterdam criteria versus revised criteria including anti-Mullerian hormone. Hum Reprod 29(4):791–801

    Article  CAS  PubMed  Google Scholar 

  3. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO (2004) The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 89(6):2745–2749

    Article  CAS  PubMed  Google Scholar 

  4. Diamanti-Kandarakis E, Kouli CR, Bergiele AT, Filandra FA, Tsianateli TC, Spina GG et al (1999) A survey of the polycystic ovary syndrome in the Greek island of Lesbos: hormonal and metabolic profile. J Clin Endocrinol Metab 84(11):4006–4011

    Article  CAS  PubMed  Google Scholar 

  5. Asuncion M, Calvo RM, San Millan JL, Sancho J, Avila S, Escobar-Morreale HF (2000) A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metab 85(7):2434–2438

    CAS  PubMed  Google Scholar 

  6. Knochenhauer ES, Key TJ, Kahsar-Miller M, Waggoner W, Boots LR, Azziz R (1998) Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern US: a prospective study. J Clin Endocrinol Metab 83(9):3078–3082

    CAS  PubMed  Google Scholar 

  7. Kim JJ, Hwang KR, Choi YM, Moon SY, Chae SJ, Park CW et al (2014) Complete phenotypic and metabolic profiles of a large consecutive cohort of untreated Korean women with polycystic ovary syndrome. Fertil Steril 101(5):1424–1430

    Article  CAS  PubMed  Google Scholar 

  8. Mani H, Levy MJ, Davies MJ, Morris DH, Gray LJ, Bankart J et al (2013) Diabetes and cardiovascular events in women with polycystic ovary syndrome: a 20-year retrospective cohort study. Clin Endocrinol 78(6):926–934

    Article  Google Scholar 

  9. Lo JC, Feigenbaum SL, Yang J, Pressman AR, Selby JV, Go AS (2006) Epidemiology and adverse cardiovascular risk profile of diagnosed polycystic ovary syndrome. J Clin Endocrinol Metab 91(4):1357–1363

    Article  CAS  PubMed  Google Scholar 

  10. Kyrkou G, Trakakis E, Attilakos A, Panagopoulos P, Chrelias C, Papadimitriou A et al (2016) Metabolic syndrome in Greek women with polycystic ovary syndrome: prevalence, characteristics and associations with body mass index. A prospective controlled study. Arch Gynecol Obstet 293(4):915–923

    Article  CAS  PubMed  Google Scholar 

  11. Stepto NK, Cassar S, Joham AE, Hutchison SK, Harrison CL, Goldstein RF et al (2013) Women with polycystic ovary syndrome have intrinsic insulin resistance on euglycaemic-hyperinsulaemic clamp. Hum Reprod 28(3):777–784

    Article  CAS  PubMed  Google Scholar 

  12. Li W, Ma L, Li Q (2012) Insulin resistance but not impaired beta-cell function: a key feature in Chinese normal-weight PCOS women with normal glucose regulation. Gynecol Endocrinol 28(8):598–601

    Article  CAS  PubMed  Google Scholar 

  13. Panidis D, Tziomalos K, Misichronis G, Papadakis E, Betsas G, Katsikis I et al (2012) Insulin resistance and endocrine characteristics of the different phenotypes of polycystic ovary syndrome: a prospective study. Hum Reprod 27(2):541–549

    Article  CAS  PubMed  Google Scholar 

  14. Wild RA, Carmina E, Diamanti-Kandarakis E, Dokras A, Escobar-Morreale HF, Futterweit W et al (2010) Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab 95(5):2038–2049

    Article  CAS  PubMed  Google Scholar 

  15. Wang Y, Qain Y, Zhang J, Tang X, Sun J, Zhu D (2013) Association of body mass index with cause specific deaths in Chinese elderly hypertensive patients: Minhang community study. PLoS One 8(8):e71223

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J et al (2009) Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 373(9669):1083–1096

    Article  PubMed  Google Scholar 

  17. Yano Y, Kario K, Ishikawa S, Ojima T, Gotoh T, Kayaba K et al (2013) Associations between diabetes, leanness, and the risk of death in the Japanese general population: the Jichi Medical School Cohort Study. Diabetes Care 36(5):1186–1192

    Article  PubMed  PubMed Central  Google Scholar 

  18. Al-Ozairi E, Quinton R, Advani A (2008) Therapeutic response to metformin in an underweight patient with polycystic ovarian syndrome. Fertil Steril 90(4):1197 e1–4

    Article  PubMed  Google Scholar 

  19. Jung JH, Hahm JR, Jung TS, Kim HJ, Kim HS, Kim S et al (2011) A 27-year-old woman diagnosed as polycystic ovary syndrome associated with Graves’ disease. Intern Med 50(19):2185–2189

    Article  PubMed  Google Scholar 

  20. Group REA-SPcw (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 19(1):41–47

    Article  Google Scholar 

  21. Rich-Edwards JW, Spiegelman D, Garland M, Hertzmark E, Hunter DJ, Colditz GA et al (2002) Physical activity, body mass index, and ovulatory disorder infertility. Epidemiology 13(2):184–190

    Article  PubMed  Google Scholar 

  22. Ludwig E (1977) Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex. Brit J Dermatol 97(3):247–254

    Article  CAS  Google Scholar 

  23. WHO (1995) Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser 854:1–452

    Google Scholar 

  24. Tan S, Hahn S, Benson S, Dietz T, Lahner H, Moeller LC et al (2007) Metformin improves polycystic ovary syndrome symptoms irrespective of pre-treatment insulin resistance. Eur J Endocrinol 157(5):669–676

    Article  CAS  PubMed  Google Scholar 

  25. Bedogni G, Bellentani S, Miglioli L, Masutti F, Passalacqua M, Castiglione A et al (2006) The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol 6:33

    Article  PubMed  PubMed Central  Google Scholar 

  26. Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB (1998) Prediction of coronary heart disease using risk factor categories. Circulation 97(18):1837–1847

    Article  CAS  PubMed  Google Scholar 

  27. II NV (2008) Nationale Verzehrsstudie II. Bundesministerium für Ernährung, Landwirtschaft und Verbraucherschutz

  28. Sheng Y, Lu G, Liu J, Liang X, Ma Y, Zhang X, et al (2016) Effect of body mass index on the outcomes of controlled ovarian hyperstimulation in Chinese women with polycystic ovary syndrome: a multicenter, prospective, observational study. J Assist Reprod Genet 34(1):61–70

    Article  PubMed  Google Scholar 

  29. Rapps N, Skoda E, Zipfel S (2016) Anorexia nervosa as differential diagnosis in underweight patients. Dtsch Med Wochenschr 141(4):261–264

    Article  PubMed  Google Scholar 

  30. Miller KK, Lawson EA, Mathur V, Wexler TL, Meenaghan E, Misra M et al (2007) Androgens in women with anorexia nervosa and normal-weight women with hypothalamic amenorrhea. J Clin Endocrinol Metab 92(4):1334–1339

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. van Binsbergen CJ, Coelingh Bennink HJ, Odink J, Haspels AA, Koppeschaar HP (1990) A comparative and longitudinal study on endocrine changes related to ovarian function in patients with anorexia nervosa. J Clin Endocrinol Metab 71(3):705–711

    Article  PubMed  Google Scholar 

  32. Tan S, Hahn S, Benson S, Janssen OE, Dietz T, Kimmig R et al (2008) Psychological implications of infertility in women with polycystic ovary syndrome. Hum Reprod 23(9):2064–2071

    Article  CAS  PubMed  Google Scholar 

  33. Lee I, Cooney LG, Saini S, Smith ME, Sammel MD, Allison KC et al (2017) Increased risk of disordered eating in polycystic ovary syndrome. Fertil Steril 107(3):796–802

    Article  PubMed  Google Scholar 

  34. Morgan J, Scholtz S, Lacey H, Conway G (2008) The prevalence of eating disorders in women with facial hirsutism: an epidemiological cohort study. Int J Eat Disord 41(5):427–431

    Article  PubMed  Google Scholar 

  35. Treasure JL, Wheeler M, King EA, Gordon PA, Russell GF (1988) Weight gain and reproductive function: ultrasonographic and endocrine features in anorexia nervosa. Clin Endocrinol 29(6):607–616

    Article  CAS  Google Scholar 

  36. Ferriman D, Purdie AW (1983) The aetiology of oligomenorrhoea and/or hirsuties: a study of 467 patients. Postgrad Med J 59(687):17–20

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Sobanski E, Hiltmann WD, Blanz B, Klein M, Schmidt MH (1997) Pelvic ultrasound scanning of the ovaries in adolescent anorectic patients at low weight and after weight recovery. Eur Child Adolesc Psychiatry 6(4):207–211

    Article  CAS  PubMed  Google Scholar 

  38. Tena G, Moran C, Romero R, Moran S (2011) Ovarian morphology and endocrine function in polycystic ovary syndrome. Arch Gynecol Obstet 284(6):1443–1448

    Article  CAS  PubMed  Google Scholar 

  39. Zuniga-Guajardo S, Garfinkel PE, Zinman B (1986) Changes in insulin sensitivity and clearance in anorexia nervosa. Metab Clin Exp 35(12):1096–1100

    Article  CAS  PubMed  Google Scholar 

  40. Dostalova I, Smitka K, Papezova H, Kvasnickova H, Nedvidkova J (2007) Increased insulin sensitivity in patients with anorexia nervosa: the role of adipocytokines. Physiol Res 56(5):587–594

    CAS  PubMed  Google Scholar 

  41. Pannacciulli N, Vettor R, Milan G, Granzotto M, Catucci A, Federspil G et al (2003) Anorexia nervosa is characterized by increased adiponectin plasma levels and reduced nonoxidative glucose metabolism. J Clin Endocrinol Metab 88(4):1748–1752

    Article  CAS  PubMed  Google Scholar 

  42. Takeuchi T, Tsutsumi O, Taketani Y (2008) Abnormal response of insulin to glucose loading and assessment of insulin resistance in non-obese patients with polycystic ovary syndrome. Gynecol Endocrinol 24(7):385–391

    Article  CAS  PubMed  Google Scholar 

  43. Chang RJ, Nakamura RM, Judd HL, Kaplan SA (1983) Insulin resistance in nonobese patients with polycystic ovarian disease. J Clin Endocrinol Metab 57(2):356–359

    Article  CAS  PubMed  Google Scholar 

  44. Dolfing JG, Stassen CM, van Haard PM, Wolffenbuttel BH, Schweitzer DH (2011) Comparison of MRI-assessed body fat content between lean women with polycystic ovary syndrome (PCOS) and matched controls: less visceral fat with PCOS. Hum Reprod 26(6):1495–1500

    Article  CAS  PubMed  Google Scholar 

  45. Morciano A, Romani F, Sagnella F, Scarinci E, Palla C, Moro F et al (2014) Assessment of insulin resistance in lean women with polycystic ovary syndrome. Fertil Steril. 102(1):250 e3–256 e3

    Article  Google Scholar 

  46. Stovall DW, Bailey AP, Pastore LM (2011) Assessment of insulin resistance and impaired glucose tolerance in lean women with polycystic ovary syndrome. J Women’s Health 20(1):37–43

    Article  Google Scholar 

  47. Salley KE, Wickham EP, Cheang KI, Essah PA, Karjane NW, Nestler JE (2007) Glucose intolerance in polycystic ovary syndrome—a position statement of the Androgen Excess Society. J Clin Endocrinol Metab 92(12):4546–4556

    Article  CAS  PubMed  Google Scholar 

  48. Tayek JA, Manglik S, Abemayor E (1997) Insulin secretion, glucose production, and insulin sensitivity in underweight and normal-weight volunteers, and in underweight and normal-weight cancer patients: a Clinical Research Center study. Metab Clin Exp 46(2):140–145

    Article  CAS  PubMed  Google Scholar 

  49. Sahin Y, Unluhizarci K, Yilmazsoy A, Yikilmaz A, Aygen E, Kelestimur F (2007) The effects of metformin on metabolic and cardiovascular risk factors in nonobese women with polycystic ovary syndrome. Clin Endocrinol 67(6):904–908

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany

    Olympia E. Anastasiou

  2. Department of Gastroenterology and Hepatology, University Hospital, University of Magdeburg, Essen, Germany

    Ali Canbay

  3. Department of Endocrinology and Metabolism and Division of Laboratory Research, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany

    Dagmar Fuhrer & Susanne Reger-Tan

Authors
  1. Olympia E. Anastasiou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ali Canbay
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dagmar Fuhrer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Susanne Reger-Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Author contributions

OEA: protocol development, data management, data analysis, manuscript writing. AC: manuscript editing, protocol development. DF: manuscript editing, project development. ST: project development, data management, manuscript editing.

Corresponding author

Correspondence to Susanne Reger-Tan.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

All authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Anastasiou, O.E., Canbay, A., Fuhrer, D. et al. Metabolic and androgen profile in underweight women with polycystic ovary syndrome. Arch Gynecol Obstet 296, 363–371 (2017). https://doi.org/10.1007/s00404-017-4422-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-017-4422-9

Keywords

Search

Navigation