Endocrine Abstracts

PCOS is the commonest endocrine disorder of young women. It has appreciable impact on wellbeing and quality of life, fertility and reproduction, and long term metabolic and cancer risks. Acknowledged a ‘condition of our times’, there was no data from Asia until recently. South Asians have early manifestation with more severe symptoms than white Europeans. Young affected Asians have significantly greater insulin resistance than older white Europeans; with approximately a third having the metabolic syndrome. Central obesity, hypertension and abnormal lipids bear greater significance than BMI; a new dimension to the South Asian phenotype. This highlights their propensity to central fat accumulation. Advancing age impacts significantly on metabolic problems, while gestational diabetes is closely interwoven. Studies in China and Thailand also demonstrate ethnic variation with less overt hirsutism.

Country specific epidemiological data reveals substantial intra-regional variation in the Asian phenotype, particularly the BMI and degree of hyperandrogenism. There is also a notable ‘culture of silence’ among young pre-marital rural Asian women with PCOS; with diminution of quality of life linked to hirsutism rather than obesity that differs from western women. This highlights socio-cultural determinants in differing ethnic groups. The metabolic problems also reveal the need for a life cycle approach. Screening for diabetes pre-conception, weight maintenance through health promotion are simple low cost interventions that require adoption in low income countries.

To study ethnic variations requires evaluation of epidemiological data based on the geographic location of affected women. This warrants a systematic review of population based data or of large clinic databases to ascertain racial and cultural determinants of manifestations of PCOS. In view of its heterogeneous phenotype, an appraisal of possible link(s) between Androgenic, Reproductive, Metabolic phenotypes among different ethnic groups is also required. The 3rd ESHRE/ARSM consensus statement on PCOS (2011) addresses ethnic variation of PCOS.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This work was supported, however funding details are unavailable.