Endocrine Abstracts

JOINT2436

Context: The diagnosis of polycystic ovary syndrome (PCOS) remains challenging due to its heterogeneous clinical presentation and the absence of a single diagnostic marker. While clinical diagnosis integrates clinical, laboratory, and imaging assessments, population studies often depend on self-reported PCOS (srPCOS), leading to inconsistent findings regarding associated health risks. This study evaluates the prevalence of key clinical symptoms of PCOS, specifically oligomenorrhea (OA) and hirsutism, among women with self-reported PCOS (srPCOS) in a developing country and investigates their reproductive and cardiometabolic outcomes.

Methods: The ELSA-Brazil study integrates cross-sectional and prospective cohort analyses of 15,105 civil servants across Brazil. Participants underwent four longitudinal evaluations, including interviews, anthropometric assessments, and biochemical tests. This analysis included 7,623 women aged 35–74 years who participated in the first two evaluations (2008–2014). srPCOS was defined as a self-reported medical diagnosis based on clinical criteria, ultrasound findings, or unspecified parameters. Clinical symptoms assessed included OA (cycles >35 days) and hirsutism (self-administered questionnaire based on Ferriman–Gallwey score ≥5). Metabolic outcomes included obesity, central obesity, type 2 diabetes mellitus (T2DM), dyslipidemia, hypertension, metabolic syndrome, and hepatic steatosis on ultrasound. Reproductive outcomes included pre-eclampsia, gestational diabetes, and infertility/subfertility, while cardiovascular outcomes encompassed self-reported myocardial infarction, angina, myocardial revascularization, stroke, and heart failure. Statistical analyses were adjusted for age, race, education, smoking, alcohol intake, and physical activity, with significance set at P < 0.05.

Results: The prevalence of srPCOS was 11.7% (n = 888), with 12.3% reporting clinical diagnosis, 78% ultrasound-based diagnosis, 4.1% both, and 5.5% unspecified. Among women with srPCOS, 3.5% reported OA, and 21.9% reported hirsutism. The proportion of women with both OA and hirsutism was very low (≤1%), while 22.5% reported either OA or hirsutism. srPCOS was associated with higher odds of obesity (OR 1.2), T2DM (OR 1.4), metabolic syndrome (OR 1.2), infertility/subfertility (OR 2.1), angina (OR 1.6), and heart failure (OR 2.3) (all P < 0.05).

Conclusions: In this large Brazilian cohort, most women with srPCOS reported an ultrasound-based diagnosis alone, and the prevalence of both hirsutism and OA was low—findings that differ from previous studies. srPCOS was linked to certain cardiometabolic and reproductive outcomes but not to others traditionally associated with PCOS. This discrepancy likely reflects diagnostic heterogeneity in self-reported cases, emphasizing the need for improved classification methods in epidemiological studies.