A recent investigation has revealed that women diagnosed with polycystic ovary syndrome (PCOS) do not experience a higher incidence of abnormal ovarian cysts compared to those without the condition. PCOS is a prevalent hormonal disorder affecting approximately one in eight women, and it can take as long as 12 years for a proper diagnosis.
The study, which examined 1,235 women in Finland, was published in JAMA Internal Medicine. It highlights the necessity for a reevaluation of the name “polycystic ovary syndrome,” advocating for a term that better captures the overall health implications associated with the disorder.
According to Terhi Piltonen, the lead author and a professor of obstetrics and gynecology at the University of Oulu in Finland, this research marks the first population-based analysis focused on the occurrence of abnormal ovarian cysts in women diagnosed with PCOS. “This is significant, as PCOS is a lifelong condition that impacts multiple organs and has extensive endocrinological, metabolic, and psychological health effects,” she noted.
The findings bolster the call for a change in terminology surrounding PCOS. The researchers stated, “The results of this cross-sectional study indicate that concerns regarding pathological ovarian cysts in relation to PCOS are unwarranted.” Many specialists in women’s health were not surprised by these conclusions, as they have long believed that the term PCOS inadequately reflects the true nature of the condition.
The precise cause of PCOS remains unclear, although genetic and environmental factors may play a role. Currently, a diagnosis requires women to exhibit two out of three specific symptoms: irregular menstrual cycles or abnormal ovulation, elevated levels of male hormones such as androgen, and the presence of 20 or more small fluid-filled sacs, known as “antral” follicles, which differ from cysts.
Women with PCOS are often at a heightened risk for various health issues, including type 2 diabetes, obesity, hypertension, and cardiovascular diseases. It can take up to a decade for many women to receive a diagnosis, resulting in missed opportunities for early intervention, as noted by Devini Ameratunga, a reproductive endocrinologist based in Brisbane who was not involved in the study. She also pointed out that there is a risk of over-diagnosis, as not all individuals with PCOS present with identical symptoms.
The ovaries in women of reproductive age are home to various types of follicles and hormonal structures essential for egg maturation and ovulation. If a mature follicle fails to release its egg or experiences bleeding during ovulation, it may develop into a non-cancerous cyst. Other abnormal cysts may arise from conditions like endometriosis or may contain skin and hair cells from birth.
This study utilized data from the extensive Finnish Women’s Health Study (WENDY) to assess cyst occurrence in a cohort of Finnish women who were not using hormonal contraception. The researchers compared the ultrasounds of 223 women with PCOS to 1,012 women without the condition. They discovered that while women with PCOS had a significantly higher likelihood of having multiple antral follicles, they did not show a greater prevalence of dominant follicles or abnormal non-cancerous cysts.
Dr. Ameratunga remarked that these results align with the understanding of specialists in the fertility field. The designation PCOS derives from the presence of antral follicles, which can sometimes resemble cysts. The study also indicated that women with PCOS do not require more frequent ultrasounds than those without the condition for monitoring benign or pathological non-cancerous ovarian cysts.
Magdalena Simonis, a practicing general practitioner and women’s health expert from the University of Melbourne who was not part of the research, characterized the study as “highly significant.” She emphasized that the findings reaffirm the understanding that counting ovarian cysts does not correlate with the cardiometabolic effects associated with the disease.
Although the researchers acknowledged some limitations, such as the predominance of white European participants and variations in ultrasound procedures conducted by different clinicians, they maintained that their findings support the movement for a change in the nomenclature of PCOS. Professor Piltonen expressed that the current term can be misleading, leading to the misconception that PCOS is primarily an ovarian disorder. “Many women and even health professionals mistakenly believe that the ovaries in PCOS contain large cysts that may burst or necessitate surgical intervention, while in reality, they are filled with numerous small, underdeveloped follicles,” she explained.
Both Dr. Simonis and Dr. Ameratunga concur that the existing name does not encapsulate the wide-ranging health impacts of the condition. Dr. Simonis argued that a rebranding would help shift the focus away from the presence of cysts and better represent the complexities of the syndrome.
