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Menstrual Dysfunction and Endometrial Neoplasia in the Polycystic Ovary Syndrome and Other Androgen Excess Disorders

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Androgen Excess Disorders in Women

Part of the book series: Contemporary Endocrinology ((COE))

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Abstract

About 80% of women with polycystic ovary syndrome (PCOS) suffer from menstrual dysfunction (oligomenorrhea, amenorrhea) at some point in their reproductive life. These conditions are associated with several factors, including obesity, degree of hyperandrogenism, and insulin insensitivity. Menstrual irregularity improves with advancing age. Women with menstrual irregularity are more likely to have an elevated luteinizing hormone (LH), altered LH-to-follicle-stimulating hormone (FSH) ratio, elevated androgens, and an altered uterine artery pulsatility index. Non-PCOS hyperandrogenemic conditions also affect menstrual function. Evidence for an association with endometrial neoplasia (endometrial hyperplasia and endometrial carcinoma) is at best incomplete. The altered hormonal environment of PCOS exerts some influence on endometrial gene expression with upregulation of human asialoglycoprotein receptor I, human secreted phosphoprotein I (osteopontin), and cytochrome P450 XVIIAI. Treatment for menstrual dysfunction must include lifestyle changes, not just in the obese woman. The low glycemic index diet has been shown to be effective in weight loss regimes, although the evidence for any benefit for insulin resistance and lipid metabolism is open to doubt. The oral contraceptive pill and progestagens are alternative means to regulating the menstrual cycle in appropriate patients.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Royal Free & University College Medical School, London, UK

    Abdulkadir Wagley

  2. University Department of Obstetrics and Gynaecology, Royal Free and University College of Medical School, London, UK

    Paul Hardiman

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  1. Abdulkadir Wagley
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Editors and Affiliations

  1. Center for Androgen Related Disorders, Cedars-Sinai Medical Center; and Department of Obstetrics and Gynecology, and Department of Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, CA

    Ricardo Azziz MD, MPH, MBA

  2. Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA

    John E. Nestler MD

  3. Department of Endocrine Gynaecology and Reproductive Medicine, Lille University Hospital, Lille, France

    Didier Dewailly MD

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© 2006 Humana Press Inc., Totowa, NJ

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Wagley, A., Hardiman, P. (2006). Menstrual Dysfunction and Endometrial Neoplasia in the Polycystic Ovary Syndrome and Other Androgen Excess Disorders. In: Azziz, R., Nestler, J.E., Dewailly, D. (eds) Androgen Excess Disorders in Women. Contemporary Endocrinology. Humana Press. https://doi.org/10.1007/978-1-59745-179-6_27

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  • DOI: https://doi.org/10.1007/978-1-59745-179-6_27

  • Publisher Name: Humana Press

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