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Polycystic Ovary Syndrome (PCOS): Arguably the Most Common Endocrinopathy Is Associated With Significant Morbidity in Women.
ICD-9 Code: 256.4
Description: Polycystic ovaries; polycystic ovary syndrome
Source: The Journal of Clinical Endocrinology and Metabolism; V.84; No.6; 1999; p1897
Statistical Information:
P r i m a r y H o s p i t a l D i a g n o s e s (1) :
Gender: Male *% Female 100.0%
Age: <15 *% 15-44 70.5% 45-64 *% 65+ *%

U.S. Trends:
1995 1996 1997 1998 1999 2000
I n p a t i e n t T r e n d s (1):
A
B * * 5,934 4,185 4,513 9,727
C
A = Primary Diagnosis; B = All Listed; C = Average Stay (days)

P h y s i c i a n O f f i c e V i s i t s (2):
A 63,110 13,139 * * 387,588 28,571
B
A = Primary Visits; B = Total Visits

H o s p i t a l O u t p a t i e n t s (3):
A * * * * 33,406 5,512
B
A = Primary Visits; B = Total Visits

G l o b a l I n c i d e n c e a n d P r e v a l e n c e (4)
U.S. Prevalence:
PREVALENCE: The authors prospectively studied both
clinically and biochemically the mothers and sisters of 93
patients with polycystic ovary syndrome (PCOS) to determine
the prevalence of PCOS as defined by current endocrinologic
criteria among first-degree relatives of affected patients.
Patients were recruited from a U.S. university reproductive
endocrinology and infertility clinic from 1995 through 1997.
Of the 78 mothers and 50 sisters who elected to participate,
19 (24%) and 16 (32%) were found to be affected by PCOS,
respectively. Premenopausal untreated relatives had a higher
prevalence of PCOS than those who were either postmenopausal
or hormonally treated: 35% versus 16% in mothers and 40%
versus 13% in sisters. The authors previously reported a 4.0%
prevalence of PCOS among unselected reproductive-aged women in
Alabama seeking a preemployment physical, and this rate was
similar between white and black subjects. (Fertility and
Sterility; V.75; No.1; 1/01; p53)

PREVALENCE: When the
presence of polycystic ovary syndrome (PCOS) is defined solely
by the finding of polycystic ovaries at either surgery or
sonography, between 1% to 20% of unselected women have been
reported to be affected. However, this marker is relatively
nonspecific, because up to 25% of patients with this ovarian
morphology on sonography are asymptomatic. If PCOS is defined
histopathologically (i.e., by the presence of polycystic
ovaries upon oophorectomy or wedge resection), between 1.4% to
3.5% of unselected women and 0.6% to 4.3% of infertile women
demonstrated evidence of the disorder. Using the more widely
accepted endocrine definition of PCOS, arising from the
NIH/NICHHD-sponsored conference in 1990, 6.2% of 129 white and
3.4% of 145 black women were estimated have the disorder. In
an unselected, minimally-biased population of consecutive
women, the overall prevalence of PCOS appeared to be about
4.6%, although it could have been as low as 3.5% and as high
as 11.2%, using the NIH/NICHHD 1990 criteria. (Journal of
Clinical Endocrinology and Metabolism; V.83; No.9; 1998;
p3078)
International Incidence:
WORLDWIDE: Polycystic ovary syndrome is the most common
cause of female hyperandrogenism, with an incidence of 3% in
both adolescents and adults. (J Clin Endocrinol Metab; V.79;
1994; p1,778)
International Prevalence:
WORLDWIDE (HAIR-AN SYNDROME): The hyperandrogenism,
insulin resistance and acanthosis nigricans (HAIR-AN) syndrome
is an unusual condition that affects females. About 1% to 3%
of women with hyperandrogenism are thought to have this
condition, with many cases remaining undiagnosed. (American
Family Physician; V.63; No.12; 6/15/01; p2385)>
WORLDWIDE: Polycystic ovary syndrome (PCOS) is extremely
prevalent and is estimated to be present in 5% to 7% of
reproductive-age women if the diagnosis is based on
hyperandrogenism and anovulation. While PCOS occurs in at
least 5% of the population, the isolated finding of
polycystic-appearing ovaries, which meets the classic
ultrasonographic criteria, occurs in 16% to 25% of the normal
population. (The Journal of Clinical Endocrinology and
Metabolism; V.84; No.6; 1999; p1897)

WORLDWIDE (WITH
UK): Polycystic ovary syndrome is a common disorder; up to
10% of reproductive-age women may have related symptoms such
as hyperandrogenism, chronic anovulation, and polycystic
ovaries. In a UK study that used ultrasonography for ovarian
morphology, 22% of 257 women were found to have polycystic
ovaries. (Contemporary Ob/Gyn; V.41; 9/96; p43)>
WORLDWIDE: Between 5% and 10% of all women have some degree
of polycystic ovary syndrome. Almost all women under age 40
with endometrial cancer have the syndrome. (Medical Tribune;
7/7/94; p7)

THE NETHERLANDS: In this study from the
Netherlands, the authors studied the possible role of
luteinizing hormone (LH) and hyperinsulinism in the
development of polycystic ovaries (PCO) or PCO syndrome (PCOS)
with data collected in the population-based POMP study
(Puberty Onset Menstrual Cycle Abnormalities: A Prospective
Study). 2248 white, ninth-grade schoolgirls filled out a
questionnaire on their menstrual cycle pattern. In a 2- to
7-year follow-up of adolescent patients, a previous study
found that major changes in ovarian ultrasound patterns were
rare. In the present study, the prevalence of PCO in the
oligomenorrhea group was comparable to that found in the
authors' adult outpatient-clinic population with
oligomenorrhea (i.e., 45%), all of whom were examined with
vaginal ultrasonography. In another Dutch oligomenorrheic
outpatient-clinic population, the prevalence of PCO was 49%.
Although the same definition for PCO is used, British authors
describe higher prevalences: 87% to 91% in adult
oligomenorrheic populations. This seems to indicate that,
even within northwestern Europe, there is wide variation in
PCO prevalence. Alternatively, it could simply result from a
difference in the interpretation of ultrasound findings by
British and Dutch authors. The frequency of PCO in the
regular menstrual cycle group (9%) is comparable to that
reported in a group of carefully selected adults with regular
menstrual cycles (8%) who were studied with vaginal
ultrasound. Another study reported polycystic ovaries in 22%
of women who considered themselves normal. In the subgroup
with strictly regular menstrual cycles, however, the
percentage was only 7%. Another study reported a prevalence
of 23% in women with regular menstrual cycles. (Fertility and
Sterility; V.74; No.1; 7/00; p49)

UNITED KINGDOM: In a
study of 175 anovulatory women presenting to a reproductive
endocrine clinic in the UK , 30% of those with amenorrhea and
75% of those with oligomenorrhea had ultrasonographic evidence
of polycystic ovaries. Polycystic ovaries were detected in 40
of 46 women presenting with hirsutism but with regular menses.
At a regional infertility center in southwest England, 37% of
those with amenorrhea and 90% of those with oligomenorrhea
(overall, 73% of the anovulatory infertility cases) were found
to have the polycystic ovary syndrome. The current
investigator (in the UK) studied the prevalence of
ultrasonographic features indicative of polycystic ovaries in
the normal population. He found ultrasonographic evidence of
polycystic ovaries in 22% of 257 volunteers; none were seeking
medical attention for gynecologic symptoms. (NEJM; V.333;
9/28/95; p853)

Sources: (1)NHDS (2)NAMCS (3)NHAMCS (4)From abstracts with same ICD
See special ICD Code 'REF.1' about sources

DEFINITION AND PREVALENCE: A uniform definition of polycystic ovary syndrome (PCOS) does not exist, in large part because of its diverse and heterogeneous nature. However, the current authors believe that the disorder is an endocrinopathy, and that it should be referred to as PCOS (i.e., a syndrome rather than a disease).

PCOS is extremely prevalent and is estimated to be present in 5% to 7% of reproductive-age women if the diagnosis is based on hyperandrogenism and anovulation. However, the spectrum of the syndrome is even wider. The authors are convinced that there is a mild form of PCOS that includes women who have hyperandrogenism and polycystic ovaries but whose ovulatory function is maintained. However, it is clear that the syndrome is milder and the hyperandrogenism is not as pronounced. These women have many of the same risks as women with more classic PCOS. While PCOS occurs in at least 5% of the population, the isolated finding of polycystic-appearing ovaries (PAO), which meets the classic ultrasonographic criteria, occurs in 16% to 25% of the normal population.

SPONTANEOUS ABORTION: The majority of women with PCOS have anovulation. With this comes infertility as well as problems of dysfunctional bleeding. Perhaps the most frustrating reproductive concern for women with PCOS is pregnancy loss. The spontaneous abortion rate in PCOS is approximately one-third of all pregnancies. This is at least double the rate for recognized early abortions in normal women (12% to 15%). Reasons for this are unclear although hypotheses include elevated luteinizing hormone levels, deficient progesterone secretion, abnormal embryos from atretic oocytes, and an abnormal endometrium.

OBESITY: Obesity is present in approximately 44% of women with PCOS. This figure varies somewhat depending on ethnicity and geography. When present, obesity worsens the clinical presentation of PCOS, increasing insulin resistance and resulting in a further elevation of ovarian and adrenal androgens and of unbound testosterone.

DIABETES: In a longitudinal study following wedge resections, fully 16% of women with PCOS developed type 2 diabetes mellitus by the age of menopause. In a recent study, impaired glucose tolerance was found in 31% of women of reproductive age, with PCOS and diabetes in 7.5%. In non-obese PCOS patients, these figures were 10.3% and 1.5%, a rate almost 3-fold that of the normal population. These results were similar in women of different races.

HEART DISEASE: It has been calculated that based on the risk profile, women with PCOS have a 7-fold increased risk of myocardial infarction. Coronary disease is more prevalent in women with PCOS.

CANCER: Ovarian cancer is also increased 2- to 3-fold in women with PCOS. Of interest, this risk is greater in those who are not obese and is greatest in women who have not been on oral contraceptives. Because of the known protective effect of oral contraceptives on ovarian and endometrial cancer risk, use of oral contraceptives should be strongly considered as a preventative therapy.

SILENT ABNORMALITIES: 16% to 25% of normal ovulatory women have PAO without evidence of the full-blown syndrome. However, a subgroup of women with PAO (up to 30%) may have subtle abnormalities resembling PCOS. These characteristics include androgenic ovarian responses to stimulation with gonadotropins, as well as metabolic changes such as lowered high-density lipoprotein-C levels and evidence of insulin resistance. While these data need further assessment, these findings suggest that important yet silent abnormalities may exist in otherwise normal women who have a trait of PCOS (namely PAO).

Note - Related Topics:
DEFINITION(S): Polycystic ovary syndrome (PCOS) -- the most widely accepted clinical definition of the PCOS is the association of hyperandrogenism with chronic anovulation in women without specific underlying disease of the adrenal or pituitary glands. Hyperandrogenism is characterized clinically by hirsutism, acne, and androgen-dependent alopecia, and biochemically by elevated serum concentrations of androgens, particularly testosterone and androstenedione. Obesity is common but not universal. These features are typically associated with hypersecretion of luteinizing hormone and androgens but with normal or low serum concentrations of follicle-stimulating hormone.

NOTE: Interpreting available data on PCOS is somewhat problematic, and an accurate estimate of prevalence is difficult to determine. One concern is that the disease may be undetected until a woman experiences difficulty in becoming pregnant. The diagnosis may thus be influenced by access to medical care; inaccuracies are also likely in patterns of age at diagnosis, as well as in estimating factors that may be associated with this disease. The prevalence of PCOS, like that of any other complex multifactorial disorder, greatly depends on the criteria used to define it. Most past studies have defined PCOS using a limited number of features, particularly morphological evidence of polycystic ovaries. When the presence of PCOS is defined solely by the finding of polycystic ovaries at either surgery or sonography, only a small number of unselected women have been reported to be affected. However, this marker is relatively nonspecific, because up to 25% of patients with this ovarian morphology on sonography are asymptomatic. In addition, not all patients with hyperandrogenic oligoovulation demonstrate polycystic-appearing ovaries. A more comprehensive definition of PCOS arose from a conference on the disorder in April 1990, sponsored by the NIH/NICHHD. Although a clear-cut consensus was never reached, the majority of participants believed that PCOS should be defined by the following: ovulatory dysfunction; clinical evidence of hyperandrogenism (hirsutism, acne, androgenic alopecia) and/or hyperandrogenemia; and exclusion of related disorders, such as hyperprolactinemia, thyroid disorders, and nonclassic adrenal hyperplasia. No indication of how to define ovulatory dysfunction, hirsutism, or hyperandrogenemia was given.

SUGGESTED READING: OUTCOME -- (1) Kelly CJG et al; "The Long Term Health Consequences of Polycystic Ovary Syndrome." British Journal of Obstetrics and Gynaecology; V.107; 2000; p1327 (review article). DIAGNOSTIC -- (1) Lobo RA; "A Disorder Without Identity: 'HCA,' 'PCO,' 'PCOD,' 'PCOS,' 'SLS.' What Are We to Call It?!" Fertility and Sterility; V.63; No.6; 6/95; p1158; (2) Yoshihito K et al; "Classification of Polycystic Ovary Syndrome Into Three Types According to Response to Human Corticotropin-Releasing Hormone." Fertility and Sterility; V.72; 7/99; p15; (3) Lobo RA et al; "The Importance of Diagnosing the Polycystic Ovary Syndrome." Annals of Internal Medicine; V.132; No.12; 6/20/00; p989; (4) Hunter MH et al; "Polycystic Ovary Syndrome: It's Not Just Infertility." Am Fam Physician; V.62; No.5; 9/1/00; p1079; ETIOLOGY -- (1) Kousta E et al; "The Prevalence of Polycystic Ovaries in Women With a History of Gestational Diabetes." Clinical Endocrinology; V.53; 2000; p501; (2) Abbott DH et al; "Developmental Origin of Polycystic Ovary Syndrome: A Hypothesis." Journal of Endocrinology; V.174; 2002; p1. GENERAL REVIEW -- (1) Lakhani K et al; "Polycystic Ovaries." Br J Radiol; V.75; 1/02; p9. OTHER -- (1) Wild RA; "Polycystic Ovary Syndrome: A Risk for Coronary Artery Disease?" Am J Obstet Gynecol; V.186; 2002; p35. NOTE: For related statistics, also see the entries for the 'root' ICD codes. (Example: Statistics for the ICD code 493.91 are a subset of those for 493.9 which are a subset of 493.) Entries with identical ICD codes have identical statistics.

Incidence and Prevalence Database
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