Relationship of the metabolic syndrome and obesity to polycystic ovary syndrome: A controlled, population-based study

OBJECTIVE: Although hyperinsulinemia seems to be an essential feature of po lycystic ovary syndrome, the frequency of gynecologic disorders related to polycystic ovary syndrome at a population level in women with evident metab olic syndrome is not known. STUDY DESIGN: We conducted a cross-sectional, population-based study. Parti cipants (N = 204) were recruited from a random sample of women in 5 age gro ups (range, 35-54 years) living in a defined area. Metabolic syndrome was c onsidered to be present if 3 of the following 8 criteria were fulfilled: (1 ) first-degree relative with type II diabetes, (2) body mass index greater than or equal to 30 kg/m(2), (3) waist/hip ratio greater than or equal to0. 88, (4) blood pressure greater than or equal to 160/95 mm Hg or drug treatm ent for hypertension, (5) fasting serum triglyceride level greater than or equal to1.70 mmol/L, (6) high-density lipoprotein cholesterol value <1.20 m mol/L, (7) abnormal glucose metabolism, and (8) fasting insulin value <grea ter than or equal to>13.0 mU/L. The frequency of metabolic syndrome was 106 (19.5%) of 543 cases. The control group consisted of 62 overweight women w ithout central obesity or metabolic syndrome and 53 healthy lean women (bod y mass index <27 kg/m(2)). RESULTS: The group with metabolic syndrome differed from the other women ac cording to most of the selection criteria and also had the highest free tes tosterone concentration. However, there were no differences between the gro ups regarding parity, infertility problems, or obstetric outcome. However, oligomenorrhea appeared to be more common in women with metabolic syndrome, especially in those with more severe symptoms (46.2%), than in obese (25.4 %) and lean (15.1%) control subjects. Polycystic-like ovaries were detected by vaginal ultrasonography with similar frequency (13.1%, 15.3%, and 13.2% in women with metabolic syndrome, obese women, and lean women, respectivel y). CONCLUSIONS: Surprisingly few women with metabolic syndrome had symptoms su ggestive of polycystic ovary syndrome, in comparison with obese and lean wo men. Our results suggest that at the population level polycystic ovary synd rome only accounts for a distinct subgroup of a much wider problem, metabol ic syndrome.