Flyer

Health Science Journal

  • ISSN: 1108-7366
  • Journal h-index: 47
  • Journal CiteScore: 16.17
  • Journal Impact Factor: 2.63
  • Average acceptance to publication time (5-7 days)
  • Average article processing time (30-45 days) Less than 5 volumes 30 days
    8 - 9 volumes 40 days
    10 and more volumes 45 days
Reach us +441518081309
20+ Million Readerbase
Indexed In
  • Genamics JournalSeek
  • China National Knowledge Infrastructure (CNKI)
  • CiteFactor
  • CINAHL Complete
  • Scimago
  • Electronic Journals Library
  • Directory of Research Journal Indexing (DRJI)
  • EMCare
  • OCLC- WorldCat
  • University Grants Commission
  • Geneva Foundation for Medical Education and Research
  • Euro Pub
  • Google Scholar
  • Secret Search Engine Labs
Share This Page

Research Article - (2022) Volume 16, Issue 7

Prevalence Of Polycystic Ovarian Syndrome (Pcos) In Women Of Child Bearing Age Within Port Harcourt Metropolis In Nigeria Using Sonographic Evaluation.

Erondu Felix O1,2*, Keung Florence M1 and Ekong Moses B3
 
1Nigerian Institute of Radiographers, a Division of the Radiographers Registration Board of Nigeria, Nigeria
2Department of Radiography and Radiation Science, Gregory University Uturu, Nigeria
3Department of Anatomy, University of Uyo, Uyo, Nigeria
 
*Correspondence: Erondu Felix O, Nigerian Institute of Radiographers, a Division of the Radiographers Registration Board of Nigeria, Nigeria, Tel: +2348086667558, Email:

Received: 14-Jun-2022, Manuscript No. Iphsj-22-12827; Editor assigned: 16-Jun-2022, Pre QC No. PQ-12827; Reviewed: 30-Jun-2022, QC No. QC No.Q-12807; Revised: 04-Jul-2022, Manuscript No. Iphsj-22-12827 (R); Published: 12-Jul-2022, DOI: 10.36648/1791-809X.16.7.959

Abstract

Polycystic ovarian syndrome (PCOS) in women of child-bearing age is one of the most common causes of primary and secondary infertility, and may often be associated with other health or social issues. The prevalence however, varies among age group and geographical area. Ultrasound plays an important role in the initial evaluation and follow-up treatment of patients with PCOS. This study was to evaluate the prevalence of polycystic ovarian syndrome based on the sonographic survey of the ovaries of 200 women of childbearing ages of 13-51 years in Port Harcourt metropolis in Nigeria. This was a retrospective study for a period of twelve months from two hospitals.

Results: A total of 33 women (16.5%) were diagnosed with PCOS. Ages 27-31 years had the highest occurrence of polycystic ovarian syndrome (18 cases 9%). The most common clinical presentations were primary and secondary infertility (24.2 and 21.2%, respectively). In conclusion, polycystic ovarian syndrome was common among women of child bearing age in Port Harcourt metropolis, with ages 27-31 years having the highest occurrence, and primary infertility being the common clinical presentation. Thus, women of child bearing age presenting with infertility should be examined with ultrasound for early diagnosis and treatment of polycystic ovarian syndrome.

Keywords

Polycystic ovarian syndrome; Sonography; Infertility; PCOS

Introduction

Polycystic ovarian syndrome, also known as Stein-Leventhal syndrome is an endocrine mediated disorder that affects the ovaries in women of child bearing age (Encyclopaedia Britannica, 2017). Although the aetiology of polycystic ovarian syndrome is not known, it is associated with numerous health risks such as diabetes mellitus, hypertension, obesity, cardiovascular diseases, and infertility problems such as anovulation, endometrial hyperplasia and hyperandrogenism among others [1,2]. Psychological impairments including depression and other mood disorders, as well as other patient observable symptoms like irregular menstrual cycle, irregular ovulation, hirsutism and acne, have all been documented [3]. Recent studies appear to establish an increasing susceptibility to coronavirus disease 2019 (COVID-19) among patients with PCOS especially in the presence of comorbidities of obesity, Type 2 diabetes mellitus (T2DM), fatty liver, and androgen excess [4]. It is also a fact that Insulin resistance which may occur in PCOS may be linked to low-grade chronic inflammation as well as androgen excess which has a direct impact on adipocyte biology and metabolism. Accordingly PCOS is also associated with comorbidities such as non-alcoholic fatty liver disease (NAFLD), obesity, metabolic syndrome as well as the alterations in the gut micro biome, further worsening the potential for COVID-19 infection [4].

Different types of polycystic ovarian syndrome have been reported to include insulin-resistant, inflammatory, hidden-cause, and pillinduced. The insulin-resistant polycystic ovary syndrome is the most common type, and is caused by smoking, pollution, sugar and trans fat, while, the pill-induced polycystic ovary syndrome comes second and is caused mostly by birth control pills [5].

A positive ultrasound diagnosis of PCOS, is one of the three conditions to be met in the Rotterdam criteria for diagnosis. A more inclusive diagnostic criterion for diagnosis of PCOS has been evaluated in Nigerian women using three-model criteria such as the 1990 National Institutes of Health (NIH), the 2003 Rotterdam and 2006 Androgen Excess Society (AES) criteria [6].

The prevalence of polycystic ovarian syndrome varies according to diagnostic consensus used, with estimates ranging from 6% (National Institutes of Health consensus) to 18% (Rotterdam consensus) of reproductive-aged women of different ethnicity (Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, 2004; The morphological features of the ovaries in women with polycystic ovary syndrome have been well described by ultrasound imaging technology; enlarged ovary size, with multiple follicles, increased ovarian stroma and echogenicity are some of the features (Figure 1).

The most basic form of treatment for women with polycystic ovary syndrome is the initiation of an exercise regimen combined with proper nutrition to encourage weight loss and improve insulin sensitivity. Suppressing excess androgen production may be the focus if the syndrome is severe. Polycystic ovarian syndrome induced infertility is often treated with drugs that induce ovulation; however, oral contraceptives can be administered in women who may desire not to become pregnant. In extreme cases, laparoscopic surgery can be used to remove portions of the ovary and thus, reduce the production of androgens. In addition, anti-diabetic drugs have been reported with positive outcome [7].

Ultrasound identification of the presence of polycystic ovarian morphology is recognized as a component of its diagnosis. Transvaginal ultrasound is considered the gold standard due to the optimal visualization it provides of the internal structure of the ovary [8]. There is, however, a paucity of data for the ovarian morphology in normal and polycystic ovary syndrome in women of child bearing age in our environment. This study therefore aimed to evaluate the prevalence of polycystic ovarian syndrome based on the sonographic survey of the ovaries in women of child bearing ages of 13-51 years in Port Harcourt metropolis in Nigeria (Figure 1).

health-science-journal-transvaginal

Figure 1: Sonographic images of the ovary in transvaginal ultrasound scan: a. Polycystic ovarian syndrome; b. Normal ovary (Lee and Rausch, 2012).

Materials and Methods

A retrospective study of polycystic ovarian syndrome in women of child bearing age, 13-51 years of age who undertook transvaginal ultrasound examination of the pelvic for a period of twelve months from fifth day of January, 2019 to the twentieth day of December, 2019 from two ultrasonography centres in port Harcourt Metropolis, Rivers, Nigeria.

The study was carried out on all women of child bearing age 13- 51 years who were clinically suspected to have polycystic ovarian syndrome, and referred for pelvic ultrasound examination within a period of 12 months, from January 2, 2019 to December 20, 2019. Approval for this study was obtained from the Ethical Committee of the Rivers State University Teaching Hospital, as well as the administration of Image Diagnostic Centre.

A total of hundred ultrasound reports were obtained from each of the two health facilities. Ultrasound images were Assessed based on pelvic ultrasound examination, diagnosis or impression of the scan images. Information on the sex, age and the clinical indications were obtained from patient request and report forms and patient’s registration log books, respectively.

Results

A total of 200 pelvic sonographic reports were analysed for sonographic diagnosis of PCOS. A total of 33 (16.5%) had diagnosis, while 167 (83.5%) were negative. The result is presented in Table 1. Out of the 100 patients for each facility, 12 cases were identified in Facility 1 and 21 cases in facility 2, giving a total of 33 positive cases (Table 1).

         Hospitals Total Number of Women Total Females With PCOS Percentage (%) Total Female Without PCOS Percentage (%)
Image Diagnostic  Centre 100 21 21        79 79
RSUTH 100 12 12 88 88
Total 200 33 33 167 16

Table 1.The number and percentage distribution of the positive and negative cases of PCOS in RSUTH and Image Diagnostic Centre.

Percentage Distribution of Polycystic Ovarian Syndrome

Twenty one per cent of the cases at Image Diagnostic Centre were positive for polycystic ovarian syndrome, while 12% of the cases at RSUTH were positive for polycystic ovarian syndrome (Figure 2).

health-science-journal-distribution

Figure 2: Percentage distribution of women of child bearing age with and without PCOS in both hospitals.

Age Distribution of Positive Polycystic Ovarian Syndrome

The Age distribution of positive polycystic ovarian syndrome at Image Diagnostic Centre and Rivers State University Teaching Hospital presented in (Figure 3).

health-science-journal-positive

Figure 3: Age distribution of percentage positive cases of PCOS.

Clinical Presentations

Primary infertility was the commonest clinical indication follow by secondary infertility, chronic anovulation, amenorrhea, oligomenorrhea, sexual transmitted disease, diabetes, obesity and metabolic syndrome (Table 2).


Clinical Presentation
Frequency Percentage (%)
Primary Infertility 8 24.2
Secondary Infertility 7 21.2
Chronic Anovulation 5 15.2
Amenorrhea 4 12.1
Oligomenorrhea 4 12.1
Sexual Transmitted Disease 3 9.2
Diabetes 1 3
Obesity and Metabolic Syndrome 1 3
Hirsutism 0 0
Total 33 100

Table 2. Clinical presentation of polycystic ovarian syndrome from the two hospitals.

Discussion

this study aimed to evaluate the prevalence of polycystic ovarian syndrome based on the sonographic survey of the ovaries in women of child bearing ages of 13-51 years in Port Harcourt metropolis in Nigeria. Out of a sample population of 200 women of child bearing age 13-51 years, only 33 (16.5%) were positive for polycystic ovarian syndrome. It was observed that polycystic ovarian syndrome was minimal between ages 12-21 and 32-51 years and increased in the age groups 22-26 and 27-31 years. Where there are larger population of ovarian follicles, the more likelihood for the diagnosis of polycystic ovarian syndrome [9- 12]. Hudecova et al. (2009) reported that ultrasonography is a reliable tool for the detection of polycystic ovarian syndrome in women of reproductive age, which may have accounted for the high incidence in age groups 22-26 and 27-31 years of the present study.

The decrease in age distribution in the 12-21 years group may be attributed to premature ovarian failure or primary ovarian insufficiency or signs and symptoms that characterize polycystic ovarian syndrome overlap with normal [13]. However, Bronstein et al. (2011) reported a high diagnosis among adolescents (13- 18 years), although his focus was among children less than 18 years. The decrease in age distribution from 32-51 years may be attributed to perimenopause/menopause as the incidence of polycystic ovarian syndrome tends to be less (Karjula et al., 2017). Perimenopause or menopause transition can begin eight to ten years before menopause, when the ovaries gradually produce less oestrogen. It usually starts in a woman‘s 40s but can start in the 30s as well [14].

Based on clinical presentation, the study showed that primary infertility was the most common indication, followed by secondary infertility, chronic anovulation, amenorrhea, oligomenorrhea, sexual transmitted disease, diabetes and obesity. The present result is similar to a previous report where the commonest clinical presentations were primary and secondary infertility [15-21].

Conclusion

In a sample population of 200 and 33 (16.5%) positive case of polycystic ovarian syndrome, it can be concluded that polycystic ovarian syndrome is common in women of child bearing age in Port Harcourt Metropolis in the South-South region of Nigeria. The affected ages were 22 to 26 years, with highest population within ages 27 to 31 years and most common clinical presentations being primary and secondary infertility.

References

  1. Akpata C B, Uadia P O, Okonofua F E (2018) Prevalence of Polycystic Ovary syndrome in Nigerian women with infertility: A prospective study with Three assessment criteria. OJOG 8.
  2. Indexed at, Google Scholar, Crossref

  3. Azziz R, Carmina E, Chen Z, Dunaif A, Laven J S E (2016) Polycystic ovary syndrome. Nat Rev Dis Primers 2:16057.
  4. Indexed at, Google Scholar, Crossref

  5. Bronstein J, Tawdekar S, Liu Y, Pawelczak M, David R (2011) Age of onset of polycystic ovarian syndrome in girls may be earlier than previously thought. J Pediatr Adolesc Gynecol 24:15-20.
  6. Indexed at, Google ScholarGoogle scholar, Crossref

  7. Brutocao C, Zaiem F, Alsawas M, Morrow A S, Murad M H et al. (2018) Psychiatric disorders in women with polycystic ovary syndrome: a systematic review and meta-analysis. Endocrine 62:318-325.
  8. Indexed at, Google Scholar, Crossref

  9. Carmina E, Oberfield S E, Lobo R A (2010) the diagnosis of polycystic ovary syndrome in adolescents. Am J Obstet Gynecol 203:201-205.
  10. Indexed at, Google Scholar, Crossref

  11. Cleveland Clinic (2019) Menopause Perimenopause and Post menopause Accessed on 6.
  12. Google Scholar

  13. Ding C, Luo L, Gu F, Jie H, Zhao Q (2017) early miscarriage rate in lean polycystic ovary syndrome women after euploid embryo transfer a matched-pair study. Reproductive Bio Medicine Online, 35:576-582.
  14. Indexed at, Google Scholar, Crossref

  15. Encyclopaedia Britannica (2017) Stein-Leventhal syndrome. Encyclopaedia Britannica Inc.
  16. Google Scholar

  17. Escobar Morreale H F (2018) polycystic ovary syndrome definition, aetiology diagnosis and treatment. Nature Reviews. Endocrin14:270-284.
  18. Indexed at, Google Scholar, Crossref

  19. Ge J J, Wang D J, Song W, Shen S M, Ge W H (2021) The effectiveness and safety of liraglutide in treating overweight/obese patients with polycystic ovary syndrome: a meta-analysis. J Endocrinol Investig.
  20. Indexed at, Google Scholar

  21. Hudecova M, Holte J, Olovsson M,  Sundstrm Poromaa I (2009) Long-term follow-up of patients with polycystic ovary syndrome: reproductive outcome and ovarian reserve. Human Reproduction 24:1176-1183.
  22. Indexed at, Google Scholar, Crossref

  23. Karjula S, Morin-Papunen L, Auvinen J, Ruokonen A, Puukka K et al. (2017) Psychological distress is more prevalent in fertile age and premenopausal women with PCOS symptoms 15-year follow-up. J Clin Endocr 102:1861-1869.
  24. Indexed at, Google Scholar, Crossref

  25. Joshi SR (2021) Polycystic Ovary Syndrome and COVID-19 An Emerging Risk Factor. J Hum Reprod Sci 14:211-212.
  26. Indexed at, Google Scholar, Crossref

  27. Lee T T, Rausch M E (2012) polycystic ovarian syndrome: Role of imaging in diagnosis. Radio Graphics 32:1643-1657.
  28. Indexed at, Google Scholar, Crossref

  29. Patel S (2018) polycystic ovary syndrome (PCOS) an inflammatory, systemic, lifestyle endocrinopathy. J Steroid Biochem Mol Biol 182:27-36.
  30. Indexed at, Google Scholar, Crossref

  31. Peng Q, Karvonen-Gutierrez C A, Randolph J F, Nan B, McConnell D et al. (2019) Age at onset of metabolic syndrome among women with and without polycystic ovary syndrome like status. The J Clin Endocr 104:1429-1439.
  32. Indexed at, Google Scholar, Crossref

  33. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility and Sterility 81:19-25.
  34. Indexed at, Google Scholar, Crossref

  35. Ruman U, Chowdhury T A, Chowdhury T S, Mahmud N, Hasan I (2015) TSH & prolactin versus LH & FSH: a dialemma in hormone assay for patients with primary or secondary infertility in a tertiary care hospital in Bangladesh. Int J Gynecol Obstet 2:212-214.
  36. Google Scholar

  37. Subramanian A, Anand A, Adderley NJ, Okoth K, Toulis KA et al. (2021) Increased COVID-19 infections in women with polycystic ovary syndrome: A population-based study. Eur J Endocrinol 184:637-645.
  38. Google Scholar, Crossref

  39. Welt C k, Carmina E (2013) Lifecycle of polycystic ovary syndrome (PCOS): From in utero to menopause. J Clin Endocr 98:4629-4638.
  40. Indexed at, Google Scholar, Crossref

  41. Zhu R Y, Wong Y C, Yong E L (2016) Sonographic evaluation of polycystic ovaries. Best Practice & Research. Clinical Obstetrics & Gynaecology 37:25-37.
  42. Indexed at, Google Scholar, Crossref

Citation: Felix OE, Florence MK, Moses BE (2022) Prevalence of Polycystic Ovarian Syndrome (Pcos) In Women of Child Bearing Age Within Port Harcourt Metropolis in Nigeria Using Sonographic Evaluation. Health Sci J. Vol. 16 No. 7: 959.