Article Type : Research Article
Authors : Harfouch RM, Ashkar MA, Ibrahim RAC, Chouman F and Ibrahim R
Keywords : Polycystic ovarian syndrome; questionnaire; Syrian society
Polycystic
Ovarian Syndrome (PCOS), also known as hyperandrogenic anovulation, is a common
endocrine system disorder among women in their reproductive age. Women with
PCOS suffer from infertility, acne, hirsutism, central obesity and insulin
resistance. We designed an electronic questionnaire of 25 questions directed to
Syrian girls to evaluate the characteristics of PCOS in Syria. Among 1032
participants in our study, a percentage of 53.3% (550 subjects) were diagnosed
with PCOS, and 33.8% of PCOS women were diagnosed at age of 16-18 years old.
The symptoms that prompted patients to seek treatment were firstly hirsutism
(57.9%), secondly irregular menstruation (50.8%), and the most diagnostic
method was pelvic ultrasound 92.3%. Hormone-regulating drugs were most used in
the treatment by 71.5% of all PCOS diagnosed participants, followed by
metformin 47.1%. This study summarizes the characteristics of polycystic ovary
patients in Syria in terms of age, symptoms, diagnosis, treatment and related
diseases in an attempt to understand this syndrome and its prevalence in Syria.
Polycystic Ovarian
Syndrome (PCOS), also known as hyper androgenic anovulation, is a common
endocrine system disorder among women in their reproductive age [1]. It is
characterized by a group of symptoms such as small cyst on ovaries,
hyperandrogenism, and irregular menstruation [2]. PCOS affects
almost 18% of women in their reproductive age [3]. In addition, women
with PCOS suffer from infertility, acne, hirsutism, central obesity, Luteinizing hormone hyper secretion, insulin resistance followed
by hyperinsulinemia, which leads to cardiovascular disorders [4]. The
main criterion for diagnosing PCOS by endocrinologists is hirsutism due to
hyperandrogenism, which is demonstrated by an increase of testosterone level in
the blood, and on the other hand, gynecologists rely on polycystic ovary
morphology with ultrasound associated with menstrual disorders and chronic
anovulation [5]. According to the Rotterdam criteria, a clinical diagnosis of
PCOS requires presenting two of the following symptoms: Oligo-ovulation or
anovulation, hyperandrogenism, and polycystic ovaries visible on ultrasound
[6]. PCOS pathogenesis
mechanism is unclear, which makes it difficult to determine clear treatment
strategies. According to the U.S. Food and Drug Administration (FDA), there is no
approved treatment for PCOs yet, there
for, PCOs treatment depends on its life-long management because the optimal
treatment plan needs more studies and research [7]. Researchers
found that PCOs is correlated to genetic factors among sisters. A study
demonstrated that PCOS was about twice as large as in dizygotic twin and other
sisters [8].
We designed and published an electronic questionnaire
directed to Syrian girls to evaluate
the prevalence and characteristics of PCOS in Syria, and we received 1032
responses within a month. This
survey was conducted at the faculty of Pharmacy, Al-Sham Private University as
an observational study [9]. The
questionnaire included 25 question divided into two parts. The first one
comprise personal information (age, city and marital status), and the other
part included questions about the PCO syndrome (symptoms, diagnostic methods
and treatment).
Among 1032 Syrian participants in our study, more than the half (550 subjects) were diagnosed with PCOS. The percentage of PCOS cases was 53.3%, while 46.7% of participants did not suffer from PCOS. We distributed the participants according to age, region, symptoms, diagnostic methods and treatment.
Distribution by age
A percentage of 33.8% of participants were diagnosed at the age of 16-18
years old (169 subjects), which is the highest percentage among all
participants, and 32.4% of them by the age of 19-21. And 20% of them are
between 22-25 years old, as shown in (Figure 1).
Figure 1: Shows the distribution of research sample according to age.
Distribution by region
The higher percentage of our studied sample was 40.6% from the coastal cities (Latakia and Tartous), secondly, from Damascus, the capital city, with a percentage of 26.3%, and a percentage of 8.1% from Homs city. The remaining percent was from other cities 25%, as shown in (Figure 2).
Figure 2: Shows the distribution of research sample according to region.
Distribution by region
The higher percentage of our studied sample
was 40.6% from the coastal cities (Latakia and Tartous), secondly, from
Damascus, the capital city, with a percentage of 26.3%, and a percentage of
8.1% from Homs city. The remaining percent was from other cities 25%, as shown
in (Figure 3).
Figure 3: Shows the distribution of research sample according to symptoms.
Distribution by diagnostic methods
The most used method for PCOS diagnosis among physicians was pelvic ultrasound (echography) to
detect the presence of cysts with a majority of 92.3% of participants’
answers, clinical history was in the second place with a percentage of (36.3%)
and finally clinical features (32.2%), as shown in (Figure
4).
Figure 4: Shows the distribution of research sample according to diagnosis.
Distribution by treatment
Hormone-regulating drugs were most used in the treatment by 71.5% of all PCOS diagnosed participants, followed by metformin which was the treatment choice for 47.1% of participants, finally, 22.6% of patients were treated by changing their life-style as shown in (Figure 5).
Figure 5:
Shows the distribution of research sample
according to treatment.
Distribution by associated diseases
A percentage of 69.3% of all patients had other disease as shown in Figure 5, including: 55.7% Depression or anxiety, and a percentage of 38.6% suffered from obesity, as shown in (Figure 6).
Figure 6: Depression or anxiety, and a percentage of 38.6% suffered from obesity.
Our results showed that the According to our study PCOS is more prevalent in the younger age group between 16-18 years
old, as it may be related to heredity, environment
and internal embryonic factors, and the most common symptom of PCOS in our
study was hirsutism (57.9%), which is in compatible with a previous study that reported
hirsutism as the strongest impact on the patients’ health-related quality of
life [10]. The most diagnostic method for PCOS in our study was pelvic
ultrasound (echography) 92.3% of participants’ answers, which matches the criteria
for the diagnosis of PCOS according to the Rotterdam consensus (2003) and
Androgen Excess & PCOS Society (2006) [11]. According to our study hormone-regulating drugs were most used in the treatment by 71.5% of all
PCOS diagnosed participants of the Syrian society, oral
contraceptive (OC) pills should be used as a first-line treatment for long-term
management of patients with no reproductive requirements [12]. Lifestyle
modification (LSM) is considered the first-line treatment for patients with
fertility requirements which took the third common treatment method in our
study after hormone-regulating drugs and metformin.
For refractory ovulation disorders, patients can choose from among the latest
treatments, including ovarian hippocampal signal path block theory, the theory
of leptin, inositol treatment, bilateral ovarian drilling to stimulate
ovulation and assisted reproductive technology. Because current treatments
cannot cure PCOS, lifelong administration is still the mainstream method of
management; however, the optimal treatment plan needs further research and
exploration. The strength point of our study is the relatively large sample of
the Syrian society (550 women of PCOS).
None.