Increased androgen, anti-Müllerian hormone, and sporadic anovulation in healthy, eumenorrheic women: a mild PCOS-like phenotype?

Abstract

CONTEXT:

Hyperandrogenism is a hallmark of polycystic ovary syndrome (PCOS) in women with irregular menses, yet the relationship between androgens and ovarian dysfunction remains poorly understood in eumenorrheic women.

OBJECTIVE:

The objective of the study was to evaluate whether sporadic anovulation was associated with higher T and anti-müllerian hormone (AMH; marker of ovarian follicle count) concentrations in eumenorrheic women.

DESIGN:

This was a prospective cohort study from 2005 to 2007.

SETTING:

The study was conducted at the University of Buffalo in western New York state.

PARTICIPANTS:

A total of 259 eumenorrheic women without a self-reported history of infertility, PCOS, or other endocrine disorder participated in the study.

MAIN OUTCOME MEASURES:

Total T and AMH were measured five to eight times per cycle for one (n = 9) or two (n = 250) cycles per woman (n = 509 cycles) with timing of menstrual cycle phase assisted by fertility monitors. Anovulatory cycles were defined biochemically by progesterone and LH concentrations. Repeated-measures ANOVA was conducted on log-transformed data with adjustment for age.

RESULTS:

Compared with ovulatory cycles (n = 467), sporadic anovulatory cycles (n = 42) had marginally higher total and significantly higher free T [mean 23.7 ng/dL (95% confidence interval [CI] 21.4-26.3) vs 21.6 ng/dL (95% CI 20.9-22.3), P = .08, and 0.36 ng/dL (95% CI 0.33-0.40) vs 0.32 ng/dL (95% CI 0.31-0.33), P = .02, respectively] during menses and also throughout the luteal phase (P < .01 for all). Women with higher T had elevated AMH concentrations, increased reporting of a history of acne requiring medical treatment, but not increased hirsutism.

CONCLUSIONS:

Mechanisms of androgen-related ovulatory dysfunction that characterize PCOS in women with menstrual disturbances may occur across a continuum of T concentrations, including in eumenorrheic women without clinical hyperandrogenism.

• Authors: Lindsey A Sjaarda, Sunni L Mumford, Kerri Kissell, Karen C Schliep, Ahmad O Hammoud, Neil J Perkins, Jennifer Weck, Jean Wactawski-Wende, Enrique F Schisterman
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 99 Issue 6 Pg. 2208-16 (Jun 2014) ISSN: 1945-7197 [Electronic] United States
• PMID: 24606085 (Publication Type: Journal Article, Research Support, N.I.H., Intramural)

Chemical References

• Androgens
• Testosterone
• Anti-Mullerian Hormone
• Luteinizing Hormone
• Follicle Stimulating Hormone

Topics

• Adolescent
• Adult
• Androgens (blood)
• Anovulation (blood, diagnosis)
• Anti-Mullerian Hormone (blood)
• Cohort Studies
• Female
• Follicle Stimulating Hormone (blood)
• Humans
• Luteinizing Hormone (blood)
• Menstrual Cycle (blood)
• Phenotype
• Polycystic Ovary Syndrome (blood, classification, diagnosis)
• Prospective Studies
• Severity of Illness Index
• Testosterone (blood)
• Young Adult