Oligoanovulation with polycystic ovaries but not overt hyperandrogenism

Objectives: By requiring a minimum of two of three items [hyperandrogenism ( HA), oligoanovulation (OA), and polycystic ovaries (PCO) at ultrasound], the Rotterdam definition recognizes four PCO syndrome ( PCOS) phenotypes: HA + OA + PCO (full-blown syndrome), HA + OA ( former National Institutes of Health definition), HA + PCO (ovulatory PCOS), and OA + PCO. However, the latter phenotype is controversial, and it is not known to what extent it shares similarities with the others. Design: The study was a comparative analysis of hormonal, metabolic, and ultrasound parameters obtained from patients and controls that were consecutively included in a database. Patients and Methods: Sixty-six patients having OA + PCO without hirsutism or elevated serum androstenedione and testosterone levels were compared with 118 normally cycling nonhyperandrogenic age-matched women without PCO ( controls). These patients ( phenotype D) were also compared with patients with HA + OA + PCO ( phenotype A, n = 246), HA + OA ( phenotype B, n = 27), and HA + PCO ( phenotype C, n = 67). Results: Patients with phenotype D had higher mean values of waist circumference and higher mean levels of serum testosterone, androstenedione, and LH than controls. Conversely, they had lower mean serum levels of FSH and SHBG ( P < 0.05 for each parameter). Variance analysis disclosed significant group effects between the different patients' phenotypes for all parameters, except age, BMI, and FSH. After multiple comparisons with post hoc analysis, phenotype D had milder endocrine and metabolic abnormalities than phenotype A, although it did not differ from phenotype C, except for androgen data, by definition. Phenotypes A and B were statistically similar, except for the ultrasound data, by definition. Conclusion: Oligoanovulatory patients with PCO but without HA have mild endocrine and metabolic features of PCOS.