The relationship between obesity and polycystic ovary syndrome (PCOS) may be exaggerated, likely because women who actively seek care tend to be heavier than those identified through screening of the general population, researchers report.

PCOS affects approximately 10% of women and is characterised by excess male hormone, irregular ovulation and menstruation, as well as increased risk of metabolic diseases often associated with being overweight.

The study in the Journal of Clinical Endocrinology & Metabolism looked at what have long been considered indicators of the disease, including obesity, high testosterone levels and excess body hair, in women actively seeking care for PCOS, as well as those identified with PCOS through a general pre-employment health screening.

Obesity screening outcomes

The researchers found that the women with PCOS identified through the screening had around the same obesity rates as those who didn’t have PCOS, said Dr Ricardo Azziz, reproductive endocrinologist and PCOS expert at the Medical College of Georgia at Georgia Regents University. However, obesity rates in patients actively seeking treatment were 2.5-times higher than in women identified with PCOS through the screening of the general population.

‘The women actively seeking care had higher male hormones, more hair growth, more severe ovulation problems, which was not surprising because patients who have a more severe condition are more apt to seek medical care,’ said Azziz, the study’s corresponding author. ‘What is surprising to us is that the rate of obesity in women with PCOS who we found in the general population is nowhere near as high as we expected from studying women with PCOS who did seek care.’

He notes that obesity has been considered a hallmark of the condition since it was first described in 1932 and that the ongoing association likely is perpetuated by a bias resulting from patients who self-refer for care.

A more accurate picture of PCOS likely would emerge if studies of the condition also included patients identified through screening the general population.