PCOS Can Present Differently Based on Geographic Region, Study Finds

Margareta D. Pisarska, MD

An analysis of data from more than 1600 women with polycystic ovary syndrome (PCOS) is providing insight into the regional variation in hormonal and metabolic parameters of the disease across the US.

Results of the study, which compared data among black and white women with PCOS from Alabama and California, indicated there were many similarities among the races, but women from Alabama were more likely to have excessive hair growth and insulin resistance, while their counterparts in California were more likely to have increased levels of testosterone.

“Our study found geographical differences in PCOS in black and white women, suggesting there are both genetic and environmental influences on how this disease manifests,” said Margareta D. Pisarska, MD, of Cedars-Sinai in Los Angeles, CA, in a statement. “Ongoing research is needed to identify modifiable risk factors for PCOS that may be race and ethnicity-specific to bring precision medicine to the management of this disease.”

Funded by the National Institutes of Health and Helping Hand of Los Angeles Inc., the study was conducted by Pisarska and colleagues citing a lack of reliable information related to geographic difference in presentations of PCOS. With this in mind, investigators designed the prospective cohort study leveraging data from 1610 women who received care at tertiary-care based specialty clinics in Alabama and California from 1987 through 2010.

The primary outcome measures of interest for the study were demographic data, menstrual cycle history, and hormonal and metabolic parameters. This information was obtained through interviews, physical examinations, and laboratory studies of participants. Metabolic parameters of interest included BMI, waist-hip-ratio (WHR), glucose tolerance test, and HOMA-IR scores.

Upon analysis, results suggested women with PCOS in Alabama were younger and had a higher BMI than their counterparts in California. In analyses adjusted for age and BMI, women in Alabama with PCOS were more likely hirsute (adjusted odds ratio [aOR], 1.8 [95% CI, 1.4-2.4]; P <.001) and to have greater HOMA-IR scores (adjusted beta coefficient, 3.6 [95% CI, 1.61-5.5]; P <.001). Further analysis suggested women from California with PCOIS were more likely to have hyperandrogenemia than their counterparts from Alabama (free testosterone aOR, 0.14; 95% CI, 0.11-0.18; P < 0.001; total testosterone aOR, 0.41; 95% CI, 0.33-0.51).

Investigators pointed out these results remained consistent when stratified by White race. Additionally, analyses stratified by Black race indicated PCOS, BMI, and WHR did not differ between locations, but differences in androgen profiles and metabolic dysfunction based on region persisted.

“Since we have now identified that there are geo-epidemiologic differences, we intend to do follow up studies comparing black and white women with PCOS, controlling for geoepidemiologic differences,” Pisarska added. “Furthermore, we are trying to look at factors that are contributing to these differences in order to tailor treatments based on specific needs for improvements in care for all women with PCOS.”

This study, “Regional Variation in Hormonal and Metabolic Parameters of White and Black Women With PCOS in the United States,” was published in the Journal of Clinical Endocrinology and Metabolism.