EP1439 - ECE_3455 - Body weight strongly influences the metabolic phenotype in women with polycystic ovary syndrome

Abstract

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, affecting approximately 10%. It is characterized by ovulatory dysfunction, hyperandrogenism and/or polycystic ovarian morphology on ultrasound. Beyond reproductive manifestations, PCOS is associated with an increased burden of metabolic abnormalities, including insulin resistance and dyslipidaemia. To describe the clinical, hormonal and metabolic characteristics of women with PCOS followed in our centre and to compare normal-weight and obese phenotypes. This retrospective study was based on the Endocrinology, Diabetes and Metabolism (EDM) database at Lausanne University Hospital (CHUV). PCOS was defined by Rotterdam criteria after exclusion of secondary causes. Women on treatments likely to interfere with hormonal/metabolic parameters at the time of assessment (eg, oral contraceptives, metformin/GLP-1 receptor agonists, spironolactone) were excluded. For group comparisons, normal-weight (BMI <25 kg/m2) and obese women (BMI ≥30 kg/m2) were analysed; overweight women were excluded. Clinical, hormonal and metabolic data were collected. Sex steroids were measured by mass spectrometry, while other biochemical parameters were measured using immunoassays. Ninety-nine women were included. Phenotype A (hyperandrogenism + ovulatory dysfunction + polycystic ovarian morphology) and phenotype B (hyperandrogenism + ovulatory dysfunction) predominated (57.6% and 21.2%), and polycystic ovarian morphology was present in 79.8%. For group comparisons, 24 normal-weight and 53 obese women were analyzed. Menstrual disturbances did not differ between groups (oligomenorrhoea 70.8% vs 67.9%; amenorrhoea 12.5% vs 15.1%; regular cycles 12.5% vs 17.0%; all P > .05). Acne was more frequent in normal-weight women (75.0% vs 35.8%, P = .003). Obese women had significantly higher fasting glucose, fasting insulin and HOMA-IR (8.21 ± 7.85 vs 2.01 ± 0.85, P = .003). Dyslipidemia was more prevalent in obese women (66% vs 19.6%, P < .001), with higher triglycerides (P = .001), lower HDL-cholesterol (P < .001), higher LDL-cholesterol (P = .01) and a higher triglyceride/HDL ratio (P < .001). SHBG concentrations were significantly lower in obese women (25.79 ± 12.33 vs 69.36 ± 61.81 nmol/L, P < .001), whereas total testosterone, androstenedione and DHEA-S levels were similar between groups (all P > .05). Obesity is strongly associated with a worse metabolic profile in women with PCOS, characterised by marked insulin resistance and dyslipidaemia, while circulating androgen concentrations are broadly comparable across weight categories. These findings highlight the central metabolic impact of adiposity and support systematic cardiometabolic screening and weight-focused management in PCOS.