Study of Prevalence of Menstrual Disorders in Cases of Insulin Resistance in Patients with Polycystic Ovary Syndrome ()
1. Introduction
Polycystic ovary syndrome (PCOs) is one of the most commonly diagnosed conditions in females of reproductive age [1]. This syndrome arises from the overlap of several congenital or acquired factors. Congenital factors may include maternal androgens or nutritional disorders affecting the fetus, while hyperinsulinemia is one of the acquired causes of insulin resistance [2]. We may see a role for the family genetic factor, as the prevalence of this syndrome within the same family ranges from 20% - 40% [3].
There are many clinical and laboratory manifestations represented by hirsutism [4], obesity [5], ovulation disorders [6] [7], acanthosis nigricans [8] and common count [9]. Ovulation disorders manifest themselves in two-thirds of patients with polycystic ovary syndrome in several forms, such as primary or secondary amenorrhea, menstrual bleeding or oligomenorrhea [6] [7].
The integration of symptoms and clinical findings with radiological investigations such as ultrasound is relied on in the approved world standards for the diagnosis of this syndrome [10]-[13], and accurate laboratory assessment also supports the diagnosis of this syndrome [14]. Insulin resistance is defined as a decrease in the response of target tissues to insulin and plays an important role in the pathogenesis of this syndrome, as hyperinsulinemia causes excessive production of androgens by the ovaries, which is the main characteristic of patients polycystic ovary syndrome [15].
2. Objective
Determining the prevalence of various menstrual disorders in polycystic ovary syndrome patients with insulin-resistant conditions, which helps in developing a treatment plan for patients.
3. Study Sample
The study included all females who attended Obstetrics And Gynecology clinic at Tishreen University Hospital in Lattakia between 2022 and 2024.
4. Study Design
Observational cross-sectional study.
5. Patients and Methods
A detailed history was taken from all patients, including personal profiles and complete medical information, with signed agreement to join this research. Radiological examination, such as ultrasound was conducted along with clinical evaluation to confirm the diagnosis of polycystic ovary syndrome.
All patients were diagnosed with insulin resistance after the following procedures:
Measurement of insulin and fasting blood sugar (FBS).
Calculation of insulin resistance is as follows: insulin*glucose/405.
All patients in this study with increased insulin resistance > 1.9.
6. Statistical Analysis
Statistical analyzes were conducted using the Statistical Package for the Social Sciences (SPSS) version 20.
Graphic forms and tables were used in the characterization of values.
Averages, Standard Deviations and Central Tendency Measures were used to characterize quantitative data.
7. Results
Table 1 shows the characteristics of the sample, which consisted of 65 patients, aged between 22 - 40 years, with an average age of 28.3 ± 3.63 years. The variety of patients was between 27 - 30 years with 40%.
Table 1. Demographic data of the sample.
Patients (n) |
65 |
Mean |
28.3 |
St.deviation |
3.63 |
Max |
40 |
Min |
22 |
Age categories |
22 - 25 |
11 (17%) |
26 - 30 |
26 (40%) |
31 - 35 |
20 (30.7%) |
36 - 40 |
8 (12.3%) |
Fasting blood sugar (FBS) was measured (after 8 - 10 hours fasting) with Insulin measurement in all patients. Insulin resistance was calculated as mentioned previously (See Table 2 and Figure 1).
Table 2. Fasting blood sugar and Insulin measurements.
|
Patients (n) |
Mean |
St.devation |
Fasting blood sugar |
65 |
85.42 |
4.8 |
Insulin measurement |
65 |
17.87 |
1.93 |
Insulin resistance |
65 |
3.74 |
0.3 |
Figure 1. Fasting blood sugar and Insulin measurements.
The patterns of menstrual disorders differ in females with polycystic ovary syndrome, and bradymenorrhea accounted for the largest percentage of the sample, with more than 66% of cases, while no case of primary amenorrhea was recorded in the study sample, as shown in Table 3 and Figure 2.
Table 3. Menstrual disorders in study sample.
Menstrual disorders |
Number (n) |
Percentage (%) |
Bradymenorrhea |
43 |
66.16% |
Metromenorrhagia |
14 |
21.53% |
Primary amenorrhea |
0 |
0.00% |
Secondary amenorrhea |
5 |
7.70% |
Epimenorrhea |
3 |
4.61% |
Figure 2. Menstrual disorders in study sample.
8. Discussion
This study included 65 women who were diagnosed with polycystic ovary syndrome PCOs with insulin resistance. All participants had menstrual disorders. The majority of them were in form of bradymenorrhea (more than 35 days between periods).
Insulin resistance in patients with polycystic ovary syndrome is considered one of the causes of menstrual disorders, ovulation disorders and infertility. Sometimes, many studies have proven the prescription of oral antidiabetics with lifestyle improvement (sport, weight reduction) has a role in reducing insulin resistance and thus reducing testosterone levels in the blood with increasing the chances of normal ovulation Our study found that all patients with polycystic ovary syndrome with insulin resistance have menstrual disorders in accordance with International Studies similar to our study [16]-[19].
Many previous studies have found that reducing insulin resistance contributed to improving ovulation and menstrual regularity in patients [16] [18] [20]. However, these studies went further in discussion the treatment type and its effects on insulin and fasting blood sugar as (Sohrevardi et al., 2016) who discussed Bioglitazon effects were better than Metformin in regulating menstrual periods in women with PCOs [18].
In this study, we aimed to find the relationship between menstrual disorders and insulin resistance apart from experimental treatments. We suggest to perform prolonged studies with a large number of patients to discuss treatments.
9. Conclusion
As polycystic ovary syndrome is very common in Syria and especially Mediterranean coastal cities as Lattakia, It is recommended to investigate insulin resistance in all patients with polycystic ovary syndrome before deciding a treatment plan, because of the significant role of reducing insulin resistance in improving ovulation and menstrual disorders which increase pregnancy chances and improve fertility.
Ethical Approval
This research received approval from the scientific research ethics committee at Tishreen University and Tishreen University Hospital.
Funding Statement
The author declares that no funds, grants, or other support were received during the preparation of this manuscript.
Conflicts of Interest
The authors have no relevant financial or non-financial interests to disclose.