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RESEARCH ARTICLE
JOURNAL OF MEDICAL SCIENCES
CYPRUS
©
Copyright 2023 by the Cyprus Turkish Medical Association / Cyprus Journal of Medical Sciences published by Galenos Publishing House.
Content of this journal is licensed under a Creative Commons Attribution 4.0 International License
27
Cyprus J Med Sci 2023;8(1):27-33
Polycystic Ovary Syndrome Among Patients of a University
Hospital in Nicosia: A Retrospective Study
Özen Asut, Songül Vaizoğlu, Gulifeiya Abuduxike, Sanda Cali
Department of Public Health, Near East University Faculty of Medicine, Nicosia, North Cyprus
ORCID IDs of the authors: Ö.A. 0000-0002-9604-4037; S.V. 0000-0001-9279-1740; G.A. 0000-0002-9798-7459; S.C. 0000-0001-9929-2637.
Abstract
Address for Correspondence: Özen Asut
E-mail : ozen.asut@neu.edu.tr
ORCID ID: orcid.org/0000-0002-9604-4037
INTRODUCTION
Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disorder
characterized by hyperandrogenism, ovulatory dysfunction and
polycystic ovarian morphology, with excessive androgen production
by the ovaries.1 PCOS is the most frequent endocrinological disorder
among women of reproductive ages leading to a number of health
complications.1,2 An international consensus definition of PCOS has been
published, which defines PCOS as at least two of the following criteria:
Reduced or no ovulation; clinical and/or biochemical signs of excessive
secretion of androgens; and/or polycystic ovaries (the presence of at
least 12 follicles measuring 2-9mm in diameter, an ovarian volume in
excess of 10mL, or both).3
In terms of ovarian functions, PCOS is a syndrome of ovarian dysfunction
characterized by an accumulation of incompletely developed follicles
in the ovaries because of anovulation. Clinical manifestations include
menstrual dysfunction, oligomenorrhea or amenorrhea, infertility,
hirsutism and acne.4 Insulin resistance affects 50-70% of women with
PCOS, gradually ending up with co-morbidities such as hypertension,
dyslipidemia, glucose intolerance, leading to diabetes and metabolic
syndrome.5
Received: 23.11.2020
Accepted: 18.03.2021
BACKGROUND/AIMS: Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disorder, characterized by hyperandrogenism, ovulatory
dysfunction and polycystic ovarian morphology leading to health complications including infertility, hirsutism and metabolic syndrome. The
aim of this study was to determine the status, features and treatments implemented for PCOS patients diagnosed in a university hospital of
Nicosia, North Cyprus, where no previous data on this issue was available in the medical literature.
MATERIALS AND METHODS: This descriptive study was administered using the records of 45,677 patients presenting to the gynecology and
obstetrics clinic for the time period of 2015-2019. The study group included 819 patients diagnosed as PCOS. The data were collected using a
data collection form designed by the researchers and analyzed by IBM-SPSS 18.0 program, with a significance level accepted as p<0.05.
RESULTS: European Society for Human Reproduction and Embryology/American Society for Reproductive Medicine Rotterdam Conference-2003
or the Androgen Excess and PCOS Society (AE-PCOS) Conference-2006 criteria were used for the diagnosis. The 819 patients diagnosed as PCOS
comprised a frequency of 1.8%, lower than the expected average value reported among gynecologic patients. Family history existed in 0.7%
of the cases. The characteristics of the patients were similar to those of other studies and treatments initiated were in accordance with PCOS
consensuses in general, with the exception of a lower use of metformin.
CONCLUSION: The frequency of PCOS among North Cyprus women was low, indicating the disease was an under-recognized condition in this
tertiary hospital compared to rates estimated in community samples globally. Further research is recommended to establish more valid data
in order to improve women’s health.
Keywords: Polycystic ovary syndrome, ovulation irregularity, hyperandrogenism, treatment, North Cyprus
To cite this article: Asut Ö, Vaizoğlu S, Abuduxike G, Cali S. Polycystic Ovary Syndrome Among Patients of a University Hospital in Nicosia: A
Retrospective Study. Cyprus J Med Sci 2023;8(1):27-33
DOI: 10.4274/cjms.2021.3522
Asut et al. Polycystic Ovary Syndrome in North Cyprus Cyprus J Med Sci 2023;8(1):27-33
28
Although the physiopathology of PCOS is unknown, most studies imply
familial heritage. Some clinical genetic studies indicate an autosomal
dominant inheritance, while others reveal a complex trait of oligogenic
basis. On the other hand, the heterogeneity of phenotypic features
point to the contribution of environmental factors.6 Genetically
transmitted β-cell dysfunction and high androgens, dyslipidemia and
insulin resistance serum markers in families of women with PCOS,
including the male population have been demonstrated.7,8 The majority
of PCOS patients exhibit metabolic dysfunction with insulin resistance,
hyperinsulinaemia and an increased risk for type 2 diabetes mellitus,
gestational diabetes and other pregnancy-related complications,
cardiovascular events and endometrial cancer.9-13
PCOS is classified into four separate phenotypes (A-D), according to the
presence or absence of three characteristics: hyperandrogenism (either
biochemical or clinical), ovulatory dysfunction and polycystic ovarian
morphology. Only phenotype A requires all three features of PCOS to
be present. The various diagnostic criteria currently available for PCOS
in
clude a greater or fewer number of PCOS phenotypes.
11
The prevalence of PCOS is remarkably similar worldwide. The prevalence
of clinically evident PCOS in women of reproductive ages from the United
States, Europe, Asia and Australia ranges between 5% and 9% based on the
original 1990 US National Institutes of Health (NIH) diagnostic criteria.
Using the broader 2003 Rotterdam criteria now accepted internationally,
the prevalence of PCOS ranges from 5.5% to 19.9%.
11
PCOS is reported to be diagnosed in 4-10% of women attending
gynecology clinics in high income countries.14In some European
studies, the prevalence of PCOS has been reported as being 6.5-8%.14,15
The prevalence of PCOS may be in the range of 15-20% using the criteria
of the European Society for Human Reproduction and Embryology/
American Society for Reproductive Medicine (ESHRE/ASRM).5 However,
among unselected general female populations of different ethnicities,
PCOS rates using other criteria were found as follows: Caucasians 5.5%
(NIH: 1990); African-American and Afro-Brazilian 7.4% (NIH: 1990);
Chinese 2.2% (NIH: 1990), 5.6% (ESHRE/ASRM, Rotterdam 2003); and
Middle East (Iranian and Turkish) 6.1% (NIH: 1990), 16.0% (ESHRE/ASRM,
Rotterdam 2003), 12.6% (AES, 2006).4,16 Diagnostic criteria for PCOS
include clinical or biochemical hyperandrogenism, oligo/anovulation
and polycystic ovarian morphology according to ESHRE/ASRM 2012
criteria while clinical or biochemical hyperandrogenism and persistent
oligo-/anovulation according to Endocrine Society 2013 criteria.16 As
a consequence, the worldwide prevalence of PCOS shows variations
according to the diagnostic criteria used. Greater estimates of PCOS
prevalence with the ESHRE/ASRM Rotterdam 2003 and Androgen Excess
and PCOS Society (AE-PCOS) 2006 criteria are largely attributed to their
more expansive definition and inclusion of additional phenotypes.16
However, the results of PCOS studies largely depend on how the
study population and the PCOS phenotypes were defined. Since the
assessment of the PCOS phenotype is a complex process,study results
may reflect underreporting due to the limitations of more intensive
investigations.15,16
Aim: The aim of this study was to determine the status and features of
PCOS and to investigate the treatments provided to patients diagnosed
in the Near East University Hospital in Nicosia, North Cyprus, where no
previous data on this issue was available in a search of the literature.
The time period of this study was set as 1
st
September, 2015 to 31
st
August, 2019.
MATERIALS AND METHODS
Study type: The study was a descriptive records-based study.
Diagnostic and inclusion criteria: In order to establish a diagnosis of
PCOS, the criteria of the ESHRE/ASRM Rotterdam Conference of 2003
or the AE-PCOS Conference 2006 were used in the Near East University
Hospital. According to these criteria, the following parameters were
considered sufficient for the diagnosis of PCOS: Clinical and biochemical
hyperandrogenism, ovulation irregularity and/or polycystic ovary
morphology.10
Study design and setting: The study was conducted between the 2nd
and 9th of August, 2019 via an investigation of the patient records of the
Gynecology and Obstetrics Clinics of the Near East University Hospital.
The study group included those patients diagnosed as PCOS starting 1st
September, 2015 until 31st August, 2019. All of the patients registered
with this diagnosis were admitted into this study without exclusion.
The data were obtained from the information system of the Near East
University Hospital with the permission of the chief physician of the
hospital.
Study tool: The data were collected and recorded by a data collection
form designed and structured by the researchers. The details of the
records of each patient were entered into the data collection form
individually.
Statistical Analysis
The data were analyzed using IBM-SPSS (Statistical Package for the Social
Sciences) version 18 (SPSS Inc., Chicago, IL, USA). Descriptive statistics
including frequency, percentage, mean, and standard deviation were
calculated to describe the characteristics of the study sample. Bivariate
analysis using the chi-squared test was performed to examine the
relationships between independent variables with a significance level
set at p<0.05.
Permission from the Near East University Gynecology and Obstetrics
Department and the Chief Physician of the Near East University Hospital
was obtained and consent and approval of the Near East University
Ethics Committee with report number YDU/2019/71-869 was provided.
RESULTS
In this descriptive study, the records of 819 patients diagnosed as PCOS
among 45,677 patients presenting to the Gynecology and Obstetrics
Clinics of the Near East University Hospital between 1st September, 2015
and 31st August, 2019 were studied. The detailed history of 80 patients
were not recorded in the system, other than their diagnosis as PCOS.
The results are given under the headings of age distribution, family
history, symptoms and findings, diagnosis and treatments. The age
distribution, the status of family history and prior drug use history of the
patients followed up with the diagnosis of PCOS are presented in Table 1.
Of the total patients, 41.5% were in the 20-24 year age group. The
mean age of the PCOS patients was 27 years, with a minimum age of
15 and maximum age of 50. Only 5 patients (0.7%) had a family history
according to their records. Of the 232 patients under drug therapy prior
to admission, 42.2% were reported as taking contraceptive drugs and
78.0% as using other medications (Table 1).
Asut et al. Polycystic Ovary Syndrome in North CyprusCyprus J Med Sci 2023;8(1):27-33
29
The analysis of the patients followed up with the diagnosis of PCOS at the
Near East University Hospital showed that 8.4% of the patients (69 patients)
had undergone surgical interventions, while 2.2% (18 patients) of them
had experienced gynecologic/obstetric operations prior to admission.
Table 2 indicates the presenting and later symptoms and signs of
the PCOS patients diagnosed at the Near East University Hospital. Of
the patients with recorded data, 45.9% were admitted to the hospital
with complaints of menstrual irregularity, followed by the desire for
offspring, hirsutism and dermatological problems as the major causes
of presentation to the hospital. Leading symptoms at a later stage of the
disease included oligomenorrhea, hirsutism and acne. In addition, data
from the records showed that 78.6% of the patients diagnosed as PCOS
had ultrasonographic findings of polycystic ovaries (Table 2).
The laboratory investigations requested of the patients followed up
with the diagnosis of PCOS at the Near East University Hospital are
given in Table 3. The patient records revealed that hormone profile,
vaginal smear, thyroid function tests and HOMA-IR (insulin resistance)
were the laboratory tests most commonly requested for those patients
with PCOS, the leading test among the total being hormone profile with
83.5%, followed by vaginal smear with 14.4% (Table 3).
The details about drug therapies provided for the PCOS patients
diagnosed at the Near East University Hospital are shown in Table 4.
Among the records of the 819 PCOS patients registered, 759 patient
records had pharmacotherapy information, 431 of whom were stated
as receiving drug therapy and 328 as receiving no drug therapy. Of
the total 431 records with information regarding pharmacologic
therapies, 69.4% were taking oral contraceptives and progesterone. Oral
contraceptive medications were prescribed for 39.2% of the patients
while 29.0% received progesterone therapy. Antibiotics, metabolic drugs
and supplements were the following groups of medications in order of
frequency recommended for the PCOS patients.
Metformin was reported to be prescribed for 5.3% of the patients. Other
ovulation stimulators used included clomiphene, dopamine agonists,
estrogen agonists and aromatase inhibitors. Dermatologic and other
medications were prescribed for 6% of the patients (Table 4).
Reporting of a PCOS symptom at first presentation to the hospital
according to age groups is given in Table 5. A significant difference was
illustrated between the age groups regarding the existence of symptoms
at first presentation. Those patients under 25 years of age had symptoms
regarding PCOS at their first visit to the hospital at significantly higher
levels than those patients 25 years or older (χ2 =13.0, p<0.01) (Table 5).
DISCUSSION
This study was conducted using the patient registration system of a
university hospital in North Cyprus.
The frequency of PCOS was established as 1.8% among the gynecologic
patients, lower than reported in the literature for the same age group of
patients in similar settings. PCOS was reported to be diagnosed in 4-10%
of women attending gynecology clinics in high income countries.14
According to our review of the literature, the prevalence of PCOS
among women had not been investigated in North Cyprus until the
present time. Therefore, a comparison with previous research was not
possible and our study may be part of the initial research on this issue
in this country.
The incidence and prevalence of PCOS among women seeking
healthcare at primary healthcare settings was found to be low,
indicating that PCOS is an under-recognized condition at the broadest
level of the healthcare systems.
13
Prevalence studies from several
countries have reported PCOS frequencies, such as 6.6% for Spain, 5%
for Türkiye, 2.2% for the Peoples Republic of China and 1.6% for the
USA.
9
A study in the UK found an overall incidence rate of 1.84% for
the time period 2004-2014, with women aged 20-24 years and women
living in deprived areas having the highest incidences. The prevalence
of PCOS for the year 2014 was estimated to be approximately 2%,
reflecting a lower level of this syndrome, similar to our study.
17
Although our study group included gynecologic patients, the frequency
of PCOS was 1.8%, lower than the reported 4-10% in the literature for
the same age group of patients in similar settings.14 In a cross-sectional
study representing the South Cyprus population, the overall prevalence
Table 1. Age distribution, family history and drug use history of those patients with a diagnosis of PCOS at Near East University Hospital (Nicosia: August,
2019)
Age group (n=814) n %
<20 36 4.4
20-24 338 41.5
25-29 218 26.8
30-34 137 16.8
35-39 61 7.5
≥40 24 3.0
Mean ± SD: 27±5.8 Median: 25 Minimum: 15 Maximum: 50
Family history (n=756)
Yes 5 0.7
No 751 99.3
Drug use history on record (n=232)*
PCOS-related drugs** 98 42.2
Other drugs (none PCOS-related) 181 78.0
*Limited to information in the patient records, **PCOS related drugs: Contraceptive drugs (cyproterone and estrogen, dienogest and ethinylestradiol, ulipristal, dienogest and estrogen,
medroxyprogesterone, drospirenone and ethinylestradiol), PCOS: Polycystic ovary syndrome, SD: Standard deviation.
Asut et al. Polycystic Ovary Syndrome in North Cyprus Cyprus J Med Sci 2023;8(1):27-33
30
of PCOS among women was found to be 6.1%, much higher than the
results of our study. The age group with the highest rate in this study
of the South Cyprus population was the 25-44 age group women with
16.0%, followed by the 18-24 age group with 8.6%.18
Additionally, the prevalence of PCOS was found to be higher using
the ESHRE-ASRM Rotterdam Conference 2003 and AE-PCOS Society
conference 2006 criteria, as compared to the NIH 1990 criteria. Since
the former two criteria were used in our clinics and the setting is a
tertiary university hospital, the present frequency finding was much
lower than the expected values, indicating an under-diagnosis of this
syndrome, which may be attributed to the private status of the university
hospital and also some missing data in the records. As PCOS is more a
condition of deprived populations, more patients probably seek health
Table 2. The presenting and later symptoms and signs of patients followed up with a diagnosis of PCOS at the Near East University Hospital (Nicosia: August, 2019)
Presenting symptom (n=758) n %
Menstrual irregularity 348 45.9
Desire for offspring 57 7.5
Hirsutism 47 6.2
Dermatological problem 47 6.2
Pain 41 5.4
Amenorrhea 41 5.4
Vaginal secretion 35 4.6
Check-up 31 4.8
Pregnancy monitoring 27 3.5
Hemorrhage 25 3.2
PCOS control 20 2.6
Dysmenorrhea 13 1.7
Metabolic disorder 12 1.5
Infertility 5 0.7
Urinary infection 4 0.5
Other infection 2 0.3
Abdominal mass 2 0.3
Abortion 1 0.1
Later symptoms and signs
Oligomenorrhea (n=759) 424 55.9
Hirsutism (n=759) 192 25.3
Acne (n=759) 87 11.5
Polycystic ovaries on ultrasound (n=760) 597 78.6
PCOS: Polycystic ovary syndrome.
Table 3. The records of the laboratory investigations requested of the patients followed up with a diagnosis of PCOS at the Near East University Hospital
(Nicosia: August, 2019)
Investigation (n=480) n %
Hormone prole 401 83.5
Vaginal smear 69 14.4
Thyroid function tests 27 5.6
HOMA-IR (insulin resistance) 26 5.4
Complete blood count test 21 4.4
Urinary analysis 14 2.9
Hepatic function tests 7 1.5
Fasting blood glucose 7 1.5
Tumor markers 6 1.3
Glucose tolerance test 5 1
Magnetic resonance imaging 3 0.7
Chorionic villus sampling 3 0.7
Hysterosalpingography 2 0.4
PCOS: Polycystic ovary syndrome.
Asut et al. Polycystic Ovary Syndrome in North CyprusCyprus J Med Sci 2023;8(1):27-33
31
services at state institutions in Cyprus or in Türkiye. However, the socio-
demographic features of the patients were not recorded in sufficient
detail in the records used in the current study. Thus, further analysis
in regard to other sociodemographic features other than age was not
possible. Regarding family history, no evidence was found suggesting
familial transmission among the majority of the patients.
Additionally, the assessment of the PCOS phenotype is a complex process
and due to the unavailability of some investigations, study results may
reflect lower prevalences.15,16 This may be one of the other reasons for
the lower prevalence found in our study.
The findings of the current study were in agreement with previous
studies conducted in other studies.18 Among the patients diagnosed
as PCOS, two or more of the PCOS criteria of menstrual irregularity,
polycystic ovary morphology, and/or hyperandrogenism-hirsutism were
present in 80% of the cases. Similarly, 75% of the patients had two or
more of these criteria in another study conducted in Denmark.19
According to the European survey of diagnosis and management of
PCOS among European Society of Endocrinology members, NIH criteria
were utilized for PCOS diagnosis by the majority of the respondents.20
The respondents were most likely to select menstrual irregularity as the
most frequent criteria used for PCOS diagnosis, followed by hirsutism
and biochemical hyperandrogenism, similar to our study as menstrual
irregularity was the first and hirsutism the third ranked findings
reported (Table 2).
The most frequent biochemical parameters in the differential diagnosis
of hyperandrogenism were total testosterone or free androgen index,
contrary to our findings regarding laboratory tests, which did not
include all of these tests.20
Treatment is recommended to be in alignment with the complaints
and needs of the patients and should involve lifestyle changes targeting
metabolic abnormalities, medications and surgery for the management
of excess weight, androgen suppression and/or blockade, endometrial
protection, reproductive therapy and the treatment of psychological
features.11,20
In the current study, 40.4% of the 431 patients prescribed medications
were reported as receiving oral contraceptives and 29% as receiving
progesterone. Totally, 16.6% of the patient records with pharmacotherapy
information indicated the use of ovulation stimulators.
Metformin use was only 5.3% in our study, considerably less than
reported in the literature. In a study from the USA, metformin
comprised 75% of the drugs administered to PCOS patients.9 However,
the rate of metformin use was lower in the UK study covering 2004-2014
at 10.2%. In this UK study, the proportion of women with a prescription
in the 24 months after their PCOS index date varied by drug type:
10.2% metformin, 15.2% combined oral contraceptives, 18.8% acne-
related treatments, and less than 5% for clomiphene, spironolactone,
cyproterone and eflornithine.17 The use of oral contraceptives was
much higher in our study than was found in the UK study, although
metformin use was lower.
In the European survey, the most common treatments for patients
with PCOS were metformin (33%), lifestyle modification (25%), oral
contraceptives (22%), antiandrogens (13%), cosmetic procedures for
hirsutism (8%) and a number of different combinations of these agents
or methods. More direct treatments of infertility included clomiphene
citrate alone or in combination with metformin, prescribed at rates of
9% and 23%, respectively, whereas only 6% used other methods for the
induction of ovulation.
20
The treatment options in the present study were
similar to the current literature, except for the low rate of metformin use.
Table 4. Drug therapies provided for the patients followed up with a diagnosis of PCOS at the Near East University Hospital (Nicosia: August, 2019)
Pharmacotherapies (n=431) n %
Oral contraceptives 174 40.4
Progesterone 125 29.0
Antibiotics 81 18.8
Metabolic drugs (anti-diabetics, thyroid hormones…) 54 12.5
Supplements (vitamins, ferrum...) 53 12.3
Ovulation stimulators
Metformin 23 5.3
Dopamine agonists 19 4.4
Estrogen agonists (tamoxifen...) 17 3.9
Other ovulation stimulators (clomiphene, aromatase inhibitors) 13 3.0
Other drugs
(Dermatologic agents and others) 26 6.0
Table 5. The distribution by age groups of the PCOS patients according to the existence of symptoms at first presentation to the hospital (Nicosia: August, 2019)
Age group
PCOS symptom at rst presentation (n=758) Under 25 years 25 years of age or over Total
n % n % n %
Existent 309 88.5 322 78.7 631 83.2
Non-existent 40 11.5 87 21.3 127 16.8
X2=13.0, p<0.01. PCOS: Polycystic ovary syndrome.
Asut et al. Polycystic Ovary Syndrome in North Cyprus Cyprus J Med Sci 2023;8(1):27-33
32
Regarding the lack of population level data on the prevalence and
distribution of common benign women’s health diseases, including
PCOS in North Cyprus, the Cyprus Women’s Health Research initiative
will be the first cross-sectional study to evaluate these conditions,
aiming to recruit 8,000 women of reproductive age and establish a
cohort of women in North Cyprus. The results of this large-scale study
are expected to shed light on the definite data on this condition of
women as well as others.21
The current study has shown that only half of the patients diagnosed
as PCOS continued their follow-up for this disease as recommended.
Under-diagnosis and lack of monitoring may lead to rapid conversion
of metabolic disorders for PCOS patients. This lack of treatment results
in increased risks of type 2 diabetes, atherosclerosis and endometrium
cancer.10,11 Therefore, there is a need for programs to effectively monitor
and treat patients diagnosed as or suspected of PCOS through accurate
data keeping and registration systems. These patients should be
informed and monitored closely and regularly regarding the possible
risks of this syndrome.
Study Limitations
The lack of full data of the patients’ records in the system is considered
to be a limitation of this study. The data and results of this study
are limited by the information covered in the records. There was
considerable missing data in the system. There is definitely a need for
a more comprehensive record-keeping and monitoring system in order
to allow for a better follow-up of these patients. Due to the descriptive
nature of this study, the results may show hints of the actual situation,
which may only be derived from representative studies. The lower PCOS
rate may be attributed to the private status of the hospital, as well as
the insufficiency of the records.
CONCLUSION
Based on the NIH’s diagnostic criteria, there is a similar prevalence
of PCOS across countries. Some studies have shown some differences
between geographical locations and ethnic groups. However, the existing
data is not conclusive enough to decide whether or not there are any
significant differences in the prevalence of PCOS across geographical
locations, racial or ethnic groups.9
Different diagnostic criteria may be one of the factors for the
considerable variations in the prevalence of PCOS. In spite of the efforts
for diagnosis, a large percentage of women are anticipated to remain
undiagnosed even after visiting multiple health care providers. This
finding points to the need for ethnicity-specific guidelines for PCOS in
order to prevent under- or over-diagnosis of this condition because
under-diagnosis may lead to rapid conversion of metabolic disorders
for patients, whereas over-diagnosis may cause negative psychological
effects on patients, worsening the major symptoms of PCOS.
This was a descriptive record-based study, covering only the patients of
a university hospital; thus it was not representative of the North Cyprus
population, but it shed light on the features of a group of women with
PCOS in this community. Our findings point to the probability of under-
diagnosis compared to the international data presented in the medical
literature. There is a need for representative studies of the whole
country for a full picture of this issue and to prevent patients from being
undiagnosed. Further knowledge about this specific women’s health
problem in the population of this geography may enlighten the road
map in order to take effective measures for this issue and may be of
assistance for interventions in similar communities.
What this paper contribues
The results of this study imply under-recognition of PCOS among
the population of women in North Cyprus, which may lead to rapid
conversion of metabolic disorders.
Only half of the patients diagnosed as PCOS continued their follow-up
for this disease as recommended.
Under-diagnosis and a lack of monitoring result in increases in risks for
type 2 diabetes, atherosclerosis and endometrium cancer.
Therefore, the results of this study point to a need for programs to
effectively diagnose, treat and monitor those patients diagnosed as or
suspected of PCOS, including accurate data keeping and registration
systems, in order to improve women’s health.
MAIN POINTS
• In the current study, the status of polycystic ovary syndrome (PCOS)
was investigated retrospectively among patients of a university
hospital in North Cyprus, where no previous research on this issue
had been conducted.
• Among the 819 PCOS patients found for the time period of 2015-2019,
78.5% displayed polycystic ovary morphology via ultrasonography
and a minority (0.7%) had a family history.
• PCOS patients comprised 1.8% of the total patients of the gynecology
clinic, lower than the expected value, although ESHRE/ASRM
Rotterdam Conference 2003 and AE-PCOS Conference 2006 criteria
were used.
• The results point to the need for further research and effective
interventions in this community for this specific women’s health
problem in order to prevent complications.
ETHICS
Ethics Committee Approval: Permission from the Near East University
Gynecology and Obstetrics Department and the Chief Physician of the
Near East University Hospital was obtained and consent and approval
of the Near East University Ethics Committee with report number
YDU/2019/71-869 was provided.
Informed Consent: It was obtained.
Peer-review: Externally peer-reviewed.
Authorship Contributions
Concept: Ö.A., S.V., G.A., S.C., Design: Ö.A., S.V., G.A., S.C., Supervision:
Ö.A., S.V., G.A., S.C., Fundings: S.C., Materials: Ö.A., S.V., G.A., S.C., Data
Collection and/or Processing: S.V., S.C., Analysis and/or Interpretation:
Ö.A., S.V., G.A., S.C., Literature Search: Ö.A., S.V., G.A., Writing: Ö.A., S.V.,
Critical Review: S.V., G.A., S.C.
Asut et al. Polycystic Ovary Syndrome in North CyprusCyprus J Med Sci 2023;8(1):27-33
33
DISCLOSURES
Conflict of Interest: No conflict of interest was declared by the authors.
Financial Disclosure: The authors declared that this study had received
no financial support.
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