Indicators for metabolic disturbances in anovulatory women with polycystic ovary syndrome diagnosed according to the Rotterdam consensus criteria.

BACKGROUND: Polycystic ovary syndrome (PCOS) is associated with metabolic abnormalities. It is debated whether all women with PCOS should be screened for metabolic abnormalities as these may vary with PCOS phenotype, age and ethnicity. The aims of this study were to assess the prevalence of metabolic abnormalities in Dutch anovulatory PCOS women and to define criteria for metabolic screening. METHODS: Anovulatory patients, diagnosed with PCOS according to the Rotterdam consensus criteria, underwent metabolic screening. Through stepwise multivariate analysis patient characteristics associated with metabolic syndrome (MetS) and insulin resistance (IR) were evaluated for their use as selection parameters for metabolic screening. RESULTS: Overall, prevalence of MetS and IR was 15.9% (n = 25) and 14% (n = 22), respectively, in 157 PCOS women (age 29.0 +/- 4.8 years, BMI 26.1 +/- 6.7 kg/m(2)). Anovulatory hyperandrogenic women (with or without polycystic ovaries) had more often MetS and IR (with, 20.8 and 19.8%; without, 100 and 40%, respectively) than non-hyperandrogenic PCOS women (0 and 1.8%; P < 0.001). Waist circumference >83.5 cm along with increased free androgen index (FAI) had the most powerful association with the presence of MetS and IR (area under the receiver operating characteristic curve 0.912) and offered a reduction in the necessity of screening for metabolic derailments of about 50%. CONCLUSIONS: The hyperandrogenic PCOS phenotypes are highly linked to the presence of MetS and IR in Dutch PCOS women. Waist circumference combined with FAI was identified as an efficient combination test to select those PCOS women who should be screened for the presence of MetS and/or IR.

Estimated hospital health costs of chronic abdominal pain in the Netherlands.

UNLABELLED: aim: Calculation of the hospital costs of chronic abdominal pain in the Netherlands. DESIGN: Cross-sectional study. METHODS: We selected 'Diagnosis-Related Groups' (DRG) of disorders that are associated with chronic abdominal pain from a large teaching hospital and a tertiary referral centre. For each DRG we determined the percentage of patients that can present with abdominal pain. The total costs for both hospitals were calculated using the registered quantity of the DRGs. Each DRG was categorised by somatic and functional origin. The results were subsequently extrapolated to the entire Dutch population demanding hospital care for chronic abdominal pain. Finally, the percentage and associated costs were calculated for patients who had two or more separate diagnoses for chronic abdominal pain in the field of gastroenterology, gynaecology, internal medicine and urology. RESULTS: The yearly outpatient and (day) clinical health costs for patients with chronic abdominal pain in the Netherlands were approximately €623 million (gastroenterology €226 million; gynaecology €303 million; internal medicine €63 million; and urology €31 million). Of these diagnoses, 53.6% were related to functional disorders, which accounts for approximately €220 million per year. The yearly costs of patients who had at least two separate diagnoses within one year for chronic abdominal pain were estimated at €23.5 million per year. CONCLUSION: Chronic abdominal pain is a common problem that entails significant healthcare costs in the Netherlands of which functional diagnoses compromise a significant amount.

PCOS according to the Rotterdam consensus criteria: Change in prevalence among WHO-II anovulation and association with metabolic factors.

OBJECTIVE: The current report aims to compare the prevalence of polycystic ovary syndrome (PCOS) diagnosed according to the new Rotterdam criteria (Rott-PCOS) versus the previous criteria as formulated by the National Institutes of Health (NIH) (NIH-PCOS) in women with normogonadotropic (WHO-II) anovulation and assess the frequency of obesity and related factors determined in these women. DESIGN: Cohort study based on large anovulation screening database. SETTING: Two large tertiary referral centres for reproductive medicine. POPULATION: WHO-II normogonadotropic, anovulatory, infertility cases. METHODS: WHO-II cases were extracted from the screening database and classified according to both the Rotterdam and NIH criteria for PCOS. Within these two classes, the prevalence of obesity, hyperglycaemia and insulin resistance was assessed and compared and their relation to the difference in diagnostic criteria applied was analysed. MAIN OUTCOME MEASURES: Prevalence of diagnosis PCOS in the WHO-II anovulation group. Prevalence of obesity, hyperglycaemia and insulin resistance in the two diagnostic classes. RESULTS: The Rott-PCOS group appeared to be more than 1.5 times larger than the group classified as NIH-PCOS (91 versus 55% of the WHO-II cohort). Especially, women with ovarian dysfunction and polycystic ovaries at ultrasound scan, but without hyperandrogenism, were added to the PCOS diagnostic group. The Rott-PCOS exhibited a lower frequency of obesity, hyperglycaemia and insulin resistance compared with the NIH-PCOS group. Obese women in the Rott-PCOS group without androgen excess had a different metabolic profile compared with obese women in the NIH-PCOS group, with lower rates of hyperglycaemia and hyperinsulinism, despite comparable distributions of body weight. CONCLUSION: The present findings indicate that with the new Rotterdam consensus criteria, oligo/anovulatory women with less severe metabolic derangement will be added to the heterogeneous group of women with PCOS.