Research Article| Volume 34, ISSUE 5, P610-616, October 2021

Polycystic Ovarian Morphology in Normocyclic Non-hyperandrogenic Adolescents

Published:February 07, 2021DOI:



      To understand whether polycystic ovarian morphology (PCOM) represents a transient phase, and whether an increased stroma could help to characterize the phenotype of the ovary in adolescence.


      Cross-sectional population-based study on high-school students in Cagliari, Italy.
      The study population consisted of 257 normocyclic non-hyperandrogenic girls selected from a sample of 600 healthy volunteers recruited from 2012 to 2016. Clinical examination, medical history, blood sampling, and pelvic ultrasound (US) were performed. Postmenarchal years and body mass index (BMI) were estimated. Follicle-stimulating hormone (FSH), luteinizing hormone (LH), 17β estradiol (E2), total testosterone (tT), delta-4-androstenedione (A), and 17-hydroxyprogesterone (17-OHP) were measured. Ovarian volume, follicular number per section (FNPS), and S/A ratio were measured by pelvic US.


      Following the Rotterdam guidelines for US PCOS diagnosis and setting the normal S/A ratio at ≤0.3, subjects were categorized into 3 groups: (1) normal ovarian morphology (NOM; n = 154, 60%); (2) polycystic ovarian morphology (PCOM) with normal S/A ratio (PCOM-NS; n = 70, 27%); and (3) PCOM with increased S/A ratio (PCOM-IS; n = 33, 13%). The NOM group had more postmenarchal years and a lower LH than both the PCOM groups, and lower A and tT than the PCOM-IS group. The PCOM-NS group had fewer postmenarchal years and lower A than the PCOM-IS group. Interestingly, unlike NOM and PCOM-NS, the prevalence of PCOM-IS remained constant among the 3 phases of postmenarchal age (10% vs 16% vs 15%, P = not significant).


      This study demonstrates that PCOM can be a transient condition, whereas a high S/A ratio is a stable US alteration present from early postmenarchal years.

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        • Carmina E.
        • Oberfield S.E.
        • Lobo R.A.
        The diagnosis of polycystic ovary syndrome in adolescents.
        Obstet Gynecol. 2010; 203: 201
        • Hardy T.S.
        • Norman R.J.
        Diagnosis of adolescent polycystic ovary syndrome.
        Steroids. 2013; 78: 751
        • Van Hooff M.H.
        • Voorhorst F.J.
        • Kaptein M.B.
        • et al.
        Relationship of the menstrual cycle pattern in 14-17-year-old adolescents.
        Hum Reprod. 2017; 13: 2252-2256
        • Clayton R.N.
        • Ogden V.
        • Hodgkinson J.
        • et al.
        How common are polycystic ovaries in normal women and what is their significance for the fertility of the population?.
        Clin Endocrinol. 1992; 37: 127
        • Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group
        Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS).
        Hum Reprod. 2003; 19: 41
        • Teede H.J.
        • Costello M.F.
        • Dokras A.
        • et al.
        International PCOS Network Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome.
        Fertil Steril. 2018; 110: 364
        • Fruzzetti F.
        • Campagna A.M.
        • Perini D.
        • et al.
        Ovarian volume in normal and hyperandrogenic adolescent women.
        Fertil Steril. 2015; 104: 196
        • Venturoli S.
        • Porcu E.
        • Fabbri R.
        • et al.
        Longitudinal change of sonographic ovarian aspects and endocrine parameters in irregular cycles of adolescence.
        Pediatr Res. 1995; 38: 974
        • Mortensen M.
        • Rosenfield R.L.
        • Littlejohn E.
        Functional significance of polycystic size ovaries in healthy adolescence.
        J Clin Endocrinol Metab. 2006; 911: 3786
        • Catteau-Jonard S.
        • Bancquart J.
        • Poncelet E.
        • et al.
        Polycystic ovaries at ultrasound: normal variant or silent polycystic ovary syndrome?.
        Ultrasound Obstet Gynecol. 2012; 40: 223
        • Hassan M.A.
        • Killick S.R.
        Ultrasound diagnosis of polycystic ovary syndrome is not associated with subfecundity or subfertility.
        Fertil Steril. 2003; 80: 966
        • Fulghesu A.M.
        • Angioni S.
        • Frau E.
        • et al.
        Ultrasound in polycystic ovary syndrome–the measuring of ovarian stroma and relationship with circulating androgens: results of a multicentric study.
        Hum Reprod. 2007; 22: 2501
        • Belosi C.
        • Giuliani M.
        • Suriano R.
        • et al.
        Diagnosis of polycystic ovary syndrome.
        Minerva Ginecol. 2004; 56: 7
        • Belosi C.
        • Selvaggi L.
        • Apa R.
        • et al.
        Is the PCOS diagnosis solved by ESHRE/ASRM 2003 consensus or could it include ultrasound examination of the ovarian stroma?.
        Hum Reprod. 2006; 21: 3108
        • Fulghesu A.M.
        • Angioni S.
        • Belosi C.
        • et al.
        Pituitary-ovarian response to the gonadotropin-releasing hormone-agonist test in anovulatory patients with polycystic ovary syndrome: predictive role of ovarian stroma.
        Clin Endocrinol. 2006; 65: 396
        • Christ J.P.
        • Willis A.D.
        • Brooks E.D.
        • et al.
        Follicle number, not assessments of the ovarian stroma, represents the best ultrasonographic marker of polycystic ovary syndrome.
        Fertil Steril. 2014; 101: 280
        • Dewailly D.
        • Lujan M.
        • Carmina E.
        • et al.
        Definition and significance of polycystic ovarian morphology: a task force report from the Androgen Excess and Polycystic Ovary Syndrome Society.
        Hum Reprod Update. 2014; 20: 334
        • Ferriman D.
        Gallway: Clinical assessment of body hair growth in women.
        J Clin Endocrinol Metab. 1961; 21: 1440
        • Jarrett B.J.
        • Vanden Brink H.
        • Brooks E.D.
        • et al.
        Impact of right–left differences in ovarian morphology on the ultrasound diagnosis of polycystic ovary syndrome.
        Fertil Steril. 2019; 112: 939
        • Lujan M.E.
        • Jarrett B.Y.
        • Brooks E.D.
        • et al.
        Updated ultrasound criteria for polycystic ovary syndrome: reliable thresholds for elevated follicle population and ovarian volume.
        Hum Reprod. 2013; 28: 1361
        • Balen A.
        • Laven J.
        • Tan S.
        • et al.
        Ultrasound assessment of the polycystic ovary: international consensus definitions.
        Hum Reprod Update. 2003; 9: 505
        • Zhu R.Y.
        • Wong Y.C.
        • Yong E.L.
        Sonographic evaluation of polycystic ovaries.
        Best Pract Res Clin Obstet Gynaecol. 2016; 37: 25
        • Cremoncini Vignati E.
        • Libroia A.
        Treatment of hirsutism and acne in women with two combinations of cyproterone acetate and ethinylestradiol.
        Acta Eur Fertil. 1976; 7: 299
        • Streiner D.L.
        Health Measurement Scales. A Practical Guide to Their Development and Use.
        Oxford University Press, New York1989
        • Ibáñez L.
        • Oberfield S.E.
        • Witchel S.
        • et al.
        An international consortium update: pathophysiology, diagnosis, and treatment of polycystic ovarian syndrome in adolescence.
        Horm Res Paediatr. 2017; 88: 371
        • Merino P.M.
        • Villarroel C.
        • Jesam C.
        • et al.
        New diagnostic criteria of polycystic ovarian morphology for adolescents: impact on prevalence and hormonal profile.
        Horm Res Paediatr. 2017; 88: 401
        • Codner E.
        • Villarroel C.
        • Eyzaguirre F.C.
        • et al.
        Polycystic ovarian morphology in postmenarchal adolescents.
        Fertil Steril. 2011; 95: 702
        • Fulghesu A.M.
        • Ciampelli M.
        • Belosi C.
        • et al.
        A new ultrasound criterion for the diagnosis of polycystic ovary syndrome: the ovarian stroma/total area ratio.
        Fertil Steril. 2001; 76: 326
        • Battaglia C.
        • Battaglia B.
        • Morotti E.
        • et al.
        Two- and three-dimensional sonographic and color Doppler techniques for diagnosis of ovary syndrome. The stromal/ovarian volume ratio as a new diagnostic criterion.
        J Ultrasound Med. 2012; 31: 1015
        • Sun L.
        • Fu Q.
        Three-dimensional transrectal ultrasonography in adolescent patients with polycystic ovarian syndrome.
        Int J Gynaecol Obstet. 2007; 98: 34
        • Leerasiri P.
        • Wongwananuruk T.
        • Rattanachaiyanont M.
        • et al.
        Ratio of ovarian stroma and total ovarian area by ultrasound in prediction of hyperandrogenemia in reproductive-aged Thai women with polycystic ovary syndrome.
        J Obstet Gynaecol Res. 2015; 41: 248
        • Adams J.
        • Franks S.
        • Polson D.W.
        • et al.
        Multifollicular ovaries: clinical and endocrine features and response to pulsatile gonadotropin releasing hormone.
        Lancet. 1985; 2: 1375