- Phenotypes and body mass in women with PCOS identified in Referral vs. Unselected populations: systematic review and meta-analysis
- Objective: To compare the prevalence of PCOS phenotypes and obesity of PCOS women seen in the clinical (referred) setting vs. those identified in general population.
- Authors of Report
- Methodology description
- Objective: To compare the prevalence of polycystic ovary syndrome (PCOS) phenotypes and obesity among patients detected in referral versus unselected populations.
Design: Systematic review and meta-analysis.
Setting: Not applicable.
Patient(s): Thirteen thousand seven hundred ninety-six reproductive-age patients with PCOS, as defined by the extended 2003
Intervention(s): Review of PUBMED, EMBASE, and Cochrane Library, 2003–2016. Only observational studies were included. Data were
extracted using a web-based, piloted form and combined for meta-analysis.
Main Outcome Measure(s): PCOS phenotypes were classified as follows: phenotype A, clinical and/or biochemical hyperandrogenism
(HA) + oligo-/anovulation (OA) + polycystic ovarian morphology (PCOM); phenotype B, HA+OA; phenotype C, HA+PCOM; and
phenotype D, OA+PCOM.
Result(s): Forty-one eligible studies, reporting on 43 populations, were identified. Pooled estimates of detected PCOS phenotype prevalence were consequently documented in referral versus unselected populations, as  phenotype A, 50% (95% confidence interval [CI], 46%–54%) versus 19% (95% CI, 13%–27%);  phenotype B, 13% (95% CI, 11%–17%) versus 25% (95% CI, 15%–37%);  phenotype C, 14% (95% CI, 12%–16%) versus 34% (95% CI, 25–46%); and  phenotype D, 17% (95% CI, 13%–22%) versus 19% (95% CI, 14%– 25%). Differences between referral and unselected populations were statistically significant for phenotypes A, B, and C. Referral PCOS subjects had a greater mean body mass index (BMI) than local controls, a difference that was not apparent in unselected PCOS.
Conclusion(s): The prevalence of more complete phenotypes in PCOS and mean BMI were higher in subjects identified in referral
versus unselected populations, suggesting the presence of significant referral bias.
- data was entered into this project prospectively (using SRDR's built-in data abstraction function and templates)
- Funding Source
- Funds from the Career Development Award (MD Medical Group) were used to support D.L. throughout the manuscript preparation. No other funding recourses were identified.