Polycystic ovary syndrome and associated metabolic features in indigenous women in the Northern Territory

Abstract

Polycystic Ovary Syndrome (PCOS), the most common endocrinological problem in reproductive aged women, has been found in population based studies to be present in 4–8% of women from Caucasian, African American and Sri Lankan backgrounds (Asunción et al. 2000, Diamanti-Kandarakis et al. 1999, Knochenhauer et al. 1998, Kumarapeli et al. 2008). Australian Indigenous women would be anticipated to be more at risk of PCOS due to rising obesity, diabetes and associated components of metabolic syndrome. A small study of Australian Indigenous women in Victoria and Western Australia appears to support this hypothesis reporting a prevalence of PCOS of 18% (Davis et al. 2002). This study aimed, therefore, to assess the reproductive characteristics, the prevalence of PCOS and the associated burden of diabetes, obesity, dyslipidaemia and hypertension in a group of urban Indigenous women living in Darwin, Northern Territory (NT). A number of issues in this study warrant further attention: a high proportion of early teenage pregnancy, significant infertility, high testosterone measures and a high proportion with PCOS. Of the 424 women screened, 248 met the study inclusion criteria and of these, 38 (15.3%) had PCOS. The frequency of PCOS increased in those women who were overweight or obese by BMI; in women with a BMI ≥ 30kg/m² the prevalence was 29.9%. The frequency of PCOS did not change with central obesity probably because it was the typical pattern of fat distribution in this group. This research highlights the importance of awareness of PCOS in Indigenous women among health providers and policy makers. Whilst the majority of women with metabolic or glucose abnormalities were overweight or obese and ≥ 35 years, a significant minority were younger with normal BMI. Screening therefore should be considered for all women with PCOS for dyslipidaemia and IGT/diabetes. Potential future research includes exploration of knowledge and attitudes to family planning and reproductive health; optimum ways to provide education and health services to Indigenous women; the identification of young women at risk of future metabolic complications and their prevention, and a comparison of androgens in Indigenous and non-Indigenous women.