Endocrine Abstracts

The action of insulin acting as a co-gonadotrophin in women with PCOS has long been a focus of research. In western populations, a key environmental effect on PCOS is through the obesity epidemic. The resulting insulin resistance has direct effects on the clinical manifestation of PCOS with serum insulin showing positive associations with BMI, serum testosterone, AMH and variably with ovarian volume. AMH is a particularly interesting marker of PCOS with respect to insulin as diverse results have been found with BMI where associations have been found to be either negative or non-existent.

The characteristics of South Asian women with PCOS has been a point of interest over recent years because of the propensity to insulin resistance and type 2 diabetes in this population. While the prevalence of metabolic syndrome has been well documented, relatively little is known about the ovarian response to insulin status in women with PCOS in this region. South Asian women with PCOS have relatively mean low BMI and it is possible to explore the effects of insulin resistance at a lower end of the spectrum than is possible in many western cohorts.

The nature of development in much of India provides an interesting model to explore the effects of environment on PCOS. In rural areas women take a simple diet of millet and undertake physical labour in agriculture. There is then a spectrum of diet and activity through to an urbanised group who have a considerable intake of refined carbohydrate and ‘junk food’ and who take little exercise. Preliminary data from India shows a major impact from life style on several ovarian markers in PCOS including serum AMH concentrations.