Dimitrios Nikolaou
Imperial College School of Medicine, UK
Title: Polycystic ovaries: Time to move on
Biography
Biography: Dimitrios Nikolaou
Abstract
The term polycystic ovary is a misnomer that has been preserved for historical or political reasons. It needs to be abolished, as it is negative, upsetting and misleading. Firstly, there are no cysts but antral follicles. Even with internationally agreed criteria, inter and intra observer variability on diagnosing a polycystic ovary on ultrasound, let alone agreeing on polycystic ovary syndrome, is average at best. Approaching the issue from the ovarian ageing perspective led to a number of interesting observations, which we will review. It is unlikely that there are two different times of human female: the normal and the PCO, with a spectrum between the almost normal ovulatory PCO and the full blown PCOS. Rather, the number of antral follicles we can see on a scan varies among women and depends on their age and ovarian reserve; which in turn depends mainly on the number of eggs they were born with. This number is a continuum in the general population. At one end of the spectrum, women who are born with fewer eggs are destined to go into menopause earlier and will experience reduced fertility at a relatively earlier age. At the other end, women who are born with many eggs will have bigger ovaries with more antral follicles. They are protected against early ovarian ageing and have a number of social characteristics that are advantageous. However, the ovaries of these women are more sensitive to environmental influences.