Increased androgen, anti-müllerian hormone, and sporadic anovulation in healthy, eumenorrheic women: A mild pcos-like phenotype?

Context: Hyperandrogenism is a hallmark of polycystic ovary syndrome (PCOS) in women with irregular menses, yet the relationship between androgens and ovarian dysfunction remains poorly understood in eumenorrheic women. Objective: The objective of the study was to evaluate whether sporadic anovulation was associated with higher T and anti-müllerian hormone (AMH; marker of ovarian follicle count) concentrations in eumenorrheic women. Design: This was a prospective cohort study from 2005 to 2007. Setting: The study was conducted at the University of Buffalo in western New York state. Participants: A total of 259 eumenorrheic women without a self-reported history of infertility, PCOS, or other endocrine disorder participated in the study. Main Outcome Measures: Total T and AMH were measured five to eight times per cycle for one (n = 9) or two (n=250) cycles per woman (n=509 cycles) with timing of menstrual cycle phase assisted by fertility monitors. Anovulatory cycles were defined biochemically by progesterone and LH concentrations. Repeated-measures ANOVA was conducted on log-transformed data with adjustment for age. Results: Compared with ovulatory cycles (n = 467), sporadic anovulatory cycles (n = 42) had marginally higher total and significantly higher free T [mean 23.7 ng/dL (95% confidence interval [CI] 21.4-26.3) vs 21.6 ng/dL (95% CI 20.9-22.3), P=.08, and 0.36 ng/dL (95% CI 0.33-0.40) vs 0.32 ng/dL (95% CI 0.31-0.33), P = .02, respectively] during menses and also throughout the luteal phase (P.01 for all). Women with higher T had elevated AMH concentrations, increased reporting of a history of acne requiring medical treatment, but not increased hirsutism. Conclusions: Mechanismsofandrogen-relatedovulatorydysfunctionthatcharacterizePCOSinwomen with menstrual disturbancesmayoccur across a continuum of T concentrations, including in eumenorrheic women without clinical hyperandrogenism.