title: Increased androgen, anti-Müllerian hormone, and sporadic anovulation in healthy, eumenorrheic women: a mild PCOS-like phenotype?
abstract: BACKGROUND
  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.
  
  
  METHODS
  This was a prospective cohort study from 2005 to 2007.
  
  
  METHODS
  The study was conducted at the University of Buffalo in western New York state.
  
  
  METHODS
  A total of 259 eumenorrheic women without a self-reported history of infertility, PCOS, or other endocrine disorder participated in the study.
  
  
  METHODS
  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
  Mechanisms of androgen-related ovulatory dysfunction that characterize PCOS in women with menstrual disturbances may occur across a continuum of T concentrations, including in eumenorrheic women without clinical hyperandrogenism.
authors.affiliation: Division of Intramural Population Health Research (L.A.S., S.L.M., K.K., K.C.S., N.J.P., J.W., E.F.S.) and Program of Reproductive and Adult Endocrinology (K.K.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892; Division of Reproductive Endocrinology and Infertility (A.O.H.), Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah 84132; and Department of Social and Preventive Medicine (J.W.-W.), School of Public Health and Health Professions, University at Buffalo, Buffalo, New York 14214.
authors.forename: Lindsey A
authors.initials: LA
authors.lastname: Sjaarda
authors.forename: Sunni L
authors.initials: SL
authors.lastname: Mumford
authors.forename: Kerri
authors.initials: K
authors.lastname: Kissell
authors.forename: Karen C
authors.initials: KC
authors.lastname: Schliep
authors.forename: Ahmad O
authors.initials: AO
authors.lastname: Hammoud
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Perkins
authors.forename: Jennifer
authors.initials: J
authors.lastname: Weck
authors.forename: Jean
authors.initials: J
authors.lastname: Wactawski-Wende
authors.forename: Enrique F
authors.initials: EF
authors.lastname: Schisterman
mesh_terms: D000293:Adolescent; D000328:Adult; D000728:Androgens / Q000097:blood*; D000858:Anovulation / Q000097:blood* / Q000175:diagnosis; D054304:Anti-Mullerian Hormone / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood; D008597:Menstrual Cycle / Q000097:blood; D010641:Phenotype; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000145:classification* / Q000175:diagnosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D013739:Testosterone / Q000097:blood; D055815:Young Adult
chemical_list: D000728:Androgens; D013739:Testosterone; D054304:Anti-Mullerian Hormone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone