Characterization of menstruation and intestinal flora in patients with polycystic ovary syndrome combined with metabolic syndrome
Objective To investigate the significance of menstrual abnormalities in polycystic ovary syndrome(PCOS)for the prediction of future combined metabolic syndrome(MS)and compare the differences in intestinal flora structure between patients with MS and those without.Methods A case-control study was used to select 111 patients with PCOS who attended the outpatient clinic of the Department of Obstetrics and Gynecology of Jinshan Hospital affiliated to Fudan University between February 2021 and December 2023,and they were divided into the group of PCOS not combined with MS(n=74,recorded as the NMS group)and the group of PCOS combined with MS(n=37,recorded as the MS group).The menstrual-related information and stool specimens of all cases were collected to analyze the menstrual characteristics of the two groups and their predictive significance for PCOS combined with MS;and the intestinal flora of the two groups were analyzed by 16S rDNA high-throughput sequencing.Results The age of menstrual changes[(23.47±4.73)years],time of menstrual changes occurring after menarche[(9.85±5.11)years],and duration of menstrual changes[(3.43±2.78)years]in the NMS group were statistically significantly different when compared with those in the MS group[(20.71±3.61)years,P=0.020;(7.04±3.34)years,P=0.025;(7.63±3.47)years,P<0.001].The rate of menstrual abnormality,scanty menstruation and amenorrhea were higher in the MS group than in the NMS group,and the difference in the ratio of the composition of the menstrual pattern between the two groups was statistically significant(P=0.036).The differences in the rates of menstrual abnormalities 8 years later after menarche between the two groups were statistically significant(all P<0.05),and the ORs from 8 to 13 years after menarche were 2.76(95%CI:1.07-7.11),3.68(95%CI:1.28-10.56),3.27(95%CI:1.13-9.41),3.07(95%CI:1.06-8.87),4.20(95%CI:1.16-15.21),11.57(95%CI:1.48-90.49),respectively;the difference in the rate of menstrual abnormality between the two groups with menstrual alteration duration of more than 4 years was also statistically significant(all P<0.05),and the ORs for menstrual alteration duration of 4-9 years were 8.89(95%CI:2.14-36.99),11.88(95%CI:3.07-46.02),16.56(95%CI:4.15-66.13),11.25(95%CI:2.88-32.95),7.80(95%CI:2.04-29.84),and 10.00(95%CI:1.91-52.48),respectively.The α-diversity index of intestinal flora was lower in the MS group than in the NMS group,but the difference was not statistically significant(P>0.05).At the phylum level,there was a statistically significant difference in the abundance of intestinal flora between the two groups(P<0.001),the abundance of Bacteroidetes was lower in the MS group than in the NMS group,and the abundance of the Firmicutes was similar in the two groups.At the genus level,there was a statistically significant difference in the abundance of intestinal flora between the two groups(P<0.001),the abundance of Bifidobacterium decreased and the abundance of Streptococcus and Escherichia increased in the MS group compared with those in the NMS group.Conclusion Abnormal menstruation 8 years later after menarche in patients with PCOS is predictive of future MS,and its predictive effect increases with age,but does not change significantly with the duration of disease in abnormal menstruation.The structure of the intestinal flora of patients with MS in PCOS is indeed significantly different from that of those without MS.
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