Home Factors influencing the prevalence of polycystic ovary syndrome (PCOS) in the United Arab Emirates
Article
Licensed
Unlicensed Requires Authentication

Factors influencing the prevalence of polycystic ovary syndrome (PCOS) in the United Arab Emirates

  • Sarah Dalibalta EMAIL logo , Yara Abukhaled and Fatin Samara
Published/Copyright: May 11, 2022

Abstract

Statistics indicate that at least 20–25% of women suffer from PCOS in the Gulf region. Despite its prevalence and negative implications on reproductive, metabolic, and physiological heath the exact cause of PCOS is unknown, in part due to the diversity of symptoms manifested by this disorder. In this review, we investigate causes of PCOS globally and draw on these studies, to determine the potential contributing factors for PCOS pathogenesis in the UAE population. The most frequently identified factors promoting PCOS pathogenesis that may be pertinent to this population include physiological factors such as insulin resistance, vitamin D deficiency, genetic factors, obesity, and anti-mullerian hormone (AMH) levels in the body as well as environmental factors such as air pollution, endocrine disrupting chemicals, and pesticide use. This evidence will help inform healthcare workers and government agencies to set up optimal guidelines for control and awareness of PCOS in the UAE.


Corresponding author: Sarah Dalibalta, Department of Biology, Chemistry and Environmental Sciences, College of Arts and Sciences, American University of Sharjah, P.O. Box 26666, Sharjah, United Arab Emirates, Phone: +971 6 5152440, Fax: +971 6 515, E-mail: .

Funding source: American University of Sharjah

Award Identifier / Grant number: Unassigned

  1. Research funding: The work was supported by the American University of Sharjah.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent is not applicable.

  5. Ethical approval: Ethical approval is not applicable.

References

1. Melo, AS, Ferriani, RA, Navarro, PA. Treatment of infertility in women with polycystic ovary syndrome: approach to clinical practice. Clinics 2015;70:765–9. https://doi.org/10.6061/clinics/2015(11)09.Search in Google Scholar

2. Bani Mohammad, M, Majdi Seghinsara, A. Polycystic ovary syndrome (PCOS), diagnostic criteria, and AMH. Asian Pac J Cancer Prev APJCP 2017;18:17–21. https://doi.org/10.22034/APJCP.2017.18.1.17.Search in Google Scholar PubMed PubMed Central

3. Knochenhauer, ES, Key, TJ, Kahsar-Miller, M, Waggoner, W, Boots, LR, Azziz, R. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J Clin Endocrinol Metab 1998;83:3078–82. https://doi.org/10.1210/jcem.83.9.5090.Search in Google Scholar PubMed

4. Kauffman, RP, Baker, VM, DiMarino, P, Gimpel, T, Castracane, VD. Polycystic ovarian syndrome and insulin resistance in white and Mexican American women: a comparison of two distinct populations. Am J Obstet Gynecol 2002;187:1362–9. https://doi.org/10.1067/mob.2002.126650.Search in Google Scholar PubMed

5. Naz, MS, Tehrani, FR, Majd, HA, Ahmadi, F, Ozgoli, G, Fakari, FR, et al.. The prevalence of polycystic ovary syndrome in adolescents: a systematic review and meta-analysis. Int J Reprod Biomed 2019;17:533–42. https://doi.org/10.18502/ijrm.v17i8.4818.Search in Google Scholar PubMed PubMed Central

6. Ding, T, Hardiman, PJ, Petersen, I, Wang, FF, Qu, F, Baio, G. The prevalence of polycystic ovary syndrome in reproductive-aged women of different ethnicity: a systematic review and meta-analysis. Oncotarget 2017;8:96351–8. https://doi.org/10.18632/oncotarget.19180.Search in Google Scholar PubMed PubMed Central

7. Begum, GS, Shariff, A, Ayman, G, Mohammad, B, Housam, R, Khaled, N. Assessment of risk factors for development of polycystic ovarian syndrome. Int J Contemp Med Res 2017;1:164–7.Search in Google Scholar

8. Attlee, A, Nusralla, A, Eqbal, R, Said, H, Hashim, M, Obaid, RS. Polycystic ovary syndrome in university students: occurrence and associated factors. Int J Fertil Steril 2014;8:261–6.Search in Google Scholar

9. Khaleej Times. Polyscystic ovarian syndrome on ‘staggering’ rise in UAE. United Arab Emirates: Khaleej Times Health; 2014. Available from: https://www.khaleejtimes.com/nation/uae-health/polycystic-ovarian-syndrome-on-staggering-rise-in-uae.Search in Google Scholar

10. Pramodh, S. Exploration of Lifestyle Choices, reproductive health knowledge, and polycystic ovary syndrome (PCOS). Awareness among female Emirati university students. Int J Wom Health 2020;12:927–38. https://doi.org/10.2147/ijwh.s272867.Search in Google Scholar PubMed PubMed Central

11. Al Khaduri, M, Al Farsi, Y, Al Najjar, TA, Gowri, V. Hospital-based prevalence of polycystic ovarian syndrome among Omani women. Middle East Fertil Soc J 2014;19:135–8. https://doi.org/10.1016/j.mefs.2013.06.006.Search in Google Scholar

12. Sharif, E, Rahman, S, Zia, Y, Rizk, NM. The frequency of polycystic ovary syndrome in young reproductive females in Qatar. Int J Wom Health 2017;9:1–10. https://doi.org/10.2147/IJWH.S120027.Search in Google Scholar PubMed PubMed Central

13. Dargham, SR, Ahmed, L, Kilpatrick, ES, Atkin, SL. The prevalence and metabolic characteristics of polycystic ovary syndrome in the Qatari population. PLoS One 2017;12:e0181467. https://doi.org/10.1371/journal.pone.0181467.Search in Google Scholar PubMed PubMed Central

14. Guraya, SS. Prevalence and ultrasound features of polycystic ovaries in young unmarried Saudi females. J Microsc Ultrastruct 2013;1:30–4. https://doi.org/10.1016/j.jmau.2013.06.002.Search in Google Scholar

15. Kalyan, S, Goshtesabi, A, Sarray, S, Joannou, A, Almawi, WY. Assessing C reactive protein/albumin ratio as a new biomarker for polycystic ovary syndrome: a case-control study of women from Bahraini medical clinics. BMJ Open 2018;8:e021860. https://doi.org/10.1136/bmjopen-2018-021860.Search in Google Scholar PubMed PubMed Central

16. Lin, MW, Wu, MH. The role of vitamin D in polycystic ovary syndrome. IJMR 2015;142:238–40. https://doi.org/10.4103/0971-5916.166527.Search in Google Scholar PubMed PubMed Central

17. Reusch, JE, Begum, N, Sussman, KE, Draznin, B. Regulation of GLUT-4 phosphorylation by intracellular calcium in adipocytes. Endocrinology 1991;129:3269–73. https://doi.org/10.1210/endo-129-6-3269.Search in Google Scholar PubMed

18. Wollheim, CB, Sharp, GW. Regulation of insulin release by calcium. Physiol Rev 1981;61:914–73. https://doi.org/10.1152/physrev.1981.61.4.914.Search in Google Scholar PubMed

19. Dubai Health, Authority. 90% of the UAE population is vitamin D deficient, says DHA officials; 2017. United Arab Emirates: Gulf News Better Health. Available from: https://www.dha.gov.ae/en/BetterHealth/Betterhealth2017nov06-60.pdf.Search in Google Scholar

20. Nimri, LF. Vitamin D status of female UAE college students and associated risk factors. J Public Health 2018;40:284–90. https://doi.org/10.1093/pubmed/fdy009.Search in Google Scholar PubMed

21. Dunaif, A, Wu, X, Lee, A, Diamanti-Kandarakis, E. Defects in insulin receptor signaling in vivo in the polycystic ovary syndrome (PCOS). Am J Physiol Endocrinol 2001;281:392–9. https://doi.org/10.1152/ajpendo.2001.281.2.E392.Search in Google Scholar PubMed

22. Ciaraldi, TP, Morales, AJ, Hickman, MG, Odom-Ford, R, Olefsky, JM, Yen, SS. Cellular insulin resistance in adipocytes from obese polycystic ovary syndrome subjects involves adenosine modulation of insulin sensitivity. J Clin Endocrinol Metab 1997;82:1421–5. https://doi.org/10.1210/jcem.82.5.3961.Search in Google Scholar PubMed

23. Baptiste, CG, Battista, MC, Trottier, A, Baillargeon, JP. Insulin and hyperandrogenism in women with polycystic ovary syndrome. J Steroid Biochem Mol Biol 2010:122:42–52. https://doi.org/10.1016/j.jsbmb.2009.12.010.Search in Google Scholar PubMed PubMed Central

24. Suresh, S, Vijayakumar, T. Correlations of insulin resistance and serum testosterone levels with LH:FSH ratio and oxidative stress in women with functional ovarian hyperandrogenism. Indian J Clin Biochem 2015;30:345–50. https://doi.org/10.1007/s12291-014-0447-z.Search in Google Scholar PubMed PubMed Central

25. Atlas, D. UAE diabetes trend. International Diabetes Federation 2015;33.Search in Google Scholar

26. Alsafar, H, Jama-Alol, KA, Hassoun, AA, Tay, GK. The prevalence of type 2 diabetes mellitus in the United Arab Emirates: justification for the establishment of the Emirates family registry. Int J Diabetes Dev Ctries 2012;32:25–32. https://doi.org/10.1007/s13410-012-0062-6.Search in Google Scholar

27. Ovalle, F, Azziz, R. Insulin resistance, polycystic ovary syndrome, and type 2 diabetes mellitus. Fertil Steril 2002;77:1095–105. https://dx.doi.org/10.1016/s0015-0282(02)03111-4.10.1016/S0015-0282(02)03111-4Search in Google Scholar

28. Dapas, M, Sisk, R, Legro, R, Urbanek, M, Dunaif, A, Hayes, G. Family-based quantitative trait meta-analysis implicates rare noncoding variants in DENND1A in polycystic ovary syndrome. Int J Clin Endocrinol Metabol 2019;104:3835–50. https://doi.org/10.1210/jc.2018-02496.Search in Google Scholar

29. Chen, ZJ, Zhao, H, He, L, Shi, Y, Qin, Y, Li, Z, et al.. Genome-wide association study identifies susceptibility loci for polycystic ovary syndrome on chromosome 2p16.3, 2p21 and 9q33.3. Nat Genet 2011;43:55–9. https://doi.org/10.1038/ng.732.Search in Google Scholar

30. Wickenheisser, JK, Quinn, PG, Nelson, VL, Legro, RS, Strauss, JF, McAllister, JM. Differential activity of the cytochrome P450 17alpha-hydroxylase and steroidogenic acute regulatory protein gene promoters in normal and polycystic ovary syndrome theca cells. Int J Clin Endocrinol Metabol 2000;85:2304–11. https://doi.org/10.1210/jcem.85.6.6631.Search in Google Scholar

31. Tucci, S, Futterweit, W, Concepcion, ES, Greenberg, DA, Villanueva, R, Davies, TF, et al.. Evidence for association of polycystic ovary syndrome in caucasian women with a marker at the insulin receptor gene locus. Int J Clin Endocrinol Metabol 2001;86:446–9. https://doi.org/10.1210/jcem.86.1.7274.Search in Google Scholar

32. Day, F, Karaderi, T, Jones, MR, Meun, C, He, C, Drong, A, et al.. Large-scale genome-wide meta-analysis of polycystic ovary syndrome suggests shared genetic architecture for different diagnosis criteria. PLoS Genet 2018;14:e1007813. https://doi.org/10.1371/journal.pgen.1007813.Search in Google Scholar

33. Franks, S, Mason, H, Willis, D. Follicular dynamics in the polycystic ovary syndrome. Mol Cell Endocrinol 2000;163:49–52. https://doi.org/10.1016/s0303-7207(99)00239-7.Search in Google Scholar

34. Pellatt, L, Hanna, L, Brincat, M, Galea, R, Brain, H, Whitehead, S, et al.. Granulosa cell production of anti-Mullerian hormone is increased in polycystic ovaries. J Clin Endocrinol Metab 2007;92:240–5. https://doi.org/10.1210/jc.2006-1582.Search in Google Scholar PubMed

35. Tata, B, Mimouni, NE, Barbotin, AL, Malone, SA, Loyens, A, Pigny, P, et al.. Elevated prenatal anti-Müllerian hormone reprograms the fetus and induces polycystic ovary syndrome in adulthood. Nat Med 2018;24:834–46. https://doi.org/10.1038/s41591-018-0035-5.Search in Google Scholar PubMed PubMed Central

36. Sam, S. Obesity and polycystic ovary syndrome. Obes Manag 2007;3:69–73. https://doi.org/10.1089/obe.2007.0019.Search in Google Scholar PubMed PubMed Central

37. Hardy, OT, Czech, MP, Corvera, S. What causes the insulin resistance underlying obesity? Curr Opin Endocrinol Diabetes Obes 2012;19:81–7. https://doi.org/10.1097/med.0b013e3283514e13.Search in Google Scholar

38. International Diabetes, Federation. IDF Diabetes Atlas, 9th ed. Brussels: International Diabetes Federation; 2020:7–44 pp.Search in Google Scholar

39. Gomathi, K, Shaafie, IA, Mummigatti, K, Shahid, S, Sreedharan, J. Biochemical parameters in women with polycystic ovary syndrome in Ajman, UAE. Nepal. J Obstet Gynaecol 2011;6:7–10.10.3126/njog.v6i2.6748Search in Google Scholar

40. Merkin, SS, Phy, JL, Sites, CK, Yang, D. Environmental determinants of polycystic ovary syndrome. Fertil Steril 2016;106:16–24. https://doi.org/10.1016/j.fertnstert.2016.05.011.Search in Google Scholar PubMed

41. Park, CJ, Barakat, R, Ulanov, A, Li, Z, Lin, PC, Chiu, K, et al.. Sanitary pads and diapers contain higher phthalate contents than those in common commercial plastic products. Reprod Toxicol 2019;84:114–21. https://doi.org/10.1016/j.reprotox.2019.01.005.Search in Google Scholar PubMed PubMed Central

42. Gao, H, Yang, BJ, Li, N, Feng, LM, Shi, XY, Zhao, WH, et al.. Bisphenol A and hormone-associated cancers: current progress and perspectives. Medicine 2015;94:e211. https://doi.org/10.1097/md.0000000000000211.Search in Google Scholar PubMed PubMed Central

43. Kandaraki, E, Chatzigeorgiou, A, Livadas, S, Palioura, E, Economou, F, Koutsilieris, M, et al.. Endocrine disruptors and polycystic ovary syndrome (PCOS): elevated serum levels of bisphenol A in women with PCOS. J Clin Endocrinol Metab 2011;96:480–4. https://doi.org/10.1210/jc.2010-1658.Search in Google Scholar PubMed

44. Takeuchi, T, Tsutsumi, O, Ikezuki, Y, Takai, Y, Taketani, Y. Positive relationship between androgen and the endocrine disruptor, bisphenol A, in normal women and women with ovarian dysfunction. Endocr J 2004;51:165–9. https://doi.org/10.1507/endocrj.51.165.Search in Google Scholar PubMed

45. Hannon, PR, Flaws, JA. The effects of phthalates on the ovary. Front Endocrinol 2015;6:104–7. https://doi.org/10.3389/fendo.2015.00008.Search in Google Scholar PubMed PubMed Central

46. Blount, BC, Silva, MJ, Caudill, SP, Needham, LL, Pirkle, JL, Sampson, EJ, et al.. Levels of seven urinary phthalate metabolites in a human reference population. Environ Health Perspect 2000;108:979–82. https://doi.org/10.1289/ehp.00108979.Search in Google Scholar PubMed PubMed Central

47. Heudorf, U, Mersch-Sundermann, V, Angerer, J. Phthalates: toxicology and exposure. Int J Hyg Environ Health 2007;210:623–34. https://doi.org/10.1016/j.ijheh.2007.07.011.Search in Google Scholar PubMed

48. Aldyreva, MV, Klimova, TS, Iziumova, AS, Timofeevskaia, LA. Vliianie ftalatnykh plastifikatorov na generativnyiu funkstsiiu [The effect of phthalate plasticizers on the generative function]. Gig Tr Prof Zabol 1975;12:25–9.Search in Google Scholar

49. Eladak, S, Grisin, T, Moison, D, Guerquin, MJ, N’Tumba-Byn, T, Pozzi-Gaudin, S, et al.. A new chapter in the bisphenol A story: bisphenol S and bisphenol F are not safe alternatives to this compound. Fertil Steril 2015;103:11–21. https://doi.org/10.1016/j.fertnstert.2014.11.005.Search in Google Scholar PubMed

50. Herrero, Ó, Aquilino, M, Sánchez-Argüello, P, Planelló, R. The BPA-substitute bisphenol S alters the transcription of genes related to endocrine, stress response and biotransformation pathways in the aquatic midge Chironomus riparius (Diptera, Chironomidae). PLoS One 2018;13:e0193387. https://doi.org/10.1371/journal.pone.0193387.Search in Google Scholar PubMed PubMed Central

51. Wang, W, Abualnaja, KO, Asimakopoulos, AG, Covaci, A, Gevao, B, Johnson-Restrepo, B, et al.. A comparative assessment of human exposure to tetrabromobisphenol A and eight bisphenols including bisphenol A via indoor dust ingestion in twelve countries. Environ Int 2015;83:183–91. https://doi.org/10.1016/j.envint.2015.06.015.Search in Google Scholar PubMed

52. Li, Y, Zhang, MW, Wang, YJ. Association between the persistent organic pollutants and polycystic ovary syndrome: a protocol for a systematic review and meta-analysis. Medicine 2018;98: e16948. https://doi.org/10.1097/MD.0000000000016948.Search in Google Scholar PubMed PubMed Central

53. Pan, W, Ye, X, Yin, S, Ma, X, Li, C, Zhou, J, et al.. Selected persistent organic pollutants associated with the risk of primary ovarian insufficiency in women. Environ Int 2019;129:51–8. https://doi.org/10.1016/j.envint.2019.05.023.Search in Google Scholar PubMed

54. Guo, Z, Qiu, H, Wang, L, Wang, L, Wang, C, Chen, M, et al.. Association of serum organochlorine pesticides concentrations with reproductive hormone levels and polycystic ovary syndrome in a Chinese population. Chemosphere 2017;171:595–600. https://doi.org/10.1016/j.chemosphere.2016.12.127.Search in Google Scholar PubMed

55. Annamalai, J, Namasivayam, V. Endocrine disrupting chemicals in the atmosphere: their effects on humans and wildlife. Environ Int 2015;76:78–97. https://doi.org/10.1016/j.envint.2014.12.006.Search in Google Scholar PubMed

56. Yang, Q, Zhao, Y, Qiu, X, Zhang, C, Li, R, Qiao, J. Association of serum levels of typical organic pollutants with polycystic ovary syndrome (PCOS): a case–control study. Hum Reprod 2015;30:1964–73. https://doi.org/10.1093/humrep/dev123.Search in Google Scholar PubMed

57. Bretveld, RW, Thomas, CM, Scheepers, PT, Zielhuis, GA, Roeleveld, N. Pesticide exposure: the hormonal function of the female reproductive system disrupted. RBE (Rev Bras Entomol) 2006;4:30. https://doi.org/10.1186/1477-7827-4-30.Search in Google Scholar PubMed PubMed Central

58. Gulf, News. Move to rein in high use of pesticides in UAE agriculture. United Arab Emirates: Gulf News; 2012 Available from: https://gulfnews.com/uae/environment/move-to-rein-in-high-use-of-pesticides-in-uae-agriculture-1.994615.Search in Google Scholar

59. Yaghmour, F, Samara, F, Alam, I. Analysis of polychlorinated biphenyls, polycyclic aromatic hydrocarbons and organochlorine pesticides in the tissues of green sea turtles, Chelonia mydas, (Linnaeus, 1758) from the eastern coast of the United Arab Emirates. Mar Pollut Bull 2020;160:111574. https://doi.org/10.1016/j.marpolbul.2020.111574.Search in Google Scholar PubMed

60. Samara, F, Elsayed, Y, Soghomonian, B, Knuteson, SL. Chemical and biological assessment of sediments and water of Khalid Khor, Sharjah, United Arab Emirates. Mar Pollut Bull 2016;111:268–76. https://doi.org/10.1016/j.marpolbul.2016.06.107.Search in Google Scholar PubMed

61. Dalibalta, S, Samara, F, Qadri, H, Adouchana, H. Potential causes of asthma in the United Arab Emirates: drawing insights from the Arabian Gulf. Rev Environ Health 2018;33:205–12. https://doi.org/10.1515/reveh-2017-0030.Search in Google Scholar PubMed

62. International Association for Medical Assistance to Travellers. United Arab Emirates General Health Risks; 2020. Available from: https://www.iamat.org/country/united-arab-emirates/risk/air-pollution#:∼:text=The%20most%20recent%20data%20indicates,industrial%20emissions%20and%20vehicle%20emissions.Search in Google Scholar

63. Lin, SY, Yang, YC, Chang, CY, Lin, CC, Hsu, WH, Ju, SW, et al.. Risk of polycystic ovary syndrome in women exposed to fine air pollutants and acidic gases: a nationwide cohort analysis. Int J Environ Res 2019;16:4816. https://doi.org/10.3390/ijerph16234816.Search in Google Scholar PubMed PubMed Central

64. Li, Y, Gibson, JM, Jat, P, Puggioni, G, Hasan, M, West, JJ, et al.. Burden of disease attributed to anthropogenic air pollution in the United Arab Emirates: estimates based on observed air quality data. Sci Total Environ 2010;408:5784–93. https://doi.org/10.1016/j.scitotenv.2010.08.017.Search in Google Scholar PubMed

65. Wolf, WM, Wattick, RA, Kinkade, ON, Olfert, MD. The current description and future need for multidisciplinary PCOS clinics. Clin Med 2018;7:395. https://doi.org/10.3390/jcm7110395.Search in Google Scholar PubMed PubMed Central

Received: 2021-03-16
Accepted: 2022-04-14
Published Online: 2022-05-11
Published in Print: 2022-09-27

© 2022 Walter de Gruyter GmbH, Berlin/Boston

Downloaded on 10.11.2025 from https://www.degruyterbrill.com/document/doi/10.1515/reveh-2021-0036/html
Scroll to top button