Comment on trends in onomastics-the case of PCOS by Kalra et al.

Sir,

The earliest description of polycystic ovaries (PCO) dates back to 1721 when Vallisneri reported a “young married peasant woman, moderately obese and infertile with two larger than normal ovaries, bumpy, shiny and whitish, like pigeon eggs”.[1] In 1921 Achard and Theirs observed bearded diabetic women.[2] This was followed in 1935 by Stein and Leventhal's case series of seven women with amenorrhoea, infertility and enlarged cystic ovaries.[3] Polycystic ovaries (PCO) since then have been the focal point of debates in various specialities of modern medicine.

Though polycystic ovaries are included in the Rotterdam diagnostic criteria for PCOS, it can be diagnosed with the other two criteria (hyperandrogensim and chronic anovulation) occurring together without PCO.[4] NIH-NIHCD criteria do not mention it and the Androgen Excess Society has it as an and/or criterion.[56] The pivotal hormonal imbalance is the excess of androgens predominantly ovarian in origin along with insulin resistance, hyperinsulinemia and ensuing cardiovascular risk. The issue of renaming PCOS has been elegantly discussed by Dunaif and Fauser in the September 2013 issue of JCEM.[7] They also quote “Metabolic Reproductive Syndrome (MRS)”, a novel nomenclature suggested by Sheila E Laredo, which aptly highlights the hormonal milieu and its implications. Whether it is MRS, EASY or HAPPY, the time has come to give some thought to the name. While the acronyms suggested by Kalra et al. sound appealing, none of them allude to insulin resistance or its consequences.[8] MRS rectifies this by neatly alluding to metabolic syndrome in the name itself.

While connotation to androgenic/metabolic features applies to large section of patients with polycystic ovaries, the nomenclature fails to encompass some phenotypes where hyperandogenemia/ism are not present. Hence, polycystic ovaries should still be used to describe this morphological feature, when found. It is also of note that for obstetricians and gynaecologists especially in the speciality of infertility where ovarian hyper stimulation is dreaded, this would of help.[7]

Also, as molecular biology and genetics advance, molecular targets may be identified and new names put forth. A phenomic approach focusing on phenotypical features is also being suggested by some. Finally to ponder on, why not give Stein and Leventhal due credit for their original observations and continue to name it after them.