International Journal of Clinical Obstetrics and Gynaecology

Author(s): Aishhwarrya Umeshchandara G, Sonali Appaiah, Vageesh Ayyar, Ganapathi Bantwal and Belinda George

Abstract:

Introduction: Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism, anovulation, and metabolic dysfunction, with adiposity and insulin resistance contributing to long-term cardiometabolic risk. Autonomic imbalance has been proposed as an additional mechanistic link, but data remains inconclusive. Given the ethnic variation in adiposity distribution and autonomic adaptation, evaluating autonomic function in early, untreated PCOS is clinically relevant.

Aim: To compare cardiac autonomic function between treatment-naïve women with PCOS and healthy controls using standardized autonomic testing, and to examine associations between autonomic indices, adiposity, metabolic parameters, and serum testosterone.

Methodology: This cross-sectional study included 30 women with PCOS and 30 age-matched controls. Anthropometry, body fat percentage, lipid profile, and serum testosterone were assessed. Cardiac autonomic function was evaluated using CANWin® implementing Ewing’s protocol (30:15 ratio, Valsalva ratio, deep-breathing E:I ratio) and HRV spectral measures (Low frequency power (LF), high frequency power(HF) and ratio LF/HF).

Results: PCOS participants exhibited significantly higher BMI, waist-hip ratio(WHR), and body fat percentage (all p<0.001). However, autonomic function indices, including 30:15 ratio, Valsalva ratio, E:I ratio, LF, HF, and LF/HF, were comparable between groups (all p>0.05). Within the PCOS group, serum testosterone showed a positive association with HF power (r = 0.40, p = 0.031), while LF/HF ratio correlated negatively with HDL cholesterol (r = -0.39, p = 0.02). No significant correlations were found with BMI, WHR and body fat.

Conclusion: Despite greater adiposity and metabolic derangements, treatment-naïve Indian women with PCOS demonstrated preserved cardiac autonomic function. The positive association of testosterone with vagal indices and the HDL-LF/HF relationship suggest early compensatory autonomic modulation rather than overt sympathovagal imbalance. These findings support the possibility that autonomic dysfunction may emerge later in the disease course or differ across ethnic phenotypes.

DOI: https://doi.org/10.33545/gynae.2025.v9.i6i.1816

Pages: 1439-1444 | 120 Views | 57 Downloads

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