GYNECOLOGIC ENDOCRINOLOGY AND REPRODUCTIVE MEDICINE Comparison of clinical and hormonal characteristics among four phenotypes of polycystic ovary syndrome based on the Rotterdam criteria Avin S. Jamil 1 • Shahla K. Alalaf 1 • Namir G. Al-Tawil 2 • Talha Al-Shawaf 3 Received: 11 March 2015 / Accepted: 11 September 2015 Ó Springer-Verlag Berlin Heidelberg 2015 Abstract Purpose Polycystic Ovary Syndrome (PCOS) is the most common endocrine disturbances in women and is divided into different phenotypes. The aim of study is to compare the clinical and hormonal parameters among the four phenotypes of PCOS based on the Rotterdam criteria and with control group. Methods Women with PCOS (n = 263) confirmed based on the Rotterdam criteria and 263 women with no evidence of PCOS were recruited as controls using observational case–control study. Evaluation of clinical and hormonal parameters, and differences in anti-Mullerian hormone (AMH) were compared between four phenotypes of PCOS and controls. Results Women with phenotype A (olig-anovulation (O) ? hyperandrogenism (H) ? polycystic ovary mor- phology (P)) had significantly larger waist than phenotype D (O ? P) and higher body mass index than phenotype C (H ? P). The LH/FSH ratio was significantly higher in phenotype A than phenotype D and controls along with significantly higher serum total testosterone levels in phe- notype A compared to the phenotype B (O ? H), C, D, and controls. AMH was significantly higher with phenotype A, C, and D than in women phenotype B and controls. Conclusions The highest AMH levels were found in phenotype A. Phenotype B similar to controls had signifi- cantly low AMH compared to other three PCOS pheno- types. Women in the phenotypes D and controls showed significantly lower levels of LH/FSH ratio, total testos- terone, and free androgen index, and higher levels of FSH and SHBG compared with phenotype A (P \ 0.001). In logistic regression analysis, AMH and LH were predictors for PCOS. Keywords PCOS Á Rotterdam PCOS phenotypes Á Anti- mullerian hormone Á Hyperandrogenism Á Obesity Introduction Polycystic ovary syndrome (PCOS) is the most frequently encountered endocrinopathy and affects 5–8 % of repro- ductive-age women [1]. PCOS is characterized by chronic oligo-ovulation or anovulation (O), clinical or biochemical hyperandrogenism (H), and polycystic ovaries morphology (P) [2]. This disorder is associated with an increased risk of hyperinsulinemia, insulin resistance, type 2 diabetes mel- litus, dyslipidemia, and cardiovascular diseases [3]. PCOS is heterogeneous disorder that may include different phe- notypes [4]. The Rotterdam ESHRE/ASRM definition rec- ognizes four PCOS phenotypes, based on the presence of olig-anovulation (O), hyperandrogenism (H), and & Avin S. Jamil avinsadiq_2008@yahoo.com Shahla K. Alalaf shahla_alaf@yahoo.com Namir G. Al-Tawil namiraltawil@yahoo.com Talha Al-Shawaf talhayas@aol.com 1 Department of Obstetrics and Gynecology, College of Medicine, Hawler Medical University, Khanzad Street, PO Box 383-65, Erbil, Iraq 2 Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq 3 Women’s Health Research Unit, Centre for Primary Care and Public Health, Barts and The London Medical College, Queen Mary University, London, UK 123 Arch Gynecol Obstet DOI 10.1007/s00404-015-3889-5