Polycystic Ovary Syndrome: An Evolutionary Adaptation to Lifestyle and the Environment

Abstract

Polycystic ovary syndrome (PCOS) is increasingly recognized as a complex metabolic disorder that manifests in genetically susceptible women following a range of negative exposures to nutritional and environmental factors related to contemporary lifestyle. The hypothesis that PCOS phenotypes are derived from a mismatch between ancient genetic survival mechanisms and modern lifestyle practices is supported by a diversity of research findings. The proposed evolutionary model of the pathogenesis of PCOS incorporates evidence related to evolutionary theory, genetic studies, in-utero developmental epigenetic programming, transgenerational inheritance, metabolic features including insulin resistance, obesity and the apparent paradox of lean phenotypes, reproductive effects and subfertility, the impact of the microbiome and dysbiosis, endocrine disrupting chemical exposure, and the influence of lifestyle factors such as poor quality diet and physical inactivity. Based on these premises, the diverse lines of research are synthesized into a composite evolutionary model of the pathogenesis of PCOS. It is hoped that this model will assist clinicians and patients to understand the importance of lifestyle interventions in the prevention and management of PCOS and provide a conceptual framework for future research. It is appreciated that this theory represents a synthesis of the current evidence and that it is expected to evolve and change over time.

A narrative review of the role of gastrointestinal dysbiosis in the pathogenesis of polycystic ovary syndrome

“…As a class of agents, synbiotics have a growing evidence base for the treatment of obesity [ 104 ], gestational diabetes [ 105 ], type 1 [ 106 ], and type 2 diabetes [ 107 ]. It is not surprising that synbiotics have also been evaluated in the treatment of women with PCOS, since PCOS is part of this related cluster of metabolic conditions [ 5 , 108 – 110 ].…”

“…Polycystic ovary syndrome (PCOS) is both a metabolic and endocrine syndrome that affects 6–15% of reproductive-age women, or approximately 200 million globally, and is believed to be increasing in frequency [ 1 – 4 ]. PCOS is now being recognized as an ecological condition that arises in genetically susceptible women due to a mismatch between ancestral inherited adaptive genetic polymorphisms and modern lifestyle [ 5 ]. This evolving ecological view of PCOS takes into account the interaction between lifestyle and environmental factors, such as diet and activity levels, with developmentally programmed metabolic and endocrine pathways [ 3 , 5 – 7 ].…”

“…PCOS is now being recognized as an ecological condition that arises in genetically susceptible women due to a mismatch between ancestral inherited adaptive genetic polymorphisms and modern lifestyle [ 5 ]. This evolving ecological view of PCOS takes into account the interaction between lifestyle and environmental factors, such as diet and activity levels, with developmentally programmed metabolic and endocrine pathways [ 3 , 5 – 7 ]. This view supports the recommendations of the 2018 International Guidelines that the first-line management of women with PCOS should focus on lifestyle-based approaches [ 8 ].…”

“…This view supports the recommendations of the 2018 International Guidelines that the first-line management of women with PCOS should focus on lifestyle-based approaches [ 8 ]. The pathogenesis of many chronic diseases, particularly a range of metabolic diseases associated with PCOS, such as obesity, type-2 diabetes, metabolic syndrome, and gestational diabetes, are also being considered from an evolutionary perspective [ 5 , 6 , 9 ].…”

Polycystic Ovary Syndrome: An Evolutionary Adaptation to Lifestyle and the Environment

“…Extensive research suggests that the etiology of PCOS involves an interaction between environmental factors and gene variants, although it has been suggested that genetic factors contribute less than 10% to disease susceptibility [26][27][28]. A large number of genetic and genome-wide association studies (GWAS) have identified common gene loci associated with PCOS phenotypes in different ethnic populations [29][30][31].…”