Endometriosis and polycystic ovary syndrome are diametric disorders

Natalie L. Dinsdale; Bernard J. Crespi

doi:10.1111/eva.13244

journal article Open Access May 14, 2021

Endometriosis and polycystic ovary syndrome are diametric disorders

Natalie L. Dinsdale Bernard J. Crespi

Evolutionary Applications Vol. 14 No. 7 pp. 1693-1715 · Wiley

View at Publisher Save 10.1111/eva.13244

Abstract

AbstractEvolutionary and comparative approaches can yield novel insights into human adaptation and disease. Endometriosis and polycystic ovary syndrome (PCOS) each affect up to 10% of women and significantly reduce the health, fertility, and quality of life of those affected. PCOS and endometriosis have yet to be considered as related to one another, although both conditions involve alterations to prenatal testosterone levels and atypical functioning of the hypothalamic–pituitary–gonadal (HPG) axis. Here, we propose and evaluate the novel hypothesis that endometriosis and PCOS represent extreme and diametric (opposite) outcomes of variation in HPG axis development and activity, with endometriosis mediated in notable part by low prenatal and postnatal testosterone, while PCOS is mediated by high prenatal testosterone. This diametric disorder hypothesis predicts that, for characteristics shaped by the HPG axis, including hormonal profiles, reproductive physiology, life‐history traits, and body morphology, women with PCOS and women with endometriosis will manifest opposite phenotypes. To evaluate these predictions, we review and synthesize existing evidence from developmental biology, endocrinology, physiology, life history, and epidemiology. The hypothesis of diametric phenotypes between endometriosis and PCOS is strongly supported across these diverse fields of research. Furthermore, the contrasts between endometriosis and PCOS in humans parallel differences among nonhuman animals in effects of low versus high prenatal testosterone on female reproductive traits. These findings suggest that PCOS and endometriosis represent maladaptive extremes of both female life‐history variation and expression of sexually dimorphic female reproductive traits. The diametric disorder hypothesis for endometriosis and PCOS provides novel, unifying, proximate, and evolutionary explanations for endometriosis risk, synthesizes diverse lines of research concerning the two most common female reproductive disorders, and generates future avenues of research for improving the quality of life and health of women.

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Details

Published: May 14, 2021
Vol/Issue: 14(7)
Pages: 1693-1715
License: View

Authors

N

Natalie L. Dinsdale

Department of Biological Sciences Simon Fraser University Burnaby BC Canada

B

Bernard J. Crespi

Department of Biological Sciences Simon Fraser University Burnaby BC Canada

Cite This Article

Natalie L. Dinsdale, Bernard J. Crespi (2021). Endometriosis and polycystic ovary syndrome are diametric disorders. Evolutionary Applications, 14(7), 1693-1715. https://doi.org/10.1111/eva.13244

Endometriosis and polycystic ovary syndrome are diametric disorders

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