Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 18-10: Polycystic Ovary Syndrome + Key Features Download Section PDF Listen +++ +++ Essentials of Diagnosis ++ Clinical or biochemical evidence of hyperandrogenism Anovulation or oligoovulation Polycystic ovaries on ultrasonography +++ General Considerations ++ Etiology is unknown Presence of at least two of the following features outlined by the Rotterdam Criteria are diagnostic Androgen production Ovulatory dysfunction Polycystic ovaries Associated with hirsutism, obesity as well as an increased risk of diabetes mellitus, cardiovascular disease, and metabolic syndrome Unrecognized or untreated PCOS is a risk factor for cardiovascular disease +++ Demographics ++ Affects 5–10% of women of reproductive age + Clinical Findings Download Section PDF Listen +++ +++ Symptoms and Signs ++ Often presents as a menstrual disorder (from amenorrhea to menorrhagia) and infertility Skin disorders due to peripheral androgen excess, including hirsutism or acne, are common Patients may show signs of insulin resistance and hyperinsulinemia; these women are at increased risk for early-onset type 2 diabetes and metabolic syndrome Patients who do become pregnant are at increased risk for perinatal complications, such as gestational diabetes and preeclampsia In addition, they have an increased long-term risk of endometrial cancer secondary to unopposed estrogen secretion +++ Differential Diagnosis ++ Hypothalamic amenorrhea, eg, stress, weight change, exercise Obesity Hyperthyroidism or hypothyroidism Hyperprolactinemia Premature ovarian failure Cushing syndrome Congenital adrenal hyperplasia Androgen-secreting tumor (adrenal, ovarian) Pregnancy + Diagnosis Download Section PDF Listen +++ +++ Laboratory Tests ++ Check serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and thyroid-stimulating hormone (TSH) Fasting glucose test, hemoglobin A1C Lipoprotein profile Women with signs of Cushing syndrome should have a 24-hour urinary free cortisol or a low-dose dexamethasone suppression test +++ Imaging Studies ++ Pelvic ultrasound may document polycystic ovaries (not necessary for diagnosis) + Treatment Download Section PDF Listen +++ +++ Medications ++ If the patient wishes to become pregnant Clomiphene or other drugs can be used for ovarian stimulation Clomiphene is the first-line therapy for infertility Metformin can improve menstruation but has little or no benefit in treating infertility; it is beneficial for metabolic or glucose abnormalities If the patient does not desire pregnancy Medroxyprogesterone acetate, 10 mg daily orally for the first 10 days of every 1–3 months If contraception is desired, a combination hormonal contraceptive (pill, ring, or patch) can be used The levonorgestrel-containing IUD Another option to minimize uterine bleeding and protect against endometrial hyperplasia However, the IUD does not help control hirsutism Hirsutism A low-dose combination oral contraceptive for at least 6–12 months Spironolactone is also useful in doses of 25 mg three or four times daily orally Flutamide, 125–250 mg once daily orally, and finasteride, 5 mg once daily orally, are also effective Because spironolactone, flutamide, and finasteride are potentially teratogenic, they should only be used with secure contraception Topical eflornithine cream applied to affected facial areas twice daily for 6 months may be helpful +++ Therapeutic Procedures ++ In obese patients with polycystic ovaries, weight reduction is often effective; a decrease in body fat will lower the conversion of androgens to estrone and thereby help restore ovulation Hirsutism may be managed with depilatory creams, electrolysis, and laser therapy + Outcome Download Section PDF Listen +++ +++ Prognosis ++ Women have insulin resistance and hyperinsulinemia when infused with glucose and are at increased risk for early-onset type 2 diabetes mellitus Women have an increased long-term risk of cancer of the endometrium because of unopposed estrogen secretion +++ When to Refer ++ If expertise in diagnosis is needed If the patient is having infertility problems + References Download Section PDF Listen +++ + +American College of Obstetricians and Gynecologists. Practice Bulletin No. 194: Polycystic ovary syndrome. Obstet Gynecol. 2018 Jun;131(6):e157–71. [PubMed: 29794677] + +Bednarska S et al. The pathogenesis and treatment of polycystic ovary syndrome: what's new? Adv Clin Exp Med. 2017 Mar–Apr;26(2):359–67. [PubMed: 28791858] + +Gadalla MA et al. Medical and surgical treatment of reproductive outcomes in polycystic ovary syndrome: an overview of systematic reviews. Int J Fertil Steril. 2020 Jan;13(4):257–70. [PubMed: 31710185]