++
+++
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
++
++
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
++
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
++
++
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 ...