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For further information, see CMDT Part 18-08: Polycystic Ovary Syndrome

Key Features

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

    • Hyperandrogenism

    • 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

Symptoms and Signs

  • Often presents as a menstrual disorder (from amenorrhea to heavy menstrual bleeding) 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 long-term exposure to estrogen

Differential Diagnosis

  • Hypothalamic amenorrhea, eg, stress, weight change, exercise

  • Obesity

  • Hypothyroidism

  • Hyperprolactinemia

  • Premature ovarian failure

  • Cushing syndrome

  • Congenital adrenal hyperplasia

  • Androgen-secreting tumor (adrenal, ovarian)

  • Pregnancy

Diagnosis

Laboratory Tests

  • Check serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, thyroid-stimulating hormone (TSH), and dehydroepiandrosterone sulfate (DHEAS)

  • Fasting glucose, hemoglobin A1C

  • Lipoprotein profile

Imaging Studies

  • Pelvic ultrasound may document polycystic ovaries (not necessary for diagnosis)

Treatment

Medications

  • For women who are seeking pregnancy and remain anovulatory, clomiphene, letrozole, or other medications can be used for ovarian stimulation

  • For women who do not respond to weight loss and exercise, combined hormonal contraceptives are first-line treatment to manage hyperandrogenism and menstrual irregularities

  • Intermittent or continuous progestin therapy or a progestin-releasing IUD may be used for endometrial protection in women who cannot or chose not to use combined hormonal contraceptives

  • Metformin

    • May be used as a second-line therapy to improve menstrual function

    • Has little or no benefit in the treatment of hirsutism, acne, or infertility

Therapeutic Procedures

  • In obese patients, weight reduction and exercise are often effective in reversing the metabolic effects and in inducing ovulation

  • Hirsutism may be managed with depilatory creams, electrolysis, and laser therapy

Outcome

Follow-Up

  • Regular monitoring of lipid profiles and glucose

When to Refer

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