POLYCYSTIC OVARY SYNDROME
By Gary M. White, MD
Polycystic ovary syndrome (PCOS) is a the most common endocrinopathy in women and is characterized by hyperandrogenemia, hyperinsulinemia, central obesity, polycystic ovaries and annovulation.
- Ask about/evaluate for acne, hirsutism, increased BMI, insulin resistance, and irregular periods or no periods at all.
- The etiology involves a complex interplay between androgens, insulin, luteinizing hormone and estrogen and is not fully understood.
- Cutaneous features include acne, hirsutism, acanthosis nigricans and alopecia.
- Signs of virilization are notably uncommon.
2 of the following 3 are needed for diagnosis:
- Clinical and/or biochemical signs of hyperandrogenism
- Oligo- or anovulation. Ask about oligomenorrhea (< 9 menses a year) or amenorrhea (missed menses >= 3 months)
- Ultrasonographic evidence of polycystic ovaries.
as well as exclusion of other causes of hyperandrogenism and anovulation, e.g. Cushing Syndrome, congenital adrenal hyperplasia (CAH) and androgen-secreting tumor.
Workup can include DHEAS, free testosterone, sex-hormone binding globulin, prolactin, 24-hour urine cortisol, 17-OH progesterone, TSH, pregnancy tests, FSH and LH, and pelvic ultrasound. If periods are regular, it is best to get labs early morning days 4-10 of the period.
Associated conditions include diabetes mellitus, type 2, cardiovascular disease, endometrial cancer, obstructive sleep apnea, steatohepatitis and psychiatric disorders (e.g. depression, anxiety, and eating disorders).
Usually, treatment is carried out by a gynecologist or endocrinologist. Combined oral contraceptive pills (e.g. ethinyl estradiol and a synthetic progestin) are commonly employed.
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