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.

Diagnosis

2 of the following 3 are needed for diagnosis:

as well as exclusion of other causes of hyperandrogenism and anovulation, e.g. Cushing Syndrome, congenital adrenal hyperplasia (CAH) and androgen-secreting tumor.

Workup

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.

Associations

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).

Treatment

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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