Polycystic Ovarian Syndrome (PCOS)

PCOS is common—it affects 12–18% of women. It is not the same as polycystic ovaries, which occur in approx. 25% of normal women.

Features

• Ovarian dysfunction—subfertility, oligomenorrhoea, anovulation

• Androgen excess—acne, hirsutism, male-pattern balding

• Metabolic features—upper truncal obesity, impaired glucose tolerance, dyslipidaemia, diabetes

• Psychological symptoms—anxiety, depression, eating disorders

Diagnosis

Can be made if a woman presents with:

• irregular periods or oligo/anovulation and

• hyperandrogenism—clinical or biochemical (elevated free testosterone or FAI)

• if only one of the above is present, a pelvic ultrasound confirming polycystic ovary morphology (≥10 follicles per ovary) may also confirm diagnosis, although not reliable in women <20 yrs.

Management

The key to management is lifestyle modification with weight management and exercise. The oral contraceptive pill can be used for symptoms of hyperandrogenism. Metformin may assist weight management and ovulation/menstrual regularity.