PCOS is a ovulatory dysfunction resulting in irregular menses and androgen excess. It is diagnosed clinically and confirmed with blood tests (for androgen) and ultrasound (for polycystic ovaries). It is treated with oral contraceptives.

Pathophysiology

• Anovulation or ovulatory dysfunction
• Increase in androgen likely due to cytochrome P450c17 affecting rate-limiting enzyme in androgen production
• Exacty etiology unclear

Contextual Factors

• Family history
• Obesity
• Insulin resistance
• Fetal androgen exposure

Clinical Manifestation

• Irregular menses
• Hirsutism
• Acnes
• Hair thinning
• Acanthosis nigricans: thick, darkened skin
  • Due to insulin resistance resulting in high insulin levels

Complications

• Infertility
• Endometrial hyperplasia/ endometrial cancer
• Metabolic syndrome

Diagnosis

• Clinical criteria (2+/3)
  • Ovulatory dysfunction presenting as irregular menses
  • Hyperandrogenism

  • 10 follicles/ ovary vis pelvic ultrasound

Supporting Tests

• Pregnancy test
• FSH
• Prolactin
• TSH
• Serum free testosterone
• Serum cortisol (rules out Cushing syndrome)

Treatment

• Combined estrogen/ progestin oral contraceptives (COC)
• Progestin-only contraceptive (if unable to take COC)
• Symptomatic treatment (hirsutism, infertility, etc.)