Polycystic ovary syndrome

What it is

PCOS is one of the most common endocrine conditions in women of reproductive age. Insulin resistance and higher androgen levels disrupt follicle development, so ovulation becomes irregular. It also raises the long-term risk of type 2 diabetes, sleep apnea and mood disorders.

Symptoms

• Irregular or absent periods

• Acne and excess facial or body hair

• Scalp hair thinning

• Difficulty conceiving

• Weight gain, especially around the abdomen

How it's diagnosed

Adults are diagnosed with 2 of 3 features: irregular cycles, clinical or biochemical androgen excess, and polycystic ovarian morphology on ultrasound or a raised AMH level. Thyroid disease, high prolactin and non-classic congenital adrenal hyperplasia are ruled out first. Ultrasound and AMH are not used in adolescents.

Treatment

Lifestyle changes that improve insulin sensitivity come first. Combined oral contraceptives regulate cycles and reduce hair and acne; metformin helps metabolic features; spironolactone, used with reliable contraception, treats hirsutism. Letrozole is first-line for ovulation induction. Anti-obesity medicines may be considered where appropriate.

Clinical pearls

• Screen for diabetes (ideally with an OGTT), lipids, blood pressure, sleep apnea and depression.

• PCOS is a lifelong metabolic condition, not just a fertility issue.