Polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women. It typically presents with symptoms of anovulation associated with clinical and/or biochemical evidence of androgen excess, although its spectrum of presentation includes women with hyperandrogenism who have regular periods. It is the most common cause of anovulatory infertility, and is now recognized as a major risk factor for the development of type 2 diabetes mellitus. Its aetiology remains unclear, but both genetic and environmental factors are involved. Typical biochemical features are raised serum concentrations of testosterone and luteinizing hormone, particularly in anovulatory women. The diagnosis is made primarily on clinical criteria. A finding of raised serum testosterone and/or luteinizing hormone complements the clinical diagnosis. In obese women, an oral glucose tolerance test should be undertaken to detect impaired glucose tolerance. Management of PCOS includes treatment of infertility, menstrual regulation in women who do not desire pregnancy and treatment of associated symptoms of hyperandrogenism. Another important aspect of management is the introduction of diet and lifestyle changes for overweight and obese women with PCOS; this improves fertility and also helps prevent the possible long-term consequences of the metabolic disturbance characteristic of anovulatory women with PCOS.