Polycystic Ovary Syndrome

Introduction

• Description: Polycystic ovary syndrome (PCOS) consists of amenorrhea, hirsutism, insulin resistance, and obesity in association with enlarged, multicystic ovaries.

• Prevalence: 5%–10% of women; 30% of secondary amenorrhea. The most common hormonal disorder among women of reproductive age.

• Predominant Age: Begins at menarche.

• Genetics: No genetic pattern established; suggestion of increased family tendency.

Etiology and Pathogenesis

• Causes: The exact pathophysiology of PCOS is not well established, but increased amplitude of gonadotropin-releasing hormone (GnRH) pulsation and abnormal secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) during puberty are considered to result in excess androgen. Elevated levels of LH persist and may be used to help establish the diagnosis. Insulin resistance is a prominent aspect of this syndrome.

• Risk Factors: Borderline adrenal hyperplasia, occult hypothyroidism, and childhood obesity.

Signs and Symptoms

• Anovulation and amenorrhea/oligomenorrhea (<9 menses/year, 75%–80%)

• Infertility (75%)

• Excessive hair growth, primarily along the angle of the jaw, upper lip, and chin (70%)

• Obesity (54%–85%; “apple-shaped” obesity centered around the lower half of the torso)

• Acanthosis nigricans

• Acne

Diagnostic Approach