Polycystic ovary syndrome is diagnosed in women with at least two of the following otherwise unexplained abnormalities: hyperandrogenism (clinical, biochemical, or both), ovulatory dysfunction (>9 periods/year), and polycystic ovarian morphologic features, after other similarly presenting conditions have been ruled out.
The name is a bit of a misnomer. as most do not have “cysts”
- Most women who have PCOS also have insulin resistance.- meaning that her body can’t effectively respond to the insulin it produces to help manage blood sugar levels- even if the blood sugar measured in the lab is normal
- These women are more likely to be overweight, but this is not always the case.
- Women with the polycystic ovary syndrome are at risk of medical conditions due to anovulation: infertility, endometrial hyperplasia or cancer- thus ultrasound monitoring is useful
- Metabolic syndrome: abnormal glucose metabolism (diabetes, gestational diabetes), dyslipidemia, fatty liver disease, hypertension, obstructive sleep apnea.
- Mental health: depression, and anxiety and eating disorders acne, male pattern hair loss or growth- which are highly correlated with metabolic dysfunction and mental health concerns
In young women the menstrual cycle and hormonal symptoms becomes “vital signs” to alter us of risks or predisposition to medical conditions such as those above
Nonpharmacologic therapies can be key:
- Lifestyle modification is important for patients who are (or are at risk for being) overweight, such as 5-10% reduction in weight (the hardest of all therapies), ideally with sustainable approach. Regular exercise may help with menstrual frequency as well.
- Mechanical hair removal (e.g., shaving) is an important treatment strategy in patients with hirsutism.
Pharmocologic:
- Combined (estrogen–progestin) oral contraceptives can be used for hyperandrogenism (e.g., hirsutism), and endometrial protection result in predictable withdrawal bleeding, and provide reliable endometrial protection if contraception is desired
- Spironolactone (with appropriate contraception) can be used for hirsutism, Cyclic or continuous progestin therapy for endometrial protection, Metformin for cycle regular or abnormal glucose tolerance