|  | Healthcare Industry | PPOs

Polycystic Ovary Syndrome (PCOS): Symptoms, Diagnosis & Evidence-Based Management

PCOS affects 8–13% of reproductive-age women (NIH criteria). It’s a heterogeneous endocrine-metabolic disorder, not just "ovarian cysts."

Diagnostic Criteria (Rotterdam – 2 of 3)

  1. Oligo/anovulation: Irregular cycles (>35 days or <8/year).
  2. Hyperandrogenism: Clinical (hirsutism, acne, alopecia) or biochemical (↑ total/free testosterone, DHEAS, androstenedione).
  3. Polycystic ovaries on ultrasound: ≥20 follicles (2–9 mm) per ovary or ovarian volume >10 mL.

Exclude: thyroid disease, hyperprolactinemia, NCAH (17-OHP), androgen-secreting tumors, Cushing's.

Clinical Manifestations

DomainFeatures
ReproductiveInfertility (anovulation), endometrial hyperplasia/cancer risk (unopposed estrogen)
MetabolicInsulin resistance (70%), obesity (40–80%), prediabetes/T2DM, dyslipidemia, NAFLD
DermatologicHirsutism (Ferriman-Gallwey score), acne, androgenic alopecia, acanthosis nigricans
PsychiatricDepression, anxiety, binge eating, body dysmorphia (2–3× risk)
ObstetricGDM, preeclampsia, preterm birth, miscarriage

Management by Goal

1. Menstrual Regulation / Endometrial Protection

  • Combined OCP (first-line): suppresses LH, ↑ SHBG → ↓ free testosterone.
  • Cyclic progestin (medroxyprogesterone 10 mg × 10–14 days q1–3 mo) if OCP contraindicated.
  • Hormonal IUD (levonorgestrel): local endometrial suppression.

2. Hyperandrogenism (Hirsutism/Acne)

  • OCP + anti-androgen (spironolactone 50–200 mg/day, cyproterone acetate in some countries).
  • Topical eflornithine (hirsutism); retinoids/benzoyl peroxide (acne).
  • Laser/IPL hair reduction (6–8 sessions).

3. Fertility / Ovulation Induction

  • Lifestyle: 5–10% weight loss restores ovulation in many.
  • Letrozole (first-line): 2.5–7.5 mg days 3–7; higher live birth, lower multiples vs. clomiphene.
  • Clomiphene citrate (alternative).
  • Gonadotropins / IVF if resistant.

4. Metabolic Health

  • Metformin: improves insulin sensitivity, ovulation, androgen; consider if IGT/T2DM or BMI >25.
  • GLP-1 agonists (semaglutide, liraglutide): weight loss + metabolic benefit; emerging data.
  • Diet: Mediterranean, low-glycemic, adequate protein.
  • Exercise: 150 min/week moderate + resistance training.

5. Long-Term Surveillance

  • Annual: BP, lipids, HbA1c/OGTT, liver enzymes, mood screen.
  • Endometrial assessment if amenorrhea >3 months off hormones.
  • Sleep apnea screen (snoring, witnessed apneas).

Multidisciplinary Care

Endocrinologist + gynecologist + dermatologist + dietitian + mental health. Shared decision-making; address patient priorities (fertility vs. hirsutism vs. metabolic).

PPOs - Related Articles