Polycystic ovary syndrome

Clinical information

Polycystic ovary syndrome (PCOS) is the most common endocrine condition. It affects between 8 % and 13 % of reproductive-aged women, with signs and symptoms typically starting in adolescence. The clinical presentation is heterogeneous and includes reproductive, metabolic, and psychological features.

PCOS is associated with an increased risk of metabolic complications starting from a young age. These comorbidities include traditional cardiovascular disease (CVD) risk factors such as obesity, impaired glucose tolerance, type 2 diabetes mellitus (DM), dyslipidemia, and hypertension. The prevalence of obesity in women with PCOS is also increased with an obesity rate from 50 % to 80 %, depending on ethnicity.

Despite its prevalence in reproductive-aged women, diagnosis and management of PCOS remains challenging. Once diagnosed, assessment and management should address its reproductive, metabolic, cardiovascular, dermatologic, and psychological features. A lifelong health plan is recommended including focus on a healthy lifestyle, prevention of excess weight gain, management of fertility and preconception risk factors, and prevention and treatment of the diverse clinical features.

Diagnostics

The most recent international guidelines recommend PCOS should be diagnosed in adults based on the presence of at least two out of the following criteria: ovulatory dysfunction, clinical/biochemical hyperandrogenism, and polycystic ovaries on ultrasound or an elevated anti-Mullerian hormone (AMH) level, with the exclusion of other aetiologies. Where irregular menstrual cycles and hyperandrogenism are present, diagnosis is simplified and ultrasound or increased AMH are not required. In adolescents, both hyperandrogenism and ovulatory dysfunction are mandatory, and ovarian morphology is not included due to poor specificity.

Hyperandrogenism has been evaluated using clinical signs, such as hirsutism, but steroid analysis (e.g. testosterone, free testosterone, androstenedione, DHEA-S) is now also considered important in PCOS diagnosis because it can provide detailed information on the biochemical basis of hyperandrogenism.

Other disorders with similar clinical features to PCOS, such as thyroid disease, hyperprolactinemia, and non-classical congenital adrenal hyperplasia, should be excluded.