Polycystic Ovarian Syndrome: Overview and Risk Factors

Diagnosis

• For diagnosis, two of the following three criteria should be met, and other diseases with similar symptoms should be ruled out:
• Menstrual irregularity: Lack of periods, decreased frequency of periods, or irregular bleeding may all occur.
• Signs of increased androgen hormones: This may appear as hirsutism, acne, male–pattern baldness, or elevated testosterone concentration in the blood.
• Polycystic ovaries, visible on transvaginal ultrasound: However, an isolated finding of polycystic ovaries in the absence of symptoms is common and does not indicate PCOS.
• Several blood tests are necessary to evaluate the effects of the disease, including measurements of various hormones, blood glucose, and insulin.
• Because coronary artery disease is common in patients with PCOS, cardiovascular risk factors should be evaluated (e.g., high cholesterol levels), and further testing may be necessary, such as an electrocardiogram and stress testing. Smoking should also be discouraged.

Treatment

• Weight loss, increased physical activity, and diabetes medications (e.g., metformin) are usually necessary.
• Oral contraceptives are used to regulate the menstrual cycle and protect the uterus in women who are not interested in becoming pregnant.
• Hirsutism is treated by hair removal (e.g., electrolysis or laser treatment) and various medications, including oral contraceptive pills, anti–androgen medication (e.g., spironolactone), or gonadotropin–releasing hormone analogs (e.g., leuprolide).
• Acne is treated with topical or oral medications.
• Treatment of infertility is often necessary if the patient desires pregnancy. This may include medical therapies (e.g., clomiphene ormetformin) or assisted reproductive technologies (e.g., in–vitro fertilization).