Polycystic Ovarian Syndrome: Diagnosis and Treatment

Diagnosis

For diagnosis, 2 of the following 3 criteria should be met, and other diseases with similar clinical presentation should be ruled out³:

Menstrual irregularity. Anovulation, oligo–ovulation, amenorrhea, oligomenorrhea, or irregular bleeding.

Signs of hyperandrogenism. Hirsutism, acne, male–pattern baldness, or elevated serum free testosterone concentration.

Polycystic ovaries, visible on transvaginal ultrasound. An isolated finding of polycystic ovaries in the absence of clinical hyperandrogenism is common and does not indicate PCOS.

Laboratory studies may include measurements of prolactin, blood glucose, and insulin.

A glucose tolerance test is indicated in most cases.

Because coronary artery disease is common in patients with PCOS, cardiovascular risk factors should be evaluated (eg, hypercholesterolemia, hypertriglyceridemia). Smoking should also be discouraged.

Testing for sleep apnea (sleep questionnaire, overnight polysomnography) may be indicated.

Treatment

Weight loss, physical activity, and insulin–sensitizing agents (eg, metformin, thiazolidinediones) are usually necessary to reduce insulin resistance.

Oral contraceptives are used to regulate the menstrual cycle and protect the endometrium in women who are not interested in becoming pregnant.

Hirsutism is treated by hair removal (eg, electrolysis, laser treatment), oral contraceptive pills combined with an anti–androgen medication (eg, spironolactone), or gonadotropin–releasing hormone (GnRH) analogs.

Acne is treated with topical or oral agents.

Treatment of infertility is often necessary if the patient desires pregnancy.

• Weight loss and exercise may be beneficial.
• Clomiphene or metformin are initial choices to induce ovulation.
• Assisted reproductive technologies (eg, in–vitro fertilization) may be necessary.