Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies in reproductive-age women. It often presents during late adolescence but in some cases certain features are evident even before menarche. PCOS is a spectrum of disorders with any combination of oligo/
anovulation, clinical and/or biochemical evidence of
androgen excess,
obesity,
insulin resistance and polycystic ovaries on ultrasound. The pathogenesis is unknown; however, it is a complex multigenetic disorder where disordered
gonadotropin release, dysregulation of steroidogenesis,
hyperinsulinism and
insulin resistance play a role. The diagnosis is based on a typical physical exam (
acne,
hirsutism,
obesity, and
acanthosis nigricans) and laboratory evidence of
hyperandrogenism, such as elevated free
testosterone,
androstenedione and
dehydroepiandrosterone sulfate (DHEAS), decreased
sex hormone-binding globulin (SHBG) and increased
luteinizing hormone (LH). An ovarian ultrasound may detect the multiple
cysts. Secondary causes of PCOS need to be excluded. There are several classes of medications correcting different parameters of PCOS that can be used alone or in combination.
Oral contraceptive therapy is used to reduce
androgen and LH levels with resultant improvement in
acne and
hirsutism, and the induction of regular menses.
Antiandrogens are usually required for a substantial improvement in
hirsutism score.
Insulin sensitizers such as
metformin are a new class of drugs utilized in treatment of PCOS. By improving
insulin sensitivity and decreasing
insulin levels, they improve the unfavorable metabolic profile of patients with PCOS.
Metformin also helps to increase SHBG, decrease
androgen levels and induce ovulation. Despite all the available medications, life-style changes are the mainstay of
therapy as
weight loss and exercise improve all parameters of PCOS without the potential side effects of medication.