Polycystic ovary syndrome (PCOS) is a common heterogeneous endocrine disorder characterized by
irregular menses,
hyperandrogenism, and polycystic ovaries. The prevalence of PCOS varies depending on which criteria are used to make the diagnosis, but is as high as 15%-20% when the European Society for Human Reproduction and Embryology/American Society for Reproductive Medicine criteria are used. Clinical manifestations include
oligomenorrhea or
amenorrhea,
hirsutism, and frequently
infertility. Risk factors for PCOS in adults includes
type 1 diabetes,
type 2 diabetes, and
gestational diabetes.
Insulin resistance affects 50%-70% of women with PCOS leading to a number of comorbidities including
metabolic syndrome,
hypertension,
dyslipidemia,
glucose intolerance, and diabetes. Studies show that women with PCOS are more likely to have increased coronary artery
calcium scores and increased carotid intima-media thickness. Mental health disorders including depression, anxiety,
bipolar disorder and
binge eating disorder also occur more frequently in women with PCOS.
Weight loss improves
menstrual irregularities, symptoms of
androgen excess, and
infertility. Management of clinical manifestations of PCOS includes
oral contraceptives for
menstrual irregularities and
hirsutism.
Spironolactone and
finasteride are used to treat symptoms of
androgen excess. Treatment options for
infertility include
clomiphene, laparoscopic ovarian drilling,
gonadotropins, and assisted reproductive technology. Recent data suggest that
letrozole and
metformin may play an important role in ovulation induction. Proper diagnosis and management of PCOS is essential to address patient concerns but also to prevent future metabolic, endocrine, psychiatric, and cardiovascular complications.