Diagnosis and Management of Polycystic Ovary Syndrome (PCOS)

Abstract

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-age women (5-15 %). All PCOS definitions include hyperandrogenism and oligo/anovulation in the proposed diagnostic criteria. Polycystic ovary morphology on ultrasound was not part of the initial definition and is not considered necessary for diagnosis if the patient meets the other two criteria. PCOS remains a diagnosis of exclusion and other disorders which are associated with symptoms/signs of androgen excess in women must be excluded. The clinical expression of PCOS is variable with hirsutism representing the most common clinical manifestation (65-75 %). Moreover, there is a strong link between PCOS and metabolic syndrome manifestations, including obesity, insulin resistance, type 2 diabetes mellitus (T2DM), dyslipidaemia, hypertension and non-alcoholic fatty liver disease (NAFLD). PCOS women exhibit increased incidence of obesity (30-75 %) and central adiposity even within the normal BMI range (50-70 %). In the spectrum of PCOS phenotypes, presence of hyperandrogenism is associated with a more adverse cardiometabolic profile, whereas menstrual irregularity and polycystic ovary morphology are more closely linked to infertility problems. Oral contraceptives are recommended as first-line treatment for hirsutism/acne in PCOS. Lifestyle modifications for weight loss are also essential in overweight/obese PCOS women. Metformin therapy may improve metabolic and reproductive outcomes in selected PCOS women and is recommended in PCOS patients with T2DM or impaired glucose tolerance who are failing lifestyle modification. Clomiphene citrate is mainly used for ovulation induction in anovulatory PCOS women without other infertility factors. The long-term management plan for the care of PCOS women must include regular screening and follow-up in order to prevent, diagnose and treat T2DM, cardiovascular risk factors, NAFLD, obstructive sleep apnea, eating disorders, depression/anxiety, endometrial hyperplasia/cancer and pregnancy complications.