Polycystic ovary syndrome (PCOS)

Abstract

Key content The symptoms of polycystic ovary syndrome (PCOS) include menstrual cycle disturbance and features of hyperandrogenism (hirsutism, acne and alopecia), with associated fertility problems, obesity and psychological issues. There are ethnic variations in expression of PCOS related to differences in insulin metabolism and this may impact upon treatment algorithms. Obesity has a major impact on the expression of PCOS and the efficacy of the management of all aspects of the syndrome, in particular infertility. The management of anovulatory infertility involves lifestyle modification and therapies to induce ovulation, namely clomifene citrate, gonadotrophin therapy and laparoscopic ovarian diathermy. For those who do not wish to conceive the management of menstrual problems requires prevention of endometrial hyperplasia and adenocarcinoma and consideration of the long term metabolic risks. Learning objectives To understand the full spectrum of the syndrome that is PCOS to include how to make the diagnosis and differentiate from other causes of menstrual irregularity and androgen excess. To appreciate the role of insulin resistance and the long‐term health implications for women with PCOS. To understand how to manage the issues that may affect a woman in different ways at different times in her life, namely menstrual cycle irregularity, hyperandrogenism and infertility. Ethical issues A contentious issue is the appropriateness to deny fertility treatment based upon a cut‐off for body mass index (BMI), when BMI is a crude measure of metabolic risk and the risks of conception at a high BMI are not absolute. This also has to be balanced against the decline in fertility with age which may have an additional impact. To what extent should young women who are found to have polycystic ovaries on ultrasound scan but without any features of the syndrome be advised about the potential for developing problems in the future? Should relatives of individuals with PCOS be screened for either PCOS or metabolic syndrome (the latter may apply to male relatives too)?