Polycystic Ovary Syndrome (PCOS)
Polycystic ovary syndrome is diagnosed using the Rotterdam criteria (2 of 3: irregular ovulation, clinical or lab evidence of excess androgens, polycystic-appearing ovaries), affecting an estimated 8-13% of women, per the 2023 International Evidence-Based PCOS Guideline (endorsed by the Endocrine Society, ASRM, and ESHRE).
Symptoms
Irregular or absent periods, excess facial or body hair, acne, and difficulty losing weight are the most common presenting complaints; many women are diagnosed while being evaluated for infertility.
Causes and risk
Insulin resistance and genetics both play a central role; PCOS clusters with obesity, though it also occurs in lean women.
How it is evaluated
Labs (androgens, and other hormones to rule out mimics) and pelvic ultrasound confirm the diagnosis when the clinical picture is unclear; anti-Müllerian hormone (AMH) is now accepted as an ultrasound alternative in adults per the 2023 guideline.
Treatment
Combined oral contraceptives are first-line for menstrual and hyperandrogenic symptoms; metformin targets the metabolic features specifically. GLP-1 medications are increasingly used as anti-obesity agents in PCOS per general population guidelines, with mandatory contraception given a lack of pregnancy safety data. Letrozole is first-line for ovulation induction when pregnancy is the goal.
When to seek care
Rapid-onset severe hair growth or voice deepening (virilization) suggests a cause other than typical PCOS and needs prompt evaluation. Abnormal heavy bleeding, or blood clot symptoms while on combined oral contraceptives, also warrant urgent attention.