Polycystic Ovary Syndrome (PCOS)
Polycystic ovary syndrome is the most common endocrine disorder in reproductive-age women, affecting 6 -- 12%. It is characterized by androgen excess, ovulatory dysfunction, and/or polycystic ovarian morphology on ultrasound. Beyond menstrual irregularity and fertility impact, PCOS carries long-term metabolic risks including type 2 diabetes, dyslipidemia, and cardiovascular disease.
Symptoms
Irregular or absent periods, excess facial or body hair (hirsutism), acne, scalp hair thinning, weight gain especially in the abdomen, skin tags, darkened skin in body folds, difficulty conceiving, and mood changes.
Causes and risk
The exact cause is multifactorial -- insulin resistance amplifies androgen production from the ovaries, disrupting follicle development and ovulation. Genetic predisposition, low birth weight, and early puberty are additional risk factors. Approximately 70% of women with PCOS have insulin resistance.
How it is evaluated
Rotterdam criteria require two of three features: oligo/anovulation, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology on ultrasound. We measure total and free testosterone, DHEAS, LH, FSH, estradiol, and rule out thyroid disease, hyperprolactinemia, and non-classic congenital adrenal hyperplasia.
Treatment
Lifestyle modification is first-line: a 5 -- 10% weight reduction significantly improves ovulatory function and metabolic markers. Combined oral contraceptives regulate cycles and reduce androgens. Metformin improves insulin sensitivity and cycle regularity. Letrozole is first-line for ovulation induction in women seeking conception. Spironolactone addresses hirsutism and acne.