Polycystic Ovary Syndrome
Polycystic ovary syndrome (PCOS) is the single most common endocrine disorder affecting at least 10% of reproductive-aged women. The syndrome is most commonly diagnosed according to the Rotterdam criteria in the presence of any two of these three conditions: Androgen excess, ovulatory dysfunction, and polycystic morphology on ultrasound. However, PCOS can only be diagnosed after other underlying conditions have been excluded, including hypothyroidism and androgen-secreting tumors of the ovaries or adrenal glands. The pathogenesis of PCOS is complex and can vary among women. In many women, it is linked to insulin resistance, resulting in hyperinsulinemia and hyperandrogenemia. In other women without insulin resistance, hyperandrogenemia from other causes appears to play a ual role. Approximately 70% of these women are obese, and at least 70% will have infertility. Management starts with weight reduction in the obese and treatment of insulin resistance, particularly in the presence of glucose intolerance. Fertility treatments consist of ovulation induction and assisted reproductive technologies when required. Long-term treatment focuses on menstrual regulation, typically with combined estrogen-progestin contraceptives, and treatment of hirsutism when present. Health surveillance for associated conditions is important, including type 2 diabetes mellitus, hypertension, hyperlipidemia, and endometrial cancer.
