Workup and Management of Polycystic Ovary Syndrome

Abstract

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in females. It is a heterogeneous condition that frequently manifests in adolescence. Signs and symptoms include various combinations of hyperandrogenism, ovulatory dysfunction, and polycystic ovaries. The etiology of PCOS is still largely unknown, although genetic and environmental factors, including insulin resistance and obesity, have been implicated. Diagnosis is based on the fulfillment of the 2003 Rotterdam criteria, which require two of three cardinal features – hyperandrogenism, oligomenorrhea, or amenorrhea – and polycystic ovaries on ultrasound. Careful history and physical examination are critical first steps in evaluation. Initial evaluation also involves documenting the presence of hyperandrogenism and ruling out other diagnoses. Ultrasound imaging should be considered as part of the initial evaluation and monitoring but is not necessary for all patients. Treatment remains largely empirical with an emphasis on managing the risks of metabolic sequelae, such as diabetes and cardiovascular disease. Other features, such as hyperandrogenism and menstrual irregularity, are managed symptomatically. This chapter discusses the clinical features of PCOS with a focus on diagnostic workup and management.