Polycystic Ovary syndrome
Related Subjects:
|Anatomy of the Uterus
|Anatomy of the Ovary
|Gynaecological History Taking
|Colposcopy
|Premature Menopause
|Polycystic Ovary syndrome
🌸 Polycystic Ovary Syndrome (PCOS) is the most common cause of anovulation in young women, often leading to infertility and hirsutism.
📖 About
- PCOS is the leading cause of infertility and hirsutism in reproductive-age women.
- It affects around 4–8% of women worldwide.
- Diagnosis is usually clinical, supported by labs and imaging where necessary.
🧬 Aetiology
- Ovarian stromal hyperplasia → increased androgen (testosterone) secretion.
- Multiple follicular cysts disrupt ovulation.
- Hormonal imbalance: ↑ LH, relatively low/normal FSH; often linked to obesity and insulin resistance.
- Frequently associated with Metabolic Syndrome (Syndrome X) – insulin resistance, hypertension, hyperlipidaemia.
🩺 Clinical Features
- ⚖️ Obesity (not universal).
- 📆 Menstrual irregularities: oligomenorrhoea, amenorrhoea, or dysfunctional bleeding.
- 💇 Signs of androgen excess: acne, alopecia, hirsutism.
- 🟤 Acanthosis nigricans (dark skin patches, usually neck/axillae).
🧪 Investigations
- Hormones: ↑ LH, relatively normal/low FSH; ↑ Testosterone, DHEAS, Androstenedione; ↑ Oestrone.
- ↓ SHBG → higher free androgens.
- Occasionally ↑ Prolactin.
- OGTT for diabetes risk (high prevalence of insulin resistance).
- Ultrasound: “string of pearls” multiple cysts – though not required for diagnosis.
🔍 Differential Diagnosis
- Congenital adrenal hyperplasia
- Prolactinoma
- Acromegaly
- Cushing’s syndrome
- Ovarian/adrenal tumours
💊 Management
- ⚖️ Weight reduction – improves ovulation & metabolic profile (dietician referral helpful).
- 💊 Metformin – enhances insulin sensitivity, may restore ovulation.
- 🩸 Progesterone therapy every 3 months to prevent endometrial hyperplasia, or combined OCP with cyproterone acetate for cycle regulation & anti-androgen effect.
- 👶 Clomiphene – first-line ovulation induction for infertility.
- OCPs help with acne, hirsutism, and menstrual regulation.
- Routine diabetes screening (especially in overweight patients).
⚠️ Complications
- ⬆️ Risk of endometrial carcinoma from unopposed oestrogen.
- ⬆️ Risk of Type 2 diabetes and cardiovascular disease due to metabolic syndrome.
