Polycystic Ovary Syndrome

About Polycystic Ovary Syndrome

Polycystic Ovary Syndrome PCOS is the most common endocrine disorder in women of reproductive age, affecting approximately 8 to 13 percent. It is the leading cause of anovulatory infertility. The Rotterdam criteria require two of three: oligo or anovulation menstrual cycles over 35 days or absent, hyperandrogenism clinical hirsutism, acne, male pattern hair loss or biochemical elevated free testosterone, and polycystic ovarian morphology on ultrasound, with the 2023 international guideline also allowing elevated anti Mullerian hormone AMH in adults. Symptoms typically begin around puberty and include irregular periods, heavy bleeding, acne, hirsutism excess facial and body hair, male pattern hair loss, weight gain particularly abdominal, difficulty losing weight, acanthosis nigricans dark velvety skin patches indicating insulin resistance, and infertility. PCOS is strongly associated with insulin resistance, a several fold higher risk of type 2 diabetes, metabolic syndrome, cardiovascular risk, obstructive sleep apnea, endometrial cancer from unopposed estrogen, anxiety, and depression. The etiology involves genetic susceptibility and environmental factors. Management is symptom based and life stage dependent. In people with excess weight, modest weight loss can restore ovulation in many cases. Combined oral contraceptives regulate cycles and treat hirsutism and acne. Metformin improves insulin sensitivity and may regulate cycles. Letrozole is first line for ovulation induction, more effective than clomiphene. Spironolactone treats hirsutism. Inositol supplements show benefit in some studies. Clinicians also consider endometrial protection, for example with periodic progestogen, in people with infrequent periods who are not using hormonal contraception.