Polycystic Ovary Syndrome

Hetrogenous disorder characterised by hyperandrogenism, oligoovulation/anovulation and/or the presence of polycystic ovaries

Aetiology

  • Commonest endocrine disorder in women - affects 5-15% of women of reproductive age
  • Inherited condition
  • Exacerbated by weight gain

Pathophysiology

  • 50%-80% of patients will have insulin resistance, 20% will have frank glucose intolerance or T2DM
    • Exacerbated by obesity, but also seen in 'lean' PCOS
  • Glucose acts as co-gonadotrophin to LH
    • 60% elevated LH
    • 95% altered LH/FSH radios
  • Insulin lowers SHBG levels - increased free testosterone contributes to hyperandrogenism

Clinical presentation

  • Obesity
  • Hirsutism or acne
  • Menstrual cycle abnormalities and infertility

Investigations

Diagnosis: need 2/3

  • Chronic anovulation
  • Polycystic ovaries - seen in USS
  • Hyperandrogenism (clinical or biochemical)

Endocrine features

  • Normal gonadotrophins/excess LH
  • Normal oestrogen levels
  • Raised testosterone

Management

  • Depends on patients symptoms