Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a commonly encountered endocrine disorder that is characterized by a combination of hyperandrogenism, menstrual disturbances (predominantly oligomenorrhea), and a classic sonographic polycystic ovarian morphology. Additional sequelae associated with PCOS include infertility and enhanced risk of developing type 2 diabetes mellitus and cardiovascular disease. The prevalence of depressive disorders and obstructive sleep apnea is disproportionately higher in women with PCOS, and this population is at increased risk for endometrial hyperplasia and endometrial cancer. This chapter reviews the definition, epidemiology, etiology and genetics, pathophysiology, diagnosis (including history, physical examination, and laboratory tests), differential diagnosis, and management of PCOS. Syndromes and diseases associated with PCOS are discussed. Tables describe the three approaches to PCOS, conditions mimicking PCOS, diagnosis of the metabolic syndrome in women using the National Cholesterol Education Program criteria, workup for PCOS, comprehensive care for PCOS patients, and the multistep approach to treatment of PCOS-related anovulatory infertility. Figures include transvaginal ultrasound images of a normal ovary and a multifollicular ovary in a woman with PCOS, the Ferriman-Gallwey scoring system for quantifying hirsutism, acanthosis nigrans on the neck of a woman with PCOS and insulin resistance, the relationship between body mass index and basal luteinizing hormone levels, oral glucose challenge results in nonobese women with PCOS, and an algorithm for treatment decision making. This review contains 6 highly rendered figures, 6 tables, and 120 references.