Polycystic ovarian syndrome

The definition for polycystic ovarian syndrome varies, but the one adopted by the RCOG is 2 of 3 of: 

• Polycystic ovaries (12 or more peripheral follicles or ovarian volume >10cm^3) 
• Oligo or anovulation 
• Clinical and/or biochemical signs of hyperandrogenism (hirsuitism, acne, alopecia) 

Features associated with polycystic ovarian syndrome include: 

• Polycystic ovaries 
• Hirsuitism 
• Acne 
• Obesity (40-50% of patients) 
• Subfertility 
• Oligo/amenorrhoea 
• Hypertension 
• Acanthosis nigricans
• Increased risk of 
• Type 2 diabetes 
• Obstructive sleep apnoea 

Biochemically:

• Raised LH (40% of women) 
• Raised testosterone 
• Low or normal FSH 

Management 

• Lifestyle changes to encourage weight loss 
• OCP to block androgen effects
• Topical eflornithine hydrochloride (an inhibitor of the enzyme ornithine decarboxylase) for hirsuitism 
• Metformin
• Clomifene if fertility issues 
• ?ovarian drilling 

References

Badawy, A. and Einashar, A. Treatment options for polycystic ovary syndrome. Int J Womens Health. 2011; 3:25-35. 

Balen, A. and Rutherford, A. Managing anovulatory infertility and polycystic ovary syndrome. BMJ. 2007. 335(7621): 663-666. 

Conway, G. and Jacobs, H. Acanthosis nigricans in obese women with the polycystic ovary syndrome: disease spectrum not distinct entity. Postgrad Med J. 1990; 66(777): 536-538. 

Royal College of Obstetricians and Gynaecologists (RCOG). Long-term consequences of polycystic ovary syndrome. 2007. Available at http://www.rcog.org.uk/womens-health/clinical-guidance/long-term-consequences-polycystic-ovary-syndrome-green-top-33