Polycystic ovary syndrome

She is 29, her cycles have always been irregular, she has struggled with her weight and acne for a decade, and she is in your clinic because she and her partner have been trying for a baby for eighteen months. PCOS is the commonest reason a young woman walks into a gynaecology clinic, and it is far more than an ovary problem — it reframes her metabolic, psychological and cancer risk for life. Diagnosis is still delayed, often taking years and multiple health-care visits; this topic is your blueprint for shortening that journey and managing her across the whole of it.^[2][5]

Overview and definition

PCOS affects approximately 11 to 13% of women globally by the current International Guideline definition — making it the commonest endocrine disorder of reproductive-age women. It is heterogeneous: four recognised phenotypes, a spectrum of metabolic and reproductive severity, and a diagnosis that is one of exclusion.^[5]

The diagnosis, in adults, requires two of three features:^[1][5]

• Clinical or biochemical hyperandrogenism — hirsutism, acne, androgenic alopecia, or elevated free testosterone/free androgen index.
• Ovulatory dysfunction — oligomenorrhoea, amenorrhoea, irregular cycles.
• Polycystic ovarian morphology on ultrasound, OR elevated anti-Mullerian hormone — the 2023 International Guideline allows AMH as an alternative to ultrasound in adults.^[2][5]

Two of three, after exclusion of mimics — that is the diagnostic rule for adults, and the sentence to say first at any station.^[1][5]

References16ShowHide

1. [1]Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome Fertil Steril, 2004.PMID 14711538
2. [2]Teede HJ, Tay CT, Laven JJE, Dokras A, Moran LJ, Piltonen TT, et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome Fertil Steril, 2023.PMID 37589624
3. [3]Legro RS, Brzyski RG, Diamond MP, et al. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome N Engl J Med, 2014.PMID 25006718
4. [4]Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome Fertil Steril, 2018.PMID 30033227
5. [5]Stener-Victorin E, Teede H, Norman RJ, et al. Polycystic ovary syndrome Nat Rev Dis Primers, 2024.PMID 38637590
6. [6]Lizneva D, Kirubakaran R, Mykhalchenko K, Suturina L, Chernukha G, Diamond MP, Azziz R Phenotypes and body mass in women with polycystic ovary syndrome identified in referral versus unselected populations: systematic review and meta-analysis Fertil Steril, 2016.PMID 27530062
7. [7]Barry JA, Azizia MM, Hardiman PJ Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis Hum Reprod Update, 2014.PMID 24688118
8. [8]Kakoly NS, Khomami MB, Joham AE, et al. Ethnicity, obesity and the prevalence of impaired glucose tolerance and type 2 diabetes in PCOS: a systematic review and meta-regression Hum Reprod Update, 2018.PMID 29590375
9. [9]Franik S, Le QK, Kremer JA, Kiesel L, Farquhar C Aromatase inhibitors (letrozole) for ovulation induction in infertile women with polycystic ovary syndrome Cochrane Database Syst Rev, 2022.PMID 36165742
10. [10]Costello M, Shrestha B, Eden J, Sjoblom P, Johnson N Insulin-sensitising drugs versus the combined oral contraceptive pill for hirsutism, acne and risk of diabetes, cardiovascular disease, and endometrial cancer in polycystic ovary syndrome Cochrane Database Syst Rev, 2007.PMID 17253562
11. [11]Legro RS, Arslanian SA, Ehrmann DA, et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline J Clin Endocrinol Metab, 2013.PMID 24151290
12. [12]Fauser BC, Tarlatzis BC, Rebar RW, et al. Consensus on women's health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group Fertil Steril, 2012.PMID 22153789
13. [13]Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, et al. Positions statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline J Clin Endocrinol Metab, 2006.PMID 16940456
14. [14]McCartney CR, Marshall JC Clinical practice. Polycystic Ovary Syndrome N Engl J Med, 2016.PMID 27406348
15. [15]Cooney LG, Dokras A Cardiometabolic Risk in Polycystic Ovary Syndrome: Current Guidelines Endocrinol Metab Clin North Am, 2021.PMID 33518188
16. [16]Cooney LG, Lee I, Sammel MD, Dokras A High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: a systematic review and meta-analysis Hum Reprod, 2017.PMID 28333286