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Polycystic
ovary syndrome is characterized by mild obesity, irregular menses
or amenorrhea, and signs of androgen excess (hirsutism, acne). Typically,
the ovaries contain multiple cysts. Diagnosis is by pregnancy testing,
hormone level measurement, and imaging to exclude a virilizing tumor.
Treatment is symptomatic.
Polycystic ovary syndrome is a common female endocrinopathy occurring in 5 to 10% of women and involving anovulation and androgen excess of unclear etiology. It is defined by symptoms, not by the presence of ovarian cysts. Ovaries may be enlarged with smooth, thickened capsules or may be normal in size. Typically, ovaries contain many 2- to 6-mm follicular cysts and sometimes larger cysts containing atretic cells. Estrogen levels are elevated, increasing risk of endometrial hyperplasia and, eventually, endometrial cancer. Androgen levels are often elevated, increasing risk of metabolic syndrome (see Obesity and the Metabolic Syndrome: Metabolic Syndrome) and causing hirsutism.
Symptoms,
Signs, and Diagnosis
Symptoms typically begin during puberty and worsen with time; a clear-cut history of regular menses for a time following menarche makes the diagnosis unlikely. Examination usually detects abundant cervical mucus, reflecting high estrogen levels. The diagnosis is suspected if women have at least 2 typical symptoms (mild obesity, hirsutism, and irregular menses or amenorrhea).
Testing includes pregnancy testing and measurement of serum estradiol , follicle-stimulating hormone, prolactin, and thyroid-stimulating hormone. Diagnosis is confirmed by ultrasonography showing > 10 follicles per ovary; follicles usually occur in the periphery and resemble a string of pearls.
If ovarian follicles or hirsutism is present, serum testosterone and dehydroepiandrosterone sulfate (DHEAS) levels are measured. Abnormal levels are evaluated as for amenorrhea (see Menstrual Abnormalities: Testing).
Treatment
For women who are anovulatory (ie, with a history of absent or irregular menses and no evidence of progesterone production), who are not hirsute, and who do not desire pregnancy, an intermittent progestin (eg, medroxyprogesterone 5 to 10 mg po once/day for 10 to 14 days q 1 to 2 mo) or oral contraceptives should be given to reduce risk of endometrial hyperplasia and cancer and to reduce circulating androgens.
For women who are anovulatory, who are hirsute, and who do not desire pregnancy, treatment aims to reduce hirsutism and is guided by testosterone and DHEAS levels (see Menstrual Abnormalities: Treatment). For women who desire pregnancy, infertility treatments are used (see Infertility: Treatment).
Last full review/revision November 2005
Content last modified November 2005
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