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Last Updated: 2/24/2014  

Polycystic Ovary Syndrome

  • Consider the possibility of PCOS in patients with irregular menses or amenorrhea beginning at menarche, infertility, hirsutism, acne, central obesity, or a family history of PCOS.

  • Diagnose PCOS in women with two of the following three criteria: androgen excess, ovulatory dysfunction, and polycystic ovaries.

  • Measure serum androgens including total or free (bioavailable) testosterone level and possibly androstenedione level. If there is severe hyperandrogenemia, consider other causes.

  • Measure LH and FSH levels, if necessary, to exclude other causes of amenorrhea or infertility.

  • Perform an ultrasound of the ovaries to help make the diagnosis.

  • Look for evidence of insulin resistance:

    • Obtain fasting glucose and serum lipid levels.

    • Consider obtaining insulin level and a 2-hour oral glucose tolerance result as well.

  • Consider other causes of irregular menses and amenorrhea if other evidence of PCOS is lacking.

  • Encourage weight loss through diet and exercise.

  • Recommend local measures for hair removal when hirsutism is the major complaint.

  • Use drug therapy for hirsutism and acne if local measures do not provide acceptable results or if hirsutism is moderate to severe.

  • For irregular menses or amenorrhea associated with anovulation, use an oral contraceptive in most women who do not desire pregnancy.

  • When fertility is the primary concern, use agents that restore or induce ovulation.

  • Tell women explicitly of the risks involved with becoming pregnant while using insulin sensitizers such as metformin.

  • Patient Education

  • Encourage women to report >3 months of amenorrhea so that a progesterone challenge can be given if appropriate, because prolonged amenorrhea in women with PCOS is a risk factor for endometrial cancer.

  • Discuss the risk for infertility so women can seek help as needed.

  • Discuss the potential complications during pregnancy before a patient with PCOS conceives:

    • Screen women for diabetes and hypertension before they become pregnant.

    • Counsel patients on the increased risk for gestational diabetes and preeclampsia during pregnancy.

    • Recommend closer surveillance in pregnancy for women with PCOS.

DOI: 10.7326/d222
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Author(s) and Disclosures:
Erin Keely, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Nikolaos P. Polyzos, MD, PhD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.

One or more of the present or past ACP Smart Medicine physician editors worked on this module and had nothing to disclose: Davoren Chick, MD, FACP; Deborah Korenstein, MD, FACP; Marjorie Lazoff, MD, FACP; Richard Lynn, MD, FACP.

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