Polycystic Ovary Syndrome

 Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a disorder characterized by hyperandro-
genism, ovulatory dysfunction, and polycystic ovaries. Its etiology remains
unknown, and treatment is largely symptom based and empirical. PCOS has the
potential to cause substantial metabolic sequelae, including an increased risk of
diabetes and cardiovascular disease,and these factors should be considered when
determining long-term treatment. The purpose of this document is to examine the
best available evidence for the diagnosis and clinical management of PCOS.
Background
Incidence, Definition, and Diagnostic Criteria
There is no universally accepted definition of PCOS and expert generated diag-
nostic criteria have proliferated in recent years (see Table 1). The Rotterdam cri-
teria, which supplanted the National Institutes of Health (NIH) diagnostic
criteria (1),incorporated the appearance of the ovary based on ultrasound exam-
ination into the schema (2). Ultrasound criteria for the diagnosis of polycystic
ovaries were decided by expert consensus (see Box 1) (3). These criteria have
been criticized for including more mild phenotypes, which increases the preva-
lence of PCOS and may complicate treatment decisions. The Androgen Excess
Society (AES) criteria recognizes hyperandrogenism as a necessary diagnostic
factor, in combination with other symptoms of the syndrome (4). Hyperandro-
genism can be established on the basis of clinical findings (eg, hirsutism or
acne) or serum hormone measurement. All diagnostic approaches recommend
that secondary causes (such as adult-onset congenital adrenal hyperplasia,
hyperprolactinemia,and androgen-secreting neoplasms) should first be excluded.
All diagnostic schemes also require more than one sign or symptom (Table 1,
Box 3). Polycystic ovaries alone,for example,are a nonspecific finding and also
are frequently noted in women with no endocrine or metabolic abnormalities.



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