Polycystic ovary syndrome is a common hormonal disorder in which the ovaries do not release an egg regularly and androgen levels are high. It is linked to insulin resistance, so it raises the risk of diabetes, heart disease and endometrial cancer.
Key symptoms
- Irregular, rare or absent periods
- Excess facial or body hair
- Acne and thinning scalp hair
- Weight gain and trouble getting pregnant
What you find on exam
- Weight, BMI, waist size and blood pressure
- Hirsutism, acne and male-pattern hair loss
- Acanthosis nigricans in skin folds, a sign of insulin resistance
- Signs of other causes: rapid virilization, Cushing features, galactorrhea
Tests
- Rotterdam criteria, 2 of 3: irregular ovulation, high androgens, polycystic ovaries on ultrasound
- Pregnancy test, TSH, prolactin and 17-hydroxyprogesterone to exclude look-alikes
- Total or free testosterone
- Screen for diabetes and high cholesterol: HbA1c or glucose tolerance test, lipid panel
Treatment basics
- Healthy diet, exercise and weight loss when needed
- Combined hormonal contraceptives to regulate periods and reduce hair growth and acne
- Metformin for insulin resistance or prediabetes
- Letrozole to induce ovulation when pregnancy is wanted
- Spironolactone for hirsutism, with reliable contraception
Red flags
- Rapid virilization such as a deeper voice or clitoral enlargement: think of a tumor
- No period for many months: risk of endometrial hyperplasia
- Depressed mood or disordered eating
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.