Polycystic ovary syndrome
Description
- Hyperandrogenism + ovulatory dysfunction + polycystic ovarian morphology, after exclusion of mimics
- Not a gynaecological problem - a lifelong metabolic and reproductive one
Phenotypes (all four are PCOS)
| Hyperandrogenism | Anovulation | PCOM | |
|---|---|---|---|
| A (classic, most metabolic) | + | + | + |
| B | + | + | - |
| C (ovulatory) | + | - | + |
| D (non-hyperandrogenic, mildest) | - | + | + |
Clinical features
- Menstrual - oligo/amenorrhoea, anovulatory infertility, dysfunctional bleeding
- Androgenic - hirsutism (Ferriman-Gallwey), acne, androgenic alopecia
- Virilisation - clitoromegaly, deep voice, rapid onset - is not PCOS. Think tumour or CAH
- Metabolic - central obesity, IGT/T2DM, MASLD, dyslipidaemia, OSA, acanthosis nigricans
- Psychological - anxiety, depression, disordered eating, body image distress (guideline mandates screening)
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