PCOS

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age. It features a combination of ovulatory dysfunction, hyperandrogenism, and polycystic-appearing ovaries on ultrasound. The exact cause is unknown but involves genetic susceptibility and factors such as insulin resistance and obesity that disrupt hormonal balance.

Symptoms include irregular or absent periods, excess hair growth, acne, and thinning scalp hair. Many women with PCOS have obesity or metabolic features such as insulin resistance, impaired glucose tolerance, or dyslipidemia. Fertility can be reduced due to irregular ovulation.

Diagnosis is typically based on criteria such as the Rotterdam criteria, which require two of three features: oligo- or anovulation, hyperandrogenism, and polycystic ovaries on ultrasound, after excluding other causes of androgen excess or menstrual disturbance (e.g., congenital adrenal hyperplasia, androgen-secreting tumors, Cushing's syndrome).

Management is individualized and often starts with lifestyle modification to promote weight loss and improve metabolic health. For those not seeking pregnancy, hormonal contraception can regulate menses and reduce androgenic symptoms. Antiandrogens may be added with contraception. Metformin is used for insulin resistance. For infertility, treatments include clomiphene or letrozole and, if needed, assisted reproductive techniques.

Long-term risks include impaired glucose tolerance and type 2 diabetes, dyslipidemia, and higher cardiovascular risk in some studies, partly related to obesity. Pregnancy with PCOS has higher risks of gestational diabetes and preeclampsia. Regular monitoring and lifestyle strategies are recommended to reduce metabolic and reproductive complications.

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