From the Guidelines
Polycystic ovary syndrome (PCOS) is a complex endocrine disorder affecting women of reproductive age, characterized by the presence of two of three of the following: oligo/anovulation, polycystic ovaries, and clinical or biochemical hyperandrogenism, with a prevalence of 8%–13% according to the Rotterdam criteria 1.
Definition and Prevalence
The definition of PCOS is based on the Rotterdam criteria, which require the presence of at least two of the following three features: oligo/anovulation, polycystic ovaries, and clinical or biochemical hyperandrogenism 1. This disorder affects a significant proportion of women of reproductive age, with a prevalence estimated to be between 8% and 13% 1.
Pathophysiology and Symptoms
The pathophysiology of PCOS involves insulin resistance (IR), which plays a crucial role in many symptoms of the disorder, including hyperandrogenism, and is present regardless of body mass index (BMI) 1. The symptoms of PCOS can include irregular menstrual cycles, acne, hirsutism, and difficulty conceiving, among others.
Management and Treatment
Lifestyle modification, including weight loss and regular exercise, is a crucial component of PCOS management, as it can improve many symptoms of the disorder 1. Additionally, medications such as oral contraceptives and metformin may be prescribed to regulate hormones and improve insulin sensitivity. It is essential for individuals suspected of having PCOS to consult a healthcare provider for proper diagnosis and personalized treatment advice.
Key Considerations
- The current understanding of PCOS emphasizes the importance of insulin resistance and its role in the development of symptoms 1.
- Lifestyle changes, including maintaining a healthy weight and engaging in regular physical activity, are fundamental to managing PCOS 1.
- A comprehensive approach to PCOS management involves a multidisciplinary team, including healthcare providers from various specialties, as well as the individual's active participation in their care 1.
From the Research
Definition and Prevalence of PCOS
- Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age, affecting 5-10% of women in this age group 2.
- It is the most common cause of anovulatory infertility in women of reproductive age 3, 4, 2.
- PCOS is a heterogeneous disorder, defined by a combination of signs and symptoms of androgen excess and ovarian dysfunction in the absence of other specific diagnoses 5.
Pathogenesis and Risk Factors
- The exact mechanism of pathogenesis is not clear, but it may be related to heredity, environment, and internal embryonic factors 3.
- PCOS is frequently associated with abdominal adiposity, insulin resistance, obesity, metabolic disorders, and cardiovascular risk factors 5.
- The syndrome is multifactorial and polygenic in nature, with neuroendocrine, ovarian, and metabolic dysfunctions playing a significant role in the pathophysiology 2.
Clinical Features and Diagnosis
- The hallmark features of PCOS include hyperandrogenism and hyperinsulinemia, which have systemic long-term implications 6.
- Clinical features of PCOS include menstrual abnormalities (oligo- or amenorrhea), subfertility, obesity, and symptoms of androgen excess, such as hirsutism, acne, and alopecia 4, 6, 2.
- Diagnosis of PCOS requires the judicious application of a few well-standardized diagnostic methods, and appropriate therapeutic approaches addressing hyperandrogenism, ovarian dysfunction, and associated metabolic disorders 5.
Treatment and Management
- Lifestyle modification is considered the first-line treatment for PCOS, regardless of fertility status, without the addition of metformin 3.
- Oral contraceptive pills should be used as a first-line treatment for long-term management in patients with no reproductive requirements 3.
- For patients with fertility requirements, ovulation therapy is an effective treatment, and assisted reproductive technology may be considered for refractory ovulation disorders 3, 4.