What are the common symptoms and treatment options for Polycystic Ovary Disorder (PCOD)?

PCOD/PCOS Clinical Presentation and Treatment

Common Clinical Presentations

Women with PCOS typically present with menstrual irregularities, signs of hyperandrogenism (hirsutism, acne, male-pattern hair loss), and metabolic disturbances including insulin resistance and obesity. 1

Reproductive and Hormonal Manifestations

• Menstrual irregularities are a hallmark feature, ranging from oligomenorrhea to amenorrhea due to chronic anovulation 2
• Hirsutism affects the majority of patients as a result of elevated androgen levels 1
• Acne and androgenic alopecia (male-pattern baldness) commonly occur due to hyperandrogenism 1, 3
• Infertility affects approximately 80% of women with anovulatory cycles 3

Metabolic and Dermatologic Signs

• Acanthosis nigricans appears as darkened, velvety skin patches, indicating underlying insulin resistance 1
• Obesity and abdominal adiposity are frequently present, though not universal 4
• Insulin resistance occurs in a significant proportion of patients, increasing diabetes risk 1

Treatment Algorithm

For Women NOT Attempting Conception

Combination oral contraceptive pills are the first-line therapy for regulating menstrual cycles, providing endometrial protection, and suppressing androgen secretion. 1

Primary Management Steps:

1. Weight loss of as little as 5% of initial body weight improves metabolic and reproductive abnormalities, ovulation rates, and pregnancy outcomes 5
2. Oral contraceptive pills regulate cycles and reduce androgen levels, though they may increase triglycerides and HDL cholesterol 5
3. Metformin improves insulin sensitivity and glucose tolerance over time, though it lacks FDA approval specifically for PCOS 5, 1

Hirsutism Management:

• Combined medical therapy using an antiandrogen (spironolactone, flutamide, or finasteride) plus an oral contraceptive is most effective 5
• Topical eflornithine hydrochloride cream is the only FDA-approved medication specifically for hirsutism 5
• Mechanical hair removal (laser, electrolysis) typically requires concomitant medical androgen suppression 5

For Women Attempting Conception

Begin with weight control and regular exercise, then proceed to clomiphene citrate as first-line ovulation induction therapy. 5

Stepwise Fertility Treatment:

1. Lifestyle modification first: Weight loss and exercise program 5
2. Clomiphene citrate: Induces ovulation in approximately 80% of women, with 50% achieving pregnancy 5, 1
3. Low-dose gonadotropins: If clomiphene fails, use low-dose (not high-dose) protocols to minimize ovarian hyperstimulation risk 5
4. Metformin: Improves ovulation frequency, though effects on early pregnancy outcomes remain unclear 5

Important caveat: Laparoscopic ovarian drilling has undetermined benefit and should not be routinely recommended 5

Metabolic Screening and Prevention

All women with PCOS require screening for type 2 diabetes using fasting glucose and 2-hour oral glucose tolerance test, plus fasting lipid profiles to assess cardiovascular risk. 1

Essential Screening Tests:

• Thyroid-stimulating hormone and prolactin levels to exclude other causes of hyperandrogenism 1
• Total testosterone or free/bioavailable testosterone to assess androgen excess severity 1
• Two-hour oral glucose tolerance test for diabetes screening 1
• Fasting lipid profile for dyslipidemia assessment 1
• Regular blood pressure monitoring due to increased cardiovascular disease risk 1

Long-term Complications to Monitor:

• Endometrial hyperplasia and carcinoma risk increases with chronic anovulation and requires investigation 6
• Cardiovascular disease risk factors accumulate, though oral contraceptive use does not appear to increase cardiovascular events compared to the general population 5

Key Clinical Pitfalls

Do not use high-protein diets as evidence is limited and concerns exist regarding adverse effects on renal function and lipids 5

Exercise programs have positive effects even without weight loss, though data are limited 5

Insulin-sensitizing agents (metformin, thiazolidinediones) improve ovulation but lack FDA approval for PCOS treatment, and their role in cardiovascular disease prevention remains unknown 5