Polycystic Ovarian Syndrome: Diagnosis and Management

Abstract

Polycystic ovarian syndrome (PCOS) affects 4% to 12% of women of reproductive age. The lack of well-defined diagnostic criteria makes identification of this common disease confusing to many clinicians. Also, with the varied manifestations of the disorder a patient may present to any one of several providers: an internist, family practitioner, nurse practitioner, pediatrician, gynecologist, dermatologist, or endocrinologist. Furthermore, the most distressing aspect of PCOS for any given patient may change over time, from hirsutism as a teenager to infertility as a young adult-potentially requiring several different providers along the way. It is important, therefore, that those caring for these patients understand not only the management issues pertinent to their specialty, but also appreciate the other potential health risks in these women. Recent insights into the pathophysiology of PCOS have shown insulin resistance to play a substantial role and as such have brought the long-term issues of type 2 diabetes mellitus and its resultant increased risk of coronary artery disease to the forefront. No longer can irregular menses and/or hirsutism be thought of as benign nuisances. This review will focus on the two most confusing aspects of PCOS for the practicing provider-diagnosis/differential diagnosis and treatment options. Special attention is given to the role of insulin resistance and the potential utility of insulin sensitizers in management. The benefit and utmost importance of lifestyle modification for the long-term health of these women is stressed as well. It is hoped that some clarity in this regard will allow more women to not only be diagnosed and managed properly for their presenting symptoms (hirsutism, irregular menses, etc.), but also to be educated and managed for the continuing health risk of insulin resistance throughout their lives.

Comparison of clinical outcomes in clomiphene citrate resistant infertile polycystic ovarian syndrome women after treatment with laparoscopic ovarian drilling (LOD) versus gonadotropins

“…Clinical manifestations of PCOS include oligomenorrhea/amenorrhea, infertility/first trimester miscarriage, obesity, hirsutism, acne, acanthosis nigricans and male pattern alopecia. 5 Clomiphene resistance is common and occurs in approximately 15%-40% of women with PCOS. 6 Clomiphene resistance is defined as failure to ovulate after receiving up to 150 mg of clomiphene citrate (CC) daily for 5 days from 2nd day of cycle for at least 3 menstrual cycles.…”

Implementation and Evaluation of Effectiveness of Educating Program for Upgrading Nurses’ Knowledge Regarding Polycystic Ovaries Syndrome

“…It is a common disorder affecting 4-12% of women of reproductive age (1,2) . PCOS was first described in the United States in 1935 (3) , and it is characterized by chronic anovulation and hyperandrogenism in the absence of underlying adrenal or pituitary disease (4) .…”

Role of Steroid Hormones in Polycystic Ovarian Syndrome (Pcos) in South Indian Women

“…In a systemic review and meta-analysis it was shown that women with PCOS had a greater risk of overweight, obesity, and central obesity 8 . Lack of exercise and low physical activity may play a significant role in the rise in prevalence of PCOS 9 .The rate of obesity in the PCOS population ranges from 38% to 87% 10 . We found an increase in the waist circumference observed in the normal control women compared to PCOS subjects in our taken population.…”