Polycystic ovary syndrome (PCOS) occurs in 5 to 10% of women. In the US, it is the most common cause of infertility. PCOS is a common cause of ovulatory dysfunction.
PCOS is usually defined as a clinical syndrome, not by the presence of ovarian cysts. But typically, ovaries contain many 2- to 6-mm follicular cysts and sometimes larger cysts containing atretic cells. Ovaries may be enlarged with smooth, thickened capsules or may be normal in size.
Symptoms of polycystic ovary syndrome typically begin during puberty and worsen with time. Premature adrenarche, characterized by excess dehydroepiandrosterone sulfate (DHEAS) and often the early growth of axillary hair, body odor, and microcomedonal acne, is common.
Other symptoms may include weight gain (sometimes seems hard to control), fatigue, low energy, sleep-related problems (including sleep apnea), mood swings, depression, anxiety, and headaches. In some women, fertility is impaired. Symptoms vary from woman to woman.
Weight loss and regular exercise are encouraged. They may help induce ovulation, make menstrual cycles more regular, increase insulin sensitivity, and reduce acanthosis nigricans and hirsutism. Weight loss may also help improve fertility. However, weight loss is unlikely to benefit normal-weight women with PCOS.
Hormonal contraceptives as prescribed by a gynecologist for first-line therapy for menstrual abnormalities, hirsutism, and acne in women who have PCOS and who do not desire pregnancy. Women are usually given an intermittent progestin (eg, medroxyprogesterone 5 to 10 mg po once/day for 10 to 14 days every 1 to 2 mo) or oral contraceptives to reduce the risk of endometrial hyperplasia and cancer.
Because the risk of depression and anxiety is increased in PCOS, women, and adolescents with PCOS should be screened for these problems based on history, and if a problem is identified, they should be referred to a mental health care practitioner and/or treated as needed.
Overweight or obese adolescents and women with PCOS should be screened for symptoms of obstructive sleep apnea using polysomnography and treated as needed.
These treatments also reduce circulating androgens and usually help make menstrual cycles more regular.
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