Polycystic ovary syndrome

Stephen Franks
Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital, London

Endocrine Nurses Training Course 2005, John MacIntyre Centre, The University of Edinburgh, 18 Holyrood Park Road, Edinburgh EH16 5AY, UK
30 August - 1 September 2005

Polycystic ovary syndrome (PCOS) is the commonest cause of anovulatory infertility. In its classic form the presentation is of amenorrhoea or oligomenorrhoea associated with clinical and/or biochemical evidence of hyperandrogenism. However, it is clear from ultrasonographic studies that the spectrum of presenting symptoms of women with polycystic ovaries is wide, including anovulation without hirsutism (androgen levels are usually raised) and hirsutism with regular cycles. The typical gonadotrophin profile is elevated serum levels of LH with normal or slightly low FSH. PCOS is also associated with a metabolic disturbance in which the central abnormalities appear to be hyperinsulinaemia and insulin resistance. The diagnosis of PCOS is made principally on clinical grounds, supported by a small number of biochemical investigations. The choice of investigations in women with PCOS depends primarily on the mode of presentation. Because of the high risk of impaired glucose tolerance or frank diabetes, we suggest that obese, anovulatory women with PCOS should have a routine oral glucose tolerance test, or, al least a fasting plama glucose estimation. Treatment should be tailored to the presenting complaint. For example, in infertile women, induction of ovulation can be achieved in most cases by the use of antioestrogens. Treatment of clomiphene-resistant subjects is difficult; conventional doses of gonadotrophins are associated with high rates of ovarian hyperstimulation syndrome and multiple pregnancy. On the other hand, low-dose gonadotrophin therapy has proven effective in inducing unifollicular ovulation. Weight reduction in obese subjects with PCOS not only increases the chance of fertility but also improves the long-term prognosis with regard to development of diabetes. Insulin sensitizing drugs such as metformin may also have a place in treatment of PCOS

References
Franks S. Polycystic ovary syndrome. N Engl J Med 1995, 333 853-61
Ehrmann D. Polycystic ovary syndrome. N Engl J Med 2005, 352 1223-36

Revised: 16-Sep-2005