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Clinical manifestations of polycystic ovary syndrome in adults

Authors
Robert L Barbieri, MD
David A Ehrmann, MD
Section Editors
Peter J Snyder, MD
William F Crowley, Jr, MD
Deputy Editor
Kathryn A Martin, MD

INTRODUCTION

The polycystic ovary syndrome (PCOS) is an important cause of both menstrual irregularity and androgen excess in women. When fully expressed, the manifestations include irregular menstrual cycles, hirsutism, acne, and, frequently, obesity. The clinical manifestations of PCOS will be reviewed here. The epidemiology and pathogenesis of, diagnostic criteria for, and treatment of PCOS are described in detail separately. (See "Epidemiology and pathogenesis of the polycystic ovary syndrome in adults" and "Diagnosis of polycystic ovary syndrome in adults" and "Treatment of polycystic ovary syndrome in adults".)

OVERVIEW

Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies in women of reproductive age, affecting between 6.5 and 8 percent of women overall [1,2]. Its prevalence is strikingly similar across populations of women of reproductive age: 6.6, 6.8, and 6.7 percent in the southeastern United States, the Greek island of Lesbos, and Spain, respectively [2-4]. The epidemiology of PCOS is reviewed in detail separately. (See "Epidemiology and pathogenesis of the polycystic ovary syndrome in adults".)

It is important to appreciate that PCOS is a syndrome, reflecting multiple potential etiologies and variable clinical presentations. Its key features are oligo- or anovulation and hyperandrogenism. Other features are polycystic ovaries on pelvic ultrasonography, infertility due to oligoovulation, obesity, and insulin resistance.

REPRODUCTIVE ABNORMALITIES

Menstrual dysfunction — The menstrual dysfunction in polycystic ovary syndrome (PCOS) is characterized by oligo- or amenorrhea and, therefore, infrequent or absent ovulation. The menstrual disturbances classically have a peripubertal onset. Affected women may have a normal or slightly delayed menarche followed by irregular cycles. Other women may apparently have regular cycles at first and subsequently develop menstrual irregularity in association with weight gain. Although the mechanism is not fully elucidated, many obese women with PCOS resume more regular menstrual cycles after relatively small amounts of weight loss. (See "Treatment of polycystic ovary syndrome in adults", section on 'Weight reduction'.)

Gonadotropin dynamics — Many, but not all, women with PCOS have abnormal gonadotropin secretory dynamics. Most commonly, there is an increase in mean luteinizing hormone (LH) levels (figure 1), and in LH pulse frequency and amplitude when blood is sampled frequently (a minimum of every 10 minutes throughout the day) [5,6]. The likelihood of finding an elevation in serum LH depends upon the timing of the sample relative to the last menstrual period, the ovarian activity, the use of oral contraceptive (OC) pills, body mass index (BMI), and the frequency of LH-sampling [6]. Thus, the absence of an elevated serum LH level does not exclude the diagnosis of PCOS. (See "Diagnosis of polycystic ovary syndrome in adults", section on 'Diagnosis'.)

                             

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