Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age.
A leading cause of infertility and pregnancy complications.
Associated with insulin resistance, metabolic syndrome, nonalcoholic fatty liver disease, and increased risk of developing type 2 diabetes.
Main treatment goals are to reduce hyperandrogenism or to induce fertility.
Letrozole and clomiphene are considered first-line pharmacologic treatments for infertility in PCOS. Increasing evidence suggests that letrozole may be superior to clomiphene.
History and exam
Key diagnostic factors
- female of reproductive age
- irregular menstruation
Other diagnostic factors
- overweight or obesity
- scalp hair loss
- oily skin or excessive sweating
- acanthosis nigricans
- family history of PCOS
- premature adrenarche
- low birth weight
- fetal androgen exposure
- environmental endocrine disruptors
1st investigations to order
- serum 17-hydroxyprogesterone
- serum prolactin
- serum thyroid-stimulating hormone
- oral glucose tolerance test
- fasting lipid panel
Investigations to consider
- serum total and free testosterone
- serum dehydroepiandrosterone sulfate (DHEAS)
- serum androstenedione
- pelvic ultrasound
- basal body temperature monitoring
- luteal phase progesterone measurement
- serum LH and follicle-stimulating hormone (FSH)
with infertility and desiring fertility
not desiring current fertility
- 21-hydroxylase deficiency
- Thyroid dysfunction
- Practice bulletin: polycystic ovary syndrome
- Ovulation induction in polycystic ovary syndrome
Polycystic ovary syndrome: what is it?
Polycystic ovary syndrome: what treatments work?More Patient leaflets
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