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Feature Article

The unfolding story of polycystic ovary syndrome

Marianne Ilbery

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Abstract

Dramatic changes are afoot in the management of PCOS in light of our increasing knowledge of the pathophysiology and long term natural history of the condition.

Key Points

  • Polycystic ovary syndrome (PCOS) is the commonest endocrine problem for women, occurring in 5 to 10% of premenopausal women.
  • A ‘polycystic ovarian’ ultrasound pattern occurs as an incidental finding in about 20% of the normal female population.
  • PCOS is a heterogenous clinical picture, characterised by the association of menstrual abnormality (due to chronic anovulation), obesity and hyperandrogenism.
  • About 40% of women with PCOS are obese. Weight loss is the first line of therapy for regulating menstruation, reducing body hair in hirsutism and inducing ovulation in fertility therapy.
  • About 30 to 60% of women with PCOS have insulin resistance and hyperinsulinaemia, and are at risk of developing type 2 diabetes mellitus.
  • Although there is much observational evidence, there is, as yet, no definitive high quality evidence to support the use of metformin in treating PCOS. Definitive studies are needed to assess its use in anovulation, and for women with androgen excess and vascular risk factors.

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