Polycystic ovarian syndrome (PCOS)
- Definition. A heterogeneous disorder of unexplained hyperandrogenic chronic anovulation in which secondary causes (androgen-secreting neoplasms) have been excluded. PCOS was historically referred to as Stein–Leventhal syndrome.
- Prevalence. Five percent of women of reproductive age. It occurs among all races and nationalities, is the most common hormonal disorder of women this age, and is a leading cause of infertility.
- Etiology. Unknown: no gene or specific environmental substance has been identified.
Diagnostic evaluation
- History. The history should focus on the menstrual pattern, previous pregnancies (if any), concomitant medications, smoking, alcohol consumption, diet, and identification of family members with diabetes and cardiovascular disease.
- Physical examination should look for balding, acne, clitoromegaly, body hair distribution, and signs of insulin resistance (obesity, centripetal fat distribution, acanthosis nigricans). Bimanual examination may suggest enlarged ovaries (Figure 23.1).
- Laboratory tests such as testosterone or dehydroepiandrosterone sulfate (DHEAS) are useful for documenting ovarian hyperandrogenism. Androgen-secreting tumors of the ovary or adrenal gland are also invariably accompanied by elevated circulating androgen levels, but there is no absolute level that is pathognomonic for a tumor or minimum level that excludes a tumor.
- Imaging studies such as a pelvic sonogram can exclude a solid ovarian tumor and may demonstrate the characteristic “polycystic” appearance of the ovaries (Figure 23.1).
- Criteria. In 2003, a consensus workshop in Rotterdam indicated that PCOS should be diagnosed if two out of three criteria are met: (1) oligo-ovulation and/or anovulation, (2) excess androgen activity, and (3) polycystic ovaries by sonogram, other endocrine disorders being excluded.
