and Paula Briggs2
(1)
Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
(2)
Sexual and Reproductive Health, Southport and Ormskirk Hospital, Southport, UK
Definition
PCO is an ultrasound diagnosis – If at least one ovary has 12 or more small peripheral cysts (2–8 mm) the woman is said to have PCO.
PCOS is present in a woman who has PCO on ultrasound, and has one or more of the symptoms of hyperandrogenism. This includes oligomenorrhoea, excess hair growth, pimples/acne. greasy skin.
Incidence
Population studies have shown that Caucasian women have a 20–25 % incidence of PCO. In women from the Indian and Asian subcontinents, the incidence can be as high as 50 %.
Aetilogy and Pathogenesis
The inheritance of PCO is poorly understood, but appears to be multifactorial. Whilst there is a familial trend, a PCO gene has not been identified.
Pathogenesis appears to commence with an excess of LH secretion, resulting in hyperandrogenism (encouraging the circulating steroids to be metabolised to androgens) which then promotes a degree of insulin resistance.
Clinical Assessment
Fifty percent of women with PCO have no symptoms or signs. Gaining weight and becoming less active appear to be mechanisms which may precipitate the transition from PCO to PCOS.
History
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Menstrual irregularity – this is the commonest and earliest symptom of PCOS. This can be oligomenorrhoea or secondary amenorrhoea. Women may present with subfertility (due to irregular/anovulation) as their primary concern.
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