What Is Polycystic ovary syndrome (PCOS)?
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-aged women, affecting approximately 10–13% of this population. It is characterized by a combination of reproductive, metabolic, and psychological features, with a highly variable clinical presentation. This variability results in women experiencing a delay in diagnosis and subsequentdissatisfaction with care. The diagnosis is based on the presence of at least two of the following:
irregular or absent menstrual periods, clinical or biochemical signs of excess androgens (such as hirsutism or acne), and polycystic ovarian morphology on ultrasound, after excluding other causes. The Endocrine Society, along with other international societies, endorses the Rotterdam criteria for diagnosis.[1-3]
PCOS is associated with increased risks of infertility, type 2 diabetes, metabolic syndrome, cardiovascular disease, endometrial cancer, depression, and anxiety. Insulin resistance is a key feature, but routine clinical testing is not recommended due to lack of accuracy. Management should be individualized and address reproductive, metabolic, dermatologic, and psychological aspects. The Endocrine Society and collaborating societies recommend a lifelong health plan focusing on healthy lifestyle, prevention of excess weight gain, and optimization of fertility and metabolic health.[1-2]
Clinical practice in the assessment and management of PCOS continue to be inconsistent, resulting in ongoing key evidence-practice gaps. Typically, first-line treatment for menstrual irregularity and hyperandrogenism is the combined oral contraceptive pill, with preference for lower ethinyl estradiol doses and preparations with fewer side effects. Second-line treatment is Metformin and is primarily recommended for metabolic features, especially in those with impaired glucose tolerance or type 2 diabetes. Lifestyle modification, including diet and physical activity, is foundational and should be supported throughout the lifespan. There is no single superior diet or exercise regimen for PCOS. Psychological assessment and support are also important due to increased rates of depression and anxiety. These typical treatments are not always beneficial or successful for some women. It is thought that since GLP-1’s help manage diabetes, that it can be helpful in managing the insulin resistance that comes with PCOS. [1-2][4]
Shared decision-making and patient education are emphasized, as dissatisfaction with care is common. The Endocrine Society and other international societies highlight the need for high-quality, evidence-based resources and integrated care models for women with PCOS.[1-2]
References
1. Recommendations From the 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Teede HJ, Tay CT, Laven JJE, et al. The Journal of Clinical Endocrinology and Metabolism. 2023;108(10):2447-2469.
doi:10.1210/clinem/dgad463.
2. Recommendations From the 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome†. Teede HJ, Tay CT, Laven J, et al.Human Reproduction (Oxford, England). 2023;38(9):1655-1679. doi:10.1093/humrep/dead156.
3. Diagnosis and Treatment of Polycystic Ovary Syndrome. Williams T, Mortada R, Porter S. American Family Physician. 2016;94(2):106-13.
4. Polycystic Ovary Syndrome: Common Questions and Answers. Williams T, Moore JB, Regehr J. American Family Physician. 2023;107(3):264-272.
