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Polycystic Ovary Syndrome

Azziz, Ricardo, MD, MPH

doi: 10.1097/AOG.0000000000002698
Contents: Reproductive Endocrinology and Infertility: Clinical Expert Series
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Spanish Translation

Polycystic ovary syndrome (PCOS) is a highly prevalent disorder, representing the single most common endocrine–metabolic disorder in reproductive-aged women. Currently there are four recognized phenotypes of PCOS: 1) hyperandrogenism+oligo-anovulation+polycystic ovarian morphology; 2) hyperandrogenism+oligo-anovulation; 3) hyperandrogenism+polycystic ovarian morphology; and 4) oligo-anovulation+polycystic ovarian morphology, each with different long-term health and metabolic implications. Clinicians should clearly denote a patient's phenotype when making the diagnosis of PCOS. Polycystic ovary syndrome is a highly inherited complex polygenic, multifactorial disorder. Pathophysiologically abnormalities in gonadotropin secretion or action, ovarian folliculogenesis, steroidogenesis, insulin secretion or action, and adipose tissue function, among others, have been described in PCOS. Women with PCOS are at increased risk for glucose intolerance and type 2 diabetes mellitus; hepatic steatosis and metabolic syndrome; hypertension, dyslipidemia, vascular thrombosis, cerebrovascular accidents, and possibly cardiovascular events; subfertility and obstetric complications; endometrial atypia or carcinoma, and possibly ovarian malignancy; and mood and psychosexual disorders. The evaluation of patients suspected of having PCOS includes a thorough history and physical examination, assessment for the presence of hirsutism, ovarian ultrasonography, and hormonal testing to confirm hyperandrogenism and oligo-anovulation as needed and to exclude similar or mimicking disorders. Therapeutic decisions in PCOS depend on the patients' phenotype, concerns, and goals, and should focus on 1) suppressing and counteracting androgen secretion and action, 2) improving metabolic status, and 3) improving fertility. However, despite significant progress in understanding the pathophysiology and diagnosis of the disorder over the past 20 years, the disorder remains underdiagnosed and misunderstood by many practitioners.

Polycystic ovary syndrome is the most common endocrine–metabolic disorder in reproductive-aged women but remains underdiagnosed and misunderstood.

Department of Health Policy, Management & Behavior, School of Public Health, University at Albany, State University of New York, and the Department of Obstetrics and Gynecology, Albany Medical College, Albany, New York; the Department of Obstetrics and Gynecology, the Medical College of Georgia, Augusta University, Augusta, Georgia; and the Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California at Los Angeles, and the Pullias Center for Higher Education, Rossier School of Education, University of Southern California, Los Angeles, California.

Corresponding author: Ricardo Azziz, MD, MPH, State University Plaza, Suite 423, 353 Broadway, Albany, NY 12246; email: Ricardo.azziz@suny.edu.

Financial Disclosure Dr. Azziz is a consultant for Ansh Labs, Kindex Pharmaceuticals, Medtronics, Factryl, and Longitude Capital and is on the Advisory Board for Global PET Imaging.

Continuing medical education for this article is available at http://links.lww.com/AOG/B111.

Received August 29, 2017. Received in revised form January 18, 2018. Accepted February 1, 2018.

The author has indicated that he has met the journal's requirements for authorship.

Received August 29, 2017

Received in revised form January 18, 2018

Accepted April 26, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.