The polycystic ovary syndrome

Min, Eung Gi

Abstract

The polycystic ovary syndrome (PCOS) is a heterogeneous disorder that is characterized principally by oligomenorrhea or amenorrhea with clinical or laboratory evidence of hyperandrogenemia. Furthermore, it is now recognized that a significant proportion of overweight women with PCOS have hyperinsulinemia. Three features are generally recognized to compose this syndrome, including androgen excess, ovulatory dysfunction, and polycystic ovaries. Because its etiology and natural history are poorly understood, there is controversy about the diagnostic criteria and clinical evaluation of the syndrome. But the diagnosis of PCOS entails two principal steps: (a) to determine whether features suggestive of PCOS are present and (b) to exclude related androgen excess or ovulatory disorders. The PCOS results in a number of immediate and long-term morbidities that are associated with a significant impact on quality of life and on economic costs. Immediate morbidities include menstrual dysfunction and abnormal uterine bleeding, subfertility and infertility, and androgen excess-related dermatologic abnormalities including hirsutism, acne, and androgenic alopecia, and an increased risk of obstetrical complications such as pregnancy-induced hypertension and gestational diabetes. However, PCOS is also associated with an increased risk of various other long-term complications or morbidities including cancer, type 2 diabetes mellitus, the metabolic syndrome, and possibly cardiovascular disease. For the management of PCOS, we should consider not only immediate but also the long-term morbidities.