Heterogeneous endocrine disorder with hyperandrogenism, ovulatory dysfunction, polycystic ovaries (Rotterdam 2/3 criteria).
History taking
- • Oligomenorrhoea/amenorrhoea, hirsutism, acne, weight gain
- • Infertility, family history of PCOS/DM
- • Insulin resistance symptoms (acanthosis)
Examination
- • BMI, waist circumference, BP
- • Hirsutism (modified Ferriman-Gallwey), acne, acanthosis nigricans, alopecia
Red flags
- • Virilisation (rapid onset deep voice, clitoromegaly) — exclude androgen-secreting tumour
- • Severe acanthosis with rapid weight gain — insulin resistance/Cushing
Differential diagnosis
- • Hypothyroidism, hyperprolactinaemia, late-onset CAH, Cushing syndrome, androgen-secreting tumour
Recommended investigations
- • TSH, prolactin, total testosterone, DHEAS, 17-OH progesterone
- • Fasting glucose, OGTT, HbA1c, lipid profile
- • Pelvic USG (polycystic morphology: ≥20 follicles or ovarian volume ≥10 mL)
Diagnosis
- • Rotterdam criteria: any 2 of oligo/anovulation, hyperandrogenism, PCOM
Initial treatment / management
- • Lifestyle (weight loss 5–10%) — first-line for all
- • Cycle regulation: combined OCP
- • Hirsutism: OCP ± antiandrogen (spironolactone) after contraception
- • Anovulatory infertility: letrozole first-line
- • Metformin for metabolic features/insulin resistance
Prescription examples
- • Combined OCP (Drospirenone 3 mg + EE 30 µg) PO OD x 21 d cyclically
- • Tab Metformin 500 mg PO BD with meals (titrate)
- • Tab Spironolactone 50–100 mg PO OD with effective contraception
- • Tab Letrozole 2.5–5 mg PO OD day 2–6 of cycle (ovulation induction)
Follow-up advice
- • Quarterly weight, BP, glucose; annual lipid profile, OGTT
- • Endometrial protection in oligomenorrhoea
Patient counselling
- • Lifestyle is foundation; psychological support
- • Long-term risks: DM, dyslipidaemia, sleep apnoea, endometrial hyperplasia
- • Pregnancy outcomes improve with weight loss
Referral criteria
- • Infertility — reproductive endocrinology
- • Suspected secondary causes
Clinical pearls
- • Letrozole > Clomiphene for ovulation induction in PCOS
- • Always evaluate metabolic risk; PCOS is a lifelong condition
References
- • International Evidence-Based Guideline for PCOS 2023
- • ESHRE Guidelines on PCOS 2018
Educational outpatient guide — verify against local guidelines before clinical use.
