Clinical Presentation, Risk Assessment and Management of Polycystic Ovary Syndrome (PCOS)

Abstract

Polycystic ovary syndrome (PCOS) is a complex and heterogeneous disorder characterized by hyperandrogenemia, hyperinsulinemia, insulin resistance, and chronic anovulation. It is the most common endocrine disorder in women of reproductive age with an enigmatic pathophysiology. It is a clearly a heterogeneous syndrome, and current proposed diagnostic criteria include a number of disorders with similar phenotypes but radically different etiologies. The lack of well-defined diagnostic criteria makes identification of PCOS confusing to many clinicians and seriously delays the clarification of its etiology, clinical associations and assessment of treatment. There is no universally accepted clinical definition for PCOS. It is the most frequently encountered endocrine disturbance in women of reproductive age. Its prevalence ranges from 5% to 10% it affects all ethnic groups, and it is not only a reproductive disorder but a metabolic one. Recognition of the syndrome affords the health provider an opportunity of not only reducing the emotional impact of manifestations such as acne, hirsutism, and infertility, but of reducing the distinct development of type 2diabetes mellitus (T2DM) in 40% to 45% of afflicted women and the potential of subsequent strokes and myocardial infarction. Once a diagnosis is made, a thorough investigation of the propensity to developT2DM, noting features of the MS and markers of risk factors for cardio vascular disease (CVD), should be made in both obese and non-obese women. Studies of PCOS in India carried out in convenience samples reported a prevalence of 3.7% to 22.5%, with 9.13% to 36% prevalence in adolescents only. The wide variation in prevalence might be due to heterogeneous presentation of symptoms, diagnostic criteria practiced, limitations in diagnosis, age groups, and ethnic populations studied. This article will discuss the clinical presentation, risk assessment and management of polycystic ovary syndrome.