PCOS involves disruptions in hormone levels affecting ovulation and androgen conversion.
Diagnosis requires meeting specific criteria with emphasis on history, physical examination, and ruling out other conditions.
Deep dives
Understanding PCOS Pathophysiology
Polycystic ovary syndrome (PCOS) is characterized by various mechanisms, including disruptions in the hypothalamic-pituitary-ovarian axis. Changes in follicular development, such as lack of ovulation leading to lower progesterone and increased LH levels, contribute to the syndrome. Additionally, conversion of adrenal androgens into estrone in peripheral tissues and associations with hyperinsulinemia are key pathophysiological pathways of PCOS.
Diagnosing PCOS
Diagnosis of PCOS involves meeting at least two of three criteria, which include ovulatory dysfunction, androgen excess, and polycystic ovaries. A comprehensive history and physical exam are crucial, as PCOS presents with various symptoms such as irregular menstruation, herseutism, and acne. Differential diagnoses must be considered, ruling out other conditions like pregnancy, thyroid diseases, and hyperprolactinemia.
Management and Screening for PCOS
Treatment of PCOS depends on symptoms and patient preferences, ranging from lifestyle modifications to pharmacological interventions. Hormonal contraceptives are primary in managing menstrual abnormalities and hyperandrogenism. Screening individuals with PCOS for metabolic syndromes is essential, including dyslipidemia and diabetes. Medical management for infertility through ovulation induction and referral to fertility specialists is recommended.
At the intersection of endocrinology and gynaecology is an important topic- polycystic ovarian syndrome! This episode was written by Dr. Sooyoun Shin (Internal Medicine Resident) and reviewed by Dr. Shoba Sujana Kumar (Endocrinology) and Dr. Rupal Shah (General Internal Medicine). Podcast produced by Kiera Liblik (medical student). Infographic by Dr. Shannon Gui (Internal Medicine Resident).