Polycystic ovary syndrome.

In 1935 Stein and Leventhal described seven hirsute and infertile women with amenorrhoea or oligomenorrhoea in whom bilateral cystic ovarian enlargement was found at laparotomy' and thereby gave their names to a polycystic ovarian disorder. Since then, however, the protean manner of clinical presentation and the variability of biochemical changes in patients with this condition have led some people to doubt the existence of a disease entity. Enlarged cystic ovaries may occur in the absence of the classic clinical characteristics originally described. Polycystic ovaries may be found in those who have conceived and are not hirsute; they may also be seen in infertile women who menstruate regularly, and even in some patients with menorrhagia. On the other hand, the clinical features of oligomenorrhoea, hirsutism, and infertility may occur in the absence of bilateral ovarian enlargement, and cystic change may be found in normal sized or small ovaries. What then are the diagnostic criteria of the syndrome ? Polycystic ovaries may have several causes, and whether large or small ovaries result may be determined by the duration and severity of the particular cause.2 Thus the diagnosis need not depend on ovarian size or specific clinical characteristics but in the final analysis is made histologically from microscopical examination of ovarian tissue. "Sclerocystic ovarian change" would be a better description, but the term "polycystic" is now firmly established by common usage. The exact prevalence of the disorder is difficult to assess. In a series of 160 abdominal operations where the ovaries were examined routinely polycystic changes were found in 12 cases, which is a prevalence of 7-50o3; a prevalence of 3-5o% was change in patients attending an endocrine clinic is in our found in a necropsy series.4 The prevalence of polycystic ovarian experience, however, much higher-about 17%.5