Current Perspectives in Polycystic Ovary Syndrome - American Family Physician

Clinical Course Young women of reproductive age most frequently seek attention initially because of irregular menses, hirsutism, or infertility, but PCOS has a long prodrome with detectable abnormalities throughout the life cycle of affected women. The earliest manifestations of PCOS are discernible in the peripubertal years. Ovarian hyperandrogenism and insulin resistance develop with increased frequency in adolescent girls who have premature pubarche. In the early reproductive period, chronic anovulation results in reduced rates of conception. When pregnancy is achieved, it frequently terminates in spontaneous, firsttrimester loss or is associated with gestational diabetes. Approximately 25 to 30 percent of these women show impaired glucose tolerance by the age of 30, and 8 percent of women with PCOS develop frank type 2 diabetes mellitus annually. Markers of premature coronary artery and P olycystic ovary syndrome (PCOS) is the most common endocrinopathy among women of reproductive age and is estimated to affect up to 10 percent of the U.S. population or approximately 5 million women. In 1935, Stein and Leventhal described masculinized women with amenorrhea, sterility, and enlarged ovaries containing multiple cysts. The syndrome was placed in the gynecologic realm for control of chronic anovulation, abnormal menstrual bleeding, and infertility. By the early 1980s, this symptom complex had been linked to hyperinsulinemia and impaired glucose tolerance. The connection to an insulin post-receptor defect was isolated in women with PCOS in the early 1990s. As a result of these recent associations, attention is now focused on treating the central deficits and fundamental problems of hyperandrogenism, hyperinsulinemia, abnormal serum lipid levels, and obesity that have broader health implications (Table 1). This new information profoundly alters our view of the gravity of this condition. Family physicians Polycystic ovary syndrome has been viewed primarily as a gynecologic disorder requiring medical intervention to control irregular bleeding, relieve chronic anovulation, and facilitate pregnancy. A large body of evidence has demonstrated an association between insulin resistance and polycystic ovary syndrome. The former condition has an established link with long-term macrovascular diseases such as type 2 diabetes mellitus, hypertension, and atherosclerotic heart disease, consequences that also are observed in women with polycystic ovary syndrome. In addition, chronic anovulation predisposes women to endometrial hyperplasia and carcinoma. The purpose of this review is to examine the clinical course of this syndrome, which spans adolescence through menopause, and suggest a simple and cost-effective diagnostic evaluation to screen the large numbers of women who may be affected. Therapy, which should be individualized, should incorporate steroid hormones, antiandrogens, and insulin-sensitizing agents. Weight loss by way of reduced carbohydrate intake and gentle exercise is the most important intervention; this step alone can restore menstrual cyclicity and fertility, and provide long-term prevention against diabetes and heart disease. Treatment alternatives should be directed initially toward the most compelling symptom. Longitudinal care is of paramount importance to provide protection from long-term sequelae. (Am Fam Physician 2003;68:697-704. Copyright© 2003 American Academy of Family Physicians.) Current Perspectives in Polycystic Ovary Syndrome