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How to diagnose polycystic ovary syndrome

Mr Anil Gudi, Mr Amit Shah and Prof Roy homburg

Polycystic ovary syndrome (PCOS) is a commonly found syndrome among women of reproductive age, affecting 5%-10% of this population. The cause is a hormonal imbalance in which the polycystic ovaries produce more of the male hormone, testosterone, than the normal ovary. This produces the symptoms of an excess of facial and body hair (hirsutism) and often persistent acne of more than two years duration. In addition, the menstrual cycle is greatly prolonged or menstruation completely absent. The appearance of the polycystic ovary on ultrasound examination is very characteristic, usually larger than a normal ovary and containing a large number (more than 12) of ‘cavities’ which are really small follicles containing eggs, usually arranged like a necklace around the perimeter.

Any combination of these symptoms and signs may be present. About 50-60% of women with PCOS are overweight and 75% need help to conceive. Laboratory examinations in the blood may reveal that the luteinising hormone (LH), testosterone and fasting insulin levels may be raised. Similar to the symptoms, the laboratory findings are inconsistent but the diagnosis can often be made on clinical grounds alone as any two of the following are enough to confirm the diagnosis: irregular or absent periods, hirsutism and/or persistent acne, the characteristic appearance of polycystic ovaries on ultrasound examination.

Sometimes a polycystic appearance of the ovaries is seen by chance on ultrasound examination but unaccompanied by any symptoms. This is common and not a cause for concern although this situation may develop in later life to PCOS.

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