Purpose: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder that afflicts about 4-12% of women of reproductive age. First discovered by Stein and Leventhal in 1935, it is currently defined by the National Institute of Health as oligo- or anovulation with features of hyperandrogenism, when all other possible causes of menstrual irregularity and hyperandrogenism have been ruled out. PCOS can be distressing to women due to infertility issues and hyperandrogenism symptoms. PCOS can be challenging to diagnose by clinicians, and even more difficult to manage due to the large amount of presentations and treatment options. Currently there is no standard or universal course of therapy available.
Methods: An exhaustive literature search using the following search engines: Medline, NEJM, PudMed and CINAHL was conducted. Articles related to the topic but published more than 10 years ago were excluded.
Results: PCOS therapy should be appropriate for each patient taking into consideration her fertility, health and cosmetic desires. All PCOS patients should first be treated with lifestyle changes as this can yield improvement in all areas of pathogenesis. Diet, exercise and weight loss has proved efficacious in restoring ovulation, improving hyperandrogenism and decreasing insulin resistance. Management of anovulation and infertility will depend on whether or not the patient is attempting to conceive. If not, then oral contraceptives to decrease the risk of endometrial carcinoma will be the appropriate choice. If the individual is trying to conceive, then clomiphene citrate is considered first line in order to restore ovulation and promote fertility. If the patient is clomiphene resistant then, metformin should be tried as it has shown to improve ovulation although not as well as clomiphene. The next options include laparoscopic ovarian diathermy or gonadotropin therapy. When treating symptoms of hyperandrogenism such as: hirsutism, acne, seborrhea and male pattern baldness, anti-androgens should be used in all patients not attempting to conceive in order to reduce the amount of systemic testosterone causing the symptoms. Specifically, hirsutism is generally treated with mechanical methods. Metformin has also been shown to help improve hirsutism. Acne can be treated with topical and oral antibiotics and seborrhea can be managed with steroid creams. Rogaine should be used in women with male pattern baldness. Finally, and most importantly, women with PCOS should always be screened and treated for insulin resistance and syndrome X to prevent and slow the progression of diabetic and cardiovascular complications. If insulin resistance is found, patients should be put on metformin or TZDs to increase insulin sensitization. Also, if other disorders associated with metabolic syndrome are present, such as hyperlipidemia or hypertension, they should be treated appropriately.
Conclusion: If women with PCOS are diagnosed and managed properly with lifestyle changes and other pharmacological and surgical therapy, most distressing symptoms can be alleviated and future complications of diabetes and cardiovascular events can be slowed or prevented.
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