Polycystic Ovarian Syndrome

Polycystic ovarian syndrome (PCOS) is a common endocrine disorder in women of reproductive age. Etiology includes both genetic and environmental factors. The proposed pathophysiology of PCOS is an interaction between impaired gonadotropin secretion and action, dysfunction in ovarian folliculogenesis, insulin resistance accompanied by hyperinsulinemia, and hyperandrogenism. Diagnosis of the syndrome requires specific criteria to be met (ovulation disturbances, hyperandrogenism, and/or polycystic ovarian morphology), excluding other conditions mimicking PCOS. Importantly, PCOS may be associated with metabolic, cardiovascular, gynecological, and psychological health risks leading to a diminished quality of life. Treatment should be individualized, and a multidisciplinary approach should be followed. Treatment options include managing menstrual irregularity, hyperandrogenic characteristics, and metabolic abnormalities; preventing endometrial hyperplasia and cancer; and contraception for those not pursuing pregnancy and ovulation induction for those pursuing pregnancy. This chapter describes the above different aspects of PCOS in premenopausal adult women, adolescents, and postmenopausal women.