Polycystic ovarian disease

Polycystic ovarian disease  

Updated: 10/25/2022

© Jun Wang, MD, PhD

General features
Key pathogenesis
  • Abnormal metabolism of androgens and estrogen
  • Insulin resistance, subsequent hyperinsulinism associated overproduction of ovarian androgen
  • LH excess
Clinical presentations
  • Major features
Menstrual dysfunction
Anovulation
Signs of hyperandrogenism
  • Hirsutism
  • Infertility
  • Obesity and metabolic syndrome
  • Type II diabetes
  • Obstructive sleep apnea
Key Laboratory findings
  • Elevated total and free testosterone: Sensitive
  • Elevated LH
  • Normal or low FSH
  • LH/FSH ratio usually ≥ 2
Key morphological features
Diagnosis
  • 2 of the 3: Chronic anovulation, hyperandrogenism (clinical/biologic), and multiple cysts in ovaries
  • Elevated serum 17-hydroxyprogesterone and anti-Müllerian hormone
  • Free testosterone levels
Treatment
  • Menstrual dysfunction/Endometrium protection: estrogen-progestin if pregnancy not desired
  • Ovulation induction, if pregnancy desired
  • Treatment of androgen excess
  • Treatment of metabolic abnormalities: Weight loss, treatment of diabetes, dyslipidemia, etc



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