Polycystic ovarian disease
Polycystic ovarian disease
Updated: 10/25/2022
© Jun Wang, MD, PhD
General features
- AKA Stein-Leventhal syndrome
- Teenage and childbearing years
- Most common cause of anovulatory infertility
- Risk factor for endometrial hyperplasia, endometrioid adenocarcinoma
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
- Enlarged ovary
- Multiple cysts beneath the surface
- Multiple cystic follicles
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
Back to female genital tract
Back to contents
Comments
Post a Comment