Polycystic Ovarian Syndrome

This chapter discusses polycystic ovarian syndrome (PCOS). (PCOS) is a common endocrinopathy, but it is poorly understood. It is a disorder of unexplained hyperandrogenic chronic anovulation and clearly heterogeneous in etiology; however, many women with PCOS are noted to have profound peripheral resistance to insulin-mediated glucose uptake. Despite evidence of familial clustering, no clear molecular or genetic mechanism has been identified to date to explain the vast majority of cases. Women with PCOS present with infertility, menstrual disorders, and hirsutism. They appear to be at increased risk for diabetes and display multiple risk factors for endometrial cancer and cardiovascular disease. Unfortunately, there are few randomized, controlled trials of any treatment in PCOS to provide us with clear treatment guidelines. Therefore, treatment tends to be symptom based, although lifestyle interventions and pharmaceutical treatments directed at improving insulin sensitivity appear to improve multiple stigmata of the syndrome. For instance, studies with these agents have shown improvements in ovulation and hirsutism.