What are the signs and symptoms of polycystic ovary syndrome (PCOS)?

Updated: Apr 07, 2020
  • Author: Mohamed Yahya Abdel-Rahman, MD, MSc; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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Hirsutism is almost always a manifestation of other disease (more than 90% of the time). Because PCOS represents 80% of the etiology, it is important to ask about symptoms of this disorder. Oligomenorrhea or amenorrhea with hirsutism is sufficient to diagnose PCOS according to the revised Rotterdam criteria [29] after exclusion of other causes.

A study by Willis et al found that self-reported hirsutism in women, as measured using the modified Ferriman-Gallwey score, was associated with menstrual irregularity, bleed lengths of 7 days or more, and heavy menstrual bleeding. [30]

Regular menses, however, do not predict normal androgen status in hirsute women. Although 40% of women with hirsute have regular menses, half of them will be found to have elevated levels of one or more androgens. [31] Other cutaneous manifestations of PCOS like acne, oily skin, androgenic alopecia, seborrhea, and obesity may be present with hirsutism.

Family history

An increased prevalence of hirsutism, acne, and male pattern baldness have been found to run in some families. [32] PCOS often presents with familial clustering. However, it is unclear if this is due to genetic pattern alone or due to environmental factors such as diet. [33] Congenital adrenal hyperplasia also presents with familial clustering. The ethnic differences in hair quantity and distribution should be kept in mind.

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