Barbara is a 25-year-old morbidly obese African American female, gravida 0, who presented to the gynecology office for evaluation of irregular menses since menarche. The patient stated that on average, she has 1 period every 6 months. When she does have her period, she bleeds very heavily, passing large clots, and has a lot of cramping. She also complained about excessive facial hair, which requires her to shave at least once every several days, and a lot of hair on her abdomen and arms. Barbara stated that her mother also has a lot of facial hair but doesn't think that she does anything about it.
She denied any change in her voice or increase in the size of her muscles. She has been morbidly obese since she was a young teenager. She denied any headaches, blurred vision, or discharge from her nipples. She also denied any hyper/hypothyroid symptoms. She has never had any surgery and has never conceived, despite several years of trying. Barbara is not currently taking any medication and has never used any form of contraception.
On examination, she was clearly hirsute (Ferriman-Gallowey score of 10), especially in the chin and midabdominal regions. Her BMI was 32. Her pelvic exam was unremarkable, including no evidence for clitoromegaly, but her uterus and adnexa were very difficult to assess secondary to the patient's morbid obesity. The rest of her physical exam was unremarkable. Because she had been amenorrheic for 6 months, an endometrial aspiration was performed. The uterus sounded to 8 cm and there was a good amount of tissue on return.
A uterine ultrasound was performed, which revealed a normal appearing uterus, with an endometrial stripe of 6 mm and bilateral normal ovaries. Specifically, there was no evidence for polycystic ovaries.
Laboratory studies were undertaken to further evaluate her problem. Her FSH was normal, but her LH was elevated. Her TSH, prolactin, chemistry panel, cholesterol, triglycerides, HDL, and low-density lipoprotein (LDL) were all within normal limits. Her fasting insulin level was elevated at 36 UU/mL; fasting blood sugar was 130 mg/dL, and the 2-hour value on glucose tolerance test was 233 mg/dL. Her total testosterone was 78 ng/dL, and her free testosterone was 30 pg/mL (normal range, 1-21 pg/mL.) Her 17OH-progesterone was normal at 92 ng/dL, as was the DHEAS at 131 ug/dL. The endometrial aspirate showed proliferative endometrium without hyperplasia or neoplasia.
The clinical and laboratory results were consistent with PCOS. Because she desired a pregnancy, she was a candidate for metformin not only for control of her blood sugar but also to help regulate her menstrual cycles. She also required clomiphene to induce ovulation. After being started on a diet, an exercise program for weight loss, and metformin, her blood sugars responded well. After 6 months of blood glucose control, menstrual regularity, and increasing doses of clomiphene, she became pregnant. Today, Barbara is doing well in our high-risk OB practice.
Topics in Advanced Practice Nursing eJournal. 2002;2(3) © 2002 Medscape
Cite this: Polycystic Ovary Syndrome: An Overview - Medscape - Jul 31, 2002.