Polycystic Ovary Syndrome

Joyce King, CNM, RN, FNP, PhD

Disclosures

J Midwifery Womens Health. 2006;51(6):415-422. 

In This Article

Abstract and Introduction

Abstract

Polycystic ovary syndrome (PCOS) is a common endocrine disorder, affecting between 4% and 8% of reproductive aged women. This syndrome, a complex disorder with multiple components, including reproductive, metabolic, and cardiovascular manifestations, has long-term health concerns that cross the life span. The diagnostic criteria for PCOS are ovarian dysfunction evidenced by oligomenorrhea or amenorrhea and clinical evidence of androgen excess (e.g., hirsutism and acne) in the absence of other conditions that can cause these same symptoms. This article reviews current knowledge about the pathophysiology, clinical manifestations, diagnosis, and management of this disorder.

Introduction

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. The overall prevalence among women in this age group is between 4% and 8%,[1] although the prevalence may be as high as 30% in women with secondary amenorrhea, 75% in women with oligomenorrhea, and 90% in women with hirsutism.[2] Because of this high prevalence, it is essential that nurse-midwives understand the diagnosis, etiology, and treatment of this syndrome.

In 1935, Stein and Leventhal published their report of seven women with amenorrhea, hirsutism, obesity, and enlarged polycystic appearing ovaries. Since then, much has been learned about this complex disorder. It is now well recognized that women with this syndrome not only have reproductive health issues but their metabolic and cardiovascular health is also affected. This article reviews current knowledge about the pathophysiology, diagnosis, and treatment of PCOS.

Until recently, there has been no universally accepted definition for PCOS. In 2003, an international consensus group proposed that the diagnostic criteria for PCOS are ovarian dysfunction evidenced by oligomenorrhea or amenorrhea and clinical evidence of androgen excess (e.g., hirsutism and acne) in the absence of other conditions that can cause these same signs and symptoms.[1,3,4] The differential diagnosis for PCOS is presented in Table 1 . Polycystic ovaries, as defined by ultrasonography (the presence of 12 or more follicles in each ovary measuring 2 to 9 mm in diameter, and/or ovarian volume > 10 mL) should also be considered as one of the possible diagnostic criteria for PCOS.[3] It is important to note that polycystic ovaries need not be present to make the diagnosis of PCOS.[5,6] In fact, Clayton et al.[7] observed that 23% of normal women met the sonographic criteria for polycystic ovaries.

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