COMMENTARY

PCOS Is a Lifelong Disorder: 'Be Vigilant'

Ricardo Azziz, MD, MPH, MBA

Disclosures

May 04, 2017

Editorial Collaboration

Medscape &

Among the diseases that most people tend to get confused about is polycystic ovary syndrome (PCOS). PCOS affects between 10% and 15% of all women worldwide.[1,2] In fact, most studies have indicated that the incidence is almost the same worldwide.[2]

What Is PCOS?

PCOS is a disease that affects the endocrine, metabolic, and reproductive systems. It is detrimental to a woman's quality of life and results in long-term morbidity. We generally consider PCOS to have three components, but you only need two of the three components to make the diagnosis. These components are hyperandrogenism (evidence of excess male hormones like hirsutism or high androgen levels), evidence of irregular ovulation (generally reflected in irregular menstruation), and evidence of polycystic ovaries, most often detected on ultrasound.[2,3]

Who Should Be Screened for PCOS?

We should screen women who present with a complaint of unwanted hair growth—it does not matter whether you actually see it or not—and women who complain of irregular menstrual cycles.

A good history and physical examination are essential. If you think you have a patient with PCOS, it is very critical that you obtain a very thorough medical history and examine the patient carefully. Exclude other disorders such as adrenal hyperplasia, thyroid dysfunction, and hyperprolactinemia.[3] To do so, check 17-hydroxyprogesterone, thyroid-stimulating hormone, and prolactin levels.

If the patient does not have a lot of hirsutism and you are unsure whether she has excess male hormones, obtain total and free testosterone levels.[3] Use a very good laboratory. Mass spectrometry is the best way to determine whether these women have elevated levels of androgens. However, not all women with PCOS have elevated levels of androgens in their blood, and it is not necessary for the diagnosis of PCOS. You can make the diagnosis using the clinical picture and excluding other disorders as mentioned.

What Comes After a Diagnosis of PCOS?

Women with PCOS require long-term care because many of them are at increased risk for diabetes and glucose intolerance—problems that raise their risk for heart disease and other conditions.

The recommendation today is that all women with PCOS should undergo a glucose tolerance test. A 2-hour, 75-g glucose tolerance test should tell you whether the patient is diabetic.[4] It is also okay to check an insulin level during the test, because that will give you an idea about whether the insulin level is high during the glucose tolerance test.

About 75%-85% of women with PCOS have metabolic dysfunction and are at increased risk for diabetes and heart disease.[2] You need to pay attention to their glucose tolerance and their lipid levels. They need to be counseled about weight loss, lifestyle modification, eating better, and treating all of the other risk factors that we know about.

For a patient with PCOS, once you have counseled her about the disease and have done the tests for glucose intolerance, determine what you are going to tell her over the long term. It is your job to make sure that she continues to receive care and understands that this is a lifelong disorder.

PCOS is the single most common endocrine metabolic disorder of humans, affecting up to 15% of women.[1] You should never forget it and should always be vigilant.

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