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{{Polycystic ovary syndrome}}
{{Polycystic ovary syndrome}}
 
{{CMG}}; {{AE}} {{ADG}}
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==Overview==
==Overview==
The significant information that needs to focus on the history of patient includes menstrual abnormalities, [[infertility]], signs of [[virilization]] on physical examination and family history of [[PCOS]] among first-degree relatives. The most common symptoms of PCOS include [[amenorrhea]] or [[oligomenorrhea]], [[abnormal uterine bleeding]] and [[androgenization]], including [[hirsutism]], [[acne]], oily skin.


==History==
==History==
Obtaining the history is the most important aspect of making a diagnosis of PCOS. It provides insight into the cause, precipitating factors and associated comorbid conditions. The significant information that needs to be focused on history of patient includes:<ref>http://www.cfp.ca/cgi/content/full/53/6/1041/T50531041</ref><ref name="pmid17872783">{{cite journal |author=Pedersen SD, Brar S, Faris P, Corenblum B |title=Polycystic ovary syndrome: validated questionnaire for use in diagnosis |journal=Canadian family physician Médecin de famille canadien |volume=53 |issue=6 |pages=1042–7, 1041 |year=2007 |pmid=17872783 |doi=}}</ref>
*Menstrual abnormalities
*[[Infertility]]
*Signs of [[virilization]] in physical examination
*Family history of [[PCOS]] among first-degree relatives
==Common Symptoms==
The most common symptoms of PCOS include:<ref name="AMN">{{cite web | author = Christine Cortet-Rudelli, Didier Dewailly | title =Diagnosis of Hyperandrogenism in Female Adolescents| work =Hyperandrogenism in Adolescent Girls | url=http://www.health.am/gyneco/more/diagnosis-of-hyperandrogenism-in-female/ | year = 2006 | month= Sep 21 | publisher=Armenian Health Network, Health.am}}</ref><ref name="pmid28919160">{{cite journal |vauthors=Rothenberg SS, Beverley R, Barnard E, Baradaran-Shoraka M, Sanfilippo JS |title=Polycystic ovary syndrome in adolescents |journal=Best Pract Res Clin Obstet Gynaecol |volume= |issue= |pages= |year=2017 |pmid=28919160 |doi=10.1016/j.bpobgyn.2017.08.008 |url=}}</ref><ref name="pmid25840648">{{cite journal |vauthors=Rosenfield RL |title=The Polycystic Ovary Morphology-Polycystic Ovary Syndrome Spectrum |journal=J Pediatr Adolesc Gynecol |volume=28 |issue=6 |pages=412–9 |year=2015 |pmid=25840648 |pmc=4387116 |doi=10.1016/j.jpag.2014.07.016 |url=}}</ref><ref name="pmid15713728">{{cite journal |vauthors=Legro RS, Chiu P, Kunselman AR, Bentley CM, Dodson WC, Dunaif A |title=Polycystic ovaries are common in women with hyperandrogenic chronic anovulation but do not predict metabolic or reproductive phenotype |journal=J. Clin. Endocrinol. Metab. |volume=90 |issue=5 |pages=2571–9 |year=2005 |pmid=15713728 |doi=10.1210/jc.2004-0219 |url=}}</ref><ref name="pmid9536213">{{cite journal |vauthors=Rosenfield RL |title=Current concepts of polycystic ovary syndrome |journal=Baillieres Clin Obstet Gynaecol |volume=11 |issue=2 |pages=307–33 |year=1997 |pmid=9536213 |doi= |url=}}</ref><ref name="pmid16691383">{{cite journal |vauthors=Hassa H, Tanir HM, Yildiz Z |title=Comparison of clinical and laboratory characteristics of cases with polycystic ovarian syndrome based on Rotterdam's criteria and women whose only clinical signs are oligo/anovulation or hirsutism |journal=Arch. Gynecol. Obstet. |volume=274 |issue=4 |pages=227–32 |year=2006 |pmid=16691383 |doi=10.1007/s00404-006-0173-8 |url=}}</ref>
*[[Amenorrhea]] or [[oligomenorrhea]]
*[[Abnormal uterine bleeding]]
*[[Androgenization]], including [[hirsutism]] (often slowly progressive), [[acne]], oily skin
*[[Polycystic ovaries]], with or without ovarian enlargement
*[[Insulin resistance]]
*[[Endometrial hyperplasia]]


History-taking, specifically for menstrual pattern, [[obesity]], [[hirsutism]], and the absence of breast discharge. A [[clinical prediction rule]] found that these four questions<ref>http://www.cfp.ca/cgi/content/full/53/6/1041/T50531041</ref> can diagnose PCOS with a [[sensitivity (tests)|sensitivity]] of 85% and a [[specificity (tests)|specificity]] of 85%.<ref name="pmid17872783">{{cite journal |author=Pedersen SD, Brar S, Faris P, Corenblum B |title=Polycystic ovary syndrome: validated questionnaire for use in diagnosis |journal=Canadian family physician Médecin de famille canadien |volume=53 |issue=6 |pages=1042–7, 1041 |year=2007 |pmid=17872783 |doi=}}</ref>
==Less Common Symptoms==
==Symptoms==
* [[Dyspareunia]]  
Common symptoms of PCOS include
* Androgenic [[alopecia]]
* [[Ovarian Cysts]] &mdash; (also called Polcystic Ovaries or PCO) is not a necessary symptom to be 'PCOS', many do not have cyst issues. Likewise, having cysts does not prove PCOS as many women without any medical problems have cysts at some point in their lives.
* [[Seborrheic dermatitis|Seborrhea]]
* [[Oligomenorrhea]], [[amenorrhea]] &mdash; irregular, few, or absent [[menstrual period]]s; cycles that do occur may be heavy (heavy bleeding is also an early warning sign of [[endometrial cancer]](in post menopausal women), for which women with PCOS are at slightly higher risk)
* [[Acanthosis nigricans]]  
* [[Infertility]], generally resulting from chronic [[anovulation]] (lack of ovulation)
* [[Acrochordons]]  
* Elevated serum (blood) levels of [[androgen]]s (male hormones), specifically testosterone, [[androstenedione]], and [[dehydroepiandrosterone sulfate]] (DHEAS), causing [[hirsutism]] and occasionally [[masculinization]]
*[[Weight gain]] or [[obesity]]
* [[Dyspareunia]] &mdash; pain during sexual intercourse
* Androgenic [[alopecia]] &mdash; male-pattern baldness
* [[Acne vulgaris|Acne]], oily skin, [[seborrheic dermatitis|seborrhea]]
* [[Acanthosis nigricans]] &mdash; dark patches of skin, tan to dark brown or black, a sign of [[insulin resistance]], which is associated with PCOS
* [[Acrochordons]] (skin tags) &mdash; tiny flaps of skin
* Prolonged periods of [[Premenstrual stress syndrome|PMS]]-like symptoms ([[bloating]], [[mood swing]]s, [[pelvic pain]], [[backaches]])
*Infrequent [[menstrual period]]s, no menstrual periods, and/or irregular [[bleeding]]  
*[[Weight gain]] or [[obesity]], usually carrying extra weight around the waist
*[[Pelvic pain]]  
*[[Pelvic pain]]  
*Anxiety or [[depression]] due to appearance and/or [[infertility]]  
*[[Anxiety]] or [[depression]]
*[[Sleep apnea]] (excessive snoring and times when breathing stops while asleep)
*[[Sleep apnea]]
 
Mild symptoms of [[hyperandrogenism]], such as [[acne]] or [[hyperseborrhea]], are frequent in adolescent girls and are often associated with irregular [[menstrual cycles]]. In most instances, these symptoms are transient and only reflect the immaturity of the hypothalamic-pituitary-ovary axis during the first years following [[menarche]].<ref name=AMN>{{cite web | author = Christine Cortet-Rudelli, Didier Dewailly | title =Diagnosis of Hyperandrogenism in Female Adolescents| work =Hyperandrogenism in Adolescent Girls | url=http://www.health.am/gyneco/more/diagnosis-of-hyperandrogenism-in-female/ | year = 2006 | month= Sep 21 | publisher=Armenian Health Network, Health.am}}</ref>
 
==Signs==
Signs are:
* Multiple small follicles on the ovaries (10 or more) (one form of [[ovarian cyst]]). Sonographically they may look like a string of pearls.
* Enlarged ovaries, generally 1.5 to 3 times larger than normal(volume >20mls), resulting from multiple peripherally located small follicles and echogenic ovarian stroma.
* Thickened, smooth, pearl-white outer surface of ovary on [[laparoscopic_surgery|laparoscopic]] examination.
* The ratio of LH ([[Luteinizing hormone]]) to FSH ([[Follicle stimulating hormone]]) is greater than 1:1, as tested on Day 3 of the menstrual cycle.
* High levels of [[testosterone]].
* Low levels of [[sex hormone binding globulin]].
* [[Hyperinsulinemia]].
 
It is important to know that PCOS can present in any age. Many can be diagnosed as young children, some might not present until after menopause. It is [[vital]] to find a PCOS knowledgeable doctor to catch this disorder as many miss the diagnosis - sometimes for years.


==References==
==References==
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[[Category:Endocrinology]]
[[Category:Endocrinology]]
[[Category:Gynecology]]
[[Category:Gynecology]]
[[Category:Medical conditions related to obesity]]
[[Category:Syndromes]]
[[Category:Human reproduction]]
[[Category:Overview complete]]
[[Category:Obstetrics]]
[[Category:Obstetrics]]


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Latest revision as of 17:46, 1 November 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

The significant information that needs to focus on the history of patient includes menstrual abnormalities, infertility, signs of virilization on physical examination and family history of PCOS among first-degree relatives. The most common symptoms of PCOS include amenorrhea or oligomenorrhea, abnormal uterine bleeding and androgenization, including hirsutism, acne, oily skin.

History

Obtaining the history is the most important aspect of making a diagnosis of PCOS. It provides insight into the cause, precipitating factors and associated comorbid conditions. The significant information that needs to be focused on history of patient includes:[1][2]

Common Symptoms

The most common symptoms of PCOS include:[3][4][5][6][7][8]

Less Common Symptoms

References

  1. ↑ http://www.cfp.ca/cgi/content/full/53/6/1041/T50531041
  2. ↑ Pedersen SD, Brar S, Faris P, Corenblum B (2007). "Polycystic ovary syndrome: validated questionnaire for use in diagnosis". Canadian family physician Médecin de famille canadien. 53 (6): 1042–7, 1041. PMID 17872783.
  3. ↑ Christine Cortet-Rudelli, Didier Dewailly (2006). "Diagnosis of Hyperandrogenism in Female Adolescents". Hyperandrogenism in Adolescent Girls. Armenian Health Network, Health.am. Unknown parameter |month= ignored (help)
  4. ↑ Rothenberg SS, Beverley R, Barnard E, Baradaran-Shoraka M, Sanfilippo JS (2017). "Polycystic ovary syndrome in adolescents". Best Pract Res Clin Obstet Gynaecol. doi:10.1016/j.bpobgyn.2017.08.008. PMID 28919160.
  5. ↑ Rosenfield RL (2015). "The Polycystic Ovary Morphology-Polycystic Ovary Syndrome Spectrum". J Pediatr Adolesc Gynecol. 28 (6): 412–9. doi:10.1016/j.jpag.2014.07.016. PMC 4387116. PMID 25840648.
  6. ↑ Legro RS, Chiu P, Kunselman AR, Bentley CM, Dodson WC, Dunaif A (2005). "Polycystic ovaries are common in women with hyperandrogenic chronic anovulation but do not predict metabolic or reproductive phenotype". J. Clin. Endocrinol. Metab. 90 (5): 2571–9. doi:10.1210/jc.2004-0219. PMID 15713728.
  7. ↑ Rosenfield RL (1997). "Current concepts of polycystic ovary syndrome". Baillieres Clin Obstet Gynaecol. 11 (2): 307–33. PMID 9536213.
  8. ↑ Hassa H, Tanir HM, Yildiz Z (2006). "Comparison of clinical and laboratory characteristics of cases with polycystic ovarian syndrome based on Rotterdam's criteria and women whose only clinical signs are oligo/anovulation or hirsutism". Arch. Gynecol. Obstet. 274 (4): 227–32. doi:10.1007/s00404-006-0173-8. PMID 16691383.


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