Polycystic Ovary Syndrome (PCOS)
About the disease & condition
Aetiology & Pathophysiology
Aetiology:** Multifactorial with strong genetic predisposition; insulin resistance plays a central role.
Pathophysiology:** Insulin resistance leads to hyperinsulinemia, which stimulates ovarian androgen production and reduces sex hormone-binding globulin (SHBG), increasing free testosterone. Disrupted gonadotropin secretion (elevated LH relative to FSH) further contributes to anovulation and androgen excess.
Symptoms & Signs
Common symptoms:**
Menstrual irregularities (oligomenorrhea, amenorrhea).
Hirsutism, acne, alopecia.
Weight gain (especially central obesity), acanthosis nigricans.
Red flags:** Rapid virilisation (suggestive of androgen-secreting tumours), severe insulin resistance, or signs of Cushing’s syndrome warrant further investigation.
Diagnosis
Diagnostic criteria (Rotterdam criteria):** Requires at least two of:
Oligo-/anovulation.
Clinical or biochemical hyperandrogenism.
Polycystic ovaries on ultrasound.
Assessments:**
Hormonal profiling (testosterone, LH, FSH, SHBG).
Glucose tolerance test and fasting insulin.
Pelvic ultrasound (≥12 follicles per ovary and/or increased ovarian volume).
Exclusion of other disorders:** Thyroid dysfunction, hyperprolactinemia, congenital adrenal hyperplasia.
Management & Treatment
Lifestyle modification:** Weight loss (5–10% of body weight) improves metabolic and reproductive parameters.
Pharmacological:**
Combined oral contraceptives (regulate cycles, reduce androgens).
Anti-androgens (e.g., spironolactone) for hirsutism.
Metformin to improve insulin sensitivity.
Ovulation induction agents (e.g., clomiphene citrate) for infertility.
Procedural:** Ovarian drilling (laparoscopic) in select resistant cases.
Potential Complications
Reproductive:** Infertility, early pregnancy loss.
Metabolic:** Type 2 diabetes, dyslipidemia, metabolic syndrome.
Long-term risks:** Endometrial hyperplasia (due to unopposed estrogen), cardiovascular disease, obstructive sleep apnea.
Prevention & Follow-up
Prevention:** Early lifestyle intervention in high-risk individuals; no definitive preventive measures.
Follow-up:**
Annual screening for glucose intolerance, lipid profile, and blood pressure.
Endometrial surveillance in patients with prolonged amenorrhea.
Regular monitoring of weight, hirsutism, and metabolic parameters.
Relevant Specialities
Endocrinology
Our Division of Endocrinology, Diabetes & Metabolism offers specialist, long-term care for hormone and metabolic disorders such as diabetes, thyroid disease, pituitary, adrenal and bone-health conditions. Our endocrinologists work with surgery, oncology, ophthalmology, obstetrics and transplant teams to deliver personalised diagnostic pathways (blood tests, imaging, bone density and thyroid biopsy) and tailored medical, procedural and surgical plans. Services include diabetes and lipid management, obesity and metabolic-syndrome care (with bariatric pathways), pediatric growth and puberty clinics, reproductive endocrinology and gender-affirming hormone support.
