Polycystic Ovary Syndrome (PCOS)

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.

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.

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.

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.

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:** 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.