| 1: Polycystic ovary syndrome: features and investigations
Clinical features
Oligomenorrhoea or amenorrhoea, anovulation, infertility
Hirsutism, acne, accelerated scalp hair fall
Most, but not all, women with polycystic ovary syndrome are obese and have a history of easy weight gain and/or difficulty with weight reduction
Many have a family history of polycystic ovary syndrome
Many have a family history of type 2 diabetes
Associated health risks
Hyperlipidaemia,5-7 hypertension8
Myocardial infarction and ischaemic heart disease (seven times the risk of unaffected women)9,10
Type 2 diabetes or impaired glucose tolerance (affects up to 40% by age 40 years)11
Gestational diabetes and impaired glucose tolerance during pregnancy
Investigations
Pelvic ultrasound: May reveal increased ovarian volumes, multiple (>9) subcortical follicular cysts, an increased stromal density and increased stromal blood flow. Results will vary with the quality of the equipment and the radiologist's experience in gynaecological practice.
Biochemical investigations: May reveal raised serum luteinising hormone levels, typically more than 2.5 times the serum follicle stimulating hormone value, an elevated serum total testosterone level and free testosterone or free androgen index (a measure of the non-protein-bound or active testosterone level) and a reduced level of sex hormone binding globulin.
©MJA 1998
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