Diagnosis and Treatment of Polycystic Ovary Syndrome (PCOS)

Diagnostic Criteria and Laboratory Assessment

Elevated testosterone, DHEA-S, and androstenedione levels indicate biochemical hyperandrogenism, characteristic of PCOS, in a patient with irregular menstrual cycles and hyperandrogenism 1, 2
A high LH/FSH ratio (>2) is a characteristic feature of PCOS, as seen in this patient with a ratio of 7.2 2
Low progesterone levels suggest anovulation, a common feature of PCOS, in this patient with a progesterone level of 0.8 2
The presence of androgen excess, ovulatory dysfunction, and polycystic ovaries on ultrasound are diagnostic criteria for PCOS, with at least two of these criteria required for diagnosis, according to the American College of Obstetricians and Gynecologists 1, 4

The American College of Obstetricians and Gynecologists recommends combined oral contraceptives (COCs) as first-line treatment for PCOS, due to their effectiveness in regulating menstrual cycles, reducing hyperandrogenism, and improving acne and hirsutism, with a strength of evidence rated as high 1, 6
Metabolic complications, including insulin resistance, are potential risks associated with PCOS, and should be monitored and managed accordingly, as recommended by the Endocrine Society 2
Psychological impact related to symptoms of PCOS, such as hirsutism and acne, should be considered and addressed, as suggested by the American Academy of Dermatology 4

Androgen-secreting tumors are a potential cause of hyperandrogenism, although less likely in this patient given her age and moderate elevation of androgens, according to the American Urological Association 5
Metabolic complications, including insulin resistance, are potential risks associated with PCOS, and should be monitored and managed accordingly, as recommended by the Endocrine Society 2