PCOS Clinical Presentation and Management

Introduction to PCOS

Women with PCOS typically present with menstrual irregularities, signs of hyperandrogenism, and metabolic disturbances including insulin resistance and obesity, according to the American College of Physicians 1

Hirsutism affects the majority of patients as a result of elevated androgen levels, as noted by the American College of Physicians 1
Acanthosis nigricans appears as darkened, velvety skin patches, indicating underlying insulin resistance, as reported by the American College of Physicians 1
Insulin resistance occurs in a significant proportion of patients, increasing diabetes risk, according to the American College of Physicians 1

Combination oral contraceptive pills are the first-line therapy for regulating menstrual cycles, providing endometrial protection, and suppressing androgen secretion, as recommended by the American College of Physicians 1
Weight loss of as little as 5% of initial body weight improves metabolic and reproductive abnormalities, ovulation rates, and pregnancy outcomes, as stated by the American Academy of Family Physicians 2
Oral contraceptive pills regulate cycles and reduce androgen levels, though they may increase triglycerides and HDL cholesterol, according to the American Academy of Family Physicians 2
Metformin improves insulin sensitivity and glucose tolerance over time, though it lacks FDA approval specifically for PCOS, as noted by the American Academy of Family Physicians 2 and the American College of Physicians 1

Clomiphene citrate induces ovulation in approximately 80% of women, with 50% achieving pregnancy, as reported by the American Academy of Family Physicians 2 and the American College of Physicians 1
Low-dose gonadotropins should be used if clomiphene fails, to minimize ovarian hyperstimulation risk, according to the American Academy of Family Physicians 2 and 3

All women with PCOS require screening for type 2 diabetes using fasting glucose and 2-hour oral glucose tolerance test, plus fasting lipid profiles to assess cardiovascular risk, as recommended by the American College of Physicians 1
Thyroid-stimulating hormone and prolactin levels should be checked to exclude other causes of hyperandrogenism, according to the American College of Physicians 1
Total testosterone or free/bioavailable testosterone should be assessed to evaluate androgen excess severity, as noted by the American College of Physicians 1
Regular blood pressure monitoring is necessary due to increased cardiovascular disease risk, as stated by the American College of Physicians 1
Cardiovascular disease risk factors accumulate, though oral contraceptive use does not appear to increase cardiovascular events compared to the general population, according to the American Academy of Family Physicians 2