Diagnostic Criteria and Management of Polycystic Ovary Syndrome (PCOS)

Common Symptoms and Diagnostic Approach

The American College of Family Physicians recommends that women with PCOS be screened for signs of hyperandrogenism, such as hirsutism, acne, and balding or male pattern hair loss, as these symptoms are commonly associated with the condition 1
Acanthosis nigricans, a sign of insulin resistance, is a common feature of PCOS, affecting a significant proportion of women with the condition, according to the American Family Physician 1, 2
The American Family Physician suggests that thyroid-stimulating hormone, prolactin levels, and total testosterone or bioavailable/free testosterone should be measured to rule out other causes of hyperandrogenism and to assess the severity of the condition 1
A two-hour oral glucose tolerance test and fasting lipid profile are recommended to screen for diabetes and dyslipidemia, which are common comorbidities in women with PCOS, as suggested by the American Family Physician 1, 3

The American Family Physician recommends combination oral contraceptive pills as first-line therapy for regulating menstrual cycles, providing endometrial protection, and suppressing androgen secretion in women with PCOS who are not attempting conception 5
Metformin, an insulin-sensitizing agent, may improve insulin sensitivity, ovulation rates, and metabolic parameters in women with PCOS, although it is not FDA-approved specifically for PCOS treatment, as noted by the American Family Physician 6, 7
Clomiphene citrate is approximately 80% effective in inducing ovulation in women with PCOS-related anovulation, with half of these women conceiving, according to the American Family Physician 7

The American Family Physician recommends that all women with PCOS be screened for type 2 diabetes with fasting glucose and 2-hour glucose tolerance test, as well as regular screening for dyslipidemia with complete fasting lipid profile 3
Women with PCOS have increased risk factors for cardiovascular disease, and regular blood pressure monitoring is recommended, as suggested by the American Family Physician 3