Comprehensive Clinical Management of Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS), affecting 6-7% of reproductive-aged women, is often characterized by hyperandrogenism (hirsutism, acne, male-pattern hair loss), oligo-anovulation, and polycystic ovaries on ultrasound. The syndrome can lead to serious reproductive and metabolic complications. Menstrual cycle control, necessary to prevent endometrial hyperplasia, can be achieved with hormonal contraception, progesterone therapy, and weight loss (if overweight). For women desiring pregnancy, ovulation induction therapies include weight loss, clomiphene citrate, and/or metformin. Cosmetic issues such as hirsutism, acne and male-pattern hair loss can be treated with estrogen-containing hormonal contraceptive agents, antiandrogens, and topical agents, with more permanent hair reduction possible through electrolysis and laser therapy. Metabolic complications include risk for diabetes, dyslipidemia, hypertension, and nonalcoholic fatty liver disease. Women with PCOS should also be screened for sleep apnea and mental health issues. Many complications can be managed with lifestyle changes, including a healthy diet, exercise, weight loss (if overweight), and psychological support. Pharmacological therapies are also available to regulate menstrual cycles and manage cosmetic complications.