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Polycystic ovary syndrome (PCOS)
PCOS is diagnosed by two of three criteria — anovulation, androgen excess and polycystic ovaries — after excluding other causes; it is a metabolic disease, not only a gynaecological one, so glucose and lipids are checked and the endometrium is protected.
Why it matters in the exam
Exam questions present a young woman with irregular cycles, acne and hirsutism, sometimes overweight, and ask about the diagnosis, the tests needed to exclude other causes and the treatment according to the woman's goal. Before the diagnosis, exclude pregnancy, thyroid disease, raised prolactin, non-classic congenital adrenal hyperplasia (17-OH progesterone), Cushing syndrome and an androgen-secreting tumour — which shows as rapid virilisation and a very high testosterone.
Treatment follows what the woman wants. For cycle regulation and hirsutism — the combined pill; to protect the endometrium when there are no periods — cyclical progestin; for resistant hirsutism — add spironolactone with contraception; for metabolic problems — lifestyle change and metformin. For fertility, letrozole is first line and more effective than clomiphene. The long-term risks: type 2 diabetes (screen with a glucose tolerance test), dyslipidaemia, sleep apnoea, depression and endometrial cancer from oestrogen unopposed by progesterone. In adolescents ultrasound is not used for the diagnosis in the first years after menarche.
Key points
- Diagnosis: 2 of 3 — anovulation, androgen excess, polycystic ovaries.
- Exclude pregnancy, thyroid, prolactin, congenital adrenal hyperplasia and a tumour.
- Combined pill for cycles and hirsutism; progestin to protect the endometrium.
- Fertility: weight loss and letrozole.
- Metabolic screening: glucose tolerance test and lipids.
Summary table
| Topic | What is checked or decided | Treatment | Exam notes |
|---|---|---|---|
| Diagnosis (Rotterdam) | 2 of 3: anovulation, androgen excess, polycystic ovaries (20 or more follicles per ovary, or a high AMH in adults) | — | Other causes must be excluded |
| Excluding other causes | Beta-hCG, TSH, prolactin, 17-OH progesterone, testosterone | — | Very high testosterone or rapid virilisation → tumour |
| Cycles and hirsutism | Irregularity, acne, hirsutism | Combined pill; spironolactone as an add-on with contraception | Spironolactone is forbidden in pregnancy |
| Endometrial protection | Very infrequent periods | Cyclical progestin or a hormonal IUD | Risk of hyperplasia and endometrial cancer |
| Fertility | Anovulation | Weight loss; letrozole first line; then gonadotrophins or IVF | Letrozole is preferred to clomiphene |
| Metabolic risk | Glucose tolerance test, lipids, blood pressure, sleep apnoea | Lifestyle, metformin | The risk exists in slim women too |
A free exam question
איזה מהמשפטים הבאים הוא הנכון ביותר בהתייחס ל טיפול באמצעות Clomiphene Citrate בנשים עם יה( עדר ביוץ Anovulation ) עקב PCOS ? (the question as examined, in Hebrew)
- א. בנשים עם אמנוריאה שיעורי ההריון גבוהים יותר לאחר שימוש ב- Clomiphene Citrate בהשוואה לנשים עם אוליגומנוריאה
- ב. בנשים עם אמנוריאה השראת דימום לפני תחילת הטיפול ב- Clomiphene Citrate משפרת את הסיכוי להריון וללידה
- ג. בנשים שטופלו ב- Clomiphene Citrate ללא תגובה ל- 50 מ"ג יש להשרות דימום וסתי לפני עלייה במינון ל- 100 מ"ג לשיפור תוצאות הטיפול
- ד. בנשים שטופלו ב- Clomiphene Citrate במינון של 50 מ"ג ובייצו במשך שלושה מחזורים ללא הריון, יש להעלות את מינון התרופה ל- 100 מ"ג. ש אלה
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Sources
- International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome, 2023 — Diagnosis, metabolic risk, infertility
- ACOG Practice Bulletin No. 194, 2018 — Polycystic Ovary Syndrome
- Speroff's Clinical Gynecologic Endocrinology and Infertility, 9th edition (2019) — Anovulation and the Polycystic Ovary
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.