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Polycystic Ovary Syndrome.
Obstet Gynecol. 2018 08; 132(2):321-336.OG

Abstract

Polycystic ovary syndrome (PCOS) is a highly prevalent disorder, representing the single most common endocrine-metabolic disorder in reproductive-aged women. Currently there are four recognized phenotypes of PCOS: 1) hyperandrogenism+oligo-anovulation+polycystic ovarian morphology; 2) hyperandrogenism+oligo-anovulation; 3) hyperandrogenism+polycystic ovarian morphology; and 4) oligo-anovulation+polycystic ovarian morphology, each with different long-term health and metabolic implications. Clinicians should clearly denote a patient's phenotype when making the diagnosis of PCOS. Polycystic ovary syndrome is a highly inherited complex polygenic, multifactorial disorder. Pathophysiologically abnormalities in gonadotropin secretion or action, ovarian folliculogenesis, steroidogenesis, insulin secretion or action, and adipose tissue function, among others, have been described in PCOS. Women with PCOS are at increased risk for glucose intolerance and type 2 diabetes mellitus; hepatic steatosis and metabolic syndrome; hypertension, dyslipidemia, vascular thrombosis, cerebrovascular accidents, and possibly cardiovascular events; subfertility and obstetric complications; endometrial atypia or carcinoma, and possibly ovarian malignancy; and mood and psychosexual disorders. The evaluation of patients suspected of having PCOS includes a thorough history and physical examination, assessment for the presence of hirsutism, ovarian ultrasonography, and hormonal testing to confirm hyperandrogenism and oligo-anovulation as needed and to exclude similar or mimicking disorders. Therapeutic decisions in PCOS depend on the patients' phenotype, concerns, and goals, and should focus on 1) suppressing and counteracting androgen secretion and action, 2) improving metabolic status, and 3) improving fertility. However, despite significant progress in understanding the pathophysiology and diagnosis of the disorder over the past 20 years, the disorder remains underdiagnosed and misunderstood by many practitioners.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Azziz R
Department of Health Policy, Management & Behavior, School of Public Health, University at Albany, State University of New York, and the Department of Obstetrics and Gynecology, Albany Medical College, Albany, New York; the Department of Obstetrics and Gynecology, the Medical College of Georgia, Augusta University, Augusta, Georgia; and the Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California at Los Angeles, and the Pullias Center for Higher Education, Rossier School of Education, University of Southern California, Los Angeles, California.

MeSH

AdolescentAdultAnovulationCardiovascular DiseasesDiabetes Mellitus, Type 2Fatty LiverFemaleGenetic Predisposition to DiseaseGonadotropinsHirsutismHumansHyperandrogenismInfertilityInsulin ResistanceMetabolic SyndromeObesityOvaryOvulationPhenotypePolycystic Ovary SyndromeRisk Factors

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

29995717

Clinical Trial Links

Microbiome and Polycystic Ovaries

Citation

Azziz, Ricardo. "Polycystic Ovary Syndrome." Obstetrics and Gynecology, vol. 132, no. 2, 2018, pp. 321-336.
Azziz R. Polycystic Ovary Syndrome. Obstet Gynecol. 2018;132(2):321-336.
Azziz, R. (2018). Polycystic Ovary Syndrome. Obstetrics and Gynecology, 132(2), 321-336. https://doi.org/10.1097/AOG.0000000000002698
Azziz R. Polycystic Ovary Syndrome. Obstet Gynecol. 2018;132(2):321-336. PubMed PMID: 29995717.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Polycystic Ovary Syndrome. A1 - Azziz,Ricardo, PY - 2018/7/12/pubmed PY - 2019/9/29/medline PY - 2018/7/12/entrez SP - 321 EP - 336 JF - Obstetrics and gynecology JO - Obstet Gynecol VL - 132 IS - 2 N2 - Polycystic ovary syndrome (PCOS) is a highly prevalent disorder, representing the single most common endocrine-metabolic disorder in reproductive-aged women. Currently there are four recognized phenotypes of PCOS: 1) hyperandrogenism+oligo-anovulation+polycystic ovarian morphology; 2) hyperandrogenism+oligo-anovulation; 3) hyperandrogenism+polycystic ovarian morphology; and 4) oligo-anovulation+polycystic ovarian morphology, each with different long-term health and metabolic implications. Clinicians should clearly denote a patient's phenotype when making the diagnosis of PCOS. Polycystic ovary syndrome is a highly inherited complex polygenic, multifactorial disorder. Pathophysiologically abnormalities in gonadotropin secretion or action, ovarian folliculogenesis, steroidogenesis, insulin secretion or action, and adipose tissue function, among others, have been described in PCOS. Women with PCOS are at increased risk for glucose intolerance and type 2 diabetes mellitus; hepatic steatosis and metabolic syndrome; hypertension, dyslipidemia, vascular thrombosis, cerebrovascular accidents, and possibly cardiovascular events; subfertility and obstetric complications; endometrial atypia or carcinoma, and possibly ovarian malignancy; and mood and psychosexual disorders. The evaluation of patients suspected of having PCOS includes a thorough history and physical examination, assessment for the presence of hirsutism, ovarian ultrasonography, and hormonal testing to confirm hyperandrogenism and oligo-anovulation as needed and to exclude similar or mimicking disorders. Therapeutic decisions in PCOS depend on the patients' phenotype, concerns, and goals, and should focus on 1) suppressing and counteracting androgen secretion and action, 2) improving metabolic status, and 3) improving fertility. However, despite significant progress in understanding the pathophysiology and diagnosis of the disorder over the past 20 years, the disorder remains underdiagnosed and misunderstood by many practitioners. SN - 1873-233X UR - https://www.unboundmedicine.com/medline/citation/29995717/Polycystic_Ovary_Syndrome_ DB - PRIME DP - Unbound Medicine ER -