Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome may be diagnosed when two of the following three criteria are met: oligomenorrhea, hyperandrogenism, and polycystic ovaries on ultrasound. Patients may present with menstrual irregularities, infertility, hirsutism, acne, obesity, ovarian enlargement, and acanthosis nigricans. The pathophysiology of the disorder is poorly understood, but it is thought to be associated with hypothalamic pituitary dysfunction and insulin resistance. Ultrasonography may demonstrate a characteristic "string of pearls" appearance within the ovaries. Women with PCOS are at increased risk of diabetes, metabolic syndrome, and nonalcoholic fatty liver disease. Diet and exercise are recommended for all patients; metformin can also help with weight loss. Oral contraceptives are effective in treating hirsutism and acne. Infertility is typically treated with clomiphene citrate; in rare cases ovarian cautery and laser vaporization are used.