Hetrogenous disorder characterised by hyperandrogenism, oligoovulation/anovulation and/or the presence of polycystic ovaries

Aetiology

• Commonest endocrine disorder in women - affects 5-15% of women of reproductive age
• Inherited condition
• Exacerbated by weight gain

Pathophysiology

• 50%-80% of patients will have insulin resistance, 20% will have frank glucose intolerance or T2DM
  • Exacerbated by obesity, but also seen in 'lean' PCOS
• Glucose acts as co-gonadotrophin to LH
  • 60% elevated LH
  • 95% altered LH/FSH radios
• Insulin lowers SHBG levels - increased free testosterone contributes to hyperandrogenism

Clinical features

• Obesity
• Hirsutism or acne
• Menstrual cycle abnormalities and infertility

Investigations

Diagnosis: need 2/3

• Chronic anovulation
• Polycystic ovaries - seen in USS
• Hyperandrogenism (clinical or biochemical)

Endocrine features

• Normal gonadotrophins/excess LH