New diagnosis of polycystic ovary syndrome
BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.i6456 (Published 12 January 2017) Cite this as: BMJ 2017;356:i6456
- Isabel McLuskie, foundation year 2 doctor,
- Aisha Newth, general practitioner and teacher development lead in primary care
- Primary care and public health centre, Imperial College London, London, UK
- Accepted 22 November 2016
What you need to know
In women with less than one period every three months, manage the risk of endometrial hyperplasia and aim to induce a withdrawal bleed
Review women who are considering pregnancy and consider early referral to a fertility service
Combined oral contraceptives are the first line of choice for women who have polycystic ovary syndrome and acne
A 27 year old woman with a recent diagnosis of polycystic ovary syndrome comes to see you. She wants to know more about the condition and the consequences for her health (box 1).
Box 1: Background facts
Polycystic ovary syndrome affects 6%-7% of women.1
Women may experience
oligomenorrhoea
anovulatory fertility
hyperandrogenism2 and the clinical symptoms and signs of hirsutism
acne
The relation between polycystic ovary syndrome and obesity is poorly understood. Polycystic ovary syndrome is not caused by, and does not cause, obesity. However, obesity is associated with an increase in secondary complications in women with polycystic ovary syndrome, such as:
impaired glucose tolerance
type 2 diabetes
sleep apnoea
adverse cardiovascular profile (including hypertension, dyslipidaemia, and insulin resistance) (fig 1⇓)
Fig 1 A diagram showing the interaction between the hormonal profile and metabolic features of polycystic ovary syndrome
What you should cover
Find out what the patient understands about her condition and explore how it is affecting her. Consider covering:
her periods
family plans
acne or hirsutism
metabolism
wellbeing.
Irregular periods Prolonged oligomenorrhoea or amenorrhoea can increase the risk of endometrial hyperplasia and cancer. …
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