Polycystic ovary syndrome (PCOS)

Complex condition affecting reproductive and metabolic health. May affect up to 20% of Aboriginal women
Condition and symptoms result from increased androgens (male-type hormones, eg testosterone) and insulin resistance
Features may include excessive body hair growth, scalp hair loss, acne, obesity, irregular periods, infertility
Increased risk of cardiovascular disease, type 2 diabetes, obstructive sleep apnoea and endometrial cancer
Affected women are vulnerable to poor mental and emotional health

Diagnosis

PCOS diagnosed if at least 2 of these present AND other causes excluded (eg thyroid abnormality, hyperprolactinaemia)

Clinical hyperandrogenism: excessive facial or body hair, scalp hair loss, acne
OR biochemical hyperandrogenism: a blood test showing an increased free androgen index or calculated free testosterone or bioavailable free testosterone

Presence of polycystic ovaries on ultrasound in a woman more than 8 years after menarche (periods starting)

Can be difficult to diagnose in adolescents or within 8 years of menarche starting — medical consult

Cardiovascular risk assessment and manage accordingly
Adult Health Check
If not known to have diabetes — 75g OGTT or HbA1c
Blood for total testosterone, SHBG, free androgen index (FAI), free testosterone (can’t assess androgen while on hormonal contraception)
If periods irregular or absent — take blood for TFT and prolactin to exclude other problems
Mental health screen — higher risk of depression, anxiety
Medical consult — for management of type 2 diabetes, infertility, menstrual problems
If the person does not clearly meet criteria for PCOS doctor will organise other tests and investigations

Best outcomes in PCOS are achieved with holistic and team based approach — patients with PCOS are eligible for chronic disease management plan

Healthy lifestyle behaviours encouraged
Lifestyle interventions for high-risk groups (eg overweight/obesity, diabetes) — diet, exercise, quit smoking and behavioural strategies
Medical consult — if lifestyle interventions insufficient to meet goals

Use a PCOS quality of life tool (eg PCOSQ, modified PCOSQ) to assess wellbeing of women with PCOS
Medical consult — if symptoms of depression, anxiety, psychosexual dysfunction, body dysmorphia or eating disorders

If pregnancy not wanted OR optimisation of health preconception are important — organise contraception

Menstrual regularity can be improved with 5–10% weight loss
Hormonal contraception (eg COC) can be used to achieve regular withdrawal bleeds

Protect against endometrial (uterine) cancer if having less than 4 periods a year — hormonal therapy

Combined oral contraceptive pill (COC)
OR cyclical progesterone (eg medroxyprogesterone — not a contraceptive)
OR injectable progesterone
OR long-acting reversible contraceptives — see Long-acting reversible contraception (LARC)

Weight loss of 5–10% can help to restore regular ovulation and increase chances of spontaneous conception
Offer tubal patency testing if at risk of tubal factor infertility (eg history of STI)
Refer to specialist for further investigations — after 12 months of trying for pregnancy under age 35, 6 months for age 35 or more
Other options — surgery, assisted reproductive technology

Shaving and waxing can improve appearance of facial and other hair
Medicine, if directed by doctor, may include — oral contraceptive pill, spironolactone. Some medicines for excess hair growth are not safe in pregnancy
Other less accessible methods include electrolysis, laser or eflornithine cream (if small area affected)

Supporting resources