Outpatient / Endocrinology and Reproductive Medicine

Polycystic Ovarian Syndrome (PCOS)

Last Updated: 5/7/2023

# Polycystic Ovarian Syndrome (PCOS)


-- Symptoms: *** oligomenorrhea, infertility

-- Exam: *** obesity, hirsutism, acne, alopecia, acanthosis nigricans

-- DDx: *** cushing, hypothyroidism, hyperprolactnemia, androgen-secreting tumor



-- b-HCG, LH FSH, TSH, prolactin, serum total and free testosterone, DHEA-S, 17-OHP; also send lipids and A1c

-- transvaginal ultrasound


-- Lifestyle: weight loss for BMI <25, exercise

-- OCP with estrogen-progestin

-- Metformin as second line if cannot tolerate OCP, or if patient with concomitant diabetes

-- Antiandrogen such as spironolactone or finasteride can be considered for bothersome hirsutism

-- Patients wishing to conceive - letrozole or clomiphene for ovulation induction

Template PDF coming soon!

Patient Guidance and Information

Working up PCOS

We suspect that you may have polycystic ovary syndrome (PCOS), a common hormonal disorder affecting women of reproductive age. To confirm the diagnosis, we will perform blood tests to evaluate your hormone levels and metabolic health since PCOS is often associated with diabetes. A pelvic ultrasound may be performed to examine the appearance of your ovaries and rule out other gynecologic conditions.

Once we have gathered all the necessary information, we will discuss your results and determine the most appropriate treatment plan based on your individual needs. This may include lifestyle modifications, medications to regulate your hormones and menstrual cycles, or treatments to address specific concerns such as fertility or acne.

If you have any questions or concerns, please do not hesitate to reach out to our team.

If You Remember Nothing Else

Clinical Pearls

  • 75-80% of cases of hyperandrogenism is due to PCOS and usually begins in the prepubertal phase
  • Rotterdam Criteria - PCOS diagnoses based on at least 2 of 3: oligoovulation/anovulation, clinical features of hyperandrogenism, enlarged or polycystic ovaries on ultrasound
  • Elevated LH (LH:FSH ratio >2:1) is common in patients with PCOS, but no longer needed for diagnosis
  • Women with PCOS are 2x as likely to have metabolic syndrome
  • OCPs treat hirsutism, decrease risk of endometrial cancer, and decrease menstrual bleeding
  • Androgen-secreting tumors (Sertoli-Leydrig cell tumor, adrenal tumors) are uncommon and tend to occur in women 30-40 years old

Trials and Literature

Other Resources