Polycystic ovary syndrome

The description of polycystic ovaries dates back as far as 17211 but it was Stein and Leventhal who first reported the disorder, that we now know as the polycystic ovary (or ovarian) syndrome (PCOS), in seven women with amenorrhoea, enlarged ovaries with multiple cysts and hirsutism. 2 These patients were treated with ovarian wedge resection and of the seven all had return of their menstrual cycles, and two conceived. With the advent of hormonal assays in the late 1960's and early 1970's, the diagnostic focus expanded to include endocrine abnormalities in the hypothalamic-pituitary-gonadal (HPG) axis. 3 Elevated luteinising hormone (LH) levels and hyperandrogenaemia were therefore added to the diagnostic criteria for PCOS. 4 The advent of pelvic ultrasonography in the late 1970's allowed for the non-invasive detection of polycystic ovarian morphology. However, this tool confounded matters when it was discovered that polycystic ovaries was a "common finding in normal women", 5 and that it also occurred in diverse endocrine disorders such as hypothyroidism, hyperprolactinaemia, congenital adrenal hyperplasia and hypothalamic amenorrhoea. 6 The finding of polycystic ovaries in normal women has been variably referred to as polycystic ovarian disease (PCOD), polycystic ovaries (PCO) and polycystic ovarian morphology (PCOM). We prefer the to use the term PCOM in this setting as it simply describes the ultrasound appearance of the ovaries without any syndromic connotations. Despite the strong link between diabetes mellitus and PCOS, it was only in 1980 when Burghen and coworkers first described hyperinsulinaemia and insulin resistance in PCOS. 7 This has subsequently been confirmed by many others. The identification of PCOS now encompasses a heterogeneous presentation but has at its core three principal features:(8) i. Hyperandrogenism ii. Anovulation, and/or iii. Polycystic ovarian morphology (PCOM) on ultrasonography