Polycystic Ovary Syndrome (PCOS)
Endocrine disorder affecting roughly 10% of women of reproductive age. Combines irregular periods, androgen excess and ovarian morphology — the metabolic dimension drives lab work-up.
What it is
PCOS is a heterogeneous endocrine disorder characterised by some combination of irregular ovulation, clinical or biochemical androgen excess, and polycystic ovarian morphology on ultrasound. The Rotterdam criteria require 2 of these 3 features. Insulin resistance is a near-universal underlying feature, even in lean patients — this drives the metabolic complications: type 2 diabetes risk approximately doubled, metabolic syndrome strongly elevated, non-alcoholic fatty liver disease common. Long-term consequences include subfertility, increased cardiovascular risk, and endometrial cancer risk from unopposed oestrogen exposure.
Key lab markers
- Insulin and HOMA-IR — insulin resistance is central; HOMA-IR often >2.
- HbA1c, fasting glucose — type 2 diabetes screening every 1–3 years.
- TSH — thyroid dysfunction can mimic some features.
- Prolactin — rules out prolactinoma.
- Free testosterone, total testosterone, DHEAS — confirm androgen excess.
- 17-OH progesterone — rules out late-onset congenital adrenal hyperplasia.
- Lipid panel, ALT — monitor metabolic complications.
- Vitamin D — commonly low.
Symptoms
- Irregular or absent menstrual periods
- Hirsutism (excess hair growth in male-pattern distribution)
- Acne
- Hair thinning on scalp (androgenetic alopecia)
- Difficulty losing weight
- Acanthosis nigricans (velvety dark skin patches)
- Subfertility
- Mood disturbances
When to discuss with a doctor
Adolescents and young women with irregular periods plus clinical features of androgen excess (hirsutism, acne) warrant a primary-care or gynaecology visit. The metabolic dimension matters at any age — annual screening for type 2 diabetes and cardiovascular risk is standard. Treatment is symptom-targeted: combined oral contraceptives for menstrual regulation, metformin or inositol for insulin resistance, lifestyle change as a multiplier for everything.