Polycystic ovary syndrome (PCOS)
Rotterdam-criteria diagnosis, with routine metabolic and psychological screening.
1. Clinical overview & diagnosis
PCOS is diagnosed using the Rotterdam criteria — 2 of 3 of: oligo/anovulation, clinical/biochemical hyperandrogenism, polycystic ovarian morphology on ultrasound — after excluding other causes. It affects 8–13% of women and is under-recognised. Screen all patients for metabolic and psychological comorbidity (International PCOS Guideline 2023).
2. Patient diagnostic pathway
- 1History — Menstrual irregularity, hyperandrogenic symptoms (hirsutism, acne), weight change, subfertility, family history.
- 2Examination — BMI, blood pressure, signs of hyperandrogenism, acanthosis nigricans.
- 3Investigations — Total/free testosterone, SHBG, LH/FSH, prolactin, TFTs, fasting glucose/lipids, consider OGTT; pelvic ultrasound (do not use in adolescents within 8 years of menarche).
3. Treatment & management plan
First-line — Lifestyle modification (5–10% weight loss restores ovulation in many); combined OCP for cycle regulation and hyperandrogenism. Metformin for metabolic features/insulin resistance.
- • Screen for anxiety, depression, and eating disorders.
- • Fertility: letrozole is first-line for ovulation induction (higher live birth rate than clomiphene) — refer to reproductive medicine.
4. Patient pathway & referral
When & where to refer
- • Complex metabolic disease → endocrinology
- • Fertility → reproductive medicine
- • Emphasise long-term cardiometabolic risk management
Patient education & resources
Clinical decision support only. Not a substitute for independent clinical judgement. HerPath informs, it does not replace the treating practitioner.