Polycystic ovarian disease: an overview

Polycystic ovaries (PCO) is the commonest endocrine disorder in women. It is estimated that nearly one in four women have polycystic ovaries with about a quarter of these developing symptoms and having the PCO syndrome (PCOS). The commonest presentation is that of irregular menstruation associated with ovulation defects and difficulty conceiving. This is usually easily remedied by ovulation induction, initially with clomiphene citrate, maybe with metformin, and sometimes with gonadotrophins or ovarian cautery. The other reason for women seeking advice is due to the increased secretion of androgenic hormones resulting in acne, hirsutism weight gain and sometimes alopecia. These symptoms are much harder to treat, with the first line of therapy being diet and exercise. It has been recognised that the principal biochemical abnormality is insulin resistance, but the role of insulin sensitisers is not yet clear. Whilst diabetes is more common in women with PCOS, whether the condition is really a long-term health risk has not yet been conclusively proven. Further studies are required to determine whether insulin sensitisers are of any long-term benefit.