Managing polycystic ovary syndrome in primary care

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting young women.It can present with a wide spectrum of signs and symptoms, including acne, hirsutism, obesity, menstrual irregularities and infertility.These are caused by androgen excess, anovulation, insulin resistance and the ensuing metabolic syndrome.The precise aetiology of PCOS is still unclear but is likely to be a complex interaction of genetic and environmental factors.A family history of PCOS confers a higher risk of developing the condition.Other contributing factors include low birth weight, premature pubarche, obesity, diabetes mellitus (DM) and antiepileptic drug use.(1) Due to its many manifestations throughout the course of a woman's life, PCOS can have a great impact on the individual's metabolic, cardiovascular, reproductive and psychological wellbeing.Hence, it is an important syndrome to recognise and treat appropriately. HOW RELEVANT IS THIS TO MY PRACTICE?PCOS has an estimated prevalence of 6%-10%.(2) Patients typically present to primary care with acne and menstrual irregularities.Anxiety and depression are other more insidious symptoms of PCOS that are important to recognise early.Additionally, PCOS is one of the most common causes of anovulation, so patients may first present with difficulty conceiving.As PCOS is associated with insulin resistance, all women with PCOS should be screened for DM or pre-DM, especially if they are planning to conceive, as poorly controlled DM is associated with adverse pregnancy outcomes.