Polycystic ovary syndrome

Abstract

Polycystic ovary syndrome (PCOS) affects 5–20% of women of reproductive age worldwide. The condition is characterized by hyperandrogenism, ovulatory dysfunction and polycystic ovarian morphology (PCOM) — with excessive androgen production by the ovaries being a key feature of PCOS. Metabolic dysfunction characterized by insulin resistance and compensatory hyperinsulinaemia is evident in the vast majority of affected individuals. PCOS increases the risk for type 2 diabetes mellitus, gestational diabetes and other pregnancy-related complications, venous thromboembolism, cerebrovascular and cardiovascular events and endometrial cancer. PCOS is a diagnosis of exclusion, based primarily on the presence of hyperandrogenism, ovulatory dysfunction and PCOM. Treatment should be tailored to the complaints and needs of the patient and involves targeting metabolic abnormalities through lifestyle changes, medication and potentially surgery for the prevention and management of excess weight, androgen suppression and/or blockade, endometrial protection, reproductive therapy and the detection and treatment of psychological features. This Primer summarizes the current state of knowledge regarding the epidemiology, mechanisms and pathophysiology, diagnosis, screening and prevention, management and future investigational directions of the disorder.

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Figure 1: Diagnostic criteria and phenotypes of PCOS.
Figure 2: The pathophysiology of PCOS.
Figure 3: Ovarian follicular maturation arrest in PCOS.
Figure 4: Molecular mechanisms of insulin resistance in muscle in PCOS.
Figure 5: Molecular mechanisms of insulin resistance in adipose tissue in PCOS.
Figure 6: Typical polycystic ovarian morphology.

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Acknowledgements

The authors thank Y.-H. Chen, Augusta University, Georgia, USA.

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Contributions

Introduction (R.A.); Epidemiology (R.A.); Mechanisms/pathophysiology (R.A., E.C., Z.-J.C., A.D., J.S.E.L., H.J.T. and B.O.Y.); Diagnosis, screening and prevention (R.A. and H.J.T.); Management (R.A., E.C., Z.-J.C., R.S.L., D.L. and B.O.Y.); Quality of life (E.C. and B.O.Y.); Outlook (R.A., B.N.-H., D.L. and R.S.L.); Overview of Primer (R.A.).

Corresponding author

Correspondence to Ricardo Azziz.

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Competing interests

R.A. has a consulting agreement with KinDex Pharmaceutical Inc., is on the advisory board of Global PET Imaging, and has a consulting appointment with Selge Holdings and Ventures. J.S.E.L. has received unrestricted research grants from Ferring, Merck-Serono, MSD, Schering Plough, Serono and Okganon. R.S.L. is a consultant for Takeda, KinDex, Euroscreen and Ferring, and has received research funding from and is a consultant for Ferring. All other authors declare no competing interests.

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Azziz, R., Carmina, E., Chen, Z. et al. Polycystic ovary syndrome. Nat Rev Dis Primers 2, 16057 (2016). https://doi.org/10.1038/nrdp.2016.57

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