OG30.1 | PCOS — Summary & Reflection

KEY TAKEAWAYS

PCOS is the most common endocrine disorder in reproductive-age women, defined by Rotterdam 2003 criteria requiring 2 of 3 features: oligo/anovulation, clinical/biochemical hyperandrogenism, and polycystic ovarian morphology (≥20 follicles per ovary OR volume ≥10 mL on TVS). Critically, it is a diagnosis of exclusion — thyroid disease, hyperprolactinaemia, late-onset CAH (17-OHP), Cushing syndrome, and androgen-secreting tumour must be excluded first.

The central pathophysiology is a cycle of insulin resistance → hyperinsulinaemia → excess ovarian androgen → anovulation. Weight loss is the most effective first-line intervention; 5-10% weight reduction restores ovulation in many women. Medical management is goal-directed: COC for menstrual regulation and androgen excess; metformin for insulin resistance and metabolic risk; letrozole (first-line over clomiphene) for ovulation induction in women desiring fertility.

Long-term, PCOS carries serious risks requiring active surveillance: T2DM (5-10× increased risk), metabolic syndrome, CVD, endometrial hyperplasia (from chronic anovulation and unopposed oestrogen), and psychological morbidity. Endometrial protection (scheduled progestogen or COC) is mandatory in women with fewer than 4 cycles per year.

REFLECT

Riya returns in 6 months. She has lost 4 kg with dietary changes and now has a period every 9-10 weeks — better, but still oligomenorrhoeic. She is not yet planning pregnancy but asks whether she should start a pill. Reflect on the following:
- How would you explain to Riya the long-term health implications of PCOS beyond the menstrual irregularity she presented with?
- What factors would influence your choice of COC formulation for her specifically?
- If Riya came back in two years having married and wishing to conceive, how would your counselling and management plan change?
- Which aspect of PCOS management do you feel you need to explore further — endometrial surveillance? metabolic monitoring? counselling skills for long-term chronic condition management?
This reflection follows Kolb's cycle: Riya's follow-up is the concrete experience; your answers above represent reflective observation and abstract conceptualisation. Identify one clinical action you will take at your next gynaecology posting to apply this learning.