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Polycystic ovary syndrome - Management
When should I suspect polycystic ovary syndrome?
- Suspect polycystic ovary syndrome (PCOS) if the woman has one or more clinical features of:
- Infrequent or no ovulation — for example infertility, oligomenorrhoea, or amenorrhoea.
- Hyperandrogenism — for example hirsutism, acne vulgaris occurring after adolescence, or alopecia.
- Although it is not in the diagnostic criteria, women may have indirect evidence of insulin resistance, for example:
- Obesity, especially central obesity.
- Acanthosis nigricans. The skin is dry and rough, with grey-brown pigmentation; and is palpably thickened, and covered by a papillomatous elevation, giving it a velvety texture. The condition commonly affects the axillae, perineum, or extensor surfaces of the elbows and knuckles. When the neck is affected, there is often a thin necklace of warty fissures that can spread as a wide band.
- Increase the level of suspicion if there is a family history of PCOS.
- Exclude other conditions that have similar clinical presentations, as PCOS is a diagnosis of exclusion.
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