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Polycystic ovary syndrome - Management
How should I manage oligomenorrhoea or amenorrhoea?

  • Rule out other causes of oligomenorrhoea or amenorrhoea. For more information, see the CKS topic on Amenorrhoea.
  • Induce a withdrawal bleed, and then refer for ultrasonography to assess endometrial thickness.
    • If the endometrium fails to shed, endometrial thickening is present (greater than 10 mm), or the endometrium has an unusual appearance, refer for endometrial sampling to exclude endometrial hyperplasia or cancer.
    • If the endometrium is of normal thickness, advise treatment to prevent endometrial hyperplasia. The choice of treatment depends on whether the woman wishes to have regular withdrawal bleeds (at least once very 3 months) and whether she has acne or hirsutism. Options include:
      • Combined oral contraceptive. For prescribing information, see the CKS topic on Contraception.
      • A cyclical progestogen, such as medroxyprogesterone 10 mg daily for 14 days, every 1–3 months.
      • The levonorgestrel-releasing intrauterine system (LNG-IUS). For prescribing information, see the CKS topic on Contraception.
  • If the woman is unwilling to take cyclical hormone treatment or use the LNG-IUS, seek specialist advice or refer. Regular ultrasonography is likely to be required (every 6–12 months) to assess endometrial thickness and morphology.
  • Encourage the woman to lose weight if appropriate, as this alone may restore menstrual regularity.
  • Osteoporosis prophylaxis is unnecessary for women with polycystic ovary syndrome who are amenorrhoeic, as they are not oestrogen deficient.

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