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Clinical Crossroads | Clinician's Corner

A 27-Year-Old Woman With a Diagnosis of Polycystic Ovary Syndrome

Richard S. Legro, MD, Discussant
JAMA. 2007;297(5):509-519. doi:10.1001/jama.297.5.509.
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Ms R, a 27-year-old woman with polycystic ovary syndrome (PCOS) diagnosed after irregular menses, hirsutism, and polycystic ovaries, is concerned about weight gain despite regular exercise and watching her diet. Prescribed oral contraceptives to regulate her menses and help reduce her androgen levels, she wants to know the alternatives for treatment of PCOS. The varying definitions of PCOS and its heterogeneity confound the interpretation of studies on PCOS. Specific diagnostic criteria have been established based on expert opinion but have not been validated. Several commonly performed laboratory tests are generally unhelpful and the pathophysiology is poorly understood. Treatment options for Ms R, including those that may affect her weight gain, are reviewed and implications for future fertility are discussed.

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Figure 1. Polycystic Ovary on Transvaginal Ultrasound
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The peripheral small follicles lined up are often referred to as the “black pearl necklace sign.” The ovary is also larger (dimensions 4.44 cm × 2.57 cm) in cross section than a normal ovary.

Figure 2. Pathophysiology of Polycystic Ovary Syndrome
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