Diagnostic Considerations

Although no agreed-upon diagnostic criteria currently exist for adolescent polycystic ovarian syndrome (PCOS), hyperandrogenemia is essential for the diagnosis in this age group.^[45]

All conditions that mimic PCOS should be ruled out before a diagnosis of PCOS is confirmed. Consider the following in the differential diagnosis of PCOS:

Ovarian hyperthecosis
Congenital adrenal hyperplasia (late-onset)
Drugs (eg, danazol, androgenic progestins)
Hypothyroidism
Patients with menstrual disturbances and signs of hyperandrogenism
Idiopathic hirsutism
Familial hirsutism
Masculinizing tumors of the adrenal gland or ovary (rapid onset of signs of virilization)
Cushing syndrome (low K+, striae, central obesity, high cortisol; high androgens in adrenal carcinoma)
Hyperprolactinemia
Exogenous anabolic steroid use
Stromal hyperthecosis (valproic acid)

Although obesity itself is not considered part of the differential diagnosis, obesity is associated with insulin resistance or any condition that is associated with severe insulin resistance (eg, insulin receptoropathies), which may clinically manifest in the same way as PCOS. Obesity may unmask features of PCOS in women who are genetically predisposed to this syndrome.

Differential Diagnoses

Workup

Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril. 2018 Aug. 110 (3):364-379. [QxMD MEDLINE Link].
Azziz R, Carmina E, Dewailly D, et al; Task Force on the Phenotype of the Polycystic Ovary Syndrome of The Androgen Excess and PCOS Society. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009 Feb. 91(2):456-88. [QxMD MEDLINE Link].
Vause TD, Cheung AP, Sierra S, et al. Ovulation induction in polycystic ovary syndrome. J Obstet Gynaecol Can. 2010 May. 32(5):495-502. [QxMD MEDLINE Link].
American College of Obstetricians and Gynecologists. Polycystic ovary syndrome. Washington, DC: American College of Obstetricians and Gynecologists; 2009. ACOG practice bulletin; no. 108. [Full Text].
Royal College of Obstetricians and Gynaecologists. Long-term consequences of polycystic ovary syndrome. London, UK: Royal College of Obstetricians and Gynaecologists; 2007. Green-top guideline; no. 33. [Full Text].
Consensus on infertility treatment related to polycystic ovary syndrome. Fertil Steril. 2008 Mar. 89(3):505-22. [QxMD MEDLINE Link].
Barber TM, Franks S. Genetic basis of polycystic ovary syndrome. Expert Review of Endocrinology & Metabolism. 2010. 5(4):549-61.
Stein I, Leventhal M. Amenorrhea associated with bilateralpolycystic ovaries. Am J Obstet Gynecol. 1935. 29:181.
Stein IF. Duration of infertility following ovarian wedge resection. West J Surg. 1964. 72:237.
PCOS Consensus Workshop Group. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004 Jan. 81(1):19-25. [QxMD MEDLINE Link].
Copp T, Jansen J, Doust J, Mol BW, Dokras A, McCaffery K. Are expanding disease definitions unnecessarily labelling women with polycystic ovary syndrome?. BMJ. 2017 Aug 16. 358:j3694. [QxMD MEDLINE Link].
Hackethal V. PCOS Diagnosis: One Size Does Not Fit All. Medscape News & Perspective. Available at http://www.medscape.com/viewarticle/884712#vp_1. August 25, 2017; Accessed: August 28, 2017.
Azziz R, Carmina E, Dewailly D, et al. Positions statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. J Clin Endocrinol Metab. 2006 Nov. 91(11):4237-45. [QxMD MEDLINE Link].
Azziz R, Carmina E, Dewailly D, et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009 Feb. 91(2):456-88. [QxMD MEDLINE Link].
Barber TM, McCarthy MI, Wass JA, Franks S. Obesity and polycystic ovary syndrome. Clin Endocrinol (Oxf). 2006 Aug. 65(2):137-45. [QxMD MEDLINE Link].
Toulis KA, Goulis DG, Farmakiotis D, et al. Adiponectin levels in women with polycystic ovary syndrome: a systematic review and a meta-analysis. Hum Reprod Update. 2009 May-Jun. 15(3):297-307. [QxMD MEDLINE Link].
Dunaif A, Wu X, Lee A, Diamanti-Kandarakis E. Defects in insulin receptor signaling in vivo in the polycystic ovary syndrome(PCOS). Am J Physiol Endocrinol Metab. 2001 Aug. 281(2):E392-9. [QxMD MEDLINE Link].
Ehrmann DA, Kasza K, Azziz R, Legro RS, Ghazzi MN. Effects of race and family history of type 2 diabetes on metabolic status of women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2005 Jan. 90(1):66-71. [QxMD MEDLINE Link].
Vink JM, Sadrzadeh S, Lambalk CB, Boomsma DI. Heritability of polycystic ovary syndrome in a Dutch twin-family study. J Clin Endocrinol Metab. 2006 Jun. 91(6):2100-4. [QxMD MEDLINE Link].
Barber TM, Bennett AJ, Groves CJ, et al. Association of variants in the fat mass and obesity associated (FTO) gene with polycystic ovary syndrome. Diabetologia. 2008 Jul. 51(7):1153-8. [QxMD MEDLINE Link].
Wickenheisser JK, Quinn PG, Nelson VL, Legro RS, Strauss JF 3rd, McAllister JM. Differential activity of the cytochrome P450 17alpha-hydroxylase and steroidogenic acute regulatory protein gene promoters in normal and polycystic ovary syndrome theca cells. J Clin Endocrinol Metab. 2000 Jun. 85(6):2304-11. [QxMD MEDLINE Link].
Tucci S, Futterweit W, Concepcion ES, et al. Evidence for association of polycystic ovary syndrome in caucasian women with a marker at the insulin receptor gene locus. J Clin Endocrinol Metab. 2001 Jan. 86(1):446-9. [QxMD MEDLINE Link].
San Millan JL, Corton M, Villuendas G, Sancho J, Peral B, Escobar-Morreale HF. Association of the polycystic ovary syndrome with genomic variants related to insulin resistance, type 2 diabetes mellitus, and obesity. J Clin Endocrinol Metab. 2004 Jun. 89(6):2640-6. [QxMD MEDLINE Link].
Goodarzi MO, Shah NA, Antoine HJ, Pall M, Guo X, Azziz R. Variants in the 5alpha-reductase type 1 and type 2 genes are associated with polycystic ovary syndrome and the severity of hirsutism in affected women. J Clin Endocrinol Metab. 2006 Oct. 91(10):4085-91. [QxMD MEDLINE Link].
Vassiliadi DA, Barber TM, Hughes BA, et al. Increased 5 alpha-reductase activity and adrenocortical drive in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2009 Sep. 94(9):3558-66. [QxMD MEDLINE Link].
Chen ZJ, Zhao H, He L, et al. Genome-wide association study identifies susceptibility loci for polycystic ovary syndrome on chromosome 2p16.3, 2p21 and 9q33.3. Nat Genet. 2011 Jan. 43(1):55-9. [QxMD MEDLINE Link].
Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab. 2004 Jun. 89(6):2745-9. [QxMD MEDLINE Link]. [Full Text].
Knochenhauer ES, Key TJ, Kahsar-Miller M, et al. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J Clin Endocrinol Metab. 1998 Sep. 83(9):3078-82. [QxMD MEDLINE Link].
Cahill D. PCOS. BMJ Clin Evid. 2009 Jan 15. 2009:[QxMD MEDLINE Link]. [Full Text].
Asuncion M, Calvo RM, San Millan JL, et al. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metab. 2000 Jul. 85(7):2434-8. [QxMD MEDLINE Link].
Diamanti-Kandarakis E, Kouli CR, Bergiele AT, et al. A survey of the polycystic ovary syndrome in the Greek island of Lesbos: hormonal and metabolic profile. J Clin Endocrinol Metab. 1999 Nov. 84(11):4006-11. [QxMD MEDLINE Link].
Zhao X, Ni R, Li L, et al. Defining hirsutism in Chinese women: a cross-sectional study. Fertil Steril. 2011 Sep. 96(3):792-6. [QxMD MEDLINE Link].
Christian RC, Dumesic DA, Behrenbeck T, Oberg AL, Sheedy PF 2nd, Fitzpatrick LA. Prevalence and predictors of coronary artery calcification in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2003 Jun. 88 (6):2562-8. [QxMD MEDLINE Link].
Conway GS, Agrawal R, Betteridge DJ, Jacobs HS. Risk factors for coronary artery disease in lean and obese women with the polycystic ovary syndrome. Clin Endocrinol (Oxf). 1992 Aug. 37(2):119-25. [QxMD MEDLINE Link].
Dokras A. Cardiovascular disease risk factors in polycystic ovary syndrome. Semin Reprod Med. 2008 Jan. 26(1):39-44. [QxMD MEDLINE Link].
Vryonidou A, Papatheodorou A, Tavridou A, et al. Association of hyperandrogenemic and metabolic phenotype with carotid intima-media thickness in young women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2005 May. 90(5):2740-6. [QxMD MEDLINE Link].
American Association of Clinical Endocrinologists. American Association of Clinical Endocrinologists position statement on metabolic and cardiovascular consequences of polycystic ovary syndrome. National Guideline Clearinghouse. Available at http://guideline.gov/summary/summary.aspx?doc_id=7108. Accessed: August 28, 2009.
Hardiman P, Pillay OC, Atiomo W. Polycystic ovary syndrome and endometrial carcinoma. Lancet. 2003 May 24. 361(9371):1810-2. [QxMD MEDLINE Link].
Maslyanskaya S, Talib HJ, Northridge JL, Jacobs AM, Coble C, Coupey SM. Polycystic Ovary Syndrome: An Under-recognized Cause of Abnormal Uterine Bleeding in Adolescents Admitted to a Children's Hospital. J Pediatr Adolesc Gynecol. 2017 Jun. 30 (3):349-355. [QxMD MEDLINE Link].
Carmina E, Legro RS, Stamets K, et al. Difference in body weight between American and Italian women with polycystic ovary syndrome: influence of the diet. Hum Reprod. 2003 Nov. 18(11):2289-93. [QxMD MEDLINE Link].
Ehrmann DA, Barnes RB, Rosenfield RL, et al. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care. 1999 Jan. 22(1):141-6. [QxMD MEDLINE Link].
Legro RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab. 1999 Jan. 84(1):165-9. [QxMD MEDLINE Link].
Gopal M, Duntley S, Uhles M, Attarian H. The role of obesity in the increased prevalence of obstructive sleep apnea syndrome in patients with polycystic ovarian syndrome. Sleep Med. 2002 Sep. 3(5):401-4. [QxMD MEDLINE Link].
Vgontzas AN, Legro RS, Bixler EO, et al. Polycystic ovary syndrome is associated with obstructive sleep apnea and daytimesleepiness: role of insulin resistance. J Clin Endocrinol Metab. 2001 Feb. 86(2):517-20. [QxMD MEDLINE Link].
Hecht Baldauff N, Arslanian S. Optimal management of polycystic ovary syndrome in adolescence. Arch Dis Child. 2015 Nov. 100 (11):1076-83. [QxMD MEDLINE Link].
Nieman LK. Diagnostic tests for Cushing's syndrome. Ann N Y Acad Sci. 2002 Sep. 970:112-8. [QxMD MEDLINE Link].
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2009 Jan. 32 Suppl 1:S62-7. [QxMD MEDLINE Link]. [Full Text].
Nur MM, Newman IM, Siqueira LM. Glucose metabolism in overweight Hispanic adolescents with and without polycystic ovary syndrome. Pediatrics. 2009 Sep. 124(3):e496-502. [QxMD MEDLINE Link].
Alemzadeh R, Kichler J, Calhoun M. Spectrum of metabolic dysfunction in relationship with hyperandrogenemia in obese adolescent girls with polycystic ovary syndrome. Eur J Endocrinol. 2010 Jun. 162(6):1093-9. [QxMD MEDLINE Link].
Barber TM, Wass JA, McCarthy MI, Franks S. Metabolic characteristics of women with polycystic ovaries and oligo-amenorrhoea but normal androgen levels: implications for the management of polycystic ovary syndrome. Clin Endocrinol (Oxf). 2007 Apr. 66(4):513-7. [QxMD MEDLINE Link].
Kabil Kucur S, Gozukara I, Aksoy A, et al. How medical treatment affects mean platelet volume as a cardiovascular risk marker in polycystic ovary syndrome?. Blood Coagul Fibrinolysis. 2015 Dec. 26 (8):862-5. [QxMD MEDLINE Link].
Trent ME, Rich M, Austin SB, Gordon CM. Fertility concerns and sexual behavior in adolescent girls with polycystic ovary syndrome: implications for quality of life. J Pediatr Adolesc Gynecol. 2003 Feb. 16(1):33-7. [QxMD MEDLINE Link].
[Guideline] Legro RS, Arslanian SA, Ehrmann DA, et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013 Oct 22. [QxMD MEDLINE Link].
Al Khalifah RA, Florez ID, Dennis B, Thabane L, Bassilious E. Metformin or Oral Contraceptives for Adolescents With Polycystic Ovarian Syndrome: A Meta-analysis. Pediatrics. 2016 May. 137 (5):[QxMD MEDLINE Link].
[Guideline] Martin KA, Chang RJ, Ehrmann DA, et al. Evaluation and treatment of hirsutism in premenopausal women: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008 Apr. 93(4):1105-20. [QxMD MEDLINE Link].
Abd Elgafor I. Efficacy of combined metformin-letrozole in comparison with bilateral ovarian drilling in clomiphene-resistant infertile women with polycystic ovarian syndrome. Arch Gynecol Obstet. 2013 Jul. 288(1):119-23. [QxMD MEDLINE Link].
Emery G. Letrozole produces more babies in women with polycystic ovary syndrome: study. Medscape from WebMD. 2014 Jul 10. Available at http://www.medscape.com/viewarticle/828062. Accessed: July 14, 2014.
Legro RS, Brzyski RG, Diamond MP, et al. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. N Engl J Med. 2014 Jul 10. 371(2):119-29. [QxMD MEDLINE Link].
Otta CF, Wior M, Iraci GS, et al. Clinical, metabolic, and endocrine parameters in response to metformin and lifestyle intervention in women with polycystic ovary syndrome: a randomized, double-blind, and placebo control trial. Gynecol Endocrinol. 2010 Mar. 26(3):173-8. [QxMD MEDLINE Link].
Allen HF, Mazzoni C, Heptulla RA, et al. Randomized controlled trial evaluating response to metformin versus standard therapy in the treatment of adolescents with polycystic ovary syndrome. J Pediatr Endocrinol Metab. 2005 Aug. 18(8):761-8. [QxMD MEDLINE Link].
Moghetti P, Castello R, Negri C, et al. Metformin effects on clinical features, endocrine and metabolic profiles, and insulin sensitivity in polycystic ovary syndrome: a randomized, double-blind, placebo-controlled 6-month trial, followed by open, long-term clinical evaluation. J Clin Endocrinol Metab. 2000 Jan. 85(1):139-46. [QxMD MEDLINE Link]. [Full Text].
Hoeger KM, Kochman L, Wixom N, Craig K, Miller RK, Guzick DS. A randomized, 48-week, placebo-controlled trial of intensive lifestyle modification and/or metformin therapy in overweight women with polycystic ovary syndrome: a pilot study. Fertil Steril. 2004 Aug. 82(2):421-9. [QxMD MEDLINE Link].
Begum MR, Khanam NN, Quadir E, et al. Prevention of gestational diabetes mellitus by continuing metformin therapy throughout pregnancy in women with polycystic ovary syndrome. J Obstet Gynaecol Res. 2009 Apr. 35(2):282-6. [QxMD MEDLINE Link].
Khattab S, Mohsen IA, Aboul Foutouh I, et al. Can metformin reduce the incidence of gestational diabetes mellitus in pregnant women with polycystic ovary syndrome? Prospective cohort study. Gynecol Endocrinol. 2011 Oct. 27(10):789-93. [QxMD MEDLINE Link].
Cheang KI, Huszar JM, Best AM, Sharma S, Essah PA, Nestler JE. Long-term effect of metformin on metabolic parameters in the polycystic ovary syndrome. Diab Vasc Dis Res. 2009 Apr. 6(2):110-9. [QxMD MEDLINE Link]. [Full Text].
US Food and Drug Administration. Safety: statins and HIV or hepatitis C drugs: drug safety communication - interaction increases risk of muscle injury. Posted: March 1, 2012. Available at http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm294294.htm. Accessed: May 22, 2012.
US Food and Drug Administration. Safety: statin drugs - drug safety communication: class labeling change. Posted: February 28, 2012. Available at http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm293670.htm. Accessed: May 22, 2012.
US Food and Drug Administration. Safety: Zocor (simvastatin): label change - new restrictions, contraindications, and dose limitations. Posted: June 8, 2011. Available at http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm258384.htm. Accessed: May 22, 2012.
US Food and Drug Administration. Safety: Meridia (sibutramine): market withdrawal due to risk of serious cardiovascular events. Posted: October 8, 2010. Available at http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm228830.htm. Accessed: May 22, 2012.
Kiddy DS, Hamilton-Fairley D, Bush A, et al. Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin Endocrinol (Oxf). 1992 Jan. 36(1):105-11. [QxMD MEDLINE Link].
Moran LJ, Pasquali R, Teede HJ, Hoeger KM, Norman RJ. Treatment of obesity in polycystic ovary syndrome: a position statement of the Androgen Excess and Polycystic Ovary Syndrome Society. Fertil Steril. 2009 Dec. 92(6):1966-82. [QxMD MEDLINE Link].
Lord JM, Flight IH, Norman RJ. Metformin in polycystic ovary syndrome: systematic review and meta-analysis. BMJ. 2003 Oct 25. 327(7421):951-3. [QxMD MEDLINE Link]. [Full Text].
Rotondi M, Cappelli C, Magri F, et al. Thyroidal effect of metformin treatment in patients with polycystic ovary syndrome. Clin Endocrinol (Oxf). 2011 Sep. 75(3):378-81. [QxMD MEDLINE Link].
Engen Hanem LG, Stridsklev S, Júlíusson PB, Salvesen Ø, Roelants M, Carlsen SM, et al. Metformin use in PCOS pregnancies increases the risk of offspring overweight at 4 years of age; follow-up of two RCTs. J Clin Endocrinol Metab. 2018 Feb 27. [QxMD MEDLINE Link].
Leeman L, Acharya U. The use of metformin in the management of polycystic ovary syndrome and associated anovulatory infertility: the current evidence. J Obstet Gynaecol. 2009 Aug. 29(6):467-72. [QxMD MEDLINE Link].
Nestler JE, Jakubowicz DJ, Evans WS, Pasquali R. Effects of metformin on spontaneous and clomiphene-induced ovulation in the polycystic ovary syndrome. N Engl J Med. 1998 Jun 25. 338(26):1876-80. [QxMD MEDLINE Link].
Sinawat S, Buppasiri P, Lumbiganon P, Pattanittum P. Long versus short course treatment with metformin and clomiphene citrate for ovulation induction in women with PCOS. Cochrane Database Syst Rev. 2008 Jan 23. CD006226. [QxMD MEDLINE Link].
Badawy A, State O, Abdelgawad S. N-Acetyl cysteine and clomiphene citrate for induction of ovulation in polycystic ovary syndrome: a cross-over trial. Acta Obstet Gynecol Scand. 2007. 86(2):218-22. [QxMD MEDLINE Link].
Chen ZJ, Shi Y, Sun Y, et al. Fresh versus Frozen Embryos for Infertility in the Polycystic Ovary Syndrome. N Engl J Med. 2016 Aug 11. 375(6):523-533. [QxMD MEDLINE Link].
Hackethal V. Frozen Embryos Tied to Higher Live Birth Rates in PCOS. Medscape Medical News. Available at http://www.medscape.com/viewarticle/867343. August 11, 2016; Accessed: August 11, 2016.
Koulouri O, Conway GS. Management of hirsutism. BMJ. 2009 Mar 27. 338:b847. [QxMD MEDLINE Link].
Rosenfield RL. Clinical practice. Hirsutism. N Engl J Med. 2005 Dec 15. 353(24):2578-88. [QxMD MEDLINE Link].
Paparodis R, Dunaif A. The Hirsute woman: challenges in evaluation and management. Endocr Pract. 2011 Sep-Oct. 17(5):807-18. [QxMD MEDLINE Link].
Cumming DC, Yang JC, Rebar RW, Yen SS. Treatment of hirsutism with spironolactone. JAMA. 1982 Mar 5. 247(9):1295-8. [QxMD MEDLINE Link].
Roth LW, Huang H, Legro RS, et al. Altering hirsutism through ovulation induction in women with polycystic ovary syndrome. Obstet Gynecol. 2012 Jun. 119(6):1151-6. [QxMD MEDLINE Link]. [Full Text].
Liepa GU, Sengupta A, Karsies D. Polycystic ovary syndrome (PCOS) and other androgen excess-related conditions: can changes in dietary intake make a difference?. Nutr Clin Pract. 2008 Feb. 23(1):63-71. [QxMD MEDLINE Link].
Ornstein RM, Copperman NM, Jacobson MS. Effect of weight loss on menstrual function in adolescents with polycystic ovary syndrome. J Pediatr Adolesc Gynecol. 2011 Jun. 24(3):161-5. [QxMD MEDLINE Link].
Cussons AJ, Watts GF, Mori TA, Stuckey BG. Omega-3 fatty acid supplementation decreases liver fat content in polycystic ovary syndrome: a randomized controlled trial employing proton magnetic resonance spectroscopy. J Clin Endocrinol Metab. 2009 Oct. 94(10):3842-8. [QxMD MEDLINE Link].
Jamilian M, Asemi Z. The Effects of Soy Isoflavones on Metabolic Status of Patients With Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2016 Aug 4. jc20161762. [QxMD MEDLINE Link].
Busko M. Soy Isoflavones Tied to Improved Metabolic Markers in PCOS. http://www.medscape.com/viewarticle/867076#vp_2. Available at http://www.medscape.com/viewarticle/867076#vp_2. August 04, 2016; Accessed: August 11, 2016.
Wehr E, Pilz S, Schweighofer N, et al. Association of hypovitaminosis D with metabolic disturbances in polycystic ovary syndrome. Eur J Endocrinol. 2009 Oct. 161(4):575-82. [QxMD MEDLINE Link].
Poujade O, Gervaise A, Faivre E, Deffieux X, Fernandez H. Surgical management of infertility due to polycystic ovarian syndrome after failure of medical management. Eur J Obstet Gynecol Reprod Biol. 2011 Oct. 158(2):242-7. [QxMD MEDLINE Link].
Farquhar C, Lilford RJ, Marjoribanks J, Vandekerckhove P. Laparoscopic 'drilling' by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome. Cochrane Database Syst Rev. 2007 Jul 18. CD001122. [QxMD MEDLINE Link].
Roos N, Kieler H, Sahlin L, et al. Risk of adverse pregnancy outcomes in women with polycystic ovary syndrome: population based cohort study. BMJ. 2011 Oct 13. 343:d6309. [QxMD MEDLINE Link]. [Full Text].
Percy CA, Gibbs T, Potter L, Boardman S. Nurse-led peer support group: experiences of women with polycystic ovary syndrome. J Adv Nurs. 2009 Oct. 65(10):2046-55. [QxMD MEDLINE Link].
Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E, et al. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ANDROGEN EXCESS AND PCOS SOCIETY DISEASE STATE CLINICAL REVIEW: GUIDE TO THE BEST PRACTICES IN THE EVALUATION AND TREATMENT OF POLYCYSTIC OVARY SYNDROME--PART 1. Endocr Pract. 2015 Nov. 21 (11):1291-300. [QxMD MEDLINE Link].

Media Gallery

Longitudinal transabdominal ultrasonogram of an ovary. This image reveals multiple peripheral follicles.
Low power, H and E of an ovary containing multiple cystic follicles in a patient with PCOS.

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Author

Richard Scott Lucidi, MD, FACOG Associate Professor of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine

Richard Scott Lucidi, MD, FACOG is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Frances E Casey, MD, MPH Associate Professor, Director of Family Planning Services, Department of Obstetrics and Gynecology, VCU Medical Center

Frances E Casey, MD, MPH is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of Reproductive Health Professionals, National Abortion Federation, Physicians for Reproductive Health, Society of Family Planning

Disclosure: Nothing to disclose.

Chief Editor

Acknowledgements

Elizabeth Alderman, MD Director of Fellowship Training Program, Director of Adolescent Ambulatory Service, Professor of Clinical Pediatrics, Department of Pediatrics, Division of Adolescent Medicine, Albert Einstein College of Medicine and Children's Hospital at Montefiore

Elizabeth Alderman, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, North American Society for Pediatric and Adolescent Gynecology, and Society for Adolescent Medicine

Disclosure: Merck Honoraria Speaking and teaching

A David Barnes, MD, PhD, MPH, FACOG Consulting Staff, Department of Obstetrics and Gynecology, Mammoth Hospital (Mammoth Lakes, California), Pioneer Valley Hospital (Salt Lake City, Utah), Warren General Hospital (Warren, Pennsylvania), and Mountain West Hospital (Tooele, Utah)

A David Barnes, MD, PhD, MPH, FACOG is a member of the following medical societies: American College of Forensic Examiners, American College of Obstetricians and Gynecologists, American Medical Association, Association of Military Surgeons of the US, and Utah Medical Association