What are the clinical features of PCOS?

PCOS presents with features of anovulation and hyperandrogenism:

• Menstrual irregularity - oligomenorrhoea/amenorrhoea, and subfertility (anovulation)
• Hyperandrogenism - hirsutism, acne, male-pattern hair loss
• Obesity and metabolic features (insulin resistance, acanthosis nigricans) in many
• Polycystic ovaries on ultrasound

Clinical relevance. Recognising the PCOS features (irregular periods, hyperandrogenism, metabolic features) leads to diagnosis and management.

More Detail

Clinical features of PCOS

PCOS combines reproductive, androgenic, and metabolic features.

Anovulation/reproductive

• Oligomenorrhoea or amenorrhoea (irregular or absent periods).
• Subfertility (anovulatory).
• Unopposed oestrogen -> endometrial hyperplasia risk (with prolonged amenorrhoea).

Hyperandrogenism

• Hirsutism, acne, and male-pattern (frontal) hair loss.

Metabolic

• Obesity (central) in many; insulin resistance and acanthosis nigricans.
• Increased risk of impaired glucose tolerance/type 2 diabetes and dyslipidaemia.

Ultrasound

• Polycystic ovaries - multiple small peripheral follicles (a 'string of pearls').

Note

• Severity and presentation vary (some have mainly menstrual irregularity, others mainly hyperandrogenism); South Asians often have more severe insulin resistance.