Presentation of PCOS

PCOS presents in several different ways. Common features include:

  • Infertility secondary to oligomenorrhea and/or amenorrhea (4).
  • Overweight or obesity; seen in 30-80% of people with PCOS (5).
  • Hirsutism (excessive hair growth) and the presence of hairs in androgen-dependent areas (e.g., upper lip, chin, chest, back, upper arm, and shoulders). Hirsutism can be classified using the modified Ferriman-Gallwey score, with levels ≥4-6 indicating hirsutism (1,5).
  • Severe acne persisting beyond adolescence. There are no universally accepted visual assessments for evaluating acne (1,5).
  • Alopecia is a rare symptom but can occur in PCOS. Scalp hair loss tends to be at the vertex and crown (4).
  • Acanthosis nigricans occur as a result of insulin resistance. It appears as brown or grey, velvety, occasionally verrucous, hyperpigmented areas over the nape, groin, umbilicus, sub-mammary areas, elbows, and knuckles (4).

People with PCOS are at increased risk of:

  • Pregnancy complications including gestational diabetes, preeclampsia and premature delivery (6).
  • Endometrial cancer in the presence of prolonged oligomenorrhea and/or amenorrhea (1,4).
  • Long-term health complications including type 2 diabetes (secondary to IR causing raised blood glucose levels), cardiovascular disease (CVD), sleep apnea and depression. Annual monitoring, including screening for metabolic and cardiovascular risks, should be conducted (1,7).

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