Polycystic ovary syndrome

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Polycystic ovary syndrome

Endocrine system


Polycystic ovary syndrome


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Polycystic ovary syndrome

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USMLE® Step 1 style questions USMLE

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A 30-year-old woman presents to the clinic to establish care. She is starting a new job as a receptionist and wants to "take care of her irregular periods.” Her menarche was at age 14 and she has been having irregular periods since then. Review of systems is significant for deepening of voice. Past medical history is unremarkable. She only takes over the counter multivitamins. Vitals are within normal limits. BMI is 32 kg/m2. Physical examination shows papulo-pustular acne on the face and a receding hairline. Pelvic examination reveals normal external genitalia and a mobile and nontender uterus with no adnexal masses. This patient is at increased risk of developing which of the following?  

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Polycystic ovarian syndrome (PCOS)

anovulation p. 669

antiandrogens p. 681

clomiphene p. 680

endometrial hyperplasia p. 665

ovarian neoplasm risk p. 670


In polycystic ovary syndrome, “poly” means many, and “cystic” refers to cysts.

So you might think that having many ovarian cysts is a crucial part of polycystic ovary syndrome.

But while some people with polycystic ovarian syndrome do have ovarian cysts, ovarian cysts are no longer a necessary characteristic of the condition.

Instead, polycystic ovary syndrome is a dysfunction in the hypothalamic-pituitary-ovarian axis, which are the hormones that regulate the menstrual cycle.

A normal menstrual cycle can be divided into two phases: the follicular phase, which takes place before ovulation, and the luteal phase, which takes place after ovulation.

During the follicular phase, the hypothalamus secretes gonadotropin-releasing hormone, or GnRH.

GnRH makes the anterior pituitary gland secrete two other hormones, called gonadotropins, in roughly equal amounts, which it releases in pulses.

One of these gonadotropins is the luteinizing hormone, or LH.

The other is the follicle-stimulating hormone, or FSH.

LH and FSH travel to the follicles in the ovaries.

The follicles are small clusters of theca and granulosa cells that protect the developing oocyte, or egg.

The theca cells develop LH receptors which allow them to bind LH, and in response they secrete a hormone called androstenedione.

Granulosa cells develop FSH receptors, which allow them to bind to FSH and produce an enzyme called aromatase, which converts the androstenedione into 17β-estradiol - a member of the estrogen family.


Polycystic ovary syndrome or just PCOS, refers to a set of symptoms due to excessive androgen production in women. Signs and symptoms of PCOS include irregular or no menstrual periods, heavy periods, excess body and facial hair, acne, pelvic pain, trouble getting pregnant, and patches of thick, darker, velvety skin. Associated conditions include type 2 diabetes, obesity, obstructive sleep apnea, heart disease, mood disorders, and endometrial cancer. Management for PCOS may involve lifestyle modifications such as diet and exercise, hormone therapy, and medications.


  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 7/E (ENHANCED EBOOK)" McGraw Hill Professional (2014)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "Harrison's Endocrinology, 4E" McGraw-Hill Education / Medical (2016)
  6. "Genetic, hormonal and metabolic aspects of PCOS: an update" Reproductive Biology and Endocrinology (2016)
  7. "Androgens in Polycystic Ovary Syndrome: The Role of Exercise and Diet" Seminars in Reproductive Medicine (2009)

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