Polycystic ovarian syndrome remains a highly controversial topic because of its undetermined & potentially variable etiology & an undetermined phenotypic spectrum. The criterion used to diagnose PCOS is rather controversial. There is no unified consensus on the diagnostic markers. This is because of the inconsistent & inaccurate methods of evaluating androgens, examination of anovulation & polycystic ovaries on Ultrasound.
Polycystic ovarian morphology (PCOM) has been found to be a better discriminator than ovarian volume in PCOS. Although the threshold of 12 (FNPO) offered the best diagnosis; the more recent studies have mentioned follicular number per ovary of 19 & even 26. Stromal abundance is the most consistent character & key factor for the diagnosis of PCOS. This can be diagnosed by increased Stromal echogenecity on ultrasound.
The treatment modalities are numerous for PCOS but the mainstay is lifestyle modifications in terms of good nutritious diet, exercise regimes, weight loss program, getting rid of addictions especially smoking & alcohol & allying stress / anxiety.
Several ovulation induction protocols have been used for infertile PCO patients but recent studies indicate newer drugs gives the best results is terms of mono follicular growth, good endometrium, low risk of OHSS, low abortion rates, less incidence of multiple pregnancy.
Lot of research is being done at the present time to define diagnostic criteria for PCOS in adolescent age groups. Difficulties for diagnosis are
1. Overlap of symptoms of hyperandrogenism like acne, hirsutism even in normal people.
2. Irregular cycles & anovulation which normally is found in this age.
3. Trans-abdominal ultra sound (TAS) has to be used instead of TVS for detection of PCOM.
So, PCOM in adolescents can be detected if ovarian volume is > 10 CM3 because follicle count becomes difficult on TAS.
All these patients with diagnosis of PCOS should be monitored on a long term basis as they are at a risk of developing metabolic syndrome which can put them at a high risk of diabetes mellitus, Hypertension, Cardiovascular & cerebro-vascular accidents, cancers & infertility.
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