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Examination of skin folds to rule out acanthosis nigricans (a skin condition that leads to dark patches around joints such as the knuckles, armpits, elbows and knees, and is a sign of insulin resistance).
Transvaginal ultrasound to determine whether the ovaries have increased volume and follicles according to specific criteria.
Blood analysis. Assessment of androgens and hormones related ovulation: FSH, LH, oestradiol, prolactin, free testosterone, androstenedione, 17-OH progesterone. Also fasting glucose and insulin, to determine whether there is insulin resistance, as well as an oral glucose tolerance test to rule out diabetes mellitus.
Treatment of Polycystic Ovary Syndrome (PCOS) aims to improve the symptoms that each patient experiences at each stage of her life. Although the signs and symptoms treated are mainly gynaecological, this must often be accompanied by assessment and treatment from other specialists such as endocrinologists, dermatologists, internists, cardiologists, etc.
All PCOS patients are advised to follow a healthy lifestyle by means of healthy eating habits and physical exercise, with special emphasis on patients with obesity and/or insulin resistance.
Drug treatments are primarily aimed at correcting:
Signs and symptoms of excess androgen by using oral contraceptives, drugs related to insulin metabolism, drugs that block the androgen receptor or topical treatments.
Ovulatory disorder. This depends on whether the patient wishes to become pregnant or not.
If the patient does not currently wish to become pregnant and does not menstruate, or has very infrequent menstrual periods, it is essential to establish hormonal treatment to prevent complications in the uterus (hyperplasia and endometrial cancer).
If the patient wishes to become pregnant, a study is performed to rule out other causes of infertility. If only an ovulatory problem is detected and the patient is overweight or obese, the first measure to improve the ovulatory cycle is weight loss through re-education of dietary habits and an increase in physical activity. If the patient is of normal weight, or her menstrual cycle cannot be corrected by weight loss, pharmacological treatments to induce ovulation will be indicated. Treatment usually begins with oral drugs and, if these fail, treatment with subcutaneous injectable drugs is initiated. These treatments require regular clinical and ultrasound monitoring. If the patient requires IVF treatment, appropriate PCOS guidelines should be used and adapted to the patient’s specific clinical characteristics.