Box 1.

Clinical manifestations of polycystic ovarian syndrome

Signs and symptoms (proportion of patients affected)

Obesity (38%)

Menstrual disturbance (66%)

Oligomenorrhea (47%)

Amenorrhea (19%)

[Regular cycle 30%]

Hyperandrogenism (48%)

Infertility (73% of anovulatory infertility)

Symptomless–20% of those with polycystic ovaries

Hormone systems that might be disturbed

Insulin ↑

Sex-hormone-binding globulin ↓

Androgens (testosterone and androstenedione) ↑

Luteinizing hormone ↑

Prolactin ↑

Possible late sequelae

Dyslipidemia

Low-density lipoprotein (LDL) ↑, High-density lipoprotein (HDL) ↓

Triglycerides ↑

Diabetes mellitus

Cardiovascular disease; hypertension

Endometrial carcinoma

Data from Balen A. Pathogenesis of polycystic ovary syndrome—the enigma unravels? Lancet 999;354:966.