This chapter discusses the issues around the diagnosis and management of polycystic ovary syndrome (PCOS) through puberty and adolescence. The diagnosis of PCOS may be made incidentally in girls undergoing investigation for severe obesity or prospectively in young women being investigated for irregular periods, acne or hirsutism. There may be a family history of PCOS or infertility and, although the classic biochemical features and ovarian ultrasound appearances may be not being evident immediately, diagnosis unravels over time. Symptomatic treatment focused on the restoration of regular menses is the most common starting point and the oral contraceptive pills (OCPs) are the mainstay of pharmacological therapy for PCOS for many decades. The effects of metformin administration in adolescent girls with PCOS have been assessed in both obese and non-obese populations. Irregular periods are treated with OCPs with or without the inclusion of cyproterone acetate depending on the extent of hirsutism and acne.

Insulin-sensitising agents are frequently used in the treatment of women with polycystic ovary syndrome (PCOS). This chapter explores the use of insulin sensitisers, primarily metformin, for varying indications related to PCOS and discusses the evidence to develop a risk/benefit ratio for their use. These drugs were developed to treat type 2 diabetes and have been adapted as treatments for the symptoms of PCOS. Metformin has been proposed to prevent early first-trimester miscarriage. Randomised trials, primarily from one group in Spain, have shown that metformin improves many aspects of premature pubarche, including slowing the onset of puberty, reducing total and visceral fat, improving circulating lipid levels and lowering testosterone levels. There are not enough data to conclude whether insulin-sensitising agents improve hirsutism. The rationale for the use of metformin in infertility is that it lowers both circulating insulin levels and testosterone levels, and leads to increased ovulation.

This chapter describes the treatment of obesity in the context of polycystic ovary syndrome (PCOS) with anti-obesity medication and obesity (bariatric) surgery. Diet and increased levels of physical activity are crucial first steps in the management of obesity but are not sustainable in the long term. The use of anti-obesity medication as an adjunct to lifestyle modification has yielded reasonable results in terms of weight loss and improvement in hirsutism and infertility. The most effective treatment of obesity in women with PCOS, based on the limited data available, appears to be bariatric surgery, which results in resolution of all of the syndrome's parameters. The management of pregnancies in women following bariatric surgery should be conducted by a specialist multidisciplinary team, and recommendations ought to be robust and based on more comprehensive trials focusing on nutritional support, timing of conception and the management of complications in this high-risk group of women.

Hyperandrogenism is the most common endocrinopathy seen in women and may result from ovarian or adrenal overproduction of androgens, altered peripheral metabolism and/or end-organ hypersensitivity. The clinical manifestions of hyperandrogenism in polycystic ovary syndrome (PCOS) are frequently very visible and, as a result, produce significant psychological morbidity. The three main naturally occurring steroids responsible for androgen activity are testosterone and the weak androgens dehydroepiandrosterone (DHEA) and androstenedione. Managing the dermatological signs of hyperandrogenism, which generally present as acne, seborrhoea, hirsutism and female-pattern hair loss in PCOS, is achieved by reducing the circulating levels and effects of androgens. Potential mechanisms by which this may occur include: direct suppression of androgen production, change in androgen binding to sex hormone-binding globulin (SHBG), impairing the peripheral conversion of free testosterone to dihydrotestosterone by inhibiting 5 alpha-reductase type I and inhibiting androgens acting at the site of target tissue.

This chapter provides a general overview of health-related quality of life (HRQoL) measurement and reviews the HRQoL literature in relation to polycystic ovary syndrome (PCOS) and its associated symptoms, including mental health, fertility and obesity. HRQoL measurement has an important role in measuring the impact of chronic disease and in evaluative research as a measure of outcome, particularly in clinical trials where health status tools can assist in clinical decision making regarding treatment choice and policy decisions. Studies that have compared the HRQoL of women with PCOS with that of other gynaecological populations have also reported worse HRQoL scores. The symptoms typically associated with PCOS, including hirsutism and infertility, have been shown to lead to a significant reduction in quality of life. Complementary studies and qualitative studies exploring HRQoL in adolescents with PCOS would provide beneficial contributions to the existing literature.

This chapter discusses polycystic ovary syndrome (PCOS) and its clinical manifestations. It also explores the incidence of insulin resistance in PCOS. Insulin resistance can be encountered in women with PCOS. Diagnosis and treatment are also independent on insulin resistance. Management of women with PCOS depends on the symptoms. These could be ovulatory dysfunction-related infertility, menstrual disorders, or hirsutism. Treatment of hirsutism involves administration of oral contraceptive pills and antiandrogens. Clomiphene citrate, dexamethazone, gonadotropin and aromatase inhibitors are used in the treatment of ovulatory disorders. Gonadotropin-releasing hormone agonist plays a major role in IVF treatment as well as in superovulation. There are several insulin-sensitizing agents available to reduce insulin levels, and the most commonly used for women with PCOS is metformin. Metformin has replaced the surgical treatment of PCOS with ovarian drilling. Metformin improves insulin resistance and hyperandrogenism, decreases serum lipids, and improves glucose homeostasis.