Polycystic ovarian disease.

Polycystic ovarian disease (PCOD) was first described as a single disease by Stein and Leventhal in 1935 but now has been separated into several distinct entities comprising a symptom complex. The most frequent presenting symptoms associated with PCOD are obesity hirsutism amenorrhea or anovulation dysfunctional uterine bleeding irregular menses and infertility. The common finding of hirsutism in PCOD patients is a reflection of the hyperandrogenism resulting from elevation of all the androgens including testosterone androstenediol dehydroepiandrostrone sulfate (DHEA-S) and androstenedione. Some patients with all the clinical features of PCOD can be shown through appropriate testing to have an attenuated form of classic congenital adrenal hyperplasia (CAH). Serum follicle stimulating hormone (FSH) levels are usually low or in the normal range and serum luteinizing hormone (LH) levels are usually elevated in patients with PCOD resulting in an altered LH/FSH ratio. Treatment for PCOD must be based on the needs and desires of the individual patient and on the pathophysiology of the patients particular abnormalities. When pregnancy is desired ovulation induction with clomiphene is indicated. Clomiphene is a weak estrogen that induces a transient rise in serum LH and FSH followed by a gonadotropic pattern similar to normal cycles. A 72% ovulation rate and a 41.8% conception rate have been reported after treatment with clomiphene. In patients who do not respond to clomiphene or clomiphene with added human chorionic gonadotropin (hCG) human menopausal gonadotropin (hMG) can be used to induce ovulation but the patient should be closely monitored for multiple ovulation multiple pregnancy or hyperstimulation syndrome. For patients not interested in conception regular menstrual cyclicity can be restored and hyperandrogenism reduced with oral contraceptives (OCs).