History and examination
- History, including menstrual, obstetric (particularly miscarriages) and family historyCheck medication historyClinical examination including BMI and waist measurement, blood pressure, hirsutism, acne and acanthosis
- FSH, LH, oestradiol, prolactin, TSH, free T4, thyroid peroxidase antibodies, testosterone, SHBG (sex hormone binding globulin), androstenedione, DHEAS between days 2-5 of menstrual cycle.
- Fasting lipids and fasting glucose if BMI > 30 kg/m2
- Pelvic ultrasound (optional)
Rotterdam criteria for diagnosis of PCOS – Two of the following three criteria
- Polycystic ovaries (12 or more peripheral follicles with or without increased ovarian volume greater than 10 cm3, can be unilateral PCO).
- Oligo- or anovulation
- Clinical and/or biochemical signs of hyperandrogenism.
Advice weight loss for all overweight women – patients to be offered community-based weight loss programmes such as Counterweight or Slimming World.
Address the presenting symptom:
- Infrequent periods /amenorrhoea: Induce bleed with COC pill or progestagen only pill.
- Sub-fertility: pre-conception advice on diet, smoking, exercise, folic acid, rubella and referral to the Centre for Reproductive Medicine (CRM) at UHCW.
- Hirsutism/acne: consider COC and treat acne.
- Metabolic syndrome: Assess cardiovascular risk, including HbA1c. Consider if referral to an endocrinologist is needed.
Patients with suspected PCOS can be referred to a hospital gynaecologist or to the community gynae clinic, City of Coventry Health Centre. For community gynae, refer via the NHS eReferral Service: “Gynaecology Consultant Menopause and Hormone Related Problems”.