![]() Hormonal contraceptive use will affect free testosterone measures. Most laboratories will offer at least one of these. Hyperandrogenaemia is best measured with free testosterone either calculated free testosterone, free androgen index (FAI) or bioavailable testosterone. ![]() Hirsutism is difficult to assess as most women treat this so it is not obvious on examination. For these women a measure of luteal progesterone (day 21 in a 28 day cycle) will determine ovulatory status It is important to remember that even women with regular cycles may be anovulatory. oligo/anovulation is usually seen in women with menstrual cycles greater than 35 days apart or, conversely, with short cycles of less than 21 days.Metabolic features – obesity, dyslipidaemia, diabetesĭiagnosis is dependent on identifying at least two of the following three features, as per the Rotterdam criteria:.Psychological symptoms – anxiety, depression, psychosexual dysfunction, eating disorders.Hirsutism and male pattern balding consistent with hyperandrogenism.In addition, symptoms may vary with population group, for example, southeast Asian women are less likely to have hirsutism. ![]() This is true of Australian Indigenous women, possibly due to higher levels of insulin resistance and higher rates of obesity. It is important to be aware that some population groups have a higher risk of PCOS. Women are at risk if they have a genetic predisposition, and the onset of symptoms can be triggered by environmental factors, particularly obesity. Hyperandrogenaemia and insulin resistance are pathophysiological features of PCOS. The prevalence of metabolic features increases with age but can also occur in younger women who are overweight. In younger women, reproductive symptoms predominate. There are a range of symptoms that women may experience and present with if they have PCOS and these can vary with age (Table 2). Other aetiologies must be excluded such as congenital adrenal hyperplasia, androgen secreting tumours, Cushing syndrome, thyroid dysfunction and hyperprolactinaemia
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