Management. Directed toward the primary problem and the patient’s desires.
Oligomenorrhea or menstrual dysfunction
Hyperandrogenism, clinically or biochemically
Polycystic ovaries on TV sonogram (≥12 peripheral cysts)With irregular bleeding, OCPs will normalize the bleeding. The progestin
component will prevent endometrial hyperplasia.
Hirsutism can be suppressed two ways: OCPs will (a) lower testosterone
production by suppressing LH stimulation of the ovarian follicle theca cells,
and (b) increase SHBG (thus decreasing free testosterone). Spironolactone
suppresses hair follicle 5-α reductase enzyme conversion of androstenedione
and testosterone to the more potent dihydrotestosterone.
Infertility. If patient desires pregnancy, ovulation induction can be achieved
through clomiphene citrate or human menopausal gonadotropin. Metformin, a
hypoglycemic agent that increases insulin sensitivity, can enhance the
likelihood of ovulation both with and without clomiphene.