A 23 Year Old Female With Oligomenorrhea

A 23 year old female presents to the clinic with presenting symptoms of  irregular menstrual periods ( every 3-4 months) and excessive facial hair. She is sexually active and never used birth control but has never been pregnant. On General appearance she looks obese and has acne.

The pelvic ultrasound is shown below:

The ultrasound shows multiple ovarian cysts. The patient is suffering from Polycystic ovarian Syndrome.

Case Discussion
Poly Cystic Ovarian Syndrome:

• It is the most common cause of female hirsutism (male-pattern hair growth).
• Patients may have mild or no symptoms or present with oligomenorrhea, infertilty and virilization.
• The cause is umknown but hyperinsulinemia with insulin resistance is usually seen. 
• Typically affects women in the teenage age years who are obese .
• On pelvic examination palpably enlarged ovaries may be felt.
• Blood workup shows increased LH/FSH ratio (>2) and increased testosterone.
• An ultrasound may show ovaries with multiple small follicles. 
• Ovulation may be induced with clomiphene to treat infertility. 
• Oral contraceptive pills may be used to supress steroidogenesis.
• Weight loss will help with insulin resistance.