It is one of the most common causes of dysfunctional uterine bleeding, with a complaint of irregular periods being the most common presenting complaint to the doctor. The PCOS diagnostic criteria were developed by the National Institute of Health (NIH) in 1990, and include the following:
1. Hyperandrogenism: These women tend to have more androgen (the classic male sex hormones) levels floating around in their system, causing hirsutism, acne, male pattern hair loss (alopecia), and elevated blood testostosterone levels.
2. Chronic Anovulation: These women tend to ovulate less, and therefore exhibit more difficulty with their periods. They may lack periods all together (Amenorrhea), have cycles that last greater than 35 days (Oligomenorrhea), have unpredictable periods (Dysfunctional Uterine Bleeding), or report of infertility with difficulty reaching pregnancy.
3. All secondary causes of the above must be ruled out: Pregnancy, Thyroid Disease, Eating Disorders, Exercise Related Amenorrhea, Hypothalamic-Pituitary Disorder, Premature Ovarian Failure, Pituitary Adenoma, Congenital Adrenal Hyperplasia, and Cushing’s disease.

The pathophysiology includes two pathways.
First, there is a specific chemical released from the hypothalamus in the brain, called Gonadotropin Releasing Hormone (GnRH). When the hypothalamus releases GnRH in a high pulse frequency, as it does in PCOS, it signals to the pituitary gland to preferentially release another chemical called “Luteinizing Hormone,” or LH. This LH stimulates the ovarian cells to produce more androgens, thereby causing PCOS.
The second important pathway of this syndrome is caused by insulin resistance. Insulin resistance occurs in women with a predisposition to diabetes or pre-diabetes, and they often have a family history of this. The reason PCOS is important to learn about is not only because of its high incidence, but also its potential complications if left undiagnosed or untreated. Here are

some of the more important complications in those with PCOS:
* Decreased Fertility:
* Endometrial hyperplasia:
* Obesity: 30-40% of PCOS women are also obese.
* Dyslipidaemia:
* Insulin Resistance:
* Hyperandrogenism: Many fight a long battle with excess body and facial hair, adult acne, and even male pattern hair loss. Cosmetically, this is a great cause of concern and frustration for many of these women.
* Coronary Artery Disease (CAD)
* Pregnancy Risks
* Hypertension
* Sleep Apnea

There are several treatment options for those with PCOS. The most studied oral medication is metformin, which is a medication given to those with diabetes in order to decrease insulin resistance. And if there is less insulin, there is less androgen production by the ovaries.  When combined with exercise, it can facilitate weight loss. It also increases fertility, as 40-90% taking metformin report more regular periods and ovulation

Mainstay of treatment, however, is weight loss. With a 5% or greater weight loss, 82% have improved menses over a six to seven month period of time. Like in diabetics, a lower carbohydrate diet is recommended in order to increase insulin sensitivity. Weight loss decreases insulin resistance and improves hirsutism. And with a 5% weight loss, 40% have reported a pregnancy outcome.
Patients with PCOS should consult their physician regarding their individual treatment options.

Read More on   http://www.kevinmd.com/blog/2010/05/pcos-diagnosed-treated-primary-care.html