Polycystic Ovarian Syndrome


  • Irregular or absent ovulation (menstruation) and
  • Clinical and/ or biochemical signs of raised androgens 

Ultrasound is not necessary to diagnose PCOS. The Ultrasonographers at RCHT do not accept referrals from GPs to look for cysts alone.


  • other endocrine disorders need to be excluded 

Information to include in the referral letter to General Gynae Clinic

  • History of Raised Androgens, e.g. hirsuitism, acne etc. including severity of Sx.  
  • menstrual history
  • metabolic disturbance
  • obesity


  • Free androgen index (FAI = testosterone / SHBG x100 – one yellow top tube to biochemistry)
  • TSH if clinical suspicion
  • LH/FSH and prolactin if anovulation
  • If testosterone greater than 5 consider androgen secreting tumour

Treatment options please include which ones tried and response

  • weight loss, exercise for all
  • COCP/dianette  (androgenic Sx and cycle control)
  • Cyclical progestogens (cycle control)
  • Mirena (cycle control)
  • Vaniqua (hirsuitism)

Reason for referral

  • infertility- refer infertility service
  • Symptom control - if initial treatments not effective refer to endocrinology (for hirsuitism and further investigation) or gynaecology (for menstrual disorder) for consideration of anti-androgens or metformin
  • for surveillance of endometrium, or endometrium >15mm
    • thick or unusual appearance on scan (if oligo-/amenorrhoic and unable or unwilling to have cycle controlled with hormone treatments, she will need endometrial thickness assessment by ultrasound scan)

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