You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.



The Reproductive Phenotype in Polycystic Ovary Syndrome

  • Authors: R. Jeffrey Chang, MD
Start Activity

Target Audience and Goal Statement

This activity is intended for primary care clinicians, gynecologists and obstetricians, and other specialists who care for women.

The goal of this activity is to update clinicians on the pathophysiology of polycystic ovary syndrome and describe the range of clinical manifestations of the condition.

  1. Describe the prevalence of polycystic ovary syndrome (PCOS) among women with hirsutism or irregular menstrual bleeding

  2. List the defining features of PCOS

  3. Identify androgenic features of PCOS

  4. Describe the predominant body fat distribution among women with PCOS and obesity

  5. Identify the pattern of menstrual irregularity among women with PCOS


As an organization accredited by the ACCME, Medscape, LLC requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


  • R. Jeffrey Chang, MD

    Professor; Director, Division of Reproductive Endocrinology, Department of Reproductive Medicine, University of California, San Diego School of Medicine, La Jolla, California


    Disclosure: R. Jeffrey Chang, MD, has disclosed no relevant financial relationships.

CME Authors

  • Désirée Lie, MD,MSEd

    Clinical Professor, Family Medicine, University of California, Orange; Director, Division of Faculty Development, UCI Medical Center, Orange, California


    Disclosure: Désirée Lie, MD, MSEd, has disclosed no relevant financial relationships.

Accreditation Statements

    For Physicians

  • Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    Medscape, LLC designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should only claim credit commensurate with the extent of their participation in the activity.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. Medscape encourages you to complete the Activity Evaluation to provide feedback for future programming.
You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.

*The credit that you receive is based on your user profile.


The Reproductive Phenotype in Polycystic Ovary Syndrome

Authors: R. Jeffrey Chang, MDFaculty and Disclosures


Summary and Introduction


The symptoms of women with polycystic ovary syndrome (PCOS) include hirsutism and irregular menstrual bleeding due to ovarian androgen excess and chronic anovulation. Typically, these features emerge late in puberty or shortly thereafter. The proposed mechanism(s) responsible for increased ovarian androgen production include heightened theca cell responsiveness to gonadotropin stimulation, increased pituitary secretion of luteinizing hormone, and hyperinsulinemia. The cause of ovulatory dysfunction is not well understood, but is linked to abnormal follicle growth and development within the ovary. As a result, infertility is common among women with PCOS and, in many instances, is the initial presenting complaint. Insulin resistance and obesity are frequently associated with PCOS and probably contribute to the severity of symptoms. The polycystic ovary that accompanies the syndrome has recently been defined as having 12 or more follicles per ovary or an ovarian volume greater than 10 ml as determined by ultrasonography. In addition, there is an increased number of growing follicles in the polycystic ovary. Despite this distinctive appearance, the cause and development of the polycystic ovary are completely unknown.


The primary clinical manifestations of polycystic ovary syndrome (PCOS) are hirsutism and irregular menstrual bleeding due to ovarian androgen excess and chronic anovulation. The prevalence of PCOS in hirsute women is approximately 75%, whereas the frequency in women with irregular bleeding ranges from 75% to 90%.[1,2] Commonly, these features emerge late in puberty or shortly thereafter. In addition, the disorder has been inseparably linked to specific morphological changes of the ovary.

The presence of insulin resistance in 50–70% of cases, or obesity in about 60%, seems to further amplify the severity of the condition at presentation.[3] The prevalence of obesity in PCOS in the United States is greater than rates observed in other countries.[4,5] The physiologic alterations of PCOS seem to arise primarily from abnormal ovarian steroidogenesis as a consequence of inappropriate hypothalamic–pituitary–ovarian interaction. The relationship between ovarian dysfunction and the morphogenesis of the ovary is, however, not well understood. In this article, the clinical manifestations of PCOS are described with respect to the mechanisms that seem to underlie the altered reproductive physiology. In particular, the roles of androgens, gonadotropins, insulin, estrogens, and obesity are emphasized.