Guzick David S
Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA.
Obstet Gynecol. 2004 Jan;103(1):181-93. doi: 10.1097/01.AOG.0000104485.44999.C6.
Women with polycystic ovarian syndrome have chronic anovulation and androgen excess not attributable to another cause. This condition occurs in approximately 4% of women. The fundamental pathophysiologic defect is unknown, but important characteristics include insulin resistance, hyperandrogenism, and altered gonadotropin dynamics. Inadequate follicle-stimulating hormone is hypothesized to be a proximate cause of anovulation. Obesity frequently complicates polycystic ovarian syndrome but is not a defining characteristic. The diagnostic approach should be based largely on history and physical examination, thus avoiding numerous laboratory tests that don't contribute to clinical management. Women with polycystic ovarian syndrome typically present because of irregular bleeding, hirsutism, and/or infertility. These conditions can be treated directly with oral contraceptives, oral contraceptives plus spironolactone, and ovulation induction, respectively. However, women with polycystic ovarian syndrome also have a substantially higher prevalence of diabetes and increased risk factors for cardiovascular disease. They should also be screened, therefore, for these conditions and followed closely if any risk factors are uncovered. For obese women with polycystic ovarian syndrome, behavioral weight management is a central component of the overall treatment strategy.
患有多囊卵巢综合征的女性存在慢性无排卵和雄激素过多的情况，且并非由其他原因所致。这种病症在约4%的女性中出现。其根本的病理生理缺陷尚不清楚，但重要特征包括胰岛素抵抗、高雄激素血症以及促性腺激素动态变化异常。促卵泡生成素不足被认为是无排卵的直接原因。肥胖常使多囊卵巢综合征病情复杂化，但并非其决定性特征。诊断方法应主要基于病史和体格检查，从而避免进行众多对临床管理无帮助的实验室检查。患有多囊卵巢综合征的女性通常因月经不规律、多毛和/或不孕而就诊。这些情况可分别通过口服避孕药、口服避孕药加螺内酯以及诱导排卵进行直接治疗。然而，患有多囊卵巢综合征的女性患糖尿病的患病率也显著更高，且心血管疾病的危险因素增加。因此，也应对她们进行这些疾病的筛查，如果发现任何危险因素，应密切随访。对于肥胖的多囊卵巢综合征女性，行为体重管理是整体治疗策略的核心组成部分。
