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Polycystic ovary syndrome — SCE Endocrinology MCQ

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ModerateReproductive EndocrinologyPolycystic ovary syndromeSCE Endocrinology

A 29-year-old woman has oligomenorrhoea, acne and subfertility for 18 months. BMI is 32 kg/m², testosterone is mildly raised and pelvic ultrasound shows increased follicle number. TSH, prolactin and 17-hydroxyprogesterone are normal. What is the most appropriate management?

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Correct answer: D — Offer lifestyle intervention and letrozole for ovulation induction if pregnancy is desired

She meets criteria for PCOS after exclusion of mimics; weight management improves metabolic and reproductive outcomes and letrozole is commonly used for ovulation induction. Hydrocortisone would be for adrenal insufficiency or CAH, not PCOS. The pearl is that PCOS management depends on the patient's priority: fertility, hyperandrogenism, cycle control or metabolic risk.

Reference: International evidence-based PCOS guideline, NICE fertility guidance