Polycystic ovary syndrome — RACGP Fellowship MCQ

Instant feedback + full explanation. One question, done properly.

HardWomen's health and O&GPolycystic ovary syndromeRACGP Fellowship

A 31‑year‑old woman presents with irregular menstrual cycles, acne, and hirsutism. Her BMI is 33 kg/m². Pregnancy test is negative; TSH and prolactin are normal. Total testosterone is mildly elevated and a pelvic ultrasound confirms polycystic ovarian morphology. She wants cycle regulation but does not wish to become pregnant. What is the most appropriate first‑line management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Recommend lifestyle modification to address metabolic risk, and prescribe combined hormonal contraception if no contraindications

Explanation lettering: C = shown as A · E = shown as B · B = shown as C · A = shown as E

Option B is correct. Australian Prescriber notes that COCPs are the usual first‑line pharmacological treatment for irregular periods and clinical hyperandrogenism in PCOS, and emphasises concurrent lifestyle modification given the high metabolic risk associated with obesity (BMI 33 kg/m²) and PCOS ([australianprescriber.tg.org.au](https://australianprescriber.tg.org.au/articles/pharmacological-management-of-polycystic-ovary-syndrome.html?utm_source=openai)). The 2023 International Guideline, funded via the NHMRC (Australia), reinforces healthy lifestyle plus evidence‑based medical therapy including combined hormonal contraception ([pubmed.ncbi.nlm.nih.gov](https://pubmed.ncbi.nlm.nih.gov/37580037/?utm_source=openai)). The WHO fact sheet also supports the benefits of combined oral contraceptives for cycle regulation and acne/hirsutism, and endorses healthy lifestyle in all women with PCOS ([who.int](https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome?utm_source=openai)). Clomifene (A) is inappropriate without fertility desire; reassurance alone (C) neglects necessary metabolic screening and risk management; prednisolone (D) lacks any role; and oophorectomy (E) is not justified by polycystic morphology alone.

Reference: Australian Prescriber (Therapeutic Guidelines affiliate): Pharmacological management of polycystic ovary syndrome (August 2024) - combined oral contraceptive pill first‑line; 2023 International Evidence‑based Guideline for PCOS (NHMRC‑funded) 2023; WHO PCOS fact sheet (January 2026). https://australianprescriber.tg.org.au/articles/pharmacological-management-of-polycystic-ovary-syndrome.html