How should I manage a patient with suspected polycystic ovary syndrome (PCOS) in primary care?

In primary care, management of a patient with suspected polycystic ovary syndrome (PCOS) should begin with a comprehensive clinical assessment including detailed history and physical examination focusing on menstrual irregularities, hyperandrogenic symptoms (such as hirsutism or acne), and metabolic risk factors. Initial investigations should include measurement of serum testosterone and sex hormone-binding globulin to assess hyperandrogenism, and exclusion of other causes such as thyroid dysfunction or hyperprolactinemia. Pelvic ultrasound is not routinely required for diagnosis in primary care but may be considered if the diagnosis is uncertain or to exclude other pathology. Lifestyle assessment and advice on weight management are critical, as obesity exacerbates PCOS features and metabolic risks.

Management should prioritise symptom relief and prevention of long-term complications. For menstrual irregularities, combined oral contraceptives are first-line to regulate cycles and reduce androgenic symptoms. Metformin may be considered particularly in patients with glucose intolerance or metabolic syndrome features. Psychological support should be offered due to the high prevalence of anxiety and depression in PCOS. Referral to specialist care is appropriate if diagnosis is unclear, if there is poor response to initial management, or if fertility treatment is required.

Regular monitoring in primary care should include assessment of metabolic risk factors such as blood pressure, lipid profile, and glucose tolerance, with lifestyle interventions reinforced. Transition of care from adolescence to adulthood requires coordinated support to address evolving reproductive and metabolic health needs.

This integrated approach aligns with the 2023 international evidence-based guideline for PCOS assessment and management, which emphasises a holistic, patient-centred strategy in primary care settings NICE CG156 Teede et al. 2023. Recent literature also highlights the importance of comprehensive transition care and psychological support throughout the patient journey Simon et al. 2024.