PCOS

• Chronic anovulation
• Hyperandrogenism
• Hyperinsulinemia with insulin resistance (universal)
• Can have problems w/ GnRH pulsatile effect

Leads to increase & enhancement of LH-stimulated ovarian androgen production (more testosterone).  It also decreases serum SHBG.  Treatment with metformin, diazoxide or troglitazide results in fall of free testosterone.

• Diet & exercise
• Metformin - (usually used w/ obese pts. who might get diabetes) won't eliminate androgens (can decrease them) but can help regulate periods & increase fertility.  Add clomiphene to help fertility & stimulate ovulation.
• Spironolactone - to help with fertility, hirsutism & androgens
• Birth control - helps w/ hirsutism in pts who don't want to get pregnant
• TZDs - Actos (don't use)