Today, I met a very anxious and puzzled patient in the clinic, with a thick stack of medical records, and as soon as she sat down, she started to talk about her difficult journey of medical treatment in the past few years. She said: I’ve been seeing doctors for 3 years now, I’ve changed hospitals, I’ve seen more than a dozen doctors, I’ve seen Western and Chinese doctors, sometimes I have polycystic ovaries, sometimes I don’t. Some doctors say I have polycystic ovary syndrome, some say I don’t. …… So am I suffering from polycystic ovary syndrome or not? Or am I suffering from some kind of difficult disease? Her condition is like this: she is 26 years old, and three years ago she started to have irregular menstruation. Her body also started to become overweight and fat, while acne (acne) often appeared on her face and back, and body hair on her arms and lower limbs increased. Ms. Zhao had been seen by several hospitals before and after. She was diagnosed with polycystic ovary syndrome and was prescribed 3 months of Daing 35 (an oral contraceptive pill), which she took orally for 21 days a month, during which her periods came on time every month. Ms. Zhao was so happy that she thought she was cured and did not continue to take Darengo 35, but after that, her menstruation started to be disrupted slowly, often delayed and not coming. Ms. Zhao began to doubt the diagnosis and treatment of Western medicine, so she referred to the TCM clinic. The ultrasound examination was normal, there was no manifestation of polycystic, and the blood testosterone was normal. So she was given herbal soup and other menstrual regulating treatments. Ms. Zhao changed hospitals and started to see a Western medicine clinic again. After an ultrasound examination, more than ten small follicles were found in the ovaries bilaterally, and the ultrasound suggested polycystic ovaries. Half a year has passed, and the same thing happened. If I take the medicine, my period will come on time every month, but if I don’t, it will be delayed and not come. Disheartened, confused and doubtful, Ms. Zhao was introduced by a patient and came to see my clinic today! The ultrasound results came out: 6-7 small follicles bilaterally, no polycystic; the blood testosterone value was also normal. Ms. Zhao said with a helpless face: “Dr. Hong, am I having polycystic ovary syndrome or not? If not, what exactly is my disease? Will my menstruation ever return to normal? I said firmly: You should have polycystic ovary syndrome! She was surprised and said: My blood testosterone is not high and my ultrasound does not show polycystic ovaries, how come I still have polycystic ovary syndrome? I said: Don’t be anxious, listen to me slowly explain to you. According to the internationally accepted 2003 Rotterdam Diagnostic Criteria for Polycystic Ovarian Syndrome (PCOS), you are eligible for the diagnosis of PCOS, which are: 1. sporadic ovulation or anovulation; 2. clinical manifestations of hyperandrogenism and/or hyperandrogenemia; 3. polycystic ovarian changes on ultrasound (≥12 follicles of 2-9 mm in diameter in one or both ovaries); and/or 4. Any 2 of the above 3 criteria were met, and other causes of hyperandrogenism were excluded: congenital adrenal cortical hyperplasia, Cushing’s syndrome, androgen-secreting tumors, etc. I continued to explain: Because your menstrual cycle is greater than 35 days, you are in line with Article 1; Article 2 is also in line because although your blood testosterone is not high, you have obvious manifestations of hirsutism and acne, which are clinical manifestations of hyperandrogenism; your Article 3 is not in line because today’s ultrasound does not suggest polycystic ovarian changes. The next step is to rule out other hyperandrogenic causes and you will be diagnosed with polycystic ovary syndrome! Hearing this, Ms. Zhao suddenly realized: So that’s how it is! It turns out that even if there are no polycystic ovaries under ultrasound, it could still be polycystic ovary syndrome! The mystery that has puzzled me for several years has finally been solved and understood today! Polycystic ovary syndrome (PCOS) is a very common reproductive endocrine disease characterized by hyperandrogenemia, ovulation disorders and polycystic ovaries. The incidence of PCOS is about 5%-10% in adolescent and fertile women, about 75% in women with anovulatory infertility, and up to 85% in hirsute women. I. Etiology and harm: PCOS has been recognized for a long time, but many questions about its etiology and pathogenesis are not very clear, and its cause may be related to hypothalamic-pituitary-ovarian axis regulatory dysfunction, adrenal hyperfunction, insulin resistance, genetic factors, environmental factors, etc.. The incidence of PCOS is increasing year by year due to the influence of human diet, change in lifestyle habits, obesity and other factors! The recent hazards include menstrual disorders, infertility, hirsutism, acne, obesity, etc., and are easily complicated by endometrial cancer, diabetes, atherosclerosis, coronary heart disease and other long-term complications. Second, the clinical manifestations of PCOS: 1, menstrual disorders: menstruation sporadic or amenorrhea; 2, infertility; 3, hairy, acne: facial, periareolar, lower abdominal hair, axillary hair, pubic hair, etc., increased, thickened, male type (pubic hair rhombic distribution) tendency; acne is mainly distributed in the face, chest, back and other sebaceous gland-rich parts; 4, obesity: 40 to 60% of patients with obesity; 5, endocrine changes 5. Endocrine changes: abnormal serum follicle stimulating hormone (FSH) and luteinizing hormone (LH): FSH ↓, LH ↑, LH/FSH ≥2-3; hyperandrogenemia: testosterone (T) ↑, androstenedione (A2) ↑, dehydroepiandrosterone sulfate (DHEAS) ↑. Estrone (E1) ↑, estradiol (E2) elevated or normal, E1/E2 ≥ 1. Prolactin (RPL): 10-30% of patients with mildly elevated PRL. 6. Ovarian changes: ovarian enlargement, ultrasound examination can be seen on one or both ovaries with ≥ 12 follicles 2-9 mm in diameter, and/or ovarian volume ≥ 10 mL. 3. Treatment of PCOS: 1. General treatment: regularity of life. Early to bed and early to rise, strengthen exercise, more exercise, quit smoking and alcohol and other bad habits, overweight and obese people need to reduce their weight. Weight loss and weight control mainly rely on diet, usually eat more vegetarian, eat less or no dinner, do not eat fried, chocolate, large fish and meat and other junk food. Drink more plain water, no drinks, no snacks. 2, adjust the menstrual cycle: PCOS to rely on drugs to adjust the menstrual cycle, to protect the endometrium, to prevent excessive endometrial hyperplasia and cancer, etc.. You can use post-progestational semi-cycle therapy, oral contraceptives (Daing 35, Eusyn, Mafulon, etc.). 3.Hirsutism, acne and hyperandrogenism treatment: drugs such as Da-Ying 35, Eusyn, spironolactone, dexamethasone, etc. 4, insulin resistance: reducing body weight and exercise have the effect of reducing insulin resistance, severe insulin resistance can be combined with metformin, rosiglitazone and other drugs. 5, fertility requirements, need to promote ovulation: PCOS because of follicles do not grow or sparse ovulation, it is generally difficult to get pregnant naturally. If you have fertility requirements, you need to use clomiphene, letrozole, urinary gonadotropin (HMG) and other drugs to promote ovulation, to help the follicles grow and mature, so as to achieve the purpose of pregnancy. In vitro fertilization-embryo transfer technique (IVF-ET) or laparoscopic ovarian perforation can be used for those who have poor results with medications.