Ovarian Cysts & PCOS
Comprehensive integrative medicine approach for lasting healing and complete recovery
Understanding Ovarian Cysts & PCOS
Ovarian cysts are fluid-filled sacs that develop on or within the ovaries, occurring as part of normal ovulation (functional cysts) or due to pathological processes. Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder characterized by chronic anovulation, hyperandrogenism, and multiple small cysts on the ovaries. Together, these conditions affect up to 20% of women of reproductive age, causing hormonal imbalances, menstrual irregularities, and fertility challenges.
Recognizing Ovarian Cysts & PCOS
Common symptoms and warning signs to look for
Irregular, infrequent, or absent menstrual periods
Pelvic pain or pressure, especially during intercourse or menstruation
Unexplained bloating or abdominal fullness
Excessive facial or body hair growth (hirsutism)
Persistent acne that doesn't respond to standard treatments
Difficulty conceiving despite regular attempts
Sudden severe pelvic pain (possible cyst rupture or torsion)
Unexplained weight gain, particularly around the midsection
What a Healthy System Looks Like
In healthy ovarian function, the hypothalamic-pituitary-ovarian axis maintains precise hormonal coordination. Each menstrual cycle begins with FSH stimulating follicular development; a dominant follicle emerges by day 7-10, producing estrogen that triggers the LH surge around day 14. This surge causes ovulation, releasing the mature egg and transforming the follicle into a progesterone-producing corpus luteum. If fertilization doesn't occur, the corpus luteum involutes, progesterone drops, and menstruation begins. Healthy ovaries contain 15-25 antral follicles per ovary, with balanced androgen-to-estrogen ratios and normal insulin sensitivity maintaining metabolic harmony.
How the Condition Develops
Understanding the biological mechanisms
Ovarian cysts and PCOS involve complex interconnected pathophysiological mechanisms: (1) Follicular Arrest - In PCOS, multiple small follicles begin development but arrest at 2-9mm due to insufficient FSH stimulation, creating the characteristic 'string of pearls' appearance; (2) Hyperandrogenism - Excess testosterone and androstenedione from ovarian theca cells and adrenal sources disrupt follicular maturation, causing hirsutism, acne, and anovulation; (3) Insulin Resistance - Up to 70% of PCOS patients exhibit insulin resistance; hyperinsulinemia stimulates ovarian androgen production and inhibits hepatic SHBG synthesis, amplifying free testosterone; (4) LH/FSH Dysregulation - Elevated LH relative to FSH (>2:1 ratio) overstimulates theca cells and prevents normal follicular selection; (5) Functional Cyst Formation - Follicular cysts develop when a mature follicle fails to rupture; corpus luteum cysts form when the corpus luteum fills with fluid or blood instead of involuting; (6) Inflammatory Cascade - Chronic low-grade inflammation (elevated CRP, IL-6, TNF-alpha) contributes to metabolic dysfunction and cardiovascular risk; (7) Endometrial Consequences - Chronic anovulation leads to unopposed estrogen exposure, causing endometrial hyperplasia and increasing cancer risk; (8) Cyst Complications - Large cysts (>5cm) risk ovarian torsion (twisting), rupture causing internal bleeding, or pressure on adjacent organs.
Key Laboratory Markers
Important values for diagnosis and monitoring
| Test | Normal Range | Optimal | Significance |
|---|---|---|---|
| Testosterone (Total) | 8-60 ng/dL | 15-35 ng/dL | Elevated in PCOS; >60 ng/dL suggests significant hyperandrogenism; levels >200 ng/dL warrant investigation for androgen-secreting tumors |
| Free Testosterone | 0.1-6.0 pg/mL | 0.5-2.0 pg/mL | More sensitive than total testosterone; elevated due to low SHBG in insulin resistance; best marker for androgenic symptoms |
| DHEA-S (Dehydroepiandrosterone Sulfate) | 18-391 mcg/dL | 100-200 mcg/dL | Adrenal androgen marker; elevated >400 mcg/dL suggests adrenal hyperandrogenism or non-classical congenital adrenal hyperplasia |
| Androstenedione | 0.7-3.7 ng/mL | 1.0-2.0 ng/mL | Elevated in PCOS; precursor to testosterone; helps differentiate ovarian vs adrenal hyperandrogenism |
| SHBG (Sex Hormone Binding Globulin) | 18-144 nmol/L | 60-100 nmol/L | Low in PCOS due to insulin resistance; increases free testosterone bioavailability; inversely correlates with insulin levels |
| LH (Luteinizing Hormone) | 2.4-12.6 mIU/mL | 5-10 mIU/mL | Elevated with normal/low FSH suggests PCOS; LH/FSH ratio >2:1 characteristic but not required for diagnosis |
| FSH (Follicle Stimulating Hormone) | 3.5-12.5 mIU/mL | 5-8 mIU/mL | Normal or low in PCOS; elevated FSH >25 suggests premature ovarian insufficiency rather than PCOS |
| Fasting Insulin | 2-25 uIU/mL | <10 uIU/mL | Elevated in insulin-resistant PCOS; drives ovarian androgen production; key marker for metabolic intervention |
| HOMA-IR (Insulin Resistance Index) | <2.5 | <1.5 | Calculated from fasting glucose and insulin; >2.5 indicates significant insulin resistance requiring intervention |
| AMH (Anti-Müllerian Hormone) | 1.0-4.0 ng/mL | 1.5-3.5 ng/mL | Often elevated >4.5 ng/mL in PCOS due to increased antral follicle count; reflects ovarian reserve and follicle pool size |
| CA-125 (Cancer Antigen 125) | 0-35 U/mL | 0-20 U/mL | May be mildly elevated with endometriomas or large cysts; >200 U/mL warrants malignancy workup in postmenopausal women |
Root Causes We Address
The underlying factors contributing to your condition
{"cause":"Insulin Resistance and Hyperinsulinemia","contribution":"Primary Driver","assessment":"Fasting insulin, HOMA-IR calculation, 2-hour OGTT with insulin levels, body composition analysis (visceral fat measurement)"}
{"cause":"Genetic Predisposition","contribution":"40-60% heritability","assessment":"Family history of PCOS, type 2 diabetes, metabolic syndrome; genetic polymorphism testing (if indicated); first-degree relatives have 5x increased risk"}
{"cause":"Chronic Low-Grade Inflammation","contribution":"Contributing Factor","assessment":"High-sensitivity CRP, IL-6, TNF-alpha, oxidative stress markers (8-OHdG, F2-isoprostanes), white blood cell count"}
{"cause":"Environmental Endocrine Disruptors","contribution":"20-30%","assessment":"Exposure history to BPA, phthalates, parabens; serum/plasma levels if available; occupational and lifestyle exposure assessment"}
{"cause":"Gut Dysbiosis and Intestinal Permeability","contribution":"25%","assessment":"Comprehensive stool analysis, intestinal permeability testing (lactulose-mannitol), food sensitivity testing, SIBO breath testing"}
{"cause":"Chronic Stress and HPA Axis Dysregulation","contribution":"30%","assessment":"Cortisol awakening response, DUTCH hormone testing, stress inventory questionnaires, sleep quality assessment"}
{"cause":"Nutritional Deficiencies","contribution":"20%","assessment":"Vitamin D 25-OH, magnesium RBC, zinc, chromium, B-vitamin status, omega-3 index, comprehensive nutrient panel"}
{"cause":"Epigenetic Modifications","contribution":"Emerging Factor","assessment":"Maternal history of diabetes/PCOS, birth weight (low or high), early menarche history, prenatal androgen exposure assessment"}
Risks of Inaction
What happens if left untreated
{"complication":"Type 2 Diabetes Mellitus","timeline":"5-15 years","impact":"Up to 50% of women with PCOS develop prediabetes or T2DM by age 40; progressive beta-cell dysfunction; requires lifelong medication management; risk of diabetic complications (neuropathy, retinopathy, nephropathy)"}
{"complication":"Endometrial Cancer","timeline":"10-20 years","impact":"3-fold increased risk of endometrial hyperplasia progressing to carcinoma; chronic unopposed estrogen causes endometrial proliferation; may require hysterectomy; life-threatening if metastatic"}
{"complication":"Cardiovascular Disease","timeline":"15-25 years","impact":"Increased risk of hypertension, dyslipidemia, coronary artery disease, myocardial infarction, and stroke; endothelial dysfunction begins in young women with PCOS; leading cause of mortality"}
{"complication":"Infertility and Pregnancy Complications","timeline":"During reproductive years","impact":"Difficulty conceiving due to anovulation; 50% risk of gestational diabetes; increased preeclampsia, miscarriage (2x risk), preterm delivery; may require expensive fertility treatments"}
{"complication":"Ovarian Torsion","timeline":"Acute emergency","impact":"Large cysts (>5cm) can cause ovary to twist, cutting off blood supply; surgical emergency requiring immediate intervention; risk of ovarian loss if not addressed promptly; severe pain and potential peritonitis"}
{"complication":"Cyst Rupture and Hemorrhage","timeline":"Acute event","impact":"Sudden severe pelvic pain, internal bleeding, hemodynamic instability; may require emergency surgery; risk of adhesions and future fertility impact; can be life-threatening if massive hemorrhage"}
{"complication":"Non-Alcoholic Fatty Liver Disease","timeline":"10-20 years","impact":"Hepatic steatosis progressing to fibrosis, cirrhosis, and liver failure; elevated liver enzymes; increased cardiovascular risk; may require liver transplantation in severe cases"}
{"complication":"Mental Health Deterioration","timeline":"Progressive","impact":"Chronic depression, anxiety disorders, eating disorders; reduced quality of life; social isolation; impact on relationships and career; increased healthcare utilization and costs"}
{"complication":"Obstructive Sleep Apnea","timeline":"5-15 years","impact":"5-10x increased risk independent of BMI; cardiovascular strain, daytime fatigue, cognitive impairment, increased accident risk; requires CPAP therapy; contributes to metabolic dysfunction"}
How We Diagnose
Comprehensive assessment methods we use
{"test":"Rotterdam Criteria Assessment for PCOS","purpose":"Establish PCOS diagnosis using international evidence-based criteria","whatItShows":"Requires 2 of 3 criteria: (1) Oligo/anovulation (cycles >35 days or <8 cycles/year), (2) Clinical or biochemical hyperandrogenism, (3) Polycystic ovarian morphology (>20 antral follicles per ovary or volume >10 mL)"}
{"test":"Transvaginal Ultrasound","purpose":"Visualize ovarian morphology and cyst characteristics","whatItShows":"Follicle count per ovary, cyst size and characteristics (simple vs complex), endometrial thickness, ovarian volume; identifies endometriomas, dermoid cysts, or suspicious masses requiring further evaluation"}
{"test":"Comprehensive Hormone Panel","purpose":"Evaluate reproductive and adrenal hormone status","whatItShows":"LH, FSH, estradiol, progesterone, prolactin, TSH; calculates LH/FSH ratio; identifies thyroid dysfunction or hyperprolactinemia as contributing factors"}
{"test":"Complete Androgen Panel","purpose":"Quantify hyperandrogenism and identify source","whatItShows":"Total testosterone, free testosterone, DHEA-S, androstenedione, 17-hydroxyprogesterone, SHBG; distinguishes ovarian vs adrenal androgen excess; rules out androgen-secreting tumors"}
{"test":"Metabolic Assessment Panel","purpose":"Evaluate insulin resistance and cardiovascular risk","whatItShows":"Fasting glucose, fasting insulin, HOMA-IR calculation, HbA1c, lipid panel (total cholesterol, LDL, HDL, triglycerides); identifies metabolic syndrome components"}
{"test":"2-Hour Oral Glucose Tolerance Test (OGTT)","purpose":"Detect impaired glucose tolerance and insulin response","whatItShows":"Glucose and insulin levels at fasting, 1-hour, and 2-hour post-glucose load; identifies prediabetes and insulin resistance patterns missed by fasting tests alone"}
{"test":"AMH (Anti-Müllerian Hormone)","purpose":"Assess ovarian reserve and follicle pool","whatItShows":"Often elevated >4.5 ng/mL in PCOS due to increased antral follicle count; helps predict fertility treatment response and ovarian reserve status"}
{"test":"Endometrial Biopsy","purpose":"Evaluate endometrial health in amenorrheic patients","whatItShows":"Rules out endometrial hyperplasia or carcinoma in women with prolonged amenorrhea (>3 months) or abnormal bleeding; assesses histological dating and atypia"}
{"test":"MRI Pelvis (if indicated)","purpose":"Detailed evaluation of complex cysts or deep infiltrating disease","whatItShows":"Characterizes complex ovarian masses, identifies deep infiltrating endometriosis, evaluates for malignancy features; surgical planning for large or suspicious cysts"}
{"test":"Tumor Markers (if indicated)","purpose":"Risk stratification for ovarian masses","whatItShows":"CA-125, CA 19-9, CEA, AFP, inhibin B; elevated levels may indicate malignancy risk, especially in postmenopausal women or those with complex cysts"}
Our Treatment Approach
How we help you overcome Ovarian Cysts & PCOS
Phase 1: Comprehensive Diagnostic Assessment
{"phase":"Phase 1: Comprehensive Diagnostic Assessment","focus":"Establish definitive diagnosis, rule out differentials, assess metabolic status, identify root causes","interventions":["Complete medical, gynecological, and family history intake","Physical examination including BMI, waist circumference, blood pressure, acne/hirsutism scoring","Transvaginal ultrasound for ovarian morphology and cyst assessment","Comprehensive hormone panel (reproductive, adrenal, thyroid)","Complete androgen profiling","Metabolic assessment (glucose, insulin, lipids, HbA1c)","2-hour OGTT with insulin levels","Inflammatory markers and nutritional status evaluation","Body composition analysis (visceral fat, muscle mass)","Endometrial evaluation if indicated"]}
Phase 2: Acute Symptom Management and Cyst Monitoring
{"phase":"Phase 2: Acute Symptom Management and Cyst Monitoring","focus":"Address immediate symptoms, monitor cysts for resolution or complications, initiate pain management","interventions":["Watchful waiting for simple functional cysts <5cm (most resolve spontaneously in 2-3 cycles)","Serial ultrasounds to monitor cyst size and characteristics","Pain management (NSAIDs, acetaminophen, heat therapy)","Hormonal suppression for recurrent cysts (combined oral contraceptives, progestins)","Emergency protocols for suspected torsion or rupture (severe pain, nausea, fever)","Patient education on warning signs requiring immediate care","Initial dietary modifications (low glycemic index, anti-inflammatory)"]}
Phase 3: Metabolic Restoration and Insulin Sensitization
{"phase":"Phase 3: Metabolic Restoration and Insulin Sensitization","focus":"Restore insulin sensitivity, reduce androgen production, establish metabolic foundation","interventions":["Low glycemic index, anti-inflammatory dietary protocol","Myo-inositol supplementation (2-4g daily) for insulin sensitivity and ovulation","Targeted nutritional support (chromium, magnesium, zinc, NAC)","Exercise prescription (150 min/week moderate + 2-3 resistance sessions)","Weight management if overweight (5-10% loss can restore ovulation)","Stress management and cortisol regulation","Sleep optimization (7-9 hours, circadian rhythm support)","Environmental toxin reduction (BPA-free, organic when possible)"]}
Phase 4: Hormonal Rebalancing and Ovulation Restoration
{"phase":"Phase 4: Hormonal Rebalancing and Ovulation Restoration","focus":"Restore regular cycles, reduce androgenic symptoms, optimize fertility potential","interventions":["Continued metabolic and nutritional support","Herbal androgen modulation (spearmint tea, saw palmetto if indicated)","Cycle tracking and fertility awareness methods","Acne and hirsutism management (topical treatments, laser hair removal)","Ovulation induction support (if fertility desired)","Endometrial protection (cyclic progestins if anovulatory)","Anti-inflammatory and antioxidant protocols"]}
Phase 5: Surgical Intervention (When Indicated)
{"phase":"Phase 5: Surgical Intervention (When Indicated)","focus":"Address persistent or complicated cysts, restore anatomy, preserve fertility","interventions":["Laparoscopic cystectomy for persistent cysts >5cm, complex cysts, or symptomatic cysts","Ovarian drilling for PCOS resistant to medical therapy (rarely used)","Adhesiolysis if pelvic adhesions present","Oophorectomy only for suspicious/malignant masses or severe recurrent torsion","Post-surgical hormonal suppression to prevent recurrence","Fertility preservation counseling if extensive surgery required"]}
Phase 6: Long-term Maintenance and Health Optimization
{"phase":"Phase 6: Long-term Maintenance and Health Optimization","focus":"Sustain improvements, prevent recurrence, optimize lifelong health outcomes","interventions":["Personalized maintenance protocol based on individual response","Regular metabolic monitoring (annual OGTT, lipid panel)","Endometrial surveillance (annual ultrasound if persistent anovulation)","Cardiovascular risk management (blood pressure, lipids, weight)","Fertility planning and support when desired","Mental health and quality of life monitoring","Continued lifestyle optimization and education"]}
Diet & Lifestyle
Recommendations for optimal recovery
Lifestyle Modifications
Regular physical activity: 150 minutes moderate exercise weekly, Resistance training 2-3x weekly (builds muscle, improves insulin sensitivity), High-intensity interval training (HIIT) 1-2x weekly (if appropriate), Daily movement and reduced sedentary time, Stress management: meditation, yoga, tai chi, or breathwork daily, Sleep hygiene: 7-9 hours, consistent schedule, cool dark room, Circadian rhythm optimization: morning sunlight exposure, limit blue light at night, Weight management: even 5-10% loss can significantly improve symptoms, Smoking cessation (smoking increases androgens and cardiovascular risk), Environmental toxin reduction: BPA-free products, organic produce when possible, Regular meal timing to support blood sugar stability, Adequate hydration (half body weight in ounces of water daily)
Recovery Timeline
What to expect on your healing journey
Phase 1 (Weeks 1-4): Comprehensive diagnostic assessment including imaging, hormone panels, and metabolic testing. Simple cysts monitored with watchful waiting. Phase 2 (Weeks 4-12): Acute symptom management, dietary and lifestyle modifications initiated, supplement protocol started. Most functional cysts resolve spontaneously within 2-3 cycles. Phase 3 (Months 3-6): Metabolic restoration with insulin-sensitizing interventions; many patients see improved energy, sleep, and initial cycle regulation. Phase 4 (Months 6-12): Hormonal rebalancing; regular ovulation often restored; significant improvement in androgenic symptoms. Phase 5 (If needed): Surgical intervention for persistent or complicated cysts. Phase 6 (Ongoing): Long-term maintenance with lifestyle optimization and regular monitoring.
How We Measure Success
Outcomes that matter
Regular menstrual cycles every 28-35 days with predictable ovulation
Restored fertility with successful conception (if desired)
Normalized androgen levels (total testosterone <60 ng/dL, free testosterone <6 pg/mL)
Improved insulin sensitivity (HOMA-IR <1.5, fasting insulin <10 uIU/mL)
Reduction in hirsutism (Ferriman-Gallwey score decrease >30%)
Clearer skin with reduced acne lesions and inflammation
Resolution or significant reduction of functional cysts on ultrasound
Stable, healthy weight or achievement of weight loss goals
Improved lipid profile (LDL <100 mg/dL, triglycerides <150 mg/dL, HDL >50 mg/dL)
Normalized inflammatory markers (hs-CRP <1.0 mg/L)
Improved energy levels and reduced fatigue
Better sleep quality and duration
Enhanced mood and reduced anxiety/depression scores
Improved quality of life measures and body image satisfaction
Prevention of cyst complications (no torsion, rupture, or emergency interventions)
Frequently Asked Questions
Common questions from patients
What is the difference between ovarian cysts and PCOS?
Ovarian cysts are fluid-filled sacs that can develop on the ovaries, often as part of normal ovulation (functional cysts). Most are benign and resolve on their own. PCOS (Polycystic Ovary Syndrome) is a complex hormonal disorder characterized by chronic anovulation, hyperandrogenism (excess male hormones), and the presence of multiple small follicles on the ovaries. While PCOS involves 'cysts' (actually arrested follicles), it is a systemic metabolic and endocrine condition, not just an ovarian issue. A woman can have ovarian cysts without having PCOS, and vice versa.
Can ovarian cysts and PCOS be cured?
Functional ovarian cysts often resolve spontaneously within 2-3 menstrual cycles without treatment. PCOS cannot be 'cured' in the traditional sense, but it can be effectively managed and symptoms significantly improved or resolved through comprehensive treatment. Many women achieve regular menstrual cycles, fertility, and resolution of symptoms like acne and hirsutism through lifestyle modifications, targeted supplementation, and functional medicine approaches. The goal is to address root causes rather than just suppress symptoms.
Can I get pregnant if I have ovarian cysts or PCOS?
Yes, most women with ovarian cysts or PCOS can conceive. Functional cysts typically don't affect fertility unless they are large or cause complications. For PCOS, while it is a leading cause of infertility due to anovulation (lack of ovulation), the majority of women can achieve pregnancy with appropriate treatment. Weight loss of just 5-10% can restore ovulation in many women. Supplements like myo-inositol, fertility medications (clomiphene, letrozole), and assisted reproductive technologies are available if needed. Working with a fertility specialist early is recommended.
What size ovarian cyst is considered dangerous?
Cysts larger than 5cm (2 inches) have increased risk of complications including ovarian torsion (twisting), which cuts off blood supply and requires emergency surgery. Cysts larger than 7-10cm often require surgical removal. Warning signs of a dangerous cyst include: sudden severe pelvic pain (possible rupture), nausea and vomiting with pain (possible torsion), fever with pain (possible infection), and rapid growth on serial ultrasounds. Postmenopausal women with any ovarian cyst require careful evaluation due to increased malignancy risk.
What is the best diet for PCOS and ovarian cysts?
A low glycemic index, anti-inflammatory diet is most effective. This emphasizes whole foods, lean proteins, healthy fats, and high-fiber carbohydrates while avoiding refined sugars and processed foods. Key principles include: balancing blood sugar with protein at each meal, emphasizing omega-3 rich foods (fatty fish, walnuts), consuming abundant vegetables (especially cruciferous), choosing whole grains over refined, and avoiding inflammatory foods (processed meats, industrial seed oils, excess sugar). The Mediterranean diet has strong evidence for improving PCOS outcomes. Some women also benefit from reducing dairy and gluten.
How do I know if my PCOS treatment is working?
Key indicators of treatment success include: regular menstrual cycles occurring every 28-35 days, restored ovulation (confirmed by basal body temperature tracking or progesterone testing), reduction in androgenic symptoms (less hirsutism, clearer skin, reduced hair loss), improved energy levels and mood, stable blood sugar without crashes, weight stabilization or loss if overweight, and normalized lab values (testosterone, LH/FSH ratio, insulin, HOMA-IR, lipids). Most patients notice initial improvements in energy and sleep within 4-8 weeks, with significant cycle regularization by 3-6 months.
Medical References
- 1.Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Human Reproduction. 2004;19(1):41-47. PMID: 14688157
- 2.Teede HJ, Misso ML, Costello MF, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Human Reproduction. 2018;33(9):1602-1618. doi:10.1093/humrep/dey256
- 3.Unfer V, Facchinetti F, Orrù B, Giordani B, Nestler JE. Myo-inositol effects in women with PCOS: a meta-analysis of randomized controlled trials. Endocrine Connections. 2017;6(8):647-658. doi:10.1530/EC-17-0243
- 4.Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocrine Reviews. 2012;33(6):981-1030. doi:10.1210/er.2011-1034
- 5.Legro RS, Arslanian SA, Ehrmann DA, et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism. 2013;98(12):4565-4592. doi:10.1210/jc.2013-2350
- 6.American College of Obstetricians and Gynecologists. Practice Bulletin No. 194: Polycystic Ovary Syndrome. Obstetrics & Gynecology. 2018;131(6):e157-e171. doi:10.1097/AOG.0000000000002656
- 7.Toulis KA, Goulis DG, Farmakiotis D, et al. Adiponectin levels in women with polycystic ovary syndrome: a systematic review and a meta-analysis. Human Reproduction Update. 2009;15(3):297-307. doi:10.1093/humupd/dmp006
- 8.Wild RA, Carmina E, Diamanti-Kandarakis E, et al. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. Journal of Clinical Endocrinology & Metabolism. 2010;95(5):2038-2049. doi:10.1210/jc.2009-2726
- 9.Barbieri RL. Induction of ovulation in infertile women with hyperandrogenism and insulin resistance. American Journal of Obstetrics & Gynecology. 2000;183(6):1412-1418. doi:10.1067/mob.2000.111154
- 10.Nestler JE, Jakubowicz DJ, Evans WS, Pasquali R. Effects of metformin on spontaneous and clomiphene-induced ovulation in the polycystic ovary syndrome. New England Journal of Medicine. 1998;338(26):1876-1880. doi:10.1056/NEJM199806253382603
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