Introduction

Although the condition of polycystic ovaries has been known for a long time (see Chapter 2) it achieved prominence by the seminal article of Stein and Leventhal in 1935 and for many years was referred to as the Stein–Leventhal syndrome. Given the efflux of time and a concerted effort to discourage eponyms (Östör and Phillips 1999), the condition became known as polycystic ovary disease (PCO).

PCO is a clinicopathological syndrome characterized by anovulation or infrequent ovulation, obesity, hirsutism, and numerous follicular cysts in both ovaries, which are usually enlarged (Yen 1980, Scully et al. 1998). The finding of polycystic ovaries, however, does not, per se, warrant such a diagnosis. Polycystic ovaries are, in fact, more common in otherwise normal women (unpublished observation). This contention is supported by ultrasonographic studies which have revealed an overlap between women with PCO and overt clinical manifestations of the syndrome and those with multiple follicular cysts associated with menstrual irregularity or evidence of hyperandrogenism so minor that they considered themselves normal (Adams et al. 1986). In other studies of “normal” women, more than 20% had polycystic ovaries on ultrasound (Polson et al. 1988, Clayton et al. 1992). Thus, the boundary between the clinical syndrome associated with PCO and normality is blurred.

Macroscopic features

Typically both ovaries, rarely one (Futterweit 1985), are rounded and enlarged. In one study the ovarian volume was three times that of controls (Delahunt et al. 1975, Lunde et al. 1988). Occasionally, they are of normal size (Smith et al. 1965).