We have detected you are using Internet Explorer. To provide the best and most secure experience, please use a modern browser as we do not support Internet Explorer.

Clinical Opal - Hirsutism and irregular menstrual cycles

20 October 2023 - A/Prof Stephen Barnett

Patient Information

Lena, a 33-year-old Indigenous woman, presents to her GP in a remote Australian community. She's concerned about irregular menstrual periods, weight gain, and facial hair growth over the past year. Her medical history indicates that she has had no major health issues.

Clinical Examination including blood pressure, heart rate, and a general physical examination indicate all results within normal limits. On gynaecological examination, Lena has signs of hirsutism and reports irregular menstrual cycles over the past 12 months.

Based on Lena's presentation, which of the following diagnoses is most likely?

A) Early Menopause
B) Polycystic Ovary Syndrome (PCOS)
C) Hypothyroidism
D) Endometrial cancer



Polycystic Ovary Syndrome (PCOS)

Lena's symptoms, including irregular menstrual periods, weight gain, and hirsutism, align with clinical manifestations of PCOS. Current guidelines by the Royal Australian College of General Practitioners (RACGP) emphasise the importance of considering PCOS as a diagnosis in women with these symptoms, especially when other underlying causes like early menopause or thyroid disorders are ruled out.

Diagnostic criteria, as per RACGP guidelines, include irregular menstrual cycles, clinical signs of hyperandrogenism (such as hirsutism), and excluding other potential causes. Further evaluation, including ultrasound and hormonal assessments, is typically recommended to confirm the diagnosis.

As a PCOS sufferer, patients like Lena have a higher risk of premature heart disease and diabetes.  Monash University has recently released new guidelines for the assessment and management of PCOS.  This include five algorithms that summarise the key recommendations including:

  1. Screening, diagnostic assessment, risk assessment and life-stage
  2. Prevalence, screening, diagnostic, assessment and treatment of emotional wellbeing
  3. Lifestyle
  4. Pharmacological treatment for non-fertility indications
  5. Assessment and treatment of infertility

With over 13% of women globally suffering from PCOS and more than two thirds suffering undiagnosed, these guidelines contain new resources designed to help clinicians improve patient care through early diagnosis with improved diagnostic tools including hormone tests instead of ultrasound, treatment recommendations including lifestyle management, assessment & treatment of infertility and approaches to care to support the psychological distress of diagnosis.

Related Courses

You can learn more on PCOS and other Women’s Health topics via our Accredited Women’s Health In General Practice Course.



PCOS guidelines

Swannell C (2018) Australian-led PCOS guideline an international first The Medical Journal of Australia, AMA October 


A/Prof Stephen Barnett
A/Prof Stephen Barnett

Stephen is a GP Supervisor, Medical Educator, GP academic and Medical Director of Medcast. He has completed a PhD on Virtual Communities of Practice in GP Training.

Related Tags
Related Categories
Get Medcast Plus

Become a member and get unlimited access to 100s of hours of premium education.

Learn more
Latest News
Tools for your practice: VETERAN lens autofill template
Brand icon

This useful tool shows the aspects of the Veteran Health Check to incorporate into all relevant consultations with Veterans at any time after transition, including a useful autofill template.

5 mins READ
Keep the Fire Burning: bridging gaps and building trust

Australia's healthcare system, often lauded for its comprehensive and accessible nature, has a glaring gap when it comes to addressing the unique needs of First Nations people.

5 mins READ
New resources to optimise veteran healthcare
Brand icon

Launching tomorrow, the Department of Veterans’ Affairs has partnered with medical education company Medcast, to provide freely available resources for health professionals to assess and manage veterans’ health.

5 mins READ