A 23-year-old woman with PCOS has cycles every 3 to 5 months. She is not planning pregnancy for at least 2 years. Her BMI is 23 kg/m² and she has no glucose intolerance. Besides lifestyle measures, what is the MOST important intervention to reduce her long-term gynaecological risk?
- A Metformin 1500 mg daily
- B Periodic progestogen-induced withdrawal bleeds every 1 to 3 months ✓
- C Annual endometrial biopsy regardless of bleeding pattern
- D Ovarian drilling to restore regular ovulation
Correct answer: B. Periodic progestogen-induced withdrawal bleeds every 1 to 3 months
Explanation
Chronic anovulation in PCOS exposes the endometrium to unopposed oestrogen, raising the risk of endometrial hyperplasia and carcinoma. Regular progestogen withdrawal, either cyclically or at least every 1 to 3 months, protects the endometrium and is the key intervention in a lean woman not needing contraception or ovulation induction. Metformin improves metabolic parameters but does not reliably regularise shedding. Annual biopsy is reserved for women with persistent abnormal bleeding, and surgery is second line.
Reference: Williams Gynecology, 3rd ed.
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Written and medically reviewed by the StethoPrep medical team.