1: PCOS Flashcards
What are four risk factors for PCOS
- Smoking
- FH
- Obesity
- Insulin resistance
What age do symptoms of PCOS usually onset
Adolescence to early adulthood
What is the main symptom of PCOS
Oligomenorrhoea
What is oligomenorrhoea
Less than 9-periods a year due to an ovulation
What can oligomenorrhoea result in
Sub-fertility
What are 6 other symptoms of PCOS
- Hirsutism
- Acne
- Obesity
- OSA
- Acanthosis nigricans
- Male-pattern balding
Explain pathophysiology of PCOS
- Increase LH production from pituitary
- This stimulates theca cells to produce androstenedione
- Exceeds granuloma cells aromatase capacity
- Excess androstenedione converted to oestrogen by adipocytes
- Oestrogen selectively inhibits FSH
- FSH is a continual low level and hence there is no selection of dominant follicle
What is first-line investigation in PCOS
Testosterone, Oestrogen, FSH, LH
How does FSH, LH present in PCOS
High LH:FSH
What is second line investigation in PCOS
TFT
Why are TFT performed
Exclude hypothyroidism as a differential - due to presenting similarly
What imaging is performed in PCOS
USS
TV-US
How do ovaries present on USS in PCOS
More than 12 follicle
String of pearls appearance = all follicles around outside
Why is transvaginal US performed
Exclude endometrial hyperplasia/cancer
If PCOS women is planning pregnancy, what should be offered
OGTT before 20W gestation
What diagnostic criteria is used in PCOS
Rotterdam criteria
What does the Rotterdam criteria state
Individual requires two of:
- Oligomenorrhoea
- Cystic Ovaries
- Biochemical or clinical signs of high androgens
What is the qualifying criteria for polycystic ovaries
More than 12 follicles per ovary
Ovarian volume >10cm3
What is the criteria for oligomenorrhoea in PCOS
Less than nine periods per year
When may the Rotterdam criteria not be useful
Teenage girls - difficult to distinguish from normal puberty
What 2 conservative measures are indicated for treatment of PCOS
Weight-Loss
Smoking Cessation
What is first-line medical treatment for PCOS
COCP
Why is COCP given
Reduce risk of endometrial cancer due to anovulatory cycles
What BMI is COCP contraindicated
BMI > 40
