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Laura MRCOG Part 2 > 13) Gynaecological Problems - PCOS > Flashcards

13) Gynaecological Problems - PCOS Flashcards

1
Q

Incidence of PCOS

A

10-15% (2-25%)

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2
Q

Incidence of PCOS in women with anovulatory subfertility

A

85%

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3
Q

Diagnostic criteria for PCOS

A

Rotterdam criteria.

Any two of:

  • Polycystic ovaries on USS (>12 follicles 2-9mm in diameter or overall volume >10cm3)
  • Oligo/anovulation
  • Clinical or biochemical evidence of increased androgens (Increased free androgen index = total testosterone/SHBG x 100)
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4
Q

Which ethnicity is PCOS more common in?

A

SE Asian (+ more severe)

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5
Q

What percentage of people with PCOS have an affected first degree relative?

A

50%

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6
Q

What waist circumference is considered higher risk for PCOS/metabolic syndrome?

A

> 87cm (should ideally be <80cm)

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7
Q

What percentage of people with PCOS have raised LH levels?

A

40%

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8
Q

What is the effect of insulin on lipid levels in PCOS?

A

Increased lipids secondary to insulin as FFA are moved to liver and converted into LDL.

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9
Q

Biochemical investigations in PCOS

A 
Androgens usually high or normal.
SHBG usually low or normal.
LH high or normal.
FSH low or normal.
Fasting insulin usually high.
Prolactin usually normal (or occasionally slightly high)
AMH usually high.
Oestradiol usually high.
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10
Q

What percentage of body weight should women with PCOS aim to lose in first year after diagnosis?

A

5-10%

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11
Q

What measures can be used for weight loss in PCOS?

A
  • Diet
  • Exercise (30 min/day to maintain health, 60-90min/day to lose weight)
  • Bariatric surgery if BMI >40 or BMI >35 and complications
  • Orlistat
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12
Q

What weight loss results from bariatric surgery?

A

60% weight loss

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13
Q

What is the mortality associated with bariatric surgery?

A

1%

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14
Q

What is the reduction in PCOS after bariatric surgery?

A

From 45% to 7%

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15
Q

When should GTT be done in someone with PCOS?

A

If BMI >25 or other risk factors (including age>40 and ethnicity).

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16
Q

What do the GTT results mean?

A

Diabetic: >7.0, >11.1
Normal: <6.0, <7.8

Values in-between represent either impaired fasting glycemia or impaired glucose tolerance

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17
Q

When should an annual GTT be done?

A

If high risk - impaired fasting glycemia or impaired glucose tolerance

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18
Q

How often should people with PCOS have withdrawal bleeds?

A

Every 3-4 months

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19
Q

What monitoring if women with PCOS don’t have withdrawal bleeds?

A

TVUS.
<7mm unlikely to be hyperplasia.
>10mm indication for an induced withdrawal bleed, repeat scan and biopsy.

20
Q

When to investigate for an alternative cause for hirsutism?

A

If vitalisation, rapid onset or testosterone >5.

21
Q

Management of hirsutism

A

Physical treatments

  • Laser, electrolysis
  • Eflornithine (targets hair follicles)

Medical

  • Dianette
  • Yasmin
  • Spironolactone
22
Q

Benefits of metformin in PCOS

A

Benefits on insulin resistance and cardiovascular risk

23
Q

What pregnancy rate for clomifene in PCOS?

A

60-70% within 6 cycles

24
Q

Risk of multiple pregnancy with clomifene

25
Q

Benefits of ovarian electrocautery

A

Persistence of ovulation and normalisation of androgens/SHBG up to 20 years in >60%

26
Q

Who does ovarian electrocautery work best for?

A

Slim PCOS with high LH

27
Q

What percentage of women with PCOS require additional medical ovulation induction after ovarian electrocautery?

28
Q

What is the increase in risk of OSA in PCOS?

29
Q

Benefits of CPAP in PCOS

A

Improves insulin sensitivity

30
Q

Cancer risks in PCOS

A

Endometrial cancer.

Metabolic syndrome is associated with risk of cancer in pancreas, colon and breast

31
Q

What is the overall increased cardiovascular risk in PCOS?

32
Q

What is the overall increased risk of T2DM in women with PCOS?

A

5 x higher

33
Q

What percentage of women with PCOS have insulin resistance?

34
Q

What percentage of women with PCOS have undiagnosed impaired glucose tolerance?

35
Q

What percentage of women with PCOS convert to impaired glucose tolerance each year?

36
Q

What percentage of women with PCOS have undiagnosed type 2 diabetes?

37
Q

What is the increased risk of GDM with PCOS?

A

2 x higher

38
Q

What percentage of people with PCOS have metabolic syndrome?

39
Q

What are the four features of metabolic syndrome?

A

Central obesity
Insulin resistance
Dyslipidaemia
Hypertension

40
Q

What is the increase in coronary heart disease in metabolic syndrome?

A

3-6 x increased

41
Q

What is the increase in mortality associated with coronary heart disease in metabolic syndrome?

A

12% increased

42
Q

What are the diagnostic criteria for metabolic syndrome?

A

Elevated waist circumference (>80cm some definitions, >88cm other definitions)
Elevated triglycerides (>150mg/dL (1.7mmol) or on treatment)
Reduced HDL levels (<50 (1.3) or on treatment)
Elevated blood pressure (>130/85 or on treatment)
Elevated fasting glucose levels (>5.6 (some criteria) or 6.1 (other criteria))

43
Q

How often to screen women with PCOS for smoking status?

A

Ask at every visit

44
Q

How often to screen women with PCOS for obesity?

A

Assess at every visit

45
Q

How often to screen women with PCOS for hypertension?

A

BMI <25 - Annually

BMI >25 - Every visit

46
Q

How often to do complete lipid profile in women with PCOS?

A

If normal - every 2 years

If abnormal or increased BMI - annual

47
Q

How often to do OGTT in women with PCOS?

A

All women every 2 years

If risk factors annual

Laura MRCOG Part 2 (56 decks)

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