Ex. 5 L6 - Polycystic Ovarian Syndrome (48)

Question 1

PCOS stats

Answer 1

10-13% of women of reproductive age
-Varied clinical presentation
-Leading cause of anovulatory infertility
-Cause of miscarriage
-Potential for development of endometrial cancer

Question 2

Clinical Presentation of PCOS

Answer 2

Hyperandrogenism
-Hirsutism
-Acne
-Alopecia

Menstrual disturbances
-Amenorrhea
-Oligomenorrhea
-Anovulation

Overweight or obese

Question 3

PCOS symptoms

Answer 3

Hair loss
Hirsutism
Pelvic pain
Overweight
Acne
Irregular Periods
Infertility
High Testosterone Levels

Question 4

PCOS pathophysiology

Answer 4

Primary Defect is unknown
Three possible mechanisms
-Inappropriate gonadotropin secretion
-Insulin resistance with hyperinsulinemia
-Excessive androgen production

Question 5

Inappropriate Gonadotropin secretion

Answer 5

Increase in GNRH -> causes increase in LH surge too soon -> causes no rise in FSH (FSH level stay normal or low) causing no dominant follicle leading to no ovulation, leading to unopposed estrogen, meaning luteal phase is never entered, causing elevated levels of androgen (Increase in LH stimulates in ovary)

Multiple immature follicles - no ovulation

Question 6

Regular menstrual cycle vs PCOS cycle

Answer 6

Normal GnRH level
-LH and FSH level spike during the cycle
-one dominant follicle form

PCOS:
-Increase in GnRH:
-High LH level in baseline
FSH levels stay normal/low and never spike
-No dominant follicle form

Question 7

Insulin Resistance

Answer 7

-(Hyperinsulemia)
Occurs in obese AND non-obese women
-Potential defects in insulin receptor

Insulin regulated blood sugar by allowing body to use sugar for energy or store in the cells

Insulin helps produce androgens in ovaries
PCOS - increased insulin sensitivity
More sensitive = more androgens being produced
Hyperandrogenism

Insulin resistance:
Body will make more insulin to compensate to maintain normal blood sugar levels (compensatory hyperinsulinemia)

Question 8

_ is a major contributor to hyper-androgenism in PCOS

Answer 8

Hyperinsulinemia

Question 9

PCOS diagnosis Criteria

Answer 9

-Hyperandrogenism
(clinical and or biochemical)
-Chronic anovulation
-Polycystic ovaries

2 of the 3 criteria must be present

-Alternatively, anti-Mullerian hormone (AMH) can now be used instead of ultrasound

Question 10

Complications from PCOS

Answer 10

Highest to lowest risk

-Infertility
-CV disease
-Venous thromboembolism
Type 2 diabetes/abnormal glucose metabolism
-Dyslipidemia
-HTN
-Non-alcoholic fatty liver disease (NAFLD)
-Endometrial hyperplasia and cancer
-Depression and anxiety
-Eating disorders and negative body image
-Obstructive sleep apnea
-Pregnancy complications

Question 11

Treatment goals of PCOS

Answer 11

Maintain Normal Endometrium
-Block actions of androgens on target tissues
-Reduce insulin resistance and hyperinsulinemia
-Reduce weight
-Prevent long-term complications
-Ovulation induction (if pregnancy is desired)

Question 12

Treatment Decision Considerations

Answer 12

1. Patient Priorities
2. Efficacy vs. risks of treatment
3. Desire to become pregnant

Question 13

Non-Pharmacologic Treatment

Answer 13

Lifestyle intervention (core focus)

weight loss -> 5-15% (or more)
-Improved pregnancy rates/reduces miscarriages
-improve ovarian function
-Decrease free testosterone
-Decrease hyperinsulinemia

Exercise