Fertility & PCOS Flashcards
Pathology involving women with irregular periods/amenorrhea and bilaterally enlarged, cystic ovaries; can also see signs of hyperandrogenism, such as hirsutism, acne and elevated testosterone; thought to be due to Hyperinsulinemia and/or Hypothalamic dysfunction (inc. LH)
Polycystic Ovarian Syndrome (PCOS)
Diagnostic criteria for Polycystic Ovarian Syndrome
1) Irregular or no menses
2) bilateral Polycystic ovaries
3) Signs of Hyperandrogenism
need 2 out of 3
Signs of Hyperandrogenism in PCOS
Hirsutism
Acne
Elevated Testosterone
Pathophysiology of Polycystic Ovarian Syndrome
Hyperinsulinemia–> Inc. LH:FSH secretion ratio–> Inc. Ovarian Androgens synthesis by theca cells–> inc. estrone production in adipose tissue –> dec. FSH –> dec. etradiol production by granulosa cells –> dec. follicular maturation
A significant number of women with PCOS have ______
Insulin Resistance/hyperinsulinemia
What are some Conditions associated with PCOS
Insulin Resistance (70%) Type 2 DM Metabolic Syndrome Obesity Endometrial Hyperplasia/Cancer
Syndrome associated with PCOS; disorder of certain metabolic processes, resulting in either high sugars, triglycerides or cholesterol
Metabolic Syndrome
Women with PCOS who become pregnant have inc. risk for…
Gestational diabetes
Pre-eclampsia
Preterm birth
C-section
Treatment options for PCOS
Androgen receptor antagonists (Flutamide, Finasteride and Spironolactone)
OCPs (progesterone –> dec. LH)
Metformin (underlying DM)
Weight loss
Non-steroidal androgen receptor ANTAGONIST; competes with DHT and testosterone; helpful for treating hyperandrogen symptoms of PCOS, such as hirsutism
Flutamide
Inhibitor of 5a-reductase, preventing the conversion of Testosterone to DHT; helpful for treating hyperandrogen symptoms of PCOS, such as hirsutism
Finasteride
Diuretic (aldosterone antagonist) that can also be used to treat Hyperandrogenism; a competitive antagonist of testosterone receptor
Spironolactone
MOA for the use of OCPs for PCOS
Neg. feedback on Pituitary (less LH)
Inc. Sex Hormone Binding Globulin (dec. free Testosterone)
Prevention of endometrial hyperplasia by increased estrone synthesis
Treatment for PCOS patients who wish to conceive (so can’t take OCPs) (ovulation inductors)
Clomiphene
Letrozole
MOA of Clomiphene
Estrogen competitive antagonist at hypothalamus causing an increase in FSH and follicle maturation –> ovulation induction
