G16 PCOS

Question 1

what diagnosis is suggested from the blood test results? explain why?

Answer 1

the high FSH:LH ratio (normal 1-2) hers has higher LH > FH.

mildly elevated testosterone

and taking into account her sx of hirsiotism and infrequent period, are suggestive of PCOS

Question 2

what other investigation would you wish, and what would you expect if your diagnosis in 1 is correct?

Answer 2

TVUSS; >20 small antral follicles and/or ovarian volume >10ml on either ovary

Question 3

how would you explain to the women what PCOS is?

Answer 3

PCOS is a benign condition where your ovaries more than normal amount of fluid-filled sacs called the follicles. There is an imbalance of hormones in your body in particular too much testosterone causing symptoms like abnormal menstrual cycle, hirsuitism, acne, it may cause delayed fertility and obesity as well.

it may be associated with insulin resistance

Question 4

what are the long term and short term complications

Answer 4

short term

1. oligomenorrhoea: abnomal menstrual cycle/ menstrual disturbance
2. Hirsuitism/acne
3. I
4. Obesity: weight gain/difficulty in weight loss

long term

1. psychological distrubance/distress
2. oligomenorrhoea: endometrial hyperplasia/cancer
3. Insulin: diabetes/dyslipidemia/ insulin resistance/vascular disease

Question 5

describe your immediate management option?

Answer 5

1. lifestyle changes; weight
2. oligoi: COCP
3. Hirsuitism: cosmetic management, cyproterone (antiandrenogic hormone), spironolactone
4. Insulin resistance; metformin to control blood sugar level and metabolic effects of PCOS + help with fertility
5. Obesity; monitor for diabetes/dyslipidemia; fasting glucose, fasting lipid
6. infertility; ovulation induction may be required; clomephene, metformin, IVF, lentrozole