LECTURE 52 - PCOS Flashcards
List the symptoms of PCOS
High testosterone levels → hyperandrogenism
- hair loss (alopecia)
- hirsutism
- acne
- pelvic pain
- overweight or obese
- irregular periods / menstrual disturbances
(amenorrhea, oligomenorrhea, anovulation)
Describe the diagnosis criteria for PCOS
- Hyper-androgenism (clinical &/ biochemical)
- Chronic anovulation
- Polycystic ovaries
List the three proposed mechanisms that are thought to cause PCOS
- inappropriate gonadotropin secretion
- insulin resistance with hyperinsulinemia
- excessive androgen production
What is the first line treatment for PCOS?
combined oral contraceptives (COCs)
List second-line treatment options for PCOS
- cyclic progestin therapy
- progestin-only OC
- levonorgestrel-releasing IUD
- metformin
List the preferred medication treatment order for acne & hirsutism in women with PCOS
- COCs
- anti-androgens
- topical vaniqa (eflornithine)
- cosmetic procedures
Describe COCs as a treatment option for PCOS
- 1st line treatment option for hyperandrogenism and/or menstrual irregularity
- monophasic usually used
Estrogen component:
- helps with LH suppression
- 20-30 mcg EE is lowest effective dose
- 20 mcg for pts with a high risk for VTE
(obese or > 39 YO)
- 35 mcg EE is highest dose
Progestin component:
- prefer lower androgenic effects
(norgestimate, levonorgestrel, norethindrone)
- AVOID desogestrel, drospirenone, cyproterone acetate
Describe spironolactone (anti-androgen) as a treatment for PCOS
used as an add-on therapy for hirsutism / acne
- 50-100 mg BID
- monitor K+
TERATOGENIC - must use BC
List adverse effects of spironolactone
vaginal bleeding
breast tenderness
headache
dizziness
Describe finasteride (5-a reductase inhibitor / anti-androgen) as a treatment for PCOS
used when COC & spironolactone are relatively ineffective for severe hirsutism
- 2.5-5 mg daily
- MUST use reliable forms of contraception
List side effects of finasteride
headache
orthostasis
Describe metformin as a treatment for PCOS
- 1st line when pt has PCOS & BMI >/= 25
- 2nd line tx for menstrual irregularity
- helps improve metabolic issues for pts that have failed lifestyle interventions
(insulin resistance, glucose & lipid profiles) - 500 mg PO daily → 1000 mg BID
(max 2500 mg in adults) - may take up to 6 months to see results
- monitor for low vitamin B12 levels
List the preferred medication the induction of ovultation in women with PCOS
- letrozole
- clomiphene & metformin
low-dose gonadotropin therapy
laparoscopic ovarian drilling (ovaria diathermy) - IVF or IVM
Describe letrozole (Femara) (aromatase inhibitor) as treatment for inducing ovulation in women with PCOS
- 2.5 - 7.5 mg PO x 5 days
(starting day 3 of menses) - if ovulation does not occur, increase dose by 2.5 mg increment in subsequent cycle
- can be used for up to 5 cycles
List the side effects of letrozole (Femara)
Hot flashes
Edema
Dizziness / Fatigue
Headache
List drug-drug interaction & contraindications for letrozole (Femara)
- CYP-2A6 inhibitor
(avoid with substrates) - weak CYP-2C19 inhibitor
(monitor with tamoxifen & methadone)
CONTRAINDICATED - pregnancy
