Ovarian conditions

Question 1

Polycystic ovarian syndrome symptoms and tests?

Answer 1

Symptoms: subfertility/infertility, oligomenorrhea/amenorrhea, hirsutism and acne, obesity, acanthosis nigricans.
Tests: USS, FSH, LH, prolactin, testosterone, TSH.
Raised LH:FSH ratio, mildly raised testosterone and prolactin. See hyperinsulinemia so check glucose tolerance.

Question 2

PCOS- management?

Answer 2

Healthy weight
COCP for regular bleeds
Topical eflornithine for hirsutism.
Infertility- clomifene or metformin.

Question 3

Ovarian cyst types

Answer 3

Physiological- follicular cysts. Most common. Due to failed rupture of follicle, commonly regress after few menstrual cycles. Filled with blood/fluid.
Benin germ cell/dermoid cysts- mature cystic teratoma (immature ones are malignant). Filled with skin/hair/nails/teeth, common in < 30 yrs.
Benign epithelial cysts- serous or mucinous cystadenoma.

Question 4

Ovarian Torsion

Answer 4

Partial or complete torsion on supporting ligament. Compromise blood supply. If fallopian tube involved called an adnexal torsion.
Sudden onset deep colicky abdominal pain. Vomiting, Fever.
USS- free fluid, whirlpool sign. Management- laparoscopic removal.

Question 5

Ovarian cancer

Answer 5

5th most common female cancer.
90% epithelial, 70-80% serous carcinomas.
RFs: FHx BRCA1/BRCA2 genes, early menarche and late menopause, nulliparity.
Symptoms; bloating, early satiety, abdominal pain, urinary urgency and diarrhoea.
Tests: CA125 (normal < 35) and USS.
Management: surgery and chemotherapy. 80% have advanced disease at presentation.