Ovarian Disorders Flashcards
What is PCOS?
A common disorder which results in hormonal/reproductive and metabolic problems
Characterised by multiple immature follicles (cysts) within the ovaries
What are the clinical features of PCOS?
Hormonal:
- Oligo/amenorrhoea
- Subfertility or infertility
- Acne and hirsutism (due to hyperandrogenism)
Metabolic:
- Obesity
- Insulin resistance
In PCOS, hormonal blood tests will typically show…
- Raised LH (and raised LH:FSH ratio)
- Raised testosterone (hyperandrogenism)
Give some differentials of PCOS
- Hypothyroidism
- Cushing’s disease
What is the name of the criteria used to diagnose PCOS? Describe these criteria
How many criteria are required for diagnosis?
Rotterdam criteria:
1) Oligo-ovulation or anovulation
2) Hyperandrogenism (clinical and/or biochemical)
3) Polycystic ovaries on US (12 or more follicles in one ovary or ovarian volume > 10cm^3)
At least 2 criteria are required for diagnosis
Women with PCOS are at increased risk of developing… (give 2 examples)
- Diabetes (due to insulin resistance)
- Endometrial hyperplasia and cancer (lack of regular periods)
Describe the management of the following aspects of PCOS…
a) Oligo-ovulation/anovulation
b) Infertility
c) Obesity
d) Hirsutism
a) Hormonal therapy, e.g. COCP, progestogens
b) If weight loss does not help, first line drug therapy = clomifene (induces ovulation)
c) Lifestyle advice, e.g. weight loss and exercise (in severe cases orlistat can be used)
d) COCP may help; if no response, topical eflornithine
Describe the classification of benign ovarian cysts
1) Physiological/functional cysts
- Follicular cyst (most common)
- Corpus luteum cyst
2) Benign germ cell tumours
- Dermoid cyst (can contain skin, hair, teeth etc.)
3) Benign epithelial tumours
- Serous cystadenoma
- Mucinous cystadenoma
Describe the presentation (signs/symptoms) of an ovarian cyst
Commonly asymptomatic/found incidentally
If symptomatic:
- Chronic pain/pressure symptoms (urinary frequency, constipation, dyspareunia)
- Acute pain (cyst rupture or torsion)
What are the risk factors for ovarian cancer?
More ovulation = higher risk:
- Nulliparity
- Early menarche
- Late menopause
Also:
- Smoking
- Obesity
Which tumour marker is used to assess a patient’s risk of ovarian cancer?
Cancer Antigen 125 (CA125)
Which genetic mutations/syndromes are associated with a higher risk of ovarian cancer?
- BRCA1 and BRCA2
- HNCC (hereditary nonpolyposis colorectal cancer)/Lynch II Syndrome - also increases risk of endometrial cancer
Describe the pathophysiology of ovarian torsion
Partial or complete twisting of the ovary on its supporting ligaments, which may in turn compromise the blood supply
Give a risk factor for ovarian torsion
Ovarian mass (e.g. cyst)
What are the clinical features of ovarian torsion?
- Acute abdominal pain
- Associated N+V
