Ovarian / Pelvic disorders

Question 1

What are the buzzwords for PCOS?

Answer 1

• Irregular periods
• Acne
• Hirsuitism
• Obesity

Question 2

In which significant ways does PCOS impact the body?

Answer 2

• Hyperinsulinaemia / insulin resistance
• Increase androgens and decreased sex hormone binding globiulin leads to increased androgen availability
• Abnormal follicular arrest leading to anovulatory menstrual cycles
• Enlarged cystic ovaries which are hypervascular and have an androgen secreting stroma
• LH:FSH ratio Increase (<2:1, to >2:1)

Question 3

What is the rotterdam criteria for diagnosing PCOS?

Answer 3

1. Menstrual disturbance
2. Clinical OR biochemical signs of hyperandrogenism
3. Polycystic ovaries (12-20 2-9mm cysts on USS with at least one in each ovary)
   
   1. Transvaginal > Transabdominal
   2. First half of the menstrual cycle and request follicle count

Question 4

What tests shold be done to rule out differentials for PCOS?

Answer 4

• FSH
• Prolactin
• TFT
• LH

Question 5

What medications can cause PCOS symptoms?

Answer 5

• Phenytoin
• Androgens
• Diazoxide

Question 6

What are the complications of PCOS?

Answer 6

• T2DM
• Endometrial cancer
• Infertility

Question 7

What are the criteria for refferal for a patient with PCOS to endocrinologist or fertility specialist?

Answer 7

• Uncertain Dx
• Menstrual irregularityies with endometrial thickening
• Hirsuitism / acne not responding to treatment
• Infertility and ovulation not restored by weightloss
  
  • Early referral in >35 or co-existant fertility issues

Question 8

What is the necessary followup for a patient with PCOS?

Answer 8

• Yearly
  
  • BP
  • Weight
• 2-yearly
  
  • OGTT
  • Fasting lipids
• Long term
  
  • Progesterone stunulus to endometrium
  • Metformin

Question 9

What are the main treatment goals for PCOS?

Answer 9

• Weight loss
• Menstrual regulation
• Hirsutism / Acne
• Pregnancy / fertility
• Insulin resistance
• Preventing endometrial hyperplasia / Cancer

Question 10

What is the main treatment for menstural regulation in PCOS?

Answer 10

• COCP
  
  • >35 smoker is an absolute contraindication
  • Caution in smokers, HTN, Obese, or hypercholestrolaemic patients

Question 11

What is the main treatment for hirsuitism and acne in PCOS?

Answer 11

• Pharm + cosmetics
  
  • Anti-androgen containing COCP
  • Bleaching, waxing, laser, shaving
• Sever cases
  
  • Spironolactone
  • Adrocur (cyproterone acetate)
  • 5alpha reductase inhibitor (finestarise (mostly), or dutasteride

Question 12

What is the main treatment for increasing fertility in PCOS?

Answer 12

• Weight loss
• Pre-pregnancy councelling / fertility coucelling
• Ovulation induction
  
  • Letrozole
  • Clomiphene citrate

Question 13

What is the main treatment for insulin resistance in PCOS?

Answer 13

• Lifestyle
• Metformin
• As per diabetes guidelines

Question 14

What is the main treatment to prevent endometrial hyperplasia / cancer in patients with PCOS?

Answer 14

• COCP
• Mirena IUD
• Cyclical progesterone