PCOS

Question 1

What are the clinical features of PCOS? (3)

Answer 1

1. Ovulation disorders
2. Polycystic ovarian morphology
3. Hyperandrogenism (acne, hirsutism, oligomenorrhea)

Question 2

What are the complications of PCOS? (7)

Answer 2

1. CVD
2. OSA
3. Psychological disorders (anxiety, depression, etc)
4. Infertility
5. Endometrial cancer
6. Pregnancy complications (GDM, pre-eclampsia)
7. Metabolic disorders (insulin resistance and DMII)

Question 3

What is the recommended non-drug treatment in the management of PCOS? (3)

Answer 3

Lifestyle

1. Healthy eating
2. Regular exercise
3. Maintaining a healthy weight for women who are overweight or obese

Question 4

For women with PCOS who are overweight, what are the benefits of weight loss?

Answer 4

weight loss may achieve menstrual regularity and reduce insulin resistance, hyperandrogenism, and the risk of type 2 diabetes and cardiovascular disease

Question 5

What drug treatments are commonly used in managing PCOS in women who are NOT planning to become pregnant?

Answer 5

1. COCP (unlicensed) for the treatment of acne, hirsutism, and menstrual irregularity in females 2. Cyclical progestogen (unlicensed)
2. Levonorgestrel IUS (unlicensed)
3. Metformin (only initiated by a specialist) in females with PCOS who have impaired glucose tolerance or are already undergoing lifestyle modifications with no improvement in impaired glucose tolerance

Question 6

What is the management of women with PCOS who are pregnant or are considering pregnancy?

Answer 6

Consider referral for gestational DM screening and whether any changes to drug treatment are required

Question 7

How is infertility managed in women with PCOS?

Answer 7

Consider referral for fertility treatment

Question 8

What is the role of metformin in the management of PCOS?

Answer 8

may improve short-term insulin sensitivity and reduce androgen concentrations, but there is limited supporting evidence on the long-term benefits