PCOS Flashcards
1
Q
What is the diagnostic criteria of PCOS?
A
- Rotterdam Criteria - ≥2 of the following
- Oligo/anovulation (>2 years)
- Clinical or biochemical features of hyperandrogenism
- Polycystic ovaries on USS
- >12 in ≥1 ovary measuring 2-9mm
- ≥10cm3 ovarian volume
2
Q
What are the risk factors for PCOS?
A
- FHx
- Obesity
3
Q
What are the signs and symptoms of PCOS?
A
- Hirsutism - upper lips, lower abdomen
- Sub-fertility
- Amenorrhoea
- Weight gain
- Acne
- Insulin resistance (acanthosis nigricans)
4
Q
What are the appropriate investigations for suspected PCOS?
A
- TVUSS → polycystic ovaries (“Pearl Necklace” sign)
- LH : FSH index → >1 : 1
- Testosterone (H)
- SHBG (L)
- Prolactin (H)
- TSH (N)
- DM monitoring
- OGTT at diagnosis for
- BMI ≥25
- Non-Caucasian ethnicity
- >40yo
- FHx DM
- GDM Hx
- OGTT at diagnosis for
- Annual OGTT for
- IFG (fasting 6.1-6.9mmol/L)
- IGT (OGTT 7.8-11.1mmol/L)
- CVD monitoring (use QRISK2)
- Lipid profile
- Blood pressure
- Manage with diet, exercise, smoking and weight loss
5
Q
What is the management of PCOS?
A
- Weight Reduction
- COCP/Co-cyprindiol
- Cyclical progesterone
- LNG-IUS
- Topical eflornithine cream
6
Q
What is the management of PCOS infertility?
A
- 1st line = Weight loss - if normal weight, go to 2nd line
- 2nd line = Clomiphene → Clomiphene and Metformin (after 3 failed clomiphene cycles)
- 3rd line = Gonadotrophins or IVF
- Surgery = Laparoscopic ovarian drilling
7
Q
What are the risks of clomiphene and metformin for PCOS infertility?
A
Increased risk of multiple pregnancy
8
Q
What are the risks of gonadotrophins for PCOS infertility?
A
Ovarian Hyperstimulation Syndrome
9
Q
What is ovarian hyperstimulation syndrome?
A
Overstimulated ovaries → multiple luteinized cysts → lots of oestrogen, progesterone, VEGF → pain, bloating
10
Q
What are the complications of PCOS?
A
- Metabolic syndrome - DM
- Cardiovascular disease
- Sleep apnoea
- Endometrial cancer → if >7mm, may be pathological
- Recommend withdrawal bleed every 3-4 months
- Subfertility
