PCOS

Question 1

What is PCOS (aetiology and Rf)

Answer 1

Aetiology unclear -related to numerous cysts in ovaries released at same time and not releasing -causing excess androgen release, insulin resistance,
1-2 in every 10 women

Rotterdam criteria- - 2> of the following:
Oligo/anovulation
Clinical or biochem features of hyperandrogenism
Polycystic ovaries on USS

RF - Fhx Obesity

Question 2

Sx and Ix of PCOS

Answer 2

Sx - Hirsutism (upper lips, lower abdomen), ammenrorrhea, Sub-fertility
Weigh gain, acne, insulin resistance (acanthosis nigricans)

Ix -
BT- LH:FSH, T2DM, testo, ShBG, prolactin, TSH
TVUSS - polycystic ovaries - perak necless sign

DM monitoring-
OGTT at diagnosis for BMI >25, non white, any BMI if over 40, Fhx DM, GDM etc
anual OGTT for

CVD monitoring- lipid profile, blood presssure, diet, exercise smoking, weight loss

Question 3

Mx of PCOS

Answer 3

For the ammenrrhoae/oligorrhoae - Weight loss, COCP, Progesterone, LNG IUS

FOr hyperadrogenism - weight loss
COCP
Co-cyprindiol- combined progesterone
Topical eflornithine cream

Infertility -
weight loss
2nd - up to 6m-> Clomiphene
then Clomiphene + metformin
induced ovulation but increase risk of multiple preg

3rd- gonadotrophins, IVF
risk of Ovarian hyperstimulation syndrome - multiple luteinized cyst-> lots of hormones- > pain bloating

surgery

Question 4

Complications of PCOS

Answer 4

MEtabolic syndromes - DM and CVD
CVD
Sleep apnea
endometrial cancer
Recommend withdrawal bleed 4x a year
subfertility