PCOS

Question 1

How does PCOS present

Answer 1

Obesity

Diabetes

Hirsutism

Acne

Oligomenorrhoea/ amenorrhoea

Infertility

Hair loss in a male pattern

Question 2

PCOS investigations

Answer 2

Pregnancy test

Abdominal USS

TV USS

HbA1c

Bloods - free androgen index, testosterone, FSH, LH, TFT, prolactin, sex hormone-binding globulin

Question 3

PCOS management

Answer 3

Weight loss

Tight diabetes control

If wants periods - COCP

Acne - retinoids or doxycycline

Anti hypertensives

Statins

Question 4

Rotterdam Criteria for PCOS

Answer 4

2 out of 3:

1. Clinical signs of hyperandrogenism
2. Oligomenorrhoea or amenorrhoea
3. Must be 12+ cysts in one or both ovaries

Question 5

Complications of PCOS

Answer 5

Insulin resistance and diabetes

Acanthosis nigricans - darkened skin in skin folds

CVD

Hypercholesterolaemia

Endometrial hyperplasia and cancer

Obstructive sleep apnoea

Depression and anxiety

Sexual problems

Question 6

Differential Diagnosis of Hirsutism

Answer 6

Medications such as phenytoin, ciclosporin, corticosteroids, testosterone and anabolic steroids

Ovarian or adrenal tumours that secrete androgens

Cushing’s syndrome

Congenital adrenal hyperplasia

Question 7

What do hormone blood tests typically show

Answer 7

Raised LH

Raised LH to FSH ratio (high LH compared with FSH)

Raised testosterone

Raised insulin

Normal or raised oestrogen levels

Question 8

Imaging for PCOS

Answer 8

Transvaginal USS - gold standard

Pelvic USS

Question 9

String of pearls

Answer 9

The follicles may be arranged around the periphery of the ovary

Question 10

The screening test for diabetes in patients with PCOS

Answer 10

2-hour oral glucose tolerance test (OGTT)

Question 11

How to do a OGTT

Answer 11

1. Take a baseline fasting plasma glucose
2. Give a 75g glucose drink
3. Measure plasma glucose 2 hours later

Question 12

OGTT levels

Answer 12

Impaired fasting glucose – 6.1 – 6.9 mmol/l (before the glucose drink)

Impaired glucose tolerance – plasma glucose at 2 hours of 7.8 – 11.1 mmol/l

Diabetes – plasma glucose at 2 hours above 11.1 mmol/l

Question 13

Why does PCOS increase the risk of endometrial cancer

Answer 13

PCOS pts do not ovulate or ovulate infrequently

Therefore less progesterone released from the corpus luteum

Unopposed oestrogen can cause endometrial proliferation

Question 14

Options to reduce the risk of endometrial cancer in PCOS

Answer 14

• Mirena coil
• Inducing a withdrawal bleed at least every 3 – 4 months with either:
  Cyclical progestogens or COCP

Question 15

How to improve fertility in PCOS

Answer 15

Weight loss

Clomifene

Laparoscopic ovarian drilling

In vitro fertilisation (IVF)

Question 16

How to treat hirsutism

Answer 16

Weight loss

Dianette COCP (also for acne)

Topical eflornithine - treat facial hirsutism