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Zero to finals Gynae > PCOS > Flashcards

PCOS Flashcards

1
Q

What is PCOS?

A

-PCOS is a common condition causing metabolic and reproductive problems in women

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2
Q

What are key characteristic features of PCOS?

A
  • multiple ovarian cysts
  • infertility
  • oligomenorrhoea
  • hyperandrogenism
  • insulin resistance
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3
Q

What does anovulation refer to?

A

absence of ovulation

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4
Q

What does oligoovulation refer to?

A

irregular, infrequent ovulation

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5
Q

What does amenorrhoea refer to?

A

absence of menstrual periods

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6
Q

What does oligomenorrhoea refer to?

A

irregular, infrequent periods

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7
Q

What are androgens?

A

male sex hormones such as testosterone

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8
Q

What does hyperandrogenism refer to?

A

effects of high levels of androgens

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9
Q

What does hirsutism refer to?

A

growth of thick dark hair, often in a male pattern, e,g male pattern facial hair

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10
Q

What is the Rotterdam criteria?

A

-Rotterdam criteria is used to make a diagnosis of PCOS with diagnosis requiring at least 2/3 features

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11
Q

What are the features of the Rotterdam criteria?

A
  • oligoovulation or anovulation presenting with irregular periods
  • hyperandrogenism, charecterised by hirsutism and acne
  • polycystic ovaries on US
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12
Q

What are the key features in presentation of PCOS?

A
  • oligo/amenorrhoea
  • infertility
  • obesity (70% of pts)
  • hirsutism
  • acne
  • hair loss in male pattern
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13
Q

What are other features of PCOS?

A
  • Insulin resistance and diabetes
  • Acanthosis nigricans
  • Cardiovascular disease
  • Hypercholesterolaemia
  • Endometrial hyperplasia and cancer
  • Obstructive sleep apnoea
  • Depression and anxiety
  • Sexual problems
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14
Q

What is acanthosis nigricans?

A
  • thickened, rough skin, typically found in the axilla and on the elbows. It has a velvety texture.
  • It occurs with insulin resistance.
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15
Q

It is important to rule out other causes of hirsutism, what are they?

A
  • medications such as phenytoin, ciclosporin, corticosteroids, testosterine and anabolic steroids
  • ovarian or adrenal tumours that secrete androgens
  • Cushing’s syndrome
  • Congenital adrenal hyperplasia
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16
Q

How does insulin resistance further promote hyperandrogenism in PCOS?

A
  • when insulin resistant, the pancreas responds by producing more insulin
  • this insulin promotes release of androgens from the ovaries and adrenal glands
  • thus higher levels of insulin lead to higher levels of androgens
  • insulin also supresses sec hormone binding globulin SHBG which normally binds to androgens and suppresses their function
  • all in all this halts development of follicles in ovaries leading to annovulation and multiple partially developed follicles
17
Q

What can help reduce insulin resistance?

A

-diet, exercise and weight loss

18
Q

What blood tests would you do to investigate for PCOS?

A
  • testosterone
  • SHBG
  • LH
  • FSH
  • prolactin (mildly elevated in PCOS)
  • TSH
19
Q

What would the blood tests typically show in PCOS?

A
  • raised LH
  • raised LH to FSH ratio
  • raised testosterone
  • raised insulin
  • normal or raised oestrogen levels
20
Q

What imaging should be done to diagnose PCOS?

A

-transvaginal US is the gold standard for visualising the ovaries
-follicles may be arranged around the periphery of the ovary, giving a string of pearls apperance
-diagnostic criteria is:
12 or more developing follicles in one ovary
ovarian volume > 10cm3 ( this can indicate PCOS even without the presence of cysts)

21
Q

What screening test would be used for diabetes in PCOS?

A

-2-hour 75g oral glucose tolerance test (OGTT)

22
Q

What is the general first-line management for PCOS?

A

management is to first reduce risks of obesity, diabetes, high cholesterol and CVD:

  • weight loss
  • diet
  • exercise
  • smoking cessation
  • antihypertensive medications if required
  • statins if QRISK > 10%
23
Q

What complications should patients with PCOS be assessed for?

A
  • endometrial hyperplasia or cancer
  • infertility
  • hirsutism
  • acne
  • obstructive sleep apnoea
  • depression and anxiety
24
Q

Why is weight loss such a significant part of the management for PCOS?

A

-weight loss alone can lead to ovulation and restore fertility and regular menstruation, improve insulin resistance, reduce hirsutism and other associated risks

25
Q

What may be used to help weight loss in women with a BMI above 30?

A

-Orlistat -> a lipase inhibitor that stops the absorption of fat in the intestines

26
Q

Why is there a risk of endometrial cancer in PCOS?

A
  • usually the corpus luteum releases progesterone after ovulation
  • but as women with PCOS do not ovulate or do so infrequently, they do not produce sufficient progesterone but continue to produce oestrogen without regular menstruation
  • this leads to the endometrial lining continuing to proliferate due to the oestrogen without shedding in menstruation
  • this results in endometrial hyperplasia with a significant risk of cancer
27
Q

How is the risk of endometrial cancer investigated in PCOS?

A
  • women with more than 3 month gaps between periods or abnormal bleeding need to have a US to assess endometrial thickness –> cyclical progesterone should be used to induce period before US
  • if thickness > 10mm they need to be refered for a biopsy to exclude endometrial hyperplasia or cancer
28
Q

What are the management options to reduce risk of endometrial cancer in PCOS?

A
  • mirena coil for continuous endometrial protection

- inducing bleed every 3-4 months with either cyclical progestogens or combined OCP

29
Q

What are the management options to improve infertility in PCOS?

A

weight loss is the initial step, if fails then:

  • clomifene
  • laparoscopic ovarian drilling
  • IVF
30
Q

What are the management options to improve hirsutism in PCOS?

A
  • weight loss
  • Combines OCP such as co-cyprindiol (dicanette)
  • topical elfornithine
  • electrolysis
  • laser hair removal
  • spironolactone
31
Q

What are the management options to improve acnein PCOS?

A

combined oral contraceptive pill is first-line for acne in PCOS

Zero to finals Gynae (16 decks)

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