PCOS Flashcards
what disease is considered both repro and endocrine disorder
PCOS
4 characteristics of PCOS
Ovulatory and menstrual dysfunction, hyperandrogenism, polycystic ovaries, insulin resistance
what is the most common endocrine disorder in women of repro ge
PCOS
features of PCOS
irreg + infrequent menstrual cycle, anovulatory, androgenic- hirsutism, acne, obesity (50-80% obese), insulin resistance, metabolic sx, increased risk of infertility, endometrial hyperplasia (with risk of endometrial cancer)
etiology of PCOS (4 suspects)
Complex polygenic disorder influenced by environmental factors (ex- obesity)
famHx- esp with first degree relatives with Hx PCOS or T2D
Insulin resistance and compensatory hyperinsulinemia can lead to enhanced androgen production in ovaries, ↑free T lvls (↓SHBG)
↑ androgen lvls can also cause insulin resistance
diagnosis of PCOS requires
meeting 2 of 3 criteria:
Presence of hyperandrogenism (clinical/ biologic)
Ovulatory dysfunction
Polycystic ovaries
what are the 5 repro abnormalities of PCOS
↑ pulse freq of GnRH = ↑LH in early follicular phase (no ovulation, abnormal pituitary fxn)
↑ ovarian androgens (testosterone, androstenedione)- abnormal steroidogenesis
Dysfunction of ovarian follicle maturation (lack of dominant ovarian follicle) = ↓ovulation
Accumulation of small follicles in the ovaries = development of cysts
Overall ↑T = can ↑ conv to E = endometrial hyperplasia + no ovulation = ↑ building
metabolic abnormalities of PCOS
insulin resistance
impaired glucose tolerance, diabetes, metabolic syndrome
50% of pts with PCOS have family hx of ____, _____, or both
PCOS
DM
when does PCOS usually start?
teen years, usually at menarche
T or F: clitoromegly is common in PCOS
F- more if there is a T secreting tumor
progression of hirsutism in PCOS is
1. slow
2. fast
1
what is the most common cause of hirsutism in women?
PCOS
what labs may be ordered for PCOS
Testosterone- total and free
DHEAS
LH;FSH ratio in follicular phase
prolactin if amenorrheic
progesterone
antimullerian hormone
what is the diagnostic test for PCOS
pelvic ultrsound
what is AMH and how does it related to PCOS
Antimullerian hormone (AMH): hormone released from developing follicles- lvls are high in PCOS due to large number of follicles being developed at one time
what is the first step for any PCOS tx
weight loss if obese BMI =>30 = lifestyle for 3-6mths
why is weight loss the first step for PCOS tx
Wt loss of 5-10% body mass can help trigger ovulation, improve cycles and sx, improve response to fertility medications
how to treat irregular cycles from PCOS
similar to anovultory UB
CHC 1st, if CI or inadequate try progesterone PO, DMPA, or LNG IUS
metformin
what is metformin used for in PCOS
to treat irregular cycles
how does metformin work to restore cycles
Can also induce ovulation, ↑ insulin sensitivity, improve lipid profile
how long for metformin to work for PCOS
up to 6mths
can metformin be used LT for PCOS
yes for women with COS and impaired glucose tolerance or T2D that doesn’t respond to lifestyle mod
Possible use LT for CVD benefits in PCOS but confirmatory data lacking
T or F: metformin may have clinical effects on hirsutism from PCOS
F- unlikely
how to treat hirsutism from PCOS
CHC or antiandrogens +/- eflornithine
what antiandrogen is first line for hirsutism from PCOS? what else is used?
spironolactone often combo with CHC
finasteride if spironolactone and CHC not effective
how long for antiandrogens to work for hirsutism from PCOS
up to 6mths
what should women on antiandrogens also be on?
reliable contraception
eflornithine hydrochloride MOA
irreversible inhibitor of ornithine decarboxylase = no ornithine to putrescine = slows terminal hair growth but does not remove hair
how long for eflornithine to work in decreasing hair growth
~1mth
what NHP may be used in PCOS
myoinositol
myo-inositol MOA
Acts similar to an insulin sensitizer- membrane associated sodium dependent inositol cotransporter GLUT4- decreases hyperinsulinemia
Improves ovarian function, ↓LH/FSH, ↓T lvls
monitoring parameters for PCOS
Reassess in 3 mths
For hirsutism- pts on anti androgens may take up to 6 mths or longer
Discuss expected benefits with pt + be realistic
