PCOS

Question 1

what Is it?

Answer 1

s a complex condition of ovarian dysfunction thought to affect between 5-20% of women of reproductive age

Question 2

aetiology

Answer 2

The aetiology of PCOS is not fully understood. Both hyperinsulinaemia and high levels of luteinizing hormone are seen in PCOS and there appears to be some overlap with the metabolic syndrome.

Question 3

features

Answer 3

subfertility and infertility
menstrual disturbances: oligomenorrhoea and amenorrhoea
hirsutism, acne (due to hyperandrogenism)
obesity
acanthosis nigricans (due to insulin resistance)

Question 4

ix

Answer 4

1. pelvic ultrasound
2. FSH, prolactin, TSH, testosterone, sex hormone binding globulin (SHBG)
3. check for impaired glucose tolerance

Question 5

diagnostic criteria

Answer 5

the Rotterdam criteria state that a diagnosis of PCOS can be made if 2 of the following 3 are present:

1. infrequent or no ovulation (usually manifested as infrequent or no menstruation)
   clinical and/or biochemical signs of hyperandrogenism (such as hirsutism, acne, or elevated levels of total or free testosterone)
2. polycystic ovaries on ultrasound scan (defined as the presence of ≥ 12 follicles (measuring 2-9 mm in diameter) in one or both ovaries and/or increased ovarian volume > 10 cm³)

Question 6

General Mx

Answer 6

weight reduction

cocp may help

Question 7

hirsutism and acne mx

Answer 7

cocp

spironolactone, flutamide and finasteride may be used under specialist supervision

Question 8

infertility mx

Answer 8

weight reduction

metformin is also used, either combined with clomifene or alone, particularly in patients who are obese

gonadotrophins