PCOS

Question 1

What % of people have PCO but not PCOS

Answer 1

20 to 30%

Question 2

Aetiology of PCOS

Answer 2

60% LH hypersecretion
Genetics
DM
trans men

Question 3

Describe pathophysiology mechanism of PCOS

Answer 3

LH stimulates androgen secretion from thecal cells
Not enough FSH to convert androgens to oestrogen ( raised LH to FSH )
Androgens increase insulin resistance but insulin also increases androgen production

Question 4

Can diet impact PCOS

Answer 4

YES - insulin resistance

Question 5

What are the Rotterdam criteria

Answer 5

Irregular / absent ovulations (cycle >42 days)
Clinical evidence of hirsuitism, acne, alopecia
Scan shows PCO (>= 12 antral follicles >2mm on one ovary OR ovarian vol >10ml)

Question 6

How many of Rotterdam criteria are needed to diagnose PCOS

Answer 6

2/3

Question 7

What is USS sign of PCOS

Answer 7

String of pearl sign

Question 8

List secondary amenorrhoea Ix & what Dx they are excluding

Answer 8

Preg test
Prolactinoma - prolactin
Menopause - LH:FSH
anorexia / hypothyroidism - TFTs
Ashermanns/atrophy - pelvic USS
turners - karyotyping

Question 9

How high should serum testosterone be in PCOS

Answer 9

2x normal

Question 10

What is used to measure active testosterone in PCOS & how is it done

Answer 10

free androgen index
100 x total test / sex hormone binding globulin

Question 11

Clinical sign of insulin resistance

Answer 11

Acanthosis nigricans

Question 12

Mx of insulin resistance in PCOS

Answer 12

diet and exercise
Metformin

Question 13

Complications of insulin resistance in PCOS

Answer 13

GDM in preg
OSA due to obesity

Question 14

Mx of isolated acne in PCOS

Answer 14

topical retinoids

Question 15

What adjuvant Mx of acne is needed in PCOS and why

Answer 15

COCP due to teratogenic effects in preg

Question 16

Which acne Mx is most teratogenic

Answer 16

Co-cyprindol

Question 17

What is the most common cause of secondary amenorrhoea (excluding preg)

Answer 17

PCOS

Question 18

How does PCOS affect endometrial cancer risk and why

Answer 18

Increased risk
Increased unopposed oestrogen as poor ovulation

Question 19

Initial Mx of oligomenorrhoea in PCOS

Answer 19

Weight loss
COCP
metformin

Question 20

Mx of oligiomenorrhoea in PCOS after 3 months of lifestyle etc

Answer 20

Cyclical POP or IUS

Question 21

Minimum number of periods a year in PCOS, why & Mx if not achieved

Answer 21

3
Increased risk of cancer
6 monthly TVUS

Question 22

Why are PCOS pts subfertile

Answer 22

Intermittent ovulation

Question 23

Mx of infertility in PCOS

Answer 23

weight loss
Metformin
Clomifene or letrozole
Pulsatile GnRH IM
Ovarian drilling
IVF

Question 24

What is clomifene & how does it work

Answer 24

Selective ER modulator
Increases eostrogenic effects on body

Question 25

Risks of clomifene

Answer 25

Twin preg Ovarian cancer

Question 26

Which is more effective, clomifene or letrazole in PCOS

Answer 26

Letrazole but it’s off licence

Question 27

Why are pulsatile GnRH IM injections not used regularly for PCOS subgfertility

Answer 27

££££

Question 28

Surgical Mx of PCOS subfertility & draw back

Answer 28

Ovarian drilling (diathermy of follicles) Only lasts 12 months

Question 29

Risk of IVF in PCOS

Answer 29

ovarian hyper stimulation syndrome

Question 30

Preg comps of PCOS

Answer 30

GDM pre eclampsia

Question 31

How are preg complications of PCOS managed

Answer 31

GDM - OGTT before 20wks and again if neg PET - aspirin

Question 32

Psychological effects of PCOS

Answer 32

Depression Anxiety Increased risk of EDs

Question 33

Why is PCOS hard to diagnose in teens

Answer 33

Lots of them have polycycstic ovaries / acne / oligoomenorrhoea normally

Question 34

What can be done for ?PCOS in teens

Answer 34

TREAT with COCP

Question 35

When can PCOS be diagnosed in teens

Answer 35

8 years after first period