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Y5 O&G > PCOS > Flashcards

PCOS Flashcards

1
Q

What % of people have PCO but not PCOS

A

20 to 30%

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2
Q

Aetiology of PCOS

A

60% LH hypersecretion
Genetics
DM
trans men

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3
Q

Describe pathophysiology mechanism of PCOS

A

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

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4
Q

Can diet impact PCOS

A

YES - insulin resistance

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5
Q

What are the Rotterdam criteria

A

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)

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6
Q

How many of Rotterdam criteria are needed to diagnose PCOS

A

2/3

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7
Q

What is USS sign of PCOS

A

String of pearl sign

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8
Q

List secondary amenorrhoea Ix & what Dx they are excluding

A

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

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9
Q

How high should serum testosterone be in PCOS

A

2x normal

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10
Q

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

A

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

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11
Q

Clinical sign of insulin resistance

A

Acanthosis nigricans

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12
Q

Mx of insulin resistance in PCOS

A

diet and exercise
Metformin

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13
Q

Complications of insulin resistance in PCOS

A

GDM in preg
OSA due to obesity

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14
Q

Mx of isolated acne in PCOS

A

topical retinoids

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15
Q

What adjuvant Mx of acne is needed in PCOS and why

A

COCP due to teratogenic effects in preg

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16
Q

Which acne Mx is most teratogenic

A

Co-cyprindol

17
Q

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

A

PCOS

18
Q

How does PCOS affect endometrial cancer risk and why

A

Increased risk
Increased unopposed oestrogen as poor ovulation

19
Q

Initial Mx of oligomenorrhoea in PCOS

A

Weight loss
COCP
metformin

20
Q

Mx of oligiomenorrhoea in PCOS after 3 months of lifestyle etc

A

Cyclical POP or IUS

21
Q

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

A

3
Increased risk of cancer
6 monthly TVUS

22
Q

Why are PCOS pts subfertile

A

Intermittent ovulation

23
Q

Mx of infertility in PCOS

A

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

24
Q

What is clomifene & how does it work

A

Selective ER modulator
Increases eostrogenic effects on body

25
Q

Risks of clomifene

A

Twin preg
Ovarian cancer

26
Q

Which is more effective, clomifene or letrazole in PCOS

A

Letrazole but it’s off licence

27
Q

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

A

££££

28
Q

Surgical Mx of PCOS subfertility & draw back

A

Ovarian drilling (diathermy of follicles)
Only lasts 12 months

29
Q

Risk of IVF in PCOS

A

ovarian hyper stimulation syndrome

30
Q

Preg comps of PCOS

A

GDM
pre eclampsia

31
Q

How are preg complications of PCOS managed

A

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

32
Q

Psychological effects of PCOS

A

Depression
Anxiety
Increased risk of EDs

33
Q

Why is PCOS hard to diagnose in teens

A

Lots of them have polycycstic ovaries / acne / oligoomenorrhoea normally

34
Q

What can be done for ?PCOS in teens

A

TREAT with COCP

35
Q

When can PCOS be diagnosed in teens

A

8 years after first period

Y5 O&G (17 decks)

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