PCOS Flashcards
What is the clinical presentation of PCOS?
-Hyperandrogenism
-Menstrual disturbances
-Overweight or obese
What are the three possible mechanisms of PCOS?
-Inappropriate gonadotropin secretion
-Insulin resistance with hyperinsulinemia
-Excessive androgen production
What leads to ovulation and what day does this occur on?
Surge of LH on day 14 of the menstrual cycle
What is the result of hyperinsulinemia in PCOS?
Leads to hyper-androgenism
What causes an increase in androgen production?
Hypersecretion of LH and Insulin
What is the normal role of androgens?
Produced in ovaries to facilitate follicular growth
What else is increased with excessive androgen production?
Free testosterone concentrations
What are the 3 diagnosis criteria of PCOS?
Hyper-androgenism
Chronic anovulation
Polycystic ovaries
How many of the criteria must be present for a diagnosis of PCOS?
2 out of 3
What are the three considerations to keep in mind when making PCOS treatment decisions?
-Patient Priorities
-Efficacy vs Risks
-Desire to become pregnant
What is the first-line pharm treatment for PCOS?
Combined oral contraceptives
When should low dose estrogen (20mcg) combination pills be used to treat PCOS?
If patient is obese or > age 39
What affect does estrogen have on LH?
Estrogen suppresses LH
What progestins are best to be used in PCOS treatment and why?
-Norethindrone
-Norgestimate
-have a low thromboembolism risk
How does spironolactone work?
Blocks androgenic effects at hair follicles
How should spironolactone be used?
As an add on therapy for hirstuism/acne
What are some important points about spironolactone?
-Takes 6-9 months to benefit
-May increase K+ levels so they should be monitored
-Teratogenic!
How does Anti-Androgen Therapy (5-alpha Reductase Inhibitor) work?
Prevents conversion of testosterone to more potent 5-alpha dihydrotestosterone form
When are anti-androgen therapies used?
If COC and spironolactone are ineffective for severe hirstuism
What drug is a commonly used anti-androgen therapy?
Finasteride 2.5-5mg daily
When is metformin used as a first-line therapy?
If PCOS with Type 2 diabetes and failed lifestyle modifications
What is metformin a second-line therapy for?
Menstrual irregularity
How does metformin work?
Reduces insulin concentration and androgen production
What are some important points about metformin?
-Takes up to 6 months to work
-GI side effects decrease after 2-3 weeks
Discontinue if pregnant
-No endometrial protection until regular menses and ovulation is established
