PCOS Flashcards
T or F: PCOS is the leading cause of anovulatory infertility
True
T or F: PCOS has the potential for the development of endometrial cancer
True
T or F: PCOS can not cause miscarriage
False; can cause miscarriage
Clinical Presentation of PCOS
- hyperandrogenism presenting as ___, ___, and ___
- menstrual disturbances: ___ , ___ , and ___
- overweight or obese
- hirsutism, acne, alopecia
- amenorrhea, oligomenorrhea, anovulation
Patho of PCOS
primary defect is unknown
3 possible mechanisms
* inappropraite ___ secretion
* ___ resisrance with hyper ___
* excessive ___ production
- gonadotropin
- insulin, hyperinsulinemia
- androgen
Inappropriate Gonadotropin Secretion
- Increase in GnRH causes ___ to surge too soon.
- ___ will not rise, so there will not be a dominnant ___
- ___ will not occur, and unopposed ___ won’t allow us to enter the ___ phase
- levels of ___ then elevate
- LH
- FSH, follicle
- ovulation, estrogens, luteal
- androgens
T of F: in PCOS, baseline LH levels are high and FSH levels are normal/low
True
no dominant follicle will form
Insulin Resistance
Defect in insulin receptor causes insulin not to be recognized. The body thinks insulin is always ___ and compensates to make more. Increased insulin sensitivity in the ovaries causes ____
- low
- hyperandrogenism
Excess Androgen Production
Androgens are normally produced in the ovary to facilitate ___ growth
hypersecretion of LH and ___ causes raise in ___ production
- folicular
- insulin, androgen
- elevated ___
- early surge in ___ with low/normal ___
- no dominant ___, no ___
- unopposed estrogen, no ___ phase, elevated androgen (no FSH, increased ___)
- Normal ___, increased ___, overgrowth of ovarian follicles
- GnRH
- LH, FSH
- follicle, ovulation
- luteal, insulin
- FSH, LH
PCOS Diagnosis Criteria
- hyperandrogenism
- chronic anovulation
- polycystic ovaries
1st Line treatment for PCOS
Estrogen component
* ___ mcg EE of high risk VTE (obese or > age 39)
* less than or equal to ___ mcg EE
* LH suppression decreases ___ production
Progestin component
* prefer ___ and ___ only due to lower VTE risk
* avoid: desogestrel, cyproterone acetate, dropirenone, gestodene
- 20 mcg
- 35 mcg
- androgen
- norgestimate, norethindrone
T or F: monophasic COC is commonly used for PCOS
True
___ can be used as anti-androgen therapy
spironolactone
Spironolactone blocks androgenic effects at the ___
follicle
Spiranolactone SE:
* 50-100 mg ___ daily
* monitor ___ levels
* ___ bleeding
* ___ tenderness
* headache
* dizziness
* ___ - must use reliable forms of contraception
* used as an add on therapy for ___ / ___
- twice
- K+
- vaginal
- breast
- teratogenic
- hirsutism/acne
Anti-androgen Therapy: 5- α Reductase Inhibitor
- prevent formation of ___
- used when COC and spiranolactone are ineffective for treating severe ___
- finasteride (Proscar) ___mg daily
- SE: headache, and ___ hypotension
- must use reliabe forms if contraception
- DHT
- hisutism
- 2.5-5 mg
- orthostatic
___ is the 1st line treatment in PCOS with type II DM and the 2nd line treatment for menstrual ___
- Metformin
- irregularity
- Metformin reduces ___ concentration and ___ production in ovary
- 500 mg daily titrated to ___ mg BID
- up to ___ months to see results
- GI SE decrease after ___ weeks, taken with meal
- discontinue if ___
- insulin, androgen
- 1000
- 6 months
- 2-3 weeks
- pregnant
T or F: Metformin is not endometrial protective until regular menses and ovulation are established
TRUE
T or F: Metformin offers reliable endometrial protection
False
Treatment for Insulin resistance (2)
- lifestyle modifications
- Metformin (PCOS with Type II DM)
Treatment for Menstrual Irregularity (3)
- COC
- Progestin OC or levonorgestrel IUD
- metformin
Treatment for Hyperandrogenism
- COC
- anti-androgens (spironolactone, finasteride)
- topical Vaniqa (for facial hair)
- cosmetic procedures
If preganancy is desired, use ___ inhibitors (not-FDA approved for infertility)
* MOA: Nonsteroidal competitive inhibitor of the enzyme that turns androgens to ___
* by lowering this hormone, ___ is induced by triggering ___ and ___ secretion
- aromatase
- estrogen
- ovulation, LH, FSH
T or F: aromatase inhibitors like Letrozole (Femara) have better outcomes and less side effects than clomiphene
True
still not FDA approved
T or F: aromatase inhibitors are irreversible and non-selective
False; aromatase inhibitors are reversible, highly selective, ad highly potent
Aromatase inhibitors SE and contraindications
- Hot flashes
- edema
- dizziness/fatigue
- headache
Contraindication: pregnancy
Letrozole (Femara) Dosing
* ___ mg po for 5 days, starting day __ of menses
* if ovulation does not occur, move up by ___ mg in next cycle
* can be used up to ___ cycles
* strong inhibitor of CYP ____ and weak inhibitor of CYP ___
* avoid use of ___ and CYP ___ substrate
* monitor use of ___ and ____
- 2.5-7.5 mg, 3
- 2.5 mg
- 5 cycles
- CYP2A6, CYP2C19
- Tegafur, CYP2A6
- tamoxifen and methadone
Laparoscopic Ovarian Drilling decreases ___ leves and can improve ___ and ___
- androgen
- hirsutism
- acne
Treatment for Anovulation
- Letrozole
- low dose gonadotropin therapy and laparoscopic ovarian drilling
- IVF
Best med for menstrual cycle irregularity, hirsutism, and acne
COC
* 1 active tab/day for 21-24 days
Best med for Hirsutism, acne, and alopecia
Antiandrogens: Spironolactone and FInasteride
* Spiranolactone: 50-100 mg BID
* Finasteride: 2.5-5 mg daily
Best med for PCOS with type II diabetes
Metformin
* 500 mg qd up to 2000 mg qd
best med for anovulation and infertility
Letrozole
* 2.5-7.5 mg/day for 5 days
