PCOS

Question 1

What two hormones are found to be HIGH in PCOS?

Answer 1

Insulin
LH

Question 2

Describe the presenting features of PCOS

Answer 2

• subfertility/infertility
• oligo-/amenorrhoea
• hirsutism
• acne
• obesity
• acanthosis nigricans

Question 3

What investigations can be used to diagnose PCOS?

Answer 3

• Pelvic US - ovarian cysts
• raised LH:FSH ratio
• Prolactin/testosterone may be mildly elevated
• impaired glucose tolerance

Question 4

Describe the Rotterdam criteria used to make a diagnosis of PCOS

Answer 4

Need 2 of the following 3:

• infrequent or no ovulation
• clinical and/or biochemical signs of hyperandrogenism
• polycystic ovaries on ultrasound scan

Question 5

How many cysts on a pelvic US would indicate a diagnosis of PCOS?

Answer 5

• presence of ≥ 12 follicles
• 2-9 mm in diameter
• in one or both ovaries

OR increased ovarian volume
> 10 cm³

Question 6

Treatment of hirsutism/acne associated with PCOS

Answer 6

• COCP e.g. co-cyprindiol
  (increased VTE risk so not used for long periods)
• Topical eflornithine
• spironolactone, flutamide and finasteride may be used under specialist supervision

Question 7

Treatment of infertility associated with PCOS

Answer 7

• weight reduction
• clomifene may be used to stimulate ovulation
• metformin added if patients are obese
• gonadotrophins