PCOS

Question 1

Prevelance

Answer 1

PCO- 20-30% women
PCOS- 10-15%, 6-7% of reproductive age

Most common endocrine disorder and cause of infertility in women of repro age

Question 2

Risk factors

Answer 2

Multi- factorial
- Genetic
- Environmental- wt gain, insulin resistance
- Age
- BMI - VERY important RF

Question 3

Symptoms

Answer 3

• Irregular periods
• Infertility
• Acne
• Hirsutism
• Acthosis nigricans
• Scan- PCO

Question 4

Investigations

Answer 4

• Hx- symp of acne, hirsutism, infertility
• Examine
• Rule out other causes of infertility - thyroid, prolactin

Question 5

Tests

Answer 5

stop contraception for 3/12 before testing

• Testosterone, DHEA, androstenedione - all high
• Oestrodiol- low
• SHBG- low
• LH:FSH >2:1
• USS

Others:
- Insulin resistance - 65-80% women
- High cholesterol
- Check thyroid and prolactin to rule out other causes

Question 6

Testosterone

Answer 6

• Testosterone 2-5 for PCOS
• Producded by theca cells of the ovary
• If >8 check other adrenal hormones to rule out cushings.

Question 7

Oestrogen

Answer 7

• High levels
• Testosterone being converted to oestrogen in fat cells
• Inc risk of endo CA

Question 8

Rotterdam criteria for diagnosis

Answer 8

2/3 of:
1. Polycystic ovaries >12folicles, <10mm
2. Anovulation
3. Clinical hyperandrogenism

Dont use FSH/LH for dx

Question 9

Mx - conservative

Answer 9

• Lifestyle changes- Diet, exercise
• If BMI >40 or >35+CVS risks, consider bariatric surg
• No cure, only symptomatic mx

Question 10

Mx - medical

Answer 10

• Induce withdrawal bleeding - at least 4/year
• Metformin - for metabolic sympt
• Add table

Question 11

Long term risks

Answer 11

• Inc risk of multiple preg
• Infertility
• Endo CA- if bleeds not induced
• T2DM 20-40% risk
• High cholesterol
• CVS risk
• Psych- depression
• Obs sleep apnoea 10x risk (higher if obese)
• Inc risk of pregnancy complications

Question 12

Ovarian induction

Answer 12

• Use clomiphene- max 6/12
• Ovarian electrocautery - normal BMI and anovulation

Question 13

Metabolic syndrome

Answer 13

3/5 of:

1. Abdo obesity, waist size >88cm
2. Hyper triglycerides >150mg/dl
3. Low HDL <40mg/dl
4. HTN
5. high fasting glucose.

Question 14

Other causes for hyper-androgen

Answer 14

Late congenial adrenal hyperplasia (CAH)/ androgen tumour
- Signs of virilization- Deep voice, red breast size, clitoral hypertrophy

• Check 17-hydroxyprogesterone for CAH
• Prolactinomas
• High androgen +prolactin, galactorrhoea, oligomenorrhoea