PCOS Flashcards
what is PCOS?
PCOS: causes metabolic and reproductive problems within women
what criteria is used to manage PCOS?
Rotterdam criteria: to help make diagnosis of PCOS need at least 2
- Oligoovulation or anovulation presenting with irregular or absent menstrual periods
- Hyperandrogenism: hirsutism and acne
- Polycystic ovaries on US: or ovarian volume more than 10cm
how might PCOS present?
Presentation:
- Oligomenorrhoea or amenorrhoea
- Infertility
- Obesity – in about 70% of pts with PCOS
- Hirsutism
- Acne
- Hari loss in male pattern
what complications can be seen within PCOS?
Other features and complications:
- Insulin resistance and diabetes
- Acanthosis nigricans thickened rough skin typically found in axilla occurs with insulin resistance
- CVS
- Hypercholestrolaemia
- Endometrial hyperplasia and cancer
- Obstructive sleep apnoea
- Depression and anxiety
- Sexual problems
what can cause hirsutism other than PCOS?
medications
ovarian/ adrenal tumours
cushings
congenital adrenal hyperplasia
what medications can cause hisutism?
phenytoin, ciclosporin, corticosteroids, testosterone and anabolic steroids
why is there insulin resistance within PCOS?
Insulin resistance: insulin promotes release of androgens from ovaries and adrenal glands higher insulin causes higher androgens
- Insulin also suppressed sex hormone binding- globulin production by liver and suppress function
- Reduced SHBG further promotes hyperandrogenism in women
- High insulin levels halt development of follicles in ovaries and leads to anovulation
what can help with insulin resistance?
- Diet, exercise and weight loss can help reduce insulin resistance
what hormone blood panel would be done for PCOS?
Hormone bloods: testosterone, sex hormone-binding globulin, LH, FSH, prolactin (may be mildly raised) and TSH
what would hormone results show?
- High LH
- Raised LH:FSH ratio
- High testosterone
- Raised insulin
- Normal/ raised oestrogen
what are the investigations for PCOS?
hormone bloods
pelvic US
oral glucose tolerance test
what would pelvic US show to indicate PCOS?
Pelvic US: transvaginal to visualise ovaries
- String of pearls appearance
- 12 or more developing follicles in one ovary
- Ovarian volume of >10cm
- Not reliable in adolescents for diagnosis
what would oral glucose tolerance test indicate for PCOS?
Oral glucose tolerance test: 75g glucose drink and then measuring plasma glucose 2hrs later
- Impaired fasting – should be 6.1 to 6.9mmol/L
- Impaired glucose tolerance – plasma glucose at 2hrs of 7.8-11.1mmol/L
- Diabetes: having >11.1 after 2hrs
what gen management can be done for PCOS?
want to reduce obesity, T2DM, hypercholesterolaemia and CVS risk
- Weight loss
- Low glycaemic index and calorie controlled diet
- Exercise
- Smoking cessation
- Antihypertensive meds when required
- Statins – QRISK > 10%
what complications would you want to monitor for?
Managed for complications:
- Endometrial hyperplasia and cancer
- Infertility
- Hirsutism
- Acne
- OSA
- Depression and anxiety
why is weight loss so important within pcos?
significant part of managing PCOS weight loss alone can result in ovulation and restore fertility and regular menstruation
- Improve insulin resistance
- Reduce hirsutism/ acne
when would orlistat be indicated?
Orlistat: may be used to help weight loss in women with BMI >30kg/m2
what is moa of orlistat?
- MOA: lipase inhib and stops fat absorption in intestine
what are side effects of orlistat?
- Side effects: oily greasy stools, can leak into underwear
what cancer is pcos at risk of?
Endometrial cancer risk: at higher risk due to hyperplasia of endometrial tissue
what can increase endo cancer risk?
RF: obesity, DM, insulin resistance, amenorrhoea
why does pcos lead to endo cancer?
luteum releases progesterone following ovulation and PCOS women do not ovulate regularly and do not produce progesterone
- They continue to make oestrogen makes endometrial layer very thick and keeps proliferating
- Risk of hyperplasia from continuing thickening lining
- Women with extended gaps – more than 3mths are at risk the most due to endo thickness
what are management in pcos?
Management options:
- Mirena coil: continuous endometrial protection
- Inducing a withdrawal bleed: at least every 3-4mths cyclical progesterone’s or COCP
what is first line infertility management?
Managing infertility: losing weight is first line
