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Obs&Gynae > PCOS > Flashcards

PCOS Flashcards

1
Q

what is PCOS?

A

PCOS: causes metabolic and reproductive problems within women

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2
Q

what criteria is used to manage PCOS?

A

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

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3
Q

how might PCOS present?

A

Presentation:
- Oligomenorrhoea or amenorrhoea
- Infertility
- Obesity – in about 70% of pts with PCOS
- Hirsutism
- Acne
- Hari loss in male pattern

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4
Q

what complications can be seen within PCOS?

A

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

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5
Q

what can cause hirsutism other than PCOS?

A

medications
ovarian/ adrenal tumours
cushings
congenital adrenal hyperplasia

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6
Q

what medications can cause hisutism?

A

phenytoin, ciclosporin, corticosteroids, testosterone and anabolic steroids

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7
Q

why is there insulin resistance within PCOS?

A

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

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8
Q

what can help with insulin resistance?

A
  • Diet, exercise and weight loss can help reduce insulin resistance
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9
Q

what hormone blood panel would be done for PCOS?

A

Hormone bloods: testosterone, sex hormone-binding globulin, LH, FSH, prolactin (may be mildly raised) and TSH

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10
Q

what would hormone results show?

A
  • High LH
  • Raised LH:FSH ratio
  • High testosterone
  • Raised insulin
  • Normal/ raised oestrogen
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11
Q

what are the investigations for PCOS?

A

hormone bloods
pelvic US
oral glucose tolerance test

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12
Q

what would pelvic US show to indicate PCOS?

A

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

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13
Q

what would oral glucose tolerance test indicate for PCOS?

A

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

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14
Q

what gen management can be done for PCOS?

A

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%

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15
Q

what complications would you want to monitor for?

A

Managed for complications:
- Endometrial hyperplasia and cancer
- Infertility
- Hirsutism
- Acne
- OSA
- Depression and anxiety

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16
Q

why is weight loss so important within pcos?

A

significant part of managing PCOS  weight loss alone can result in ovulation and restore fertility and regular menstruation
- Improve insulin resistance
- Reduce hirsutism/ acne

17
Q

when would orlistat be indicated?

A

Orlistat: may be used to help weight loss in women with BMI >30kg/m2

18
Q

what is moa of orlistat?

A
  • MOA: lipase inhib and stops fat absorption in intestine
19
Q

what are side effects of orlistat?

A
  • Side effects: oily greasy stools, can leak into underwear
20
Q

what cancer is pcos at risk of?

A

Endometrial cancer risk: at higher risk due to hyperplasia of endometrial tissue

21
Q

what can increase endo cancer risk?

A

RF: obesity, DM, insulin resistance, amenorrhoea

22
Q

why does pcos lead to endo cancer?

A

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

23
Q

what are management in pcos?

A

Management options:
- Mirena coil: continuous endometrial protection
- Inducing a withdrawal bleed: at least every 3-4mths  cyclical progesterone’s or COCP

24
Q

what is first line infertility management?

A

Managing infertility: losing weight is first line

25
Q

what specialist options can be used to manage infertility?

A

Specialist: clomifene (induce ovulation), laproscopic ovarian drilling, IVF

26
Q

how does ovarian drilling work?

A
  • Laproscopic ovarian drilling: surgeon punctures holes into ovaries using diathermy or lasers to improve women’s hormonal profile and result in regular ovulation and fertility
27
Q

what drugs can be used to manage hirsutism?

A

co-cyprindiol (dianette)
topical eflornithine

28
Q

how does co-copyrindiol work?

A

COCP helps hirsutism and acne  had anti-androgenic effect. Has higher risk of VTE (usually stopped after 3mths)

29
Q

how does topical eflornithine work?

A
  • Topical eflornithine can be used to treat facial and takes 6-8weeks to see big improvement (hirsutism will return within 2mths)
30
Q

what specialist options can be used to manage hirsutism?

A

Specialist: electrolysis, laser hair removal, spironolactone, finasteride (5a-reductase inhib that decreases testosterone), flutamide (non-steroidal anti-androgen) and cyproteprone acetate (anti-androgen and progestin)

31
Q

what can be used to manage acne?

A

COCP can increase risk of VTE
- Topical adaplene (retinoid)
- Topical antibiotics (clindamycin with 1% benzoyl peroxide)
- Topical azelaic acid 20%
- Tetracycline antibiotics

32
Q
A

Obs&Gynae (17 decks)

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