PCOS Flashcards
Patient with suspected PCOS – diagnostic labs?
Other tests?
- TSH and prolactin
- FSH/LH
- Serum testosterone
- DHEA-S and 17-hydroxyprogesterone
Glucose intolerance screening, endometrial biopsy
5 main complications of persistent anovulation?
High estrogen state:
Diabetes, endometrial cancer, hyperlipidemia, metabolic syndrome, cardiovascular disease
Diagnostic criteria for PCOS?
- Oligomenorrhea
- Hyperandrogenism (acne, hirsutism) excluding other causes
- Evidence of multiple cysts on the ovary via transvaginal ultrasound
Other causes of hyperandrogenism that must be ruled out?
- CAH (High DHEA-S/17-hydroxyprogesterone)
- Hyperprolactinemia
- Adrenal/ovarian tumors (Ovarian mass or leydig tumor)
- Cushing’s
- Thyroid disorders
PCOS – definition?
Condition of unexplained hyperandrogenic chronic anovulation associated with excessive estrogen
When to do an endometrial biopsy in PCOS?
In patients with long-standing anovulation unopposed estrogen exposure
Treatment goals in PCOS?
- Reduce circulating androgen levels
- Protect endometrium from unopposed estrogen (to reduce cancer risk)
- Weight loss and lifestyle changes
- Monitor for diabetes and cardiovascular disease
Patient with PCOS desires pregnancy - Will likely need?
Clomiphene citrate – SERM that blocks estrogen receptor, causing increased estrogen production. Leads to better follicle recruitment.
Primary management of PCOS? Mechanisms? Can also give?
OCP
- Regulates bleeding
- Limits unopposed estrogen
- Increases sex hormone binding globulin (decreases free androgen)
- Suppresses ovarian Androgen production
Metformin
Impatient with chronic anovulation due to PCOS – most likely cancerous lesion? Treatment? Treatment if patient desires pregnancy?
Adenocarcinoma of the endometrium
Hysterectomy and surgical staging
High-dose progestin therapy and repeat endometrial sampling 2-3 months (recommend hysterectomy after childbirth)
