PCOS 2017 TOG Flashcards
How common is polycystic ovaries
20-33%
Definition of polycystic ovaries according to ESRH/ASRM consent
12+ follicles measuring 2-9mm in diameter
Ovarian voluma > 10cm3
Suggestions with better USS this should be increased to 25 and AMH should be added potentially >35
Prevalence of PCOS
25%
Risk of 1st degree relatives being effected?
50%
Definition of diabetes, impaired fasting gynaecamia and normal base on fasting glucose
DM >7
Impaired >6.1 <7
Normal <6.1
Definition of diabetes, impaired fasting and normal based on 2 hour BM post glucose
DM >11.1
Impaired 7.8-11.1
Normal <7.8
When to measure fasting glucose in PCOS
BMI >30
Unless asian then >BMI 25
Management of hirsutism
- Weight loss
- Hair removal - electrolysis, waxing, bleaching, topical eflornithine
- Hormonal therapy - COCO e.g. Dianeete (35ug ethinylloestrdaiol and cyproterone acetate), Yasmin - drosperinone (like spironolactone)
- Spironolactone - wear diuretic + antiandrogenic if COCP CI.
To reduced risk of endometrial cancer how often should shed endometrium?
Every 3 months
If decline cyclical hormones
USS ET every 5-12 months - if >10mm - should induced artificial bleeding and a repeat USS, EB if endoemerium has not shed
Or offer IUD
PCOS account for what proportion of anoultary infertility
80-90%
How is clomifebe citrate prescribed?
Day 2-5 of menstrual cycle for 5 days.
If oligo/amenhorrhea - exclude pregnancy the induce withdrawal bleed with short course progesterone such as medroxyprogestoner 20mg/day for 5-10days
Start with doses 50mg/day can increase to 100mg/day
What proportion of patients would be pregnant by 6 cycles of clomifene
60-70%
What proportion of women with PCOS have high LH? Which women is it more likely toe effect? Effect of high LH on pregnancy
40% - more likely in thin women
Reduced conception, increased risk miscarriage
If using clomifene - can have exaggerated LH, measure LH on day 8 if persistently raised consider alternative therapy
Risk of multiple pregnancy with clomifene
10%
If anovulatory infertiliy resistant to anti-estrogens, what else can be offered
Gonadotrophin therapy
Lap ovarian drilling
Benefits of tetrazole over clomifene?
How does it work?
Higher live birth rates, lower risk multiple pregnancy
Decreases atomisation of androgens to oestrogens.
How gonadotrophin therapy used?
Starting dose 25-50IU FSH or human menopausal gonadotrophin - only increased after 14 days if no response, ovulation trigger by hCG 5000 units, when there has been development of at least 1 dominant folicle atleast 17mm in diameter.
Conception rate/live birth after should 6 months gonadoptrophin therapy
70% conception
55-60% live birth rate
If no conception after 6 months - IVF
Multiple pregnancy rate with gonadotropin therapy
5%
How does metformin work
Inhibits hepatic glucose production
Enhances insulin sensitivity
Does metformin impact fertility rates
Yes some increase clinical pregnancy rate in those taking metformin
Benefits of Lap ovarian drilling
No risk multiple pregnancy and OHSS
Good for those who fail to response to CC or hyper secret LH
how LOD is it performed
4 diathermy points per ovary for 4 second at 40 wars
What additional risks in pregnancy for patient with PCOS
GDM
PIH/PET
Adverse neonatal outcomes
preterm birth
