PCOS Flashcards
1
Q
Outline the pathophysiology of PCOS
A
Cause unknown.
Polycystic ovaries produced when ovaries stimulated to produce ↑testosterone, caused by;
- ↑LH (and ↑FSH) [ant. pituitary] caused by excessive ↑GnRH pulsatility [hypothalamus]
-
↑insulin caused by insulin resistance/ diabetes, this also causes;
- ↓sex hormone binding globulin [liver] causing ↑free androgens
- Dyslipidaemia
- Adrenal disturbance causing ↑androgens
2
Q
Outline the Epidemiology of PCO/S
A
20% of women have PCO’s, but majority dont have the syndrome
PCOS is throught to affect 5-15% of women of reproductive age
3
Q
Outline the clinical presentation of PCOS
A
- Oligomenorrhea
- Hirsutism /acne /alopecia
- Infertility/ subfertility
- Psychological
- Obesity
4
Q
Outline the investigations of PCOS
A
- ↑LH (LH:FSH 2:1, FSH may be ↑)
- ↑Free testosterone (if >5nmol/L exclude tumours/ congenital adrenal hyperplasia)
- GTT (↑insulin)
- Dyslipidaemia
- TFTs & FBC
- USS/ lap
5
Q
Outline the differentials for PCOS
A
- Cushings syndrome
- Androgen secreting tumours (adrenal/ ovarian)
- Thyroid disorder (particularly Hypothyroidism)
- Congenital adrenal hyperplasia
6
Q
Outline the diagnostic criteria for PCOS
A
Rotterdam criteria
- Polycystic ovaries (12+ or 10cm+)
- Oligo-menorhoea/ anovulation
- Clinical or biochemical signs for hyperandrogenism
7
Q
Outline the treatments for PCOS
A
- Lifestyle
- Medical - not planning pregnancy
- Hirsutism & acne: Co-cyprindol [estradiol and anti-androgen] /Aflornithine
- Insulin & weight: Metformin + Orlistat [inhibits lipase]
- Oligomenohoea: COCP
- Medial - planning/ pregnant
- Clomifene +/- Metformin
- Surgical
- TAH + BSO
8
Q
Outline potential complications & so treatments of PCOS
A
- Oligomenorrhoea predisposes to Endometrial hyperplasia/ cancer
- Protect with progestogens
- High Type 2 Diabetes risk
- High CV risk
- Sleep apnoea [ask & offer investigations]
- Pregnancy complications
- Gestational diabetes [screen <20wks]
- Pre-term birth
- Pre-exlampsia
