PCOS Flashcards
1
Q
PCOS - background
A
- PCOS is the most common endocrine disorder in women.
- Responsible for 80% of all cases of anovulatory subfertility.
- Estimated prevalence is 5–10% of women of childbearing age.
- U/S evidence of polycystic ovaries is seen in 20–30% of women.
- Abnormal HPO axis results from hyperinsulinaemia, which also stimulates an increase in GnRH and therefore an imbalance between LH and FSH -> derangement of E and P -> immature follicles -> no ovulation and oligomenorrhoea
2
Q
PCOS - etiology
A
- Genetic (familial clustering).
- Insulin resistance with compensatory hyperinsulinaemia (defect on
insulin receptor). - Hyperandrogenism (elevated ovarian androgen secretion).
- Obesity (esp, central):
- BMI >30 in 35–60% of women with PCOS
- Worsens insulin resistance
Leads to…
5. Derangement of HPO axis (?)
3
Q
PCOS - clinical features
A
- Irregular menstrual cycles
- Hirsutism
- Acne
- Obesity (often)
- Infertility/subfertility
4
Q
PCOS - Rotterdam criteria for dx (3)
A
Requires the presence of two out of the following three variables and exclusion of other disorders:
- Irregular or absent ovulations (cycle >42 days).
- Clinical or biochemical signs of hyperandrogenism:
- Acne
- Hirsutism
- Alopecia - Polycystic ovaries on pelvic USS: ≥ 12 antral follicles on one ovary, and/or increased ovarian volume (>10mL). Based on 2014 systematic review, a much higher threshold has been proposed (=/>25 follicles), but only if clinician uses transducer frequency that provides maximal resolution. This technology is not available to most clinicians, and it is suggested that the 2003 criteria (≥ 12 antral follicles/ovary) be used
5
Q
PCOS - ex
A
- BMI
- Signs of endocrinopathy
- Hirsutis, alopecia
- Acne
- Acanthosis nigricans
6
Q
PCOS - ix`
A
- Basal (day 2–5): LH, FSH, TFTs, prolactin, and testosterone.
If hyperandrogenism: - Dehydroepiandrosterone sulphate (DHEAS), androstenedione
- SHBG.
- Exclude other causes of secondary amenorrhoea.
- Pelvic USS.
7
Q
PCOS - long term health consequences
A
- Obesity
- Insulin resistance and metabolic abnormalities -> type II diabetes mellitus
- GDM
- Endometrial hyperplasia and endometrial carcinoma
- Ischaemic heart disease (but long-term studies not proven)
8
Q
PCOS - mx
A
- Lifestyle modification - Weight loss through diet and exercise
- Improving menstrual regularity
- Weight loss, COCP, metformin - Controlling symptoms of hyperandrogenism
- Cosmetic (depilatory cream, electrolysis, shaving)
- Antiandrogens (e.g. eflornithin facial cream or spironolactone) - can help with acne and hirsutism; can take 6-9mo to improve hair growth; avoid pregnancy (feminises a male fetus)
- COCP - reduces serum androgen levels by increasing SHBG levles - Subfertility
- Weight loss alone may achieve spontaneous ovulation
- Clompihene (tx with the most evidence)
- Can use gonadotrophins or metformin +/- clomiphene if clomiphene unsuitable or contraindicated
- Laparoscopic ovarian drilling
- IVF if ovulation cannot be achieved or does not succeed in pregnancy
5.