PCOS Flashcards
Define PCOS. (3)
Clinical and/or biochemical evidence of hyperandrogenism
Oligo- and/or anovulation
Polycystic ovaries on ultrasound
Describe the pathophysiology of PCOS. (4)
- Increased insulin resistance causes increased insulin secretion in response to glucose (hyperinsulinaemia)
- Insulin stimulates theca cells in the ovary to produce androgens
- Insulin also stimulates decreased SHBG production in the liver
a. This leads to increased free testosterone levels - Increased free testosterone levels causes:
a. Oligo- and/or anovulation
b. Hirsutism
List 6 symptoms of PCOS.
Secondary amenorrhoea Hirsutism Acne Obesity Insulin resistance Infertility
List 5 long term consequences of PCOS.
Increased risk of diabetes Dyslipidaemia Increased risk of pregnancy-related complications Cardiovascular disease Endometrial hyperplasia/cancer
What blood tests would you do for PCOS? (5)
What sort of imaging? (1)
BLOODS: Testosterone Other androgens (androstenedione, DHEAS) LH/FSH Oestrogen Prolactin
IMAGING:
Ultrasound
What are the features of PCOS ovaries on ultrasound? (3)
Thickened capsule
Multiple 3-5mm cysts
Hyperechogenic stroma
List the differential diagnoses for high testosterone levels in females. (4)
PCOS
Congenital adrenal hyperplasia
Cushing’s syndrome
Virilising tumours
What are the 4 aspects of PCOS treatment?
lifestyle changes
Hair removal
Management of menstrual disturbance
Fertility treatments
How would you treat hirsutism in PCOS? (5)
LOCAL THERAPY:
Plucking/waxing/shaving etc.
Eflornithine cream
SYSTEMIC THERAPY:
Oestrogens (suppress ovarian androgen production)
Antiandrogens, e.g.
- Cyproterone acetate
- Spironolactone
- Flutamide
5-alpha-reductase inhibitors, e.g.
-Finasteride
How would you manage menstrual disturbances in PCOS? (2)
Cyclical oestrogen/prosterone
Metformin
How would you treat infertility in PCOS? (2)
Clomifene
Low dose FSH
Which lifestyle changes are needed to treat PCOS? (2)
Weight loss
Diet
