PCOS Flashcards
What are Sx and signs of PCOS?
Acne Irregular menstruation Hirsutism Infertility Recurrent miscarriages Metabolic syndrome: high BMI, DM, acanthosis nigricans Scalp hair loss Psych: depression, anxiety
What are the dx criteria for PCOS?
TWO of the following three criteria are required:
Oligo/anovulation
Hyperandrogenism: clinical (hirsutism or less commonly male pattern alopecia) or biochemical (raised FAI or free testosterone)
Polycystic ovaries on ultrasound: >10 follicular cysts
Other aetiologies must be excluded such as congenital adrenal hyperplasia, androgen secreting tumours, Cushing syndrome, thyroid dysfunction and hyperprolactinaemia
Complications of PCOS
Infertility
Recurrent miscarriage
Metabolic syndrome: Obesity, OSA, Insulin resistance/ DM, High cholesterol, CV disease
Endometrial cancer (prolonged anovulation in association with obesity)
Endometrial hyperplasia
What Ix would you do for PCOS?
U/S: string of pearls sign
Hormonal profile: free testosterone, DHEA, LH: FSH ratio >2
Metabolic: FBGs, lipids
To rule out other ddx: TFTs, cortisol, prolactin
What are the ddx for PCOS?
Androgen secreting tumour Congenital Adrenal hyperplasia Cushing's syndrome Primary oligo/amenorrhoea Hypothyroidism
What are the risk factors for PCOS?
FHx
Obesity
Insulin resistance
What is the management for PCOS?
Lifestyle: increased physical activity, weight reduction, diet
Pharmacological: OCP for achieving menstrual cycle regularity, endometrial protection or progesterone
Other: Monitor glucose and lipids, aim for BP <135/85, cosmetic therapy for hirsutism e.g. laser, depilatory creams, anti-androgenic COCP, infertility counselling/ clomiphene citrate, metformin, topical preparations, ABx for acne
Psych: stress + mental health, support, PCOS support groups, CBT, mindfulness
Pathophysiology of PCOS
Insulin resistance –> chronic hyperinsulinemia –> elevated LH, androgen secretion from ovaries and adrenals –> prevents ovulation
