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Reproductive Medicine > PCOS > Flashcards

PCOS Flashcards

1
Q

What might serum free testosterone be in PCOS?

A

Elevated

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2
Q

What is polycystic ovarian syndrome?

A

Polycystic ovary syndrome (PCOS) includes symptoms of hyper-androgenism, presence of hyper-androgenaemia, oligo-/anovulation, and polycystic ovarian morphology on ultrasound.

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3
Q

Why can those with PCOS present with diabetes?

A

Due to insulin resisntance

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4
Q

Why does someone with PCOS have increased androgen production?

A
  • Hyperinsulinaemia stimulates androgen production and inhibits production of sex hormone binding globulin - increases circulating levels fo free androgens
  • Excessive LH production
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6
Q

What disease processes are associated with PCOS?

A
  • Metabolic syndrome
  • T2DM
  • Sleep apnoea
  • Obesity
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7
Q

What are symptoms of PCOS?

A
  • Androgenic symptoms - Hirsutism, Acne, Scalp hair loss
  • Oligo/amenorrhoea
  • Weight gain
  • Infertility
  • First trimester miscarriage
  • Features of diabetes - polyuria, polydipsia, visual distrurbance
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8
Q

What is the following?

A

Acanthosis nigricans

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9
Q

What might you see on examination of someone with PCOS?

A
  • Hirsutism, acne, alopecia
  • Hypertension
  • Acanthosis nigricans
  • Sweating/oily skin
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11
Q

What investigations would you consider doing in someone with suspected PCOS?

A
  • Bloods -
    • Diagnosis - Free testosterone, Sex hormone binding gloulin, androgen free index, DHEAS, Fasting lipids
    • Exclude other causes of oligo/amenorrhoea - prolactin, TFTs, LH and FSH, 17-hydroxyprogesterone
  • Imaging - Pelvic USS
  • Other - OGTT
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12
Q

What is DHEAS?

A

Serum dehydroepiandrosterone sulfate - may be elevated in PCOS

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13
Q

What might you find when investigating 17-hydroxyprogesterone in someone with suspected PCOS?

A

>24 nanomol/L - indicates adrenal hyperplasia/androgen secreting tumous

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14
Q

Why might you do a serum prolactin level in someone with PCOS?

A

To exclude hyperprolactinamia as a cause of amenorrhoea

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15
Q

Why might you perform TFTs in someone with suspected PCOS?

A

Exclude hypothyroidism as a cause of amenorrhoea

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16
Q

Why might you do an OGTT in someone with suspected PCOS?

A

Check for diabetes

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17
Q

Why might you perform fasting lipid in someone with PCOS?

A

Dyslipidaemia is often observed in PCOS

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18
Q

What criteria are useed to make the diagnosis of PCOS?

A

Rotterdam Criteria

19
Q

What are the rotterdam criteria used to diagnose someone with PCOS?

A

PCOS should be diagnosed if two of three of the following criteria are present, as long as other causes of menstrual disturbance and hyperandrogenism are excluded:

  • Polycystic ovaries (12 or more follicles/ovarian volume > 10cm3 on US)
  • Oligo-ovulation/anovulation
  • Clinical and or biochemical signs of hyperandrogenism
20
Q

What might you see on pelvic USS scan in someone with PCOS?

A
  • >/= 12 follicles measuring 2-9 mm
  • Increased ovarian volume (>10 mL)
21
Q

What might you find on LH/FSH ratio in someone with PCOS?

A

>3 suggests PCOS

22
Q

What general measures would you take in someone with PCOS?

A
  • Weight loss/exercise
  • Smoking cessation
  • Treat co-morbidities - diabetes, hypertension, dyslipidaemia, sleep apnoea
23
Q

What medical options are available as antiandrogen treatment for PCOS?

A
  • COCP
  • Spironolactone
  • Eflornithine face cream
24
Q

What medications can be used as endometrial protection in PCOS?

A
  • COCP
  • Progestogens
  • Mirena IUS
25
Q

What medications can be usedd to treat infertility in someone with PCOS?

A
  • Clomifene citrate
  • Metformin
26
Q

How does metformin help in PCOS?

A

Improves insulin sensitivity in the short term and may improve mentrual abnormality and ovulatory function.

Does not have significant impact on hirsuitism and acne

27
Q

How does clomifene help with infertility in someone with PCOS?

A

Induces ovulation - inhibits oestrogen negative feedback on HP axis, which leads to an increase in FSH secretion that may allow follicular maturation and ovulation

28
Q

What are risks with using clomifene to treat infertility?

A
  • Multiple pregnancy
  • Ovarian cancer
29
Q

What are women with PCOS at risk of with assisted conception?

A

Ovarian hyperstimulation syndrome

30
Q

How does spironolactone help in PCOS?

A

Anti-androgen medication - receptor blocker

31
Q

How does COCP help in PCOS?

A

Oral contraceptive (OCP: cyclic oestrogen plus progestogen) therapy modestly inhibits gonadotrophin secretion, and thus gonadotrophin-sensitive ovarian androgen production, and increases hepatic production of sex hormone binding globulin (SHBG), which further decreases free testosterone

32
Q

What is recommended by NICE for treating infertility in individuals who have not responded to clomifene?

A

Ovarian drilling

33
Q

What are complications of PCOS?

A
  • Infertility
  • Pregnancy complicaitons
  • Type 2 DM
  • NAFLD
  • CVD
  • Metabolic syndorme
  • Dyslipidaemia
  • Sleep apnoea
  • Endometrial hyperplasia/cancer

Reproductive Medicine (43 decks)

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