PCOS Flashcards
What might serum free testosterone be in PCOS?
Elevated
What is polycystic ovarian syndrome?
Polycystic ovary syndrome (PCOS) includes symptoms of hyper-androgenism, presence of hyper-androgenaemia, oligo-/anovulation, and polycystic ovarian morphology on ultrasound.
Why can those with PCOS present with diabetes?
Due to insulin resisntance
Why does someone with PCOS have increased androgen production?
- Hyperinsulinaemia stimulates androgen production and inhibits production of sex hormone binding globulin - increases circulating levels fo free androgens
- Excessive LH production
What disease processes are associated with PCOS?
- Metabolic syndrome
- T2DM
- Sleep apnoea
- Obesity
What are symptoms of PCOS?
- Androgenic symptoms - Hirsutism, Acne, Scalp hair loss
- Oligo/amenorrhoea
- Weight gain
- Infertility
- First trimester miscarriage
- Features of diabetes - polyuria, polydipsia, visual distrurbance
What is the following?
Acanthosis nigricans
What might you see on examination of someone with PCOS?
- Hirsutism, acne, alopecia
- Hypertension
- Acanthosis nigricans
- Sweating/oily skin
What investigations would you consider doing in someone with suspected PCOS?
-
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
What is DHEAS?
Serum dehydroepiandrosterone sulfate - may be elevated in PCOS
What might you find when investigating 17-hydroxyprogesterone in someone with suspected PCOS?
>24 nanomol/L - indicates adrenal hyperplasia/androgen secreting tumous
Why might you do a serum prolactin level in someone with PCOS?
To exclude hyperprolactinamia as a cause of amenorrhoea
Why might you perform TFTs in someone with suspected PCOS?
Exclude hypothyroidism as a cause of amenorrhoea
Why might you do an OGTT in someone with suspected PCOS?
Check for diabetes
Why might you perform fasting lipid in someone with PCOS?
Dyslipidaemia is often observed in PCOS
What criteria are useed to make the diagnosis of PCOS?
Rotterdam Criteria
What are the rotterdam criteria used to diagnose someone with PCOS?
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
What might you see on pelvic USS scan in someone with PCOS?
- >/= 12 follicles measuring 2-9 mm
- Increased ovarian volume (>10 mL)
What might you find on LH/FSH ratio in someone with PCOS?
>3 suggests PCOS
What general measures would you take in someone with PCOS?
- Weight loss/exercise
- Smoking cessation
- Treat co-morbidities - diabetes, hypertension, dyslipidaemia, sleep apnoea
What medical options are available as antiandrogen treatment for PCOS?
- COCP
- Spironolactone
- Eflornithine face cream
What medications can be used as endometrial protection in PCOS?
- COCP
- Progestogens
- Mirena IUS
What medications can be usedd to treat infertility in someone with PCOS?
- Clomifene citrate
- Metformin
How does metformin help in PCOS?
Improves insulin sensitivity in the short term and may improve mentrual abnormality and ovulatory function.
Does not have significant impact on hirsuitism and acne
How does clomifene help with infertility in someone with PCOS?
Induces ovulation - inhibits oestrogen negative feedback on HP axis, which leads to an increase in FSH secretion that may allow follicular maturation and ovulation
What are risks with using clomifene to treat infertility?
- Multiple pregnancy
- Ovarian cancer
What are women with PCOS at risk of with assisted conception?
Ovarian hyperstimulation syndrome
How does spironolactone help in PCOS?
Anti-androgen medication - receptor blocker
How does COCP help in PCOS?
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
What is recommended by NICE for treating infertility in individuals who have not responded to clomifene?
Ovarian drilling
What are complications of PCOS?
- Infertility
- Pregnancy complicaitons
- Type 2 DM
- NAFLD
- CVD
- Metabolic syndorme
- Dyslipidaemia
- Sleep apnoea
- Endometrial hyperplasia/cancer
