PCOS Flashcards
what is primary amenorrhoea
where a woman has never had a period.
what are the main reasons a woman may have primary amenorrhoea?
genitourinary abnormalities: congential absence of a uterus, cervix or vagina or they may be insensitive to androgens.
Chromosomal abnormalities e.g. Turner’s syndrome
Secondary hypogonadism e.g. Kallmann’s syndrome, pituitary disease or hypothalamic (low BMI, stress, illness)
what is secondary amenorrhoea
where a woman has not had a period for 6 months or more
name some causes of secondary amenorrhoea
Uterine - Asherman’s syndrome: uterine adhesions lead to periods stopping
Ovarian - PCOS, premature ovarian failure.
Pituitary causes - prolactinoma, pituitary tumour
Hypothalamic - weight loss, stress, drugs (opiates)
define hirsutism
excessive hair growth in a male pattern due to increased androgens and increased skin sensitivity to androgens.
name the two most common causes of hirsutism
PCOS and Idiopathic
how does PCOS classically present
symptoms of anovulation associated with symptoms of hyperandrogenism e.g. hirsutism, acne, alopecia
what typical biochemical features would you see in PCOS
raised LH and testosterone
of what disease is PCOS associated with an increased risk of?
type 2 DM
name 2 common criteria used in diagnosing PCOS
- clinical and/or biochemical signs of hyper-androgenism
2. Oligo and/or annovulation
what do the LH levels in PCOS do
the increased levels activate the LH receptors on theca cells (there are an increased number of LH receptors in polycystic ovaries) increasing androgen production by the ovaries
What happens to the FSH levels and what do they do
The FSH levels drop in relation to LH (although they may not decrease). The low constant levels constantly stimulate the follicles but does not lead to ovulation due to the absence of pulses. FSH would normally stimulate the granulosa cells to convert androgens to oestradiol so there is decreased conversion of androgens.
what happens to the SHBG level in PCOS
decreases
what are insulin levels like in women with PCOS and what are the effects of this?
insulin levels are high as these women have reduced insulin sensitivity. These women tend to have a higher BMI which also leads to insulin resistance.
The high insulin levels stimulate theca cells, reduce hepatic production of SHBG and increase circulating androgens.
how is PCOS normally treated
OCP and weight-loss advice
