PCOS

Question 1

Risk factors for PCOS?

Answer 1

Obesity
T2DM
Family history
Nutrition

Question 2

Pathophysiology of PCOS?

Answer 2

Increased LH production
Decreased insulin sensitivity –> Hyperinsulinaemia
(xs insulin in body)
Excessive androgen and oestrogen production

Question 3

SSx of PCOS?

Answer 3

Mnemonic: HAVI is Fat
Hirsutisim
Amenorrhoea/ Oligomenorrhea
Virilisation
Infertility
+
Obesity
T2DM
Acanthosis nigricans (sign of insulin resistance)

Question 4

Complications

Answer 4

Endometrial carcinoma (due to no sloughing) 
Gestational diabetes 
Obstructive sleep apnoea 
Ovarian hyperstimulation syndrome

Question 5

Blood tests?

Answer 5

LH/FSH
TFT
Blood glucose
Androstenedione
DHEA-S
Sex-hormone binding globulin
Free Androgen Index –> calculate total testosterone

Question 6

What would the blood tests for PCOS show?

Answer 6

↑ LH, Normal FSH
↑ Blood glucose
↑ Total testosterone
↓ SHBG
↑ Androstenedione
↑ DHEA-S

Question 7

Imaging for PCOS and what would it show?

Answer 7

Ovarian ultrasound –> more than or equal to 12 antral follicles in one ovary/ ovarian volume > 10ml

Question 8

Criteria for PCOS?

Answer 8

Rotterdam criteria

2 out of 3 to diagnose PCOS and exclusion of other disorders
o Irregular or absent ovulations (cycle > 42 days) [oligo or amenorrhoea]
o Clinical or biochemical signs of hyperandrogenism i.e acne, hirsutism
o Polycystic ovaries on pelvic USS

Question 9

Medical Tx for PCOS?

Answer 9

Diabetes –> metformin (1st line)
Amenorrhoea–> COCP, POP if COCP contraindicated
Hyperandrogenism –> Cyproterone acetate, finasteride
Infertility –> clomefine (if used with metformin –> enhances effect)

Question 10

Surgical Tx for PCOS?

Answer 10

Infertility –> ovarian drilling, IVF if failure to conceive after 6 ovulatory cycles