PCOS Flashcards
what is PCOS? what 4 things help categorize/Dx this?
common disorder of women of reproductive age
defined by… ovulatory dysfunction, hyperandrogenism, exclusion of other disorders, and possibly polycystic ovaries
how does PCOS relate to obesity/DM?
its a metabolic problem linked to insulin resistance
what must you exclude to dx PCOS?
other causes of hyperandrogenism… as there are many
what type of women tend to get PCOS? young/old? fat/thin?
reproductive age, likely originates with obesity but CAN occur in lean women
evidence shows that ______ and consequent ______ are pivotal in the pathogenesis of PCOS. Overall: this means..
decreased peripheral insulin sensitivity and consequent hyperinsulinemia
overall: a complex feedback loop that is broken (increased hormones (androgens) increases the insulin, causing insulin resistance)
there is a suggestion of the presence of a _____ defect in PCOS
hypothalamic
menstruation for PCOS pts?
an-ovulatory cycles that are irregular (time and flow vary)
7 PCOS clinical features
acanthosis nigricans (velvety hyperpigmentation of skin - even in thin women)
acne, hirsutism and alopecia (from high androgens)
abnormal/absent periods
anovulatory infertility
central obesity
hirsutism for PCOS
from androgen excess
(male-pattern hair growth in women)
* know that this can be scored
what is the key pathogenic factor for PCOS?
insulin resistance
prevalence of metabolicsyndrome in women with PCOS is __% higher than the general population
43%
5 risk factors for metabolic syndrome. what is the requirement for Dx?
HTN: >130/85
dyslipidemia (high TriGs): >150
dyslipidemia (low HDLs): <40 for men, <50 for women
central obesity: waist >40in men, >35 in women
glucose: FBG >100
requirements for Dx: any 3 of the above
PCOS pts have a ____ increased risk for MI
7 fold increased risk for MI
1st line Txt for PCOS
lifestyle modification:
exercise, altered diet
weight loss (low fat, low carb)
1st line and 2nd line meds for PCOS:
CC is oligomennorhea (infrequent periods)
1st: estrogen-progesterone therapy
2nd: metformin, progesterin withdrawal, weight loss
1st line and 2nd line meds for PCOS:
CC hirsutism
1st: estrogen-progesterone therapy + anti-androgen (spironolactone)
2nd: hair removal
1st line and 2nd line meds for PCOS:
CC anovulatory fertility
1st: clomiphene/letrozole (ovulatory stimulant med)
2nd: weight loss, metformin (helps dec. androgens), FSH injections, IVF
PCOS txt for weight loss
phenteramine/amphetamines for short term
bariatric surgery for long term
PCOS txt for insulin resistance
insulin sensitizing agent: metformin or TZD
fertility medication for PCOS
clomiphene or letrozole
metformin for fertility?
no longer preferred for fertility but does help insulin resistance and dec. excess androgens which help with fertility
why do we have a concern for endometrial hyperplasia with PCOS? what txt would we consider for this?
excess estrogen puts pt at risk for endometrial cancer
- progestin/withdrawal with a pseudo menstrual period to shed the lining built up from absent/irregular periods
hadleys first line for PCOS txt?
metformin and weight loss (diet and exercise)
PCOS: providers need to recognize that the syndrome is assosciated with _______ in terms of reproductive and nonreproductive events.
significant morbidity
..hadley note, not really sure the significance
providers must take precautionary measures to prevent _____ and ____ in PCOS pts
CVD and type 2 DM
patho of PCOS: there is a suggestion that it is b/c of a hypothalamic defect.. what would this cause?
elevated LH (leutenizing hormone) levels
hyperandrogenism
anovulation
PCOS lab findings? (in general)
endocrine abnormalities (high LH, normal FSH, higher testosterone/androgen) *according to hadley you dont really need lab values to Dx
