PCOS Flashcards
What is the defining triad of PCOS?
Hyper-androgenism, menstrual irregularity, hyperinsulinaemia
Why is PCOS a misnomer?
There are no ovarian cysts, the appearance on USS refers to >12 follicles
Which disorder is common is the FH of PCOS patients?
DMT2
Where are the primary and secondary sources of androgen production in PCOS?
Primarily from the ovaries. Secondarily from the adrenal glands.
The increase in GnRH leads to the increased secretion of which hormone? Why does GnRH increase?
LH. Anovulation and low progesterone
2 out of which 3 criteria must be satisfied before a diagnosis of PCOS can be made?
Oligo/amenorrhoea Hyperandrogenism Polycystic ovaries on USS and exclusion of other conditions
Name 4 secondary causes of PCOS.
Congenital adrenal hyperplasia Acromegaly Cushing’s syndrome Testosterone secreting tumours
Why are PCOS patients generally obese?
Due to insulin insensitivity
How is hyperinsulinaemia related to serum free androgens?
Hyperinsulinaemia inhibits hepatic production of sex hormone binding globulin. This leads to increased free androgens in the blood.
Which 3 time periods tend to induce onset of PCOS?
Puberty Recent weight gain After stopping the OCP
What are the 5 key features of PCOS?
Oligo/amenorrhoea Hirsutism Obesity Infertility Acne
In PCOS, what is the womans risk of developing osteoporosis? Why?
Very low. These women are well oestrogenised (unlike in other causes of amenorrhoea) and are therefore at a reduced risk of developing osteoporosis
Is hirsutism in PCOS fast or slow? What other conditions show the opposite speed in onset of hirsutism?
Slow. Ovarian and adrenal tumours typically exhibit rapid onset hirsutism with increased testosterone levels of virilism.
PCOS accounts for what percentage of anovulatory infertility?
75%
Which 4 conditions are PCOS patients at a greater risk of developing?
T2DM- Due to progressive insulin insensitivity Dyslipidaemia- Endometrial hyperplasia/carcinoma Arterial disease
What 6 investigations are used to make a diagnosis of PCOS? What are their findings in PCOS?
- Serum testosterone levels- normal or mildly elevated
- LH concentration- elevated or normal. The higher the LH the greater the risk of anovulation. LH:FSH ratio will also be elevated.
- SHBG- Will be low in PCOS
- Pelvic USS of ovaries and endometrium- criteria >12 follicles between 2-9mm in diameter and ovarian volume >10cm3.
-
Serum prolactin- Mild elevation in 30% of PCOS
- 17-OHP- Check for late presentation of congenital adrenal hyperplasia
What lifestyle advice can be given to help ease the features of PCOS? Why?
Losing weight. This increases insulin sensitivity and therefore decreases hyper-androgenaemia.
Which medication can be prescribed in patients with PCOS and insulin insensitivity?
Metformin
Which 6 medication classes are used in the pharmotherapeutic management of PCOS?
Ovarian androgen suppression
Adrenal androgen suppression
Androgen receptor antagonists
Reductase inhibitors
Insulin sensitisers
Topical inhibitors of hair follicle growth
Which medications are used for ovarian androgen suppression?
Combined OCP- Dianette and Yasmin also include an antiandrogen which helps with hirsutism. Oestrogen increases SHBG and thus reduces free androgen concentrations, the progestagen component inhibits LH secretion and thus ovarian androgen production.
GnRH receptor blockers- rarely used
Which androgen receptor blockers is used in the management of PCOS?
Spironolactone
Which reductase inhibitor is used in the management of PCOS?
Finasteride
How often should patients have a withdrawal bleed? What does this protect against?
3 months.
Endometrial hyperplasia
Which two medications are recommended for managing infertility in PCOS patients? Which one is controversial?
Metformin (controversial)
Clomifene
What medication is recommended for management of mild-to-moderate acne?
What medication is recommended for management of moderate-to-severe acne?
What medication is recommended for management of severe acne?
Topical benzoyl peroxide
Topical retinoids
Isoretinoin
