PCOS Flashcards
The cause of PCOS is unknown but what is thought to happen producing the symptoms?
Hormone disturbance manifesting in polycystic ovaries and menstrual, fertility, and cosmetic problems
Why do they have oligomenorrhoea?
With PCOS, LH levels are often high when the menstrual cycle starts.
The levels of LH are also higher than FSH levels.
Because the LH levels are already quite high, there is no LH surge.
Without this LH surge, ovulation does not occur, and periods are irregular.
What criteria is used to diagnose it?
The criteria says you need 2 out of 3 features of PCOS.
What are the 3 features?
Rotterdam Criteria
Polycystic ovaries on USS
Oligo/amenorrhoea
Hyperandrogenism - leading to skin changes
Polycystic ovaries:
How many follicles need to be seen on USS?
Is it over both ovaries or just in one?
The ovarian volume can be used. How much in millilitres is classed as polycystic?
> 12 follicles
In just one ovary
> 10 ml
Oligomenorrhoea/amenorrhoea:
How long does the cycle last before being referred to as oligomenorrhoea?
What need to be excluded before oligo is +ve in the criteria?
A cycle lasting over 35 days or they just keep changing
Other causes of oligo
Hyperandrogenism:
Clinical signs - 4
Acne
Hirsutism
Alopecia
Male pattern balding
Other symptoms:
Why do they sub/infertility?
With PCOS, LH levels are often high when the menstrual cycle starts.
The levels of LH are also higher than FSH levels.
Because the LH levels are already quite high, there is no LH surge.
Without this LH surge, ovulation does not occur, and periods are irregular.
Metabolic symptoms:
The body becomes resistant to insulin. What does this lead to?
What might the patient complain of?
What is acanthosis nigricans and why does it happen?
Insulin resistance
Hyperinsulinaemia
Darkened skin on neck and skin figures BECAUSE of hyperinsulinaemia
Adverse effects of PCOS?
Adverse CVD
T2DM
Sleep apnoea
Big risk factors for PCOS? - 2
FH
Obesity - so you measure BMI
Investigations:
What scan is used to look for polycystic ovaries?
Why is someone with oligomenorrhoea given 12 days of progestogen to induce a withdrawal bleed?
TVUS
Check endometrial hyperplasia - endometrial sampling if present
Investigations - Hormone levels:
Hyperandrogenism - are the following high or low:
- Testosterone
- Sex hormone-binding globulin
What index can be used as well?
Gonadotropins - What ratio is used?
Ruling out other causes:
- Why are TFTs done?
- Prolactin - why is it done?
Why do you measure BMI?
What can be done for hyperinsulinaemia?
High T
Low or normal SHBG
Hypothyroidism
High prolactin levels interfere with the normal production of other hormones, such as estrogen and progesterone. This can change or stop ovulation (the release of an egg from the ovary). It can also lead to irregular or missed periods. Some women have high prolactin levels without any symptoms.
For obesity - a big risk factor
Oral glucose tolerance test
Management:
Advice is given to patients which will improve all symptoms?
What type of drug is used for menstrual irregularities, hyperandrogenism and endometrial hyperplasia?
Drug used for T2DM is present?
Weight loss
Combined contraceptive pill (COC)
Metformin
Management - Endometrial hyperplasia prevention and Rx:
Why do they get endometrial hyperplasia and why is it so important?
What can be offered if < 1 period every 3 months?
How may it be monitored if Rx is declined (e.g. trying for a baby)?
Due to amenorrhoea - may predispose them to endometrial cancer
Offer COC (with 3 monthly withdrawal bleed)
Levonorgestrel IUS
Cyclical progesterone
Can also monitor with regular TVUS
Management - Hirsutism:
What contraceptive is used in women with androgen properties?
Eflornithine is also offered. What does it do?
Co-cyprindiol
Hair removal cream - can also use waxing, laser (not funded by NHS)
