PCOS

Question 1

Definition?

Answer 1

Poly-cystic ovary syndrome is a manifestation of hyper-androgenism, hyper-androgenaemia, oligo/anovulation and polycystic ovarian morphology.

Question 2

RF?

Answer 2

• FH
• Premature adrenarche
• Obesity

Question 3

ddx?

Answer 3

• 21-hydroxylase deficiency
• Thyroid dysfunction
• Hyperprolactinaemia
• Cushing's syndrome
• Androgen-secreting neoplasms
• Severe insulin resistance
• Anabolic drugs
• Hypo gonadotrophic hypogonadism
• Premature ovarian failure
Cortisone reductase deficiency

Question 4

Epidemiology?

Answer 4

Age: Adolescents
Sex: Women
Ethnicity:

Question 5

Aetiology?

Answer 5

• Not well known
• Insulin resistance and compensatory hyperinsulinaemia
• Hormonal imbalances
Genetics

Question 6

CP?

Answer 6

• Onset typically duringadolescence
• Menstrual irregularities(primary orsecondary amenorrhea,oligomenorrhea)
• Difficulties conceiving orinfertility
• Obesityand possibly other signs ofmetabolic syndrome
• Hirsutism
• Androgenic alopecia
• Acne vulgarisand oilyskin
• Acanthosis nigricans:hyperpigmented, velvetyplaques(axilla, neck)
• Prematureadrenarche• A diagnosis requires at least two of the three key features:
  ○ Oligoovulationoranovulation, presenting with irregular or absent menstrual periods
  ○ Hyperandrogenism, characterised by hirsutism and acne
  ○ Polycystic ovariesonultrasound(orovarian volumeof more than 10cm3)

Question 7

Pathophysiology?

Answer 7

Normally
• Held to abdominal wall via ovarian ligament, ovary, suspensory ligament and broad ligament
• Medulla-inner-blood vessels and nerves
• Cortex-ovarian follicles-primary oocyte/follicle
• Respond to FSH and LH

• Dysfunction in HPO axis causing a normal surge of LH at the start of the cycle to not happen-dominant follicle fails to rupture/no menorrhoea-follicular cyst
• Chronic anovulation due to no rise in oestrogen/LH
• Excess androgen production
• Pathology
• Ovarianhypertrophywith thick capsule
• Stromalhyperplasiaandfibrosis
• Enlarged, multiple cystic follicles, which aresclerotic
• Hyperluteinizedtheca cells
• Decreasedgranulosa celllayer

Question 8

I-first line?

Answer 8

• First Line:
• Exam
• Sex-hormone binding globulin
• Free androgen index-active testosterone
• LH, FSH, Prolactin and TSH- to rule out other causes
• Test oestrogen
• OGTT-Test for insulin resistance and hyperlipidaemia
• Refer for US if adults- string of pearls

Question 9

M-treat infertility?

Answer 9

• If seeking treatment forinfertility
• First-line
○ Ovulationinduction withclomiphenecitrateorletrozoleand metformin
Clomipheneinhibitshypothalamicestrogenreceptors, thereby blocking the normal negative feedback effect ofestrogen→ increased pulsatile secretion ofGnRH→ increasedFSHandLH, which stimulatesovulation
○ If the patient is overweight: advise weight loss
• Second-line:ovulationinduction withexogenousgonadotropins
• Third line: IVF or laparoscopic ovarian drilling

Question 10

M-no treat infertility?

Answer 10

• If treatment forinfertilityis not sought:therapy aimed at controlling menstrual, metabolic, and hormonal irregularities
• If the patient is overweight(BMI≥ 25 kg/m2)
○ First-line:weight lossvia lifestyle changes (e.g., dietary modifications, exercise)
○ Second-line(as an adjunct):combined oral contraceptivetherapy and anti-androgen and metformin
○ Third line: GnRH analogue or progestin
• If the patient is not overweight:combined oral contraceptivetherapy

Question 11

P?

Answer 11

• Chronic condition

* Mortality rate no different to women without

Question 12

C?

Answer 12

• CVS events
• T2DM
• Endometrial cancer
• Increased miscarriage rate
• Haemorrhagic cysts
• Rupture
Torsion