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AAA-GYNECOLOGY > PCOS (AB) > Flashcards

PCOS (AB) Flashcards

1
Q

What is the most common endocrinopathy in reproductive-age women?

A

Polycystic Ovarian Syndrome (PCOS)

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2
Q

What percentage of reproductive-age women are affected by PCOS?

A

8-13% (70% undiagnosed)

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3
Q

What are the two main criteria systems used to diagnose PCOS?

A

NIH and Rotterdam Criteria

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4
Q

What is the prevalence of PCOS based on NIH criteria?

A

6-10%

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5
Q

What is the prevalence of PCOS based on Rotterdam criteria?

A

0.15

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6
Q

What are common menstrual abnormalities in PCOS?

A

Oligomenorrhea or amenorrhea with 1-2 month intervals and possible spotting or intermenstrual bleeding

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7
Q

What causes hirsutism in PCOS?

A

Effects of androgens in the periphery

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8
Q

Why do women with PCOS often experience infertility?

A

Due to anovulation

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9
Q

What is a common ultrasound finding in PCOS?

A

Polycystic ovaries

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10
Q

What are the 3 diagnostic criteria in the Rotterdam criteria for adults?

A

Oligo/amenorrhea

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11
Q

How many criteria are required to diagnose PCOS in adults using Rotterdam criteria?

A

2 out of 3

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12
Q

How many criteria are required to diagnose PCOS in adolescents using Rotterdam criteria?

A

3 out of 3

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13
Q

What are the Rotterdam criteria for diagnosing PCOS in adolescents?

A

Oligo/amenorrhea

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14
Q

How is PCOS diagnosed in menopausal women?

A

History of PCOS during reproductive years

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15
Q

What is the ultrasound finding of polycystic ovaries?

A

> 12 follicles

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16
Q

What group developed the consensus on women’s health aspects of PCOS?

A

Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group

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17
Q

What does GnRH stimulate the pituitary gland to produce?

A

LH and FSH

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18
Q

What hormone stimulates follicular growth and endometrial thickening?

A

Estrogen

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19
Q

What triggers the LH surge that causes ovulation?

A

Estrogen reaching a certain threshold

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20
Q

What hormone is produced after ovulation and helps maintain pregnancy?

A

Progesterone

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21
Q

What happens if fertilization does not occur after ovulation?

A

Menstrual bleeding

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22
Q

List 4 risk factors for PCOS.

A

Genetics

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23
Q

What hormonal imbalance is seen in PCOS regarding GnRH pulsatile release?

A

Increased GnRH pulsatility leading to increased LH compared to FSH

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24
Q

What ovarian cells produce excess androgens in PCOS?

A

Theca cells

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25
Q

What causes the arrest of follicular development in PCOS?

A

Increased androgens and decreased estrogen

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26
Q

What is the consequence of chronic anovulation in PCOS?

A

Endometrial hyperplasia and increased risk of endometrial cancer

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27
Q

What ultrasound finding is characteristic of PCOS?

A

“String of pearls” appearance with >12 small follicles

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28
Q

What metabolic complication is common in PCOS?

A

Insulin resistance

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29
Q

How does hyperinsulinemia contribute to hyperandrogenism in PCOS?

A

Increases ovarian androgen production and decreases SHBG

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30
Q

What pregnancy outcomes are associated with maternal PCOS and poor lifestyle habits?

A

Gestational diabetes

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31
Q

Why is early diagnosis and management of PCOS important?

A

To avoid long-term complications such as infertility

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32
Q

What are common symptoms of PCOS?

A

Oligomenorrhea

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33
Q

What is the minimum menstrual frequency considered normal for reproductive-aged women?

A

At least 8 cycles per year

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34
Q

What defines irregular menstrual cycles in adolescents 1-3 years post-menarche?

A

Cycle length <21 days or >45 days

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35
Q

What defines irregular menstrual cycles in women >3 years post-menarche to perimenopause?

A

Cycle length <21 days or >35 days

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36
Q

What defines primary amenorrhea in PCOS evaluation?

A

No menstruation by age 15 or >3 years post-thelarche

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37
Q

What are 4 long-term health consequences of PCOS?

A

Endometrial hyperplasia/cancer

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38
Q

What psychosocial issues are associated with PCOS?

A

Depression and anxiety

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39
Q

What percentage of weight loss can help improve fertility in PCOS?

A

2-5% weight loss

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40
Q

What lifestyle factors increase PCOS risk during pregnancy?

A

High-fat low-fiber diet

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41
Q

Why is intrauterine androgen exposure a risk factor for PCOS?

A

It programs metabolic dysfunction and increases risk for future PCOS

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42
Q

What is the hallmark biochemical feature of PCOS?

A

Hyperandrogenism

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43
Q

What causes insulin resistance in PCOS?

A

Excess insulin stimulates ovarian androgen production and reduces SHBG

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44
Q

Why is unopposed estrogen harmful in PCOS?

A

Leads to endometrial hyperplasia and cancer

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45
Q

What are common causes of abnormal uterine bleeding in PCOS?

A

Anovulation or breakthrough bleeding

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46
Q

What are 3 key elements in managing PCOS?

A

Lifestyle modification

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47
Q

What hormonal feedback mechanism is dysfunctional in PCOS?

A

Increased LH:FSH ratio

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48
Q

How does PCOS contribute to subfertility?

A

Anovulation and poor follicle maturation

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49
Q

How does obesity worsen PCOS symptoms?

A

Increases insulin resistance and androgen production

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50
Q

What is the impact of healthy maternal habits in PCOS pregnancies?

A

Normal fetal growth and reduced risk of metabolic disorders

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51
Q

What is the first-line management for overweight PCOS patients?

A

Weight loss and lifestyle modification

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52
Q

What is the relationship between insulin resistance and hyperandrogenism?

A

Insulin resistance promotes ovarian androgen production

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53
Q

What diagnostic criteria exclude other causes of hyperandrogenism in PCOS?

A

Rotterdam criteria requires exclusion of other androgen excess disorders

54
Q

What menstrual abnormality is a hallmark of PCOS?

A

Oligomenorrhea

55
Q

Why is lifestyle counseling important for pregnant women with PCOS?

A

To prevent metabolic programming that increases future PCOS risk in offspring

56
Q

What is the primary cause of infertility in PCOS?

A

Anovulation

57
Q

What are the clinical features of hyperandrogenism in PCOS?

58
Q

What endocrine axis is disrupted in PCOS?

A

Hypothalamic-pituitary-ovarian (HPO) axis

59
Q

What are two common presentations of PCOS in adolescents?

A

Irregular menses and hyperandrogenism

60
Q

Why is PCOS screening important in obese adolescents?

A

Obesity increases risk of insulin resistance and hyperandrogenism

61
Q

What common sleep disorder is associated with PCOS?

A

Obstructive sleep apnea

62
Q

What cardiovascular risk factors are increased in PCOS?

A

Hypertension

63
Q

What is the recommended initial weight loss target for lifestyle modification in PCOS?

A

2-5% weight loss

64
Q

What is the significance of net caloric intake in lifestyle modification for PCOS?

A

Significant overall decrease in net caloric intake

65
Q

Which medication is commonly recommended for lifestyle modification in PCOS?

66
Q

How many menstrual cycles per year is considered oligomenorrhea in PCOS?

A

Less than 8 cycles per year

67
Q

What type of uterine bleeding is commonly associated with anovulation in PCOS?

A

Abnormal uterine bleeding

68
Q

What factors determine whether an endometrial biopsy is needed in PCOS?

A

Clinical scenario and length of exposure to unopposed estrogen

69
Q

What is the first-line pharmacologic treatment for menstrual irregularities in PCOS?

A

Combined oral contraceptives (COCs)

70
Q

What effect do COCs have on SHBG levels?

A

COCs increase SHBG levels

71
Q

Which types of oral contraceptives are preferred for PCOS?

A

Those containing antiandrogenic progestins like cyproterone and estradiol

72
Q

When are cyclic progestins used for menstrual irregularities in PCOS?

A

If COCs are contraindicated

73
Q

When can progestins be given for irregular menses in PCOS?

A

Day 16 to day 25 of the cycle (up to 12 tablets per month)

74
Q

When should an endometrial biopsy be considered regardless of age in PCOS?

A

In cases of prolonged exposure to androgens

75
Q

What is the primary pharmacologic strategy for treating PCOS?

A

Combination of OCP and antiandrogen therapy

76
Q

Which progestogens are preferred for PCOS treatment?

A

Less androgenic progestogens like norgestimate

77
Q

Why should antiandrogens be used with OCPs in PCOS?

A

To prevent exposure during pregnancy

78
Q

How do OCPs suppress ovarian androgens in PCOS?

A

By inhibiting LH stimulation of the ovary

79
Q

What effect do OCPs have on adrenal androgens?

A

Decrease adrenal androgens (DHEAS) by ~30%

80
Q

Which enzyme’s activity is inhibited by OCPs in PCOS?

A

5α-reductase

81
Q

How does ethinyl estradiol in OCPs affect testosterone?

A

Increases SHBG

82
Q

What are examples of androgen receptor blockers used for PCOS?

A

Spironolactone and flutamide

83
Q

What type of drug is finasteride?

A

5α-reductase inhibitor

84
Q

Which antiandrogen is most frequently combined with ethinyl estradiol in PCOS treatment?

A

Cyproterone acetate

85
Q

At what dose is spironolactone more effective for hirsutism?

A

200 mg/day for 3 months

86
Q

What percentage reduction in hair shaft diameter is expected after 1 year of spironolactone treatment?

A

15-25% reduction

87
Q

Why is flutamide rarely recommended for PCOS?

A

Risk of hepatic toxicity

88
Q

What dose of finasteride is used in PCOS?

89
Q

When is finasteride considered in PCOS?

A

Second-line if spironolactone is not tolerated

90
Q

How long does it take to see a response to hirsutism treatment?

A

About 6 months

91
Q

What percentage of women respond successfully to hirsutism treatment within 1 year?

A

Approximately 70%

92
Q

What are options for removing remaining excess hair after PCOS treatment?

A

Electrolysis or laser

93
Q

How long should hirsutism treatment continue before stopping to assess recurrence?

94
Q

When are cosmetic hair removal measures appropriate in PCOS?

A

For mild isolated hirsutism or after suppressive therapy

95
Q

What are the definitive hair removal techniques?

A

Electrolysis and laser

96
Q

How does electrolysis work?

A

Electrical energy destroys hair follicles

97
Q

What are the four types of lasers used for hair removal?

98
Q

What is the preferred term for androgenic alopecia in women?

A

Female pattern hair loss (FPHL)

99
Q

Which enzyme activity is increased in female pattern hair loss with androgen excess?

A

5α-reductase

100
Q

Where does hair loss typically occur in female pattern hair loss?

A

Frontal scalp and vertex

101
Q

What is the mainstay treatment for female pattern hair loss in women?

A

Antiandrogens

102
Q

Which medications are used to treat alopecia in PCOS?

A

Spironolactone

103
Q

Is finasteride effective for female pattern hair loss in women?

104
Q

What is the role of insulin sensitizers in PCOS treatment?

A

Proposed for androgen excess but not recommended as primary therapy

105
Q

What is the mechanism of eflornithine cream for facial hirsutism?

A

Inhibits ornithine decarboxylase

106
Q

What condition was eflornithine originally developed to treat?

A

Trypanosomal sleeping sickness

107
Q

How long does it take to see improvement with eflornithine cream?

A

About 8 weeks

108
Q

What percentage of women with acne have androgen excess?

109
Q

What hormone stimulates sebum production in acne?

110
Q

What is the first-line treatment for acne in PCOS?

A

Combination oral contraceptives

111
Q

What type of progestins are preferred in OCPs for PCOS acne treatment?

A

Less androgenic progestins

112
Q

What is the next step if OCPs alone are not successful for acne in PCOS?

A

Add antiandrogens

113
Q

What criteria are used to diagnose PCOS?

A

Rotterdam criteria (oligomenorrhea

114
Q

What criteria must adolescents meet to be diagnosed with PCOS?

A

All 3 of the Rotterdam criteria

115
Q

What are the ultrasound criteria for diagnosing PCOS?

A

> 12 follicles

116
Q

What test is used to assess glycemic control in PCOS?

A

75g OGTT (glucose tolerance test)

117
Q

What are the major causes of PCOS?

118
Q

What causes increased androgen production in PCOS?

A

Synergistic action of insulin and LH on theca cells

119
Q

How does insulin affect SHBG in PCOS?

A

Inhibits SHBG production

120
Q

What effect does insulin have on IGF-1 in PCOS?

A

Increases free IGF-1

121
Q

How does hyperinsulinemia contribute to dyslipidemia in PCOS?

A

Increases free fatty acids

122
Q

Why does PCOS cause anovulation?

A

Excess androgen halts follicular growth

123
Q

What type of cholesterol predominates in PCOS?

A

LDL (bad cholesterol)

124
Q

What long-term condition can thin patients with PCOS develop?

A

Diabetes mellitus

125
Q

What diagnostic test is recommended for obese PCOS patients?

A

OGTT for type 2 diabetes screening

126
Q

What cardiovascular effect is associated with PCOS?

A

Increased long-term cardiovascular risk

127
Q

What is the management for endometrial thickening that persists despite progesterone treatment?

A

Endometrial biopsy

128
Q

What percentage of weight loss can lead to ovulation improvement in PCOS?

A

5-10% weight loss

129
Q

What dietary advice is recommended for PCOS patients?

A

Hypoglycemic diet

130
Q

What surgical option is available for obese patients with PCOS?

A

Ovarian drilling

AAA-GYNECOLOGY (12 decks)

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