PCOS and menopause

Question 1

PCOS

Answer 1

• a syndrome of ovarian dysfunction affecting 9-18% of reproductive age women world wide, most common endocrine abnormality of women of reproductive age, clinical manifestations include- chronic anovulation, hyperandrogenism (hirsutism, acne and alopecia)

The syndrome is defined by a clustering of signs and features, associated with risk of diabetes and other metabbolic abnormalities

Question 2

Clinical manifestations of PCOS Anovulation

Answer 2

Primary amenorrhea (lack of menarche by age 15) or secondary amenorrhea (>90 days without a period)
Oligomenorrhea (>35 days between periods)
Polymenorrhea (bleeding at intervals of less than 25 days), 1.5%)
Normal menstrual cyclicity does not necessarily signify ovulatory cycles (20-30% of women with regulat menses have oligo-anovulation)

Of women with regular cycles an no hirsitism, 95% are ovulatory, if regular cycles and hisutism, 60% are ovulatory

Question 3

Pathophysiology of PCOS

Answer 3

Complex disorder , Gonadotropin secretion disturbance, Steroidogenesis disorder, insulin resistance

Question 4

Similartities of PCOS and metabolic Syndrome Related to insulin resistance

Answer 4

Central obesity, hyperinsulinemia, low SHBG, Abnormal lipids (elevated TG, low HDL), low SHBG, abnormal lipids (elevated tG, low HDL), higher prevalence of IGT and diabetes, increased risk of non alcoholic Fatty liver, increased risk of OSA

Question 5

Diagnostic criteria for PCOS

Answer 5

at least 2/3:
Oligo- or anovulation, clinical or biochemical signs of hyperandrogenism, polycystic ovaries on imaging

AND: Absence of secondary causes (CAH, androgen- secreting tumors, cushings syndrome)

Question 6

Diagnosis of PCOS

Answer 6

Diagnosis of PCOS made based on history, clinical suspicion, biochemical evaluation is for excluding less common causes of hirsutism and menstrual irregularities androgen secreting tumors, CAH, thyroid disease

Biochemical testing will often result in normal results
Test s for insulin resistance are not required to make a diagnosis of PCOS

Question 7

Management of PCOS

Answer 7

treat presenting complaint
Treatment of syptoms of anovulation (regulate menses, induce ovulation, endometrial cancer risk reduction)

Treatment of symptoms hyperandrogenism

Treatment of obesity and metabolic disorders (obesity management, sleep apnea screes

Screen and treat anxiety and depression

Question 8

Treatment of PCOS OCPs

Answer 8

OCPs, suppress ovarian androgen secretion by suppression of gonadotropins, increase SHBG, deccrease free testosterone and free androgen index, improves hirsutism and acne, rgulate menses and provides adequate progesitn to protect endometrial lining

Question 9

PCOS- spironolactone

Answer 9

Competitive inhibitor of androgen receptor, improves hirsutism acne and alopecia, does not inhibit androgen secretion, requires reliable contraceptives

Question 10

Menopause

Answer 10

menopause is the final menstrual period and is usually confirmed when a women has missed her period for 12 consecutive months in the absence of other obvious causes, it reflects complete or near complete depletion of ovarian follicles and the absence of ovarian estrogen secretion, it marks the permanent end of fertility

Average age is 51 but age ranges from 40 to early 60s occurs after 55 in 5% and between 40-45 in 5%
Age of menopause influnced by genetics, ethnicity, smoking and reproductive history

Question 11

perimenopause, post menopause, premature menopause

Answer 11

Perimenopause- charachterized by variation in menstrual cycle length and bleeding pattern, mood shifts, vasomotor and vaginal sx, Sxs begin several years before the final menstrual period, transition phase is called perimenopause around menopause, rising FSH, falling AMH and inhibin B levels, it can last 6 yrs or more and ends 1 year after the final menstrual

Postmenopause- all the years beyond menopause

Premature menopause- menopause that occurs before 40 yrs

VASOMOTOR (hot flashes, sleep and depressed,

Question 12

Estrogen is the best giving post menopausal years

Answer 12

but increased risk of osteo porosis, WHI (incraste of breast cancer and CV risk )

if your 50 and very heallthy and really bad symptoms (you can give estrogen)

Essentially dont give meds to older people

Question 13

WHIMS

Answer 13

E and P

Question 14

Give CEE with Basedoxifene

Answer 14

pills and patches, vaginal rings and vaginal progesterone

ospemifene for dry vag

SSRIs etcs for just vasomotor effect