PCOS and Menopause- Lalande

Question 1

What are some consquences of the hyperandrogenism seen in PCOS?

Answer 1

Hisutism

Acne

Alopecia

Deepened Voice

Increased Muscle Mass

Clitoromegaly

Question 2

What is the Ferriman-Gallwey Hirsutism scoring system?

What areas are scored?

Answer 2

A system for qualifying hair growth from 1-4

1. Above the lip
2. Chin
3. Chest
4. Navel/Stomach
5. Pubic
6. Arms
7. Thighs
8. Back
9. Butt

Question 3

What is believed to cause PCOS?

Answer 3

Change in Gonadotropin secretion

Steroidogenesis problems (leading to insulin resistance)

Question 4

What dermatological findings might you see in a patient with PCOS?

Answer 4

Increased Hair growth

Acanthosis Nigricans

Skin tags

Question 5

What symptoms are seen in PCOS that contribute to insulin resistance?

Answer 5

• Central Obesity
• Hyperinsulinemia (listed as a symptom….)
• Low SHBG
• Elevated Triglycerides
• Low HDL
• Non-alcoholic steatohepatitis

Question 6

How is PCOS treated?

Answer 6

• Anovulation
  
  • progesterone to decrease endometrial cancer risk
  • BC pills to regulate menses
• Hyperandrogenism
  
  • BC pills to increase SHBG
  • Spironolactone as androgen receptor antagonist
• Obesity
  
  • Weight loss
  • Sleep apnea screening
  • Diabetes management/prevention
  • Lipid/CV disease risk managment
• Anxiety/Depression screening

Question 7

How is menopause “diagnosed”?

When does it typically occur?

Answer 7

Amenorrhea for 12 consecutive months

between 40-60, average age is 51

PS ONLY WOMEN HAVE MENOPAUSE

Question 8

What is perimenopause?

What is premature menopause?

Answer 8

The period surrounding menopause, lasting a few years prior to menopause to one year post menopause; this period may have symptoms similar to those seen in menopause

Menopause that occurs before age 40

Question 9

What occurs in FSH leading up to and after menopause?

What is seen in AMH (anti-mullerian hormone)?

Answer 9

FSH levels are highly variable and spike immediately prior to menopause. They are variable after menopause but stabilize eventually.

AMH is extremely low around menopause (AMH is an estimate of oocyte reserves)

Question 10

What symptoms might be seen in menopause?

Answer 10

• Vasomotor symptoms (hot flashes, chills, etc)
• Vaginal dryness
• Urinary Incontinence
• Osteoporosis
• Skin changes

Question 11

Is hormone therapy recommended for post-menopausal women?

For what? What prescription?

Answer 11

Yes, in women less than 10 years past menopause with few risk factors EG smoking, breast cancer Hx, diabetes

Used to treat symptoms, not prevent disease due to decreased estrogen. Estrogen only is preferred, but women with a uterus must also get progesterone.

Question 12

What is Bazedoxifene?

What is is used for?

Answer 12

a SERM

Combined with estrogen to treat vaginal symptoms and prevent osteoporosis, but does not have bleeding like seen with progesterone

Question 13

Why would menopausal hormone therapy be counterindicated in a symptomatic woman?

Answer 13

• Unexplained vaginal bleeding
• Hx of stroke
• MI/ Ischemia
• Hx of Breast cancer
• Hx of Endometrial cancer
• Hx of Pulmonary emboli
• Liver Disease
• Gall bladder disease
• Diabetes
• Migraines with Aura

Question 14

What are some dosing strategies for hormone replacement therapy in post-menopausal women?

Answer 14

• Give in topical form to avoid liver metabolism
• Give lowest possible dose
• Try to give for short durations
• Consider giving alternative medications
  
  • SERMs
  • SSRI/SNRI
  • Gabapentin
  • Clonidine