PCOS and Menstrual Irregularities Flashcards
what are the risk factors for epidemiology of PCOS
70% hereditary, environment is a fundamental component in gene expression and progression of disease
define endometrial hyperplasia (EH)
precancerous condition in which there is irregular thickening of the endometrium (uterine lining)
what does anovulation cause prolonged exposure of to the endometrium?
estrogen, without the regular exposure of progesterone, leading to increase risk of endometrial hyperplasia
women with PCOS have a 3.5 fold increase risk of _____?
endometrial cancer
how often should withdrawal bleeds be medically induced in women with PCOS?
at least every 3-4 months
what are the only methods that reduce the risk of endometrial cancer?
oral contraceptive and long-acting progestin (IUD)
is a transvaginal US to measure endometrial thickness in women without withdrawal bleeds routinely screened?
no, routine screening is not recommended
what are the clinical manifestations of hyperandrogenism
acne, hirsutism, androgenic alopecia
NOT: deep voice, increased muscle, clitoromegaly (if present look for androgen producing tumor)
PCOS is the cause of ____ of all hirsutism cases
70-80%
alopecia is not as common, what should also be evaluated if alopecia is seen?
thyroid dysfunction, iron-deficiency anemia
what is a major contributor to hyperandrogenism and the fundamental underlying mechanism of long-term PCOS health risks?
insulin resistance
dyslipidemia is near ___% in woman with PCOS and is most commonly____?
70%
increased LDL and Tgs, total cholesterol: HDL ratio, low HDL
when is the risk of cardiovascular disease greatest in PCOS?
post-menopause
how can you measure for anovulation, even in people with PCOS with eumenorrhea (trying to get pregnant)
mid-luteal phase serum progesterone
What is the Rotterdam criteria (2003)
meet 2/3:
chronic anovulation
clinical or biochemical hyperandrogegism
polycystic ovarian morphology
AND
exclusion of related disordered such as thyroid, non-classical congenital adrenal hyperplasia, etc.
What is the Ferriman-gallwey score used for?
assessing hirsutism
defined by a score of >/=4-6 in 9 areas
for far-east asians: >/= to 3
elevated free testosterone is found in _____of woman with PCOS
70-80%
note: should measure total and free testosterone
elevated _____ is found in 25-65%
DHEA-S
if a patient meets clinical criteria for hyperandrogenism, do biochemical androgens need to be assessed?
no
note: biochemical androgens cannot be reliably assessed in people taking combined oral contraceptive pill (COCP) or 3 months after discontinuation
Rotterdam criteria suggests that PCOM cuttoff is ____?
at least 12 follicles (“cysts”) measuring 2-9mm in the whole ovary or ovarian size > 10ml
should thyroid dysfunction be routinely screened for routine exclusion?
yes may be limited value but it is common in reproductive age women
Test: TSH
define NCAH
non-congenital adrenal hyperplasia
a genetic disorder that causes deficiency of 21-hydroxylase enzyme function
causes androgen excess and can resemble PCOS
How to test for NCAH?
basal morning 17-OH-progesterone
define hypogonadotropic hypogonadism (HH) or functional hypothalamic amenorrhea
suppression of the hypothalamic-pituitary-ovary (HPO), results in suppressed GnRH so less FSH and LH secrention -> suppression of estrogen from ovaries
both estradiol (E2) and FSH should be low
