PCOS - Chen

Question 1

PCOS symptoms

Answer 1

hirsutism
acne
alopecia
oligomenorrhea

Question 2

Causes of PCOS

Answer 2

inappropriate gonadotropin secretion
insulin resistance
excess androgen production

Question 3

Inappropriate Gonadotropin secretion

Answer 3

causes early LH pulse in menstrual cycle
no dominant follicle develops
no FSH rise
luteal phase not entered

Question 4

Insulin Resistance in PCOS

Answer 4

defect in ovarian receptor
hyperandrogenism
SHBG synthesis inhibited
higher free testosterone levels

Question 5

Non-Pharm Treatment

Answer 5

First line
weight loss
exercise

Question 6

COC therapy

Answer 6

1st line for hirsutism and acne
estrogen suppresses the LH surge
norgest and noreth progest preferred
monophasics most common

Question 7

spironolactone

Answer 7

2nd line
block androgenic effects on follicle
add after 6 months on COC if little improvement

Question 8

5 alpha reductase inhibitor

Answer 8

finasteride and dutasteride
prevent testosterone from converting to DHT
3rd line for severe hirsutism

Question 9

Metformin

Answer 9

1st line for glucose issues after non-pharm
2nd line for menstrual irregularity
decrease insulin and androgen in ovary

Question 10

Clommiphene

Answer 10

for anovulation

take for 5 days starting 2-5 days after onset of menses

Question 11

letrozole

Answer 11

aromatase inhibitor

not FDA approved for infertility, but better outcomes than clomiphene