PCOS- Polycystic Ovarian Syndrome Flashcards
What is the name given to the triad of features described in the patient of PCOS?
Rotterdam’s Criteria
What does the Rotterdam criteria consist of ?
-oligo- or anovulation (always had very irregular periods)
-hyperandrogenism defined either clinically or biochemical
( active acne as well as evidence of scarring on her face)
-polycystic ovaries on ultrasound
(multiple cysts on both ovaries)
How many criteria’s of the Rotterdam Criteria do you need to match in order to make a formal diagnose of PCOS?
2/3
A 34-year-old woman has oligomenorrhoea with only 1-2 menstrual periods a year. She also has mild acne and hirsutism. Her pelvic ultrasound scan confirms the appearance of polycystic ovaries, with normal endometrial thickness. She is sexually active and is not using any regular contraception, but does not wish to get pregnant for another 3 years. Her body mass index (BMI) is 37 kg/m2. Her HbA1c is normal.
What would you offer to the ptx?
Levonorgestrel-releasing intrauterine system
The main symptom of concern in this scenario is oligomenorrhoea. So COC and LNG-IUS are indicated.
But since BMI exceeds 35, the risks of using COC outweigh the benefits (UK Medical Eligibility Criteria category 3).
Cyclical oral progestogen (unlike continuous oral progestogen) does not provide contraceptive cover.
The LNG-IUS would be most suitable as it provides long-term contraception while also preventing uncontrolled endometrial proliferation.
A 28-year-old woman has troublesome hirsutism affecting her face, upper arms and chest. It is affecting her self-esteem and she is keen on further treatment for this symptom. She also has irregular menstrual cycles which vary between 19 and 45 days in length. She has no other medical problems and does not smoke. She has a BMI of 29 kg/m2 and blood pressure of 136/88 mmHg. Her HbA1c is normal. She does not wish to get pregnant at this time.
What would you offer to the ptx?
Combined oral contraceptive
COC would be appropriate in this patient in managing both her symptoms of hyperandrogenism and irregular periods. She does not appear to have any contraindications to this drug.
BMI is less than 35!
A 35-year-old woman has irregular periods, acne and hirsutism. She has also been trying to conceive with her partner for 6 months but has been unsuccessful. A pelvic ultrasound scan has confirmed the presence of polycystic ovaries. She has tried losing weight and her current BMI is 28 kg/m2. Her HbA1c is normal.
Referral to fertility services
What are the most appropriate investigations for this patient with PCOS?
Pelvic ultrasound, FSH, LH, TSH, prolactin, testosterone, SHBG
Hyperandrogenism;
Oligo-/ anovulation;
Cystic morphology on USS.
Rotterdam’s criteria
What’s Oligomenorrhea
Oligomenorrhea is a type of abnormal menstruation that involves infrequent periods. (IRREGULAR PERIOD)
