PCOS (Polycystic Ovarian Syndrome)

Question 1

Describe Polycystic Ovarian Syndrome (PCOS).

Answer 1

• Condition of androgen excess
• Common, complex GYN endocrinopathy
• Affects 6% - 20% of women
• Linked to insulin resistance/insensitivity (50% - 70%)

Question 2

What are the signs and symptoms of PCOS (Polycystic Ovarian Syndrome)?

Answer 2

• Oligomenorrhea (irregular menses)
• Amenorrhea
• AUB (Abnormal Uterine Bleeding)
• Hyperandrogenism
• Acne
• Hirsutism
• Cystic ovaries
• Infertility
• Mood/mental health problems

Question 3

How is PCOS (polycystic ovarian syndrome) diagnosed?

Answer 3

PCOS is a clinical diagnosis* using the Rotterdam Criteria (2 of 3):

• Oligomenorrhea (irregular menses)
• Hyperandrogenism
• Cystic ovaries

Optional: Ultrasound may confirm diagnosis, but this is optional.

Question 4

What are the potential risks/complications of PCOS (polycystic ovarian syndrome)?

Answer 4

• Endometrial cancer
• Infertility
• Diabetes
• Metabolic Syndrome
• Obesity (indépendant risk factor)
• Cardiovascular disease
• Hyperlipidemia
• Mental health challenges

Other/less significant:
- Anemia
- Iron overload
- GI microbiome
- Thyroid
- Vitamin D deficiency
- Low sex hormone-binding globulin (SHGB)

Question 6

What are the potential risks and complications of PCOS (polycystic ovarian syndrome)?

Answer 6

• Endometrial cancer
• Infertility
• Diabetes
• Metabolic syndrome
• Obesity (this is an independent risk factor)
• Cardiovascular disease
• Hyperlipidemia
• Mental health challenges

Other:
- Anemia
- Iron overload
- GI microbiome
- Thyroid
- Vitamin D

Question 7

When working up a patient with PCOS (polycystic ovarian syndrome) or suspected PCOS, what labs should be ordered and why (to rule out what condition or complication)?

Answer 7

Labs/Diagnostic Tests/Etc…….Rationale/Rule Out

• Weight/BMI>30/ …………………Obesity/
  Waist>35” Metabolic Syndrome
• BP……………………………………….HTN
• hCG…………………………………….Pregnancy
• CBC……………………………..Anemia (iron overload)
• TSH…………………………………….Hypothyroid
  (abnormalities mimic/worsen PCOS)
• Ultrasound (optional)………….PCOS
  confirmation
• Lipid panel……………………………..Abnormal lipids
• Oral GTT (most sensitive)………..Diabetes
• FBS/Random glucose/A1C≥6.4…Diabetes
• 17-Hydroxyprogesterone………..Nonclassical
  Congenital
  Adrenal Hyperplasia
• Prolactin (3-27ng/ml)………………..Prolactinemia
  (if H/A, vision changes or
  galactorrhea)
  (may be abnormal in PCOS)
• Total Testosterone
  (PCOS≥60, tumor > 150-200)
  -and-
• Free T (PCOS = 2% - 3%)……………Virilizing
  tumor
  (if rapid onset or
  increase in s/s)

Question 8

When working up a patient with PCOS (polycystic ovarian syndrome) or suspected PCOS, what labs should NOT be ordered and why?

Answer 8

LH/FSH

It’s an expensive test that is nonspecific for PCOS

Question 9

Should patients diagnosed with PCOS (polycystic ovarian syndrome) be referred and should they pursue pregnancy? Why/why not?

Answer 9

*Referred EARLY and
*Encourage EARLY pregnancy (< 35 years) due to the following risks:

• Infertility (40% cases are r/t PCOS)
• Spontaneous abortion (25% - 73% risk)
• Gestational Diabetes (3x risk)
• Preeclampsia/HTN

Question 10

What pharmaceutical treatment should be considered for patients with PCOS (polycystic ovarian syndrome)?

Answer 10

Based on labs and individual s/s, consider:

• CHC (combination hormonal contraception) to increase SHBG (sex hormone-binding globulin):
  - decrease testosterone
  - decrease s/s of PCOS
• Metformin:
  - to improve insulin sensitivity

Question 11

What lifestyle changes should be recommended for patients with PCOS (polycystic ovarian syndrome)?

Answer 11

• Weight loss (>5%)
• Exercise
• Stress reduction/mental health
• Nutrition:
  - complex carbs
  - low glycemic index
  - high protein