PMS, PCOS

Question 1

Classification of PMS

Answer 1

Mild: not annoying
Mod: no interference with function
Sev: interference with function (PMDD)

Question 2

PMS dxt

Answer 2

Clinical
Can do TFT, FBC, electrolytes, creatinine, FSH, oestradiol

Question 3

Mx of PMS

Answer 3

1. First line: CBT, exercise, dietary advice
2. CHC - EE and Drospirinone
3. SSRI - Fluoxetine/Sertraline 14days before menstruation

Question 4

**PCOS

Answer 4

1. > 12cysts/ovary
2. Obese, Inc testosterone, dec estrogen,
3. FSH/LH = 1/3 (normal = 3/1)
4. Best: Sr testosterone**
5. Rx: (for infertility <35yrs)
   Obese - diet, wt loss x6months.. tabs
   Metformin - obesity and DM Drospirinone/ciproterone acetate - acne, hirsutism

> 35yrs for infertility, directly start clomefine citrate&raquo_space; metformin
If not working - Gonadotropins

Question 5

Diagnostic criteria for PCOS

Answer 5

Two of the following three criteria are required:

1. oligo/anovulation
2. hyperandrogenism
   clinical (hirsutism or less commonly male pattern alopecia) or biochemical (raised FAI or free testosterone)
3. polycystic ovaries on ultrasound