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Obstetrics and gynaecology > Polycystic ovarian syndrome > Flashcards

Polycystic ovarian syndrome Flashcards

1
Q

What is PCOS?

A

Endocrine disorder

Characterised by excess androgen production and presence of multiple immature follicles within the ovaries

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2
Q

What percentage of women are affected by PCOS?

A

5-10%

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3
Q

What are the two most common hormonal abnormalities present in PCOS?

A

Excess LH

Insulin resistance

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4
Q

Where is LH produced?

A

Anterior pituitary gland

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5
Q

How is excess LH produced in PCOS?

A

Increased GnRH pulse frequency

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6
Q

What does LH stimulate?

A

Ovarian production of androgens

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7
Q

What does insulin resistance result in?

A

High levels of insulin secretion

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8
Q

What does high levels of insulin suppress

A

Suppresses hepatic production of sex hormone globulin, resulting in higher levels of free circulating androgens

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9
Q

Describe how cysts form in the ovaries in PCOS

A

High levels of LH, increased circulating androgens suppress the LH surge
Follicles develop within the ovary but are arrested at an early stage and remain visible as cysts within the ovary

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10
Q

List some risk factors for PCOS

A

Diabetes
Irregular menstruation
FH of PCOS

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11
Q

List the symptoms of PCOS

A 
Varied clinical presentation
Oligo/amenorrhoea 
Infertility 
Hirsutism 
Obesity 
Chronic pelvic pain 
Depression and other psychological symptoms
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12
Q

What features of PCOS might be seen on examination

A 
Hirsutism
Acne
Acanthosis nigricans 
Male pattern hair loss
Obesity 
Hypertension
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13
Q

What is acanthosis nigricans?

A

Darkened skin which occurs secondary to insulin resistance

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14
Q

What are some differentials for PCOS?

A

Hypothyroidism
Hyperprolactinaemia
Cushing’s disease

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15
Q

Which criteria is used in the UK to diagnose PCOS?

A

Rotterdam criteria

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16
Q

Describe the Rotterdam criteria

A

Gives a diagnosis of PCOS if 2 out of 3 criteria are met:

  • Oligo and/or anovulation
  • Clinical and/or biochemical signs of hyperandrogenism
  • Polycystic ovaries on imaging
17
Q

What blood tests may be ordered in PCOS investigation?

A 
Testosterone
SHBG
LH
FSH
Progesterone 
TSH 
Prolactin 
Oral glucose tolerance test (especially if the woman has BMI>30)
18
Q

Describe the blood test results in PCOS

A 
Testosterone raised 
SHBG low
LH raised
FSH normal 
Progesterone Low
19
Q

What imaging is required in PCOS?

A

Ultrasound

20
Q

Describe the typical ultrasound findings of PCOS

A

Numerous peripheral ovarian follicles and/or ovarian volume >10cm^3

21
Q

Describe the management of PCOS

A

Tailored to the woman’s individual symptoms and needs

Treat any underlying conditions such as diabetes or hypertension

22
Q

What is given to help treat oligo/amenorrhoea in PCOS?

A

Induce at least 3 bleeds a year to protect the endometrium from hyperplasia
COCP
Dydrogesterone

23
Q

What is Dydrogesterone and when is it used?

A

Progesterone analogue

Often used if the COCP is contraindicated

24
Q

How is obesity treated in PCOS?

A

Achieve a BMI <30
Advise and encourage a healthy lifestyle including healthy diet and exercise - increases insulin sensitivity
Severe cases - orlistat (pancreatic lipase)

25
Q

How can infertility be treated in PCOS?

A

Clomifene +/- metformin - help induce ovulation

Laparoscopic ovarian drilling

26
Q

What is the risk of using Clomifene?

A

Risk multiple pregnancies, ovarian hyperstimulation syndrome and ovarian cancer

27
Q

What is the maximum number of cycles that Clomifene can be safely used in?

A

6

28
Q

How is hirsutism treated in PCOS?

A

Cosmetically and/or with anti-androgen medication

29
Q

Name some anti-androgen medications used to treat hirsutism

A

Cyproterone
Spironolactone
Finasteride

30
Q

Why should the anti-androgen medications be avoided in pregnancy?

A

Teratogenic

31
Q

Name a topical cream used to reduce the growth rate of facial hair

A

Eflornithine

Obstetrics and gynaecology (67 decks)

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