Polycystic ovarian syndrome Flashcards
What is PCOS?
Endocrine disorder
Characterised by excess androgen production and presence of multiple immature follicles within the ovaries
What percentage of women are affected by PCOS?
5-10%
What are the two most common hormonal abnormalities present in PCOS?
Excess LH
Insulin resistance
Where is LH produced?
Anterior pituitary gland
How is excess LH produced in PCOS?
Increased GnRH pulse frequency
What does LH stimulate?
Ovarian production of androgens
What does insulin resistance result in?
High levels of insulin secretion
What does high levels of insulin suppress
Suppresses hepatic production of sex hormone globulin, resulting in higher levels of free circulating androgens
Describe how cysts form in the ovaries in PCOS
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
List some risk factors for PCOS
Diabetes
Irregular menstruation
FH of PCOS
List the symptoms of PCOS
Varied clinical presentation Oligo/amenorrhoea Infertility Hirsutism Obesity Chronic pelvic pain Depression and other psychological symptoms
What features of PCOS might be seen on examination
Hirsutism Acne Acanthosis nigricans Male pattern hair loss Obesity Hypertension
What is acanthosis nigricans?
Darkened skin which occurs secondary to insulin resistance
What are some differentials for PCOS?
Hypothyroidism
Hyperprolactinaemia
Cushing’s disease
Which criteria is used in the UK to diagnose PCOS?
Rotterdam criteria
Describe the Rotterdam criteria
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
What blood tests may be ordered in PCOS investigation?
Testosterone SHBG LH FSH Progesterone TSH Prolactin Oral glucose tolerance test (especially if the woman has BMI>30)
Describe the blood test results in PCOS
Testosterone raised SHBG low LH raised FSH normal Progesterone Low
What imaging is required in PCOS?
Ultrasound
Describe the typical ultrasound findings of PCOS
Numerous peripheral ovarian follicles and/or ovarian volume >10cm^3
Describe the management of PCOS
Tailored to the woman’s individual symptoms and needs
Treat any underlying conditions such as diabetes or hypertension
What is given to help treat oligo/amenorrhoea in PCOS?
Induce at least 3 bleeds a year to protect the endometrium from hyperplasia
COCP
Dydrogesterone
What is Dydrogesterone and when is it used?
Progesterone analogue
Often used if the COCP is contraindicated
How is obesity treated in PCOS?
Achieve a BMI <30
Advise and encourage a healthy lifestyle including healthy diet and exercise - increases insulin sensitivity
Severe cases - orlistat (pancreatic lipase)
How can infertility be treated in PCOS?
Clomifene +/- metformin - help induce ovulation
Laparoscopic ovarian drilling
What is the risk of using Clomifene?
Risk multiple pregnancies, ovarian hyperstimulation syndrome and ovarian cancer
What is the maximum number of cycles that Clomifene can be safely used in?
6
How is hirsutism treated in PCOS?
Cosmetically and/or with anti-androgen medication
Name some anti-androgen medications used to treat hirsutism
Cyproterone
Spironolactone
Finasteride
Why should the anti-androgen medications be avoided in pregnancy?
Teratogenic
Name a topical cream used to reduce the growth rate of facial hair
Eflornithine
