Polycystic Ovarian Syndrome

Question 1

What is polycystic ovarian syndrome (PCOS)?

Answer 1

It is defined as a condition in which there is ovarian dysfunction, resulting in the formation of multiple ovarian cysts

Question 2

What are ovarian cysts?

Answer 2

They are defined as immature follicles arrested in their ovulation phase

Question 3

What is the most common endocrine disorder affecting women of a reproductive age?

Answer 3

Polycystic ovarian syndrome

Question 4

Describe the pathophysiology of polcystic ovarian syndrome

Answer 4

There is increased androgen production, which is either due to increased luteinising hormone production or hyperinsulinemia/insulin resistance

Question 5

What four risk factors are associated with polycystic ovarian syndrome?

Answer 5

Family History

Premature Adrenarche

Diabetes Mellitus

Obesity

Question 6

What is premature adrenarche?

Answer 6

It is defined as early onset of pubic hair

Question 7

What is the inheritance of polycystic ovarian syndrome?

Answer 7

Autosomal Dominant

Question 8

What are the nine clinical features of polycystic ovarian syndrome?

Answer 8

Oligomenorrhoea

Amenorrhoea

Subfertility

Hirsutism

Acne Vulgaris

Acanthosis Nigricans

Low Mood

Weight Gain

Hypertension

Question 9

What are the two clinical features of hyperandrogenism in polycystic ovarian syndrome?

Answer 9

Hirsutism

Acne Vulgaris

Question 10

What is the most common clinical feature of polycystic ovarian syndrome?

Answer 10

Hirstuism

Question 11

What is hirsutism?

Answer 11

It is defined as excessive hair growth, which tends to affect the face, chest and back

Question 12

What is acanthosis nigricans?

Answer 12

It is defined as a dermatology condition in which there is dark discoloration in the body folds and creases

Question 13

What two investigations are used to diagnose polycystic ovarian syndrome?

Answer 13

Blood Tests

Pelvic Ultrasound Scan

Question 14

What eight blood test results indicate polycystic ovarian syndrome?

Answer 14

Increased Testosterone Levels

Normal/Decreased SHBG Levels

Increased Testosterone: SHBG

Increased LH Levels

Normal FSH Levels

Increased LH: FSH > 3

Normal/Increased Prolactin Levels

Increased Glucose Levels

Question 15

What are the three features of polycystic ovarian syndrome on pelvic ultrasound scans?

Answer 15

Ovarian Follicles > 12

Ovarian Volume > 10cm3

String of Pearls Appearance

Question 16

What is the string of pears appearance?

Answer 16

It is defined as the arrangement of follicles around the periphery of the ovary

Question 17

What diagnostic criteria is used in polycystic ovarian syndrome?

Answer 17

Rotterdam Criteria

Question 18

What is the Rotterdam criteria of polycystic ovarian syndrome?

Answer 18

It states that a diagnosis of polycystic ovarian syndrome can be obtained in cases when individuals meet two of the three following criteria…

• Oligomenorrhea/Amenorrhea Features
• Clinical/Biochemical Hyperandrogenism Evidence
• Positive Ultrasound Result

Question 19

Do we need to conduct investigations in order to obtain a diagnosis of polycystic ovarian syndrome? Explain

Answer 19

No

This is due to the fact that two of the Rotterdam criteria can be obtained clinically

Question 20

What are the five general aims of polycystic ovarian syndrome management?

Answer 20

Menstrual Restoration

Fertility Restoration

Endometrial Hyperplasia Prevention

Diabetes Mellitus Prevention

Acne/Hirsutism Management

Question 21

What are the six conservative management options of polycystic ovarian syndrome?

Answer 21

Regular Exercise

Healthy Diet

Weight Loss

Hair Shaving

Hair Waxing

Hair Electrolysis

Question 22

What are the five pharmacological management options of polycystic ovarian syndrome?

Answer 22

Combined Oral Contraceptive Pill

Clomiphene

Metformin

Orlistat

Eflornithine Hydrochloride

Question 23

How is the combined oral contraceptive pill used to manage polycystic ovarian syndrome?

Answer 23

It is used to restore regular menstruation, reduce risk of endometrial hyperplasia and reduce hyperandrogenism effects

Question 24

What should be administered when the combined oral contraceptive pill is contraindicated due to BMI > 35?

Answer 24

Levonorgestrel Intrauterine System

Question 25

How is clomiphene used to manage polycystic ovarian syndrome?

Answer 25

It is used to promote fertility, induce ovulation and increase pregnancy rates

Question 26

What are the two side effects of clomiphene?

Answer 26

Multiple Pregnancies

Ovarian Hyperstimulation Syndrome

Question 27

How is metformin used to manage polycystic ovarian syndrome?

Answer 27

It is used to reduce insulin resistance, therefore promoting regular menstruation and increasing fertility

Question 28

When is orlistat used to manage polycystic ovarian syndrome?

Answer 28

It is used to assist with weight loss, when conservative management options fail

Question 29

How is eflornithine hydrochloride used to manage polycystic ovarian syndrome?

Answer 29

It is used to reduce unwanted facial hair

Question 30

What is a risk of in vitro fertilisation (IVF) in polycystic ovarian syndrome?

Answer 30

Ovarian Hyperstimulation Syndrome

Question 31

What are the seven complications associated with polycystic ovarian syndrome?

Answer 31

Infertility

Gestational Diabetes

Pre-Eclampsia

Endometrial Hyperplasia

Endometrial Cancer

Type Two Diabetes Mellitus

Cardiovascular Disease