Polycystic Ovarian Syndrome Flashcards
What is polycystic ovarian syndrome (PCOS)?
It is defined as a condition in which there is ovarian dysfunction, resulting in the formation of multiple ovarian cysts
What are ovarian cysts?
They are defined as immature follicles arrested in their ovulation phase
What is the most common endocrine disorder affecting women of a reproductive age?
Polycystic ovarian syndrome
Describe the pathophysiology of polcystic ovarian syndrome
There is increased androgen production, which is either due to increased luteinising hormone production or hyperinsulinemia/insulin resistance
What four risk factors are associated with polycystic ovarian syndrome?
Family History
Premature Adrenarche
Diabetes Mellitus
Obesity
What is premature adrenarche?
It is defined as early onset of pubic hair
What is the inheritance of polycystic ovarian syndrome?
Autosomal Dominant
What are the nine clinical features of polycystic ovarian syndrome?
Oligomenorrhoea
Amenorrhoea
Subfertility
Hirsutism
Acne Vulgaris
Acanthosis Nigricans
Low Mood
Weight Gain
Hypertension
What are the two clinical features of hyperandrogenism in polycystic ovarian syndrome?
Hirsutism
Acne Vulgaris
What is the most common clinical feature of polycystic ovarian syndrome?
Hirstuism
What is hirsutism?
It is defined as excessive hair growth, which tends to affect the face, chest and back
What is acanthosis nigricans?
It is defined as a dermatology condition in which there is dark discoloration in the body folds and creases
What two investigations are used to diagnose polycystic ovarian syndrome?
Blood Tests
Pelvic Ultrasound Scan
What eight blood test results indicate polycystic ovarian syndrome?
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
What are the three features of polycystic ovarian syndrome on pelvic ultrasound scans?
Ovarian Follicles > 12
Ovarian Volume > 10cm3
String of Pearls Appearance
What is the string of pears appearance?
It is defined as the arrangement of follicles around the periphery of the ovary
What diagnostic criteria is used in polycystic ovarian syndrome?
Rotterdam Criteria
What is the Rotterdam criteria of polycystic ovarian syndrome?
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
Do we need to conduct investigations in order to obtain a diagnosis of polycystic ovarian syndrome? Explain
No
This is due to the fact that two of the Rotterdam criteria can be obtained clinically
What are the five general aims of polycystic ovarian syndrome management?
Menstrual Restoration
Fertility Restoration
Endometrial Hyperplasia Prevention
Diabetes Mellitus Prevention
Acne/Hirsutism Management
What are the six conservative management options of polycystic ovarian syndrome?
Regular Exercise
Healthy Diet
Weight Loss
Hair Shaving
Hair Waxing
Hair Electrolysis
What are the five pharmacological management options of polycystic ovarian syndrome?
Combined Oral Contraceptive Pill
Clomiphene
Metformin
Orlistat
Eflornithine Hydrochloride
How is the combined oral contraceptive pill used to manage polycystic ovarian syndrome?
It is used to restore regular menstruation, reduce risk of endometrial hyperplasia and reduce hyperandrogenism effects
What should be administered when the combined oral contraceptive pill is contraindicated due to BMI > 35?
Levonorgestrel Intrauterine System
How is clomiphene used to manage polycystic ovarian syndrome?
It is used to promote fertility, induce ovulation and increase pregnancy rates
What are the two side effects of clomiphene?
Multiple Pregnancies
Ovarian Hyperstimulation Syndrome
How is metformin used to manage polycystic ovarian syndrome?
It is used to reduce insulin resistance, therefore promoting regular menstruation and increasing fertility
When is orlistat used to manage polycystic ovarian syndrome?
It is used to assist with weight loss, when conservative management options fail
How is eflornithine hydrochloride used to manage polycystic ovarian syndrome?
It is used to reduce unwanted facial hair
What is a risk of in vitro fertilisation (IVF) in polycystic ovarian syndrome?
Ovarian Hyperstimulation Syndrome
What are the seven complications associated with polycystic ovarian syndrome?
Infertility
Gestational Diabetes
Pre-Eclampsia
Endometrial Hyperplasia
Endometrial Cancer
Type Two Diabetes Mellitus
Cardiovascular Disease
