Polycystic Ovarian Syndrome Flashcards
What is PCOS
oligomenorrhoea/amenorrhoea and hyperandrogenism
what is PCOS associated with
obesity, insulin resistance, T2DM, dyslipidaemia
what causes PCOS
environmental factors and genetic factors causing hormonal imbalances
what hormonal imbalances may be seen
hyperandrogenism, insulin resistance, raised LH and raised oestrogen
pathophysiology summarised
Hyperinsulinaemia results in increased ovarian androgen synthesis and reduced hepatic sex hormone binding globulin (SHBG) synthesis
This leads to an increase in free androgens (which gives rise to the symptoms)
what is PCOS the most common cause of
infertility
affects 1/3 of women
what are some presenting symptoms of PCOS
oligomennhorea,
subfertility,
acne,
hirsuitism,
mood swings/ depression/ anxiety
male pattern hair loss
due to insulin resistance what will be seen on examination
acanthosis nigricans
a skin condition that causes a dark discoloration in body folds and creases
what investigations will be done for PCOS
bloods; high LH, high LH:FSH ratio, high testosterone, low SHBG (sex-hormone binding globulin)
what else will you look for in bloods
hyperprolactinaemia, hypo/hyperthyroidism
congenital adrenal hyperplasia (17-hydroxyprogesterone levels)
cushings syndrome
T2DM- fasting blood glucose and HbA1c
fasting lipid profile
what type of ultrasound will be done and what will be seen
transvaginal USS; look for ovarian follicles and an increased ovarian volume
what syndromes/ diseases will need to be investigated/ ruled out
cushings syndrome (24 hour cortisol)
hypo/hyperthyroidism
hyperprolactinaemia
congenital adrenal hyperplasia (17-hydroxyprogesterone)
what diagnostic criteria is used to diagnose PCOS
rotterdam diagnostic criteria;
if 2 of following are present:
Polycystic ovaries (>12 cysts seen on imaging or ovarian volume >10 cubic cm)
Oligo-/anovulation
Clinical or biochemical features of hyperandrogenism
how to manage PCOS
manage the symptoms
general advice; weight loss and exercise
management of PCOS in women that desire fertility
clomiphene; induces ovulation and improves conception
metformin
ovarian drilling
gonadotrophins
