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Gynaecology > Polycystic Ovarian Syndrome > Flashcards

Polycystic Ovarian Syndrome Flashcards

1
Q

What are the characteristic feature of PCOS?

A
  1. Multiple ovarian cysts
  2. Infertility
  3. Oligomenoorhoea
  4. Hyperandrogenism
  5. Insulin resistance
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2
Q

What is anovulation?

A

Absence of ovulation

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3
Q

What is oligoovulation?

A

Irregular, infrequent ovulation

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4
Q

What criteria is used for making a diagnosis of PCOS?

A

Rotterdam Criteria.

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5
Q

Outline the Rotterdam Criteria triad.

A

PCOS diagnosis requires at least two of three key features:

  1. Oligoovulation or anovulation (presenting with irregular or absent periods)
  2. Hyperandrogenism (hirsutism and acne)
  3. Polycystic ovaries on ultrasound (or ovarian volume of more than 10cm3)
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6
Q

In addition to classic PCOS feature, what are some other features and complications of PCOS?

A

Insulin resistance and diabetes

Acanthosis nigricans

Cardiovascular disease

Hypercholesterolaemia

Endometrial hyperplasia and
cancer

Obstructive sleep apnoea

Depression and anxiety

Sexual problems

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7
Q

What is acanthosis nigricans?

A

Thickened, rough skin, typically found in axilla and on elbows.

Velvety texture.

Occurs with insulin resistance.

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8
Q

List 4 key differentials for hirsutism.

A
  1. Medications
  2. Ovarian or adrenal tumours that secrete androgens
  3. Cushing’s syndrome
  4. Congenital adrenal hyperplasia
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9
Q

What medications can cause hirsutism (5)?

A
  1. Phenytoin
  2. Ciclosporin
  3. Corticosteroids
  4. Testosterone
  5. Anabolic steroids
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10
Q

What blood tests should be performed to diagnose PCOS and exclude other pathology?

A
  1. Testosterone
  2. Sex hormone-binding globulin
  3. LH
  4. FSH
  5. Prolactin (may be mildly elevated)
  6. TSH
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11
Q

What do hormonal tests usually shown in PCOS?

A

Raised luteinising hormone

Raised LH to FSH ratio (high LH compared with FSH)

Raised testosterone

Raised insulin

Normal or raised oestrogen levels

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12
Q

What is the gold standard for visualising the ovaries?

A

Transvaginal ultrasound

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13
Q

How might follicles appear in PCOS on ultrasound and what degree constitutes PCOS?

A

Arranged around the periphery of the ovary, giving a “string of pearls” appearance.

The diagnostic criteria are either:

  1. 12 or more developing follicles in one ovary
  2. Ovarian volume of more than 10cm3
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14
Q

What screening test is required for patients with PCOS?

A

2- hour 75g oral glucose tolerance test

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15
Q

What constitutes an impaired fasting glucose?

A

Fasting glucose 6.1-6.9 mmol/l (before glucose drink)

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16
Q

What constitutes an impaired glucose tolerance?

A

Plasma glucose at 2 hours of 7.8-11.1 mmol/l

17
Q

What constitutes diabetes on a OGTT?

A

Plasma glucose at 2 hours above 11.1 mmol/l

18
Q

What is a significant lifestyle change that can improve PCOS?

A

Weight loss

19
Q

What can be used to help weight loss in women with PCOS with BMI 30+?

A

Orlistat

20
Q

What is orlistat?

A

Lipase inhibitor that stops absorption of fat in intestines

21
Q

Name 4 risk factors for endometrial cancer women with PCOS have.

A
  1. Obesity
  2. Diabetes
  3. Insulin resistance
  4. Amenorrhoea
22
Q

What gap between periods should be investigated in women with PCOS?

A

More than 3 months needs investigating with pelvic ultrasound

23
Q

What is needed prior to an ultrasound to investigate potential endometrial cancer?

A

Cyclical progestogens to induce a period

24
Q

What endometrial thickness is biopsied?

A

> 10mm

25
Q

After weight loss, what are potential options to manage infertility in PCOS (by specialist)?

A
  1. Clomifene
  2. Laparoscopic ovarian drilling
  3. IVF
  4. ? Metformin and letrozole
26
Q

Women with PCOS who become pregnant need what screening?

A

Gestational diabetes

OGTT performed pre-pregnancy and at 24-28 weeks

27
Q

What COCP is licensed for the treatment of hirsutism and acne? Why is it beneficial?

A

Co-cyprindiol (Dianette)

Has anti-androgenic effects

28
Q

What is the downside of co-cyprindiol?

A

Significantly increased risk of venous thromboembolism.

Due to this, it is usually stopped after 3 months of use.

29
Q

What can be used topically to treat facial hirrsutism?

A

Topical eflornithine (hirsutism will return 2 months after stopping)

30
Q

How long does topical eflorithine take to work?

A

6-8 weeks

31
Q

If weight loss, co-cyprindiol, and topical elfornithine fail to help hirsutism, what are other options?

A

C1. Electrolysis

  1. Laser hair removal
  2. Spironolactone (mineralocorticoid antagonist with anti-androgen effects)
  3. Finasteride (5α-reductase inhibitor that decreases testosterone production)
  4. Flutamide (non-steroidal anti-androgen)
  5. Cyproterone acetate (anti-androgen and progestin)
32
Q

What is the first-line for acne in PCOS?

A

COCP.

Co-cyprindiol may be the best option as it has anti-androgen effects; however, there is a significantly increased risk of venous thromboembolism.

33
Q

Other than the COCP, what are other standard treatments for acne?

A
  1. Topical adapalene (a retinoid)
  2. Topical antibiotics (e.g. clindamycin 1% with benzoyl peroxide 5%)
  3. Topical azelaic acid 20%
  4. Oral tetracycline antibiotics (e.g. lymecycline)

Gynaecology (25 decks)

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