Polycystic Ovarian Syndrome

Question 1

Polycystic Ovarian Syndrome Overview

Answer 1

Insulin resistance and hyperinsulinaemia drive ovarian androgen production and suppress sex-hormone binding globulin, leading to greater bioavailability of androgens.
Diagnosis via Rotterdam criteria - At least 2 features of the following
- History of oligo/anovulation
- Hyperandrogenism - Clinical through hirsutism/acne/male-pattern alopecia or biochemical (raised FAI or free testosterone,)
- Polycystic ovaries on US
- Note: Up to 70% of young women will have polycystic ovaries on US.
- Number of follicles counted. Not number of cysts
- >= 12 follicles measuring 2-9mm indicative of US-evidence of polycystic ovaries.

Question 2

Management of PCOS

Answer 2

COCP
- Contraindicated? Consider mirena
Metformin to improve insulin resistance
Weight control, aim BMI < 25
Smoking cessation
Exercise for 30minutes per exercise day
Screening for diabetes - OGTT 3-yearly
- Menorrhagia?
- Medroxyprogesterone 5-10mg PO OD for 12 days each calendar month
- Norethisterone 5mg PO OD for 12 days of calendar month
- Progesterone 200-300mg PO OD for 12 days of calendar monthy.

Question 3

Complications of PCOS

Answer 3

• Subfertility
• Diabetes (Initial OGTT recommended then screen every 1-3 years)
• Cardiovascular disease
• Depression / Anxiety / Disordered eating
• Sleep apnoea
• Metabolic Associated Fatty Liver Disease