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Reproductive Health > Polycystic ovarian syndrome > Flashcards

Polycystic ovarian syndrome Flashcards

1
Q

What is PCOS

A

Common condition causing metabolic and reproductive problems in women

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2
Q

Characteristic features of PCOS

A

Multiple ovarian cysts
Infertility
Oligomenorrhea
Hyperandrogenism
Insulin resistance

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3
Q

What is oligovulation

A

Irregular, infrequent menstrual periods

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4
Q

What is oligomenorrhea

A

Irregular, infrequent menstrual periods

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4
Q

What is oligomenorrhea

A

Irregular, infrequent menstrual periods

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5
Q

What is hirsutism

A

Growth of thick dark hair, often in a male pattern eg facial hair

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6
Q

What criteria is used for PCOS

A

Rotterdam

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7
Q

What is the Rotterdam criteria

A

At least 2 of:
Oligoovulation or anovulation - irregular or absent periods
Hyperandrogenism - hirsutism + acne
Polycsystic ovaries on US or ovarian volume >10cm3

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8
Q

Presentation of PCOS

A

Acne
Hirsutism
Hair loss in male pattern
Obesity
Infertility
Oligomenorrhea or amneorrhea

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9
Q

Other related features of PCOS not characterising

A

Insulin resistance and diabetes
Acanthosis nigricans
CVD
Hypercholesterolemia
Endometrial hyperplasia and cancer
Obstructive sleep apnoea
Depression and anxiwty
Sexual problems

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10
Q

What is acanthosis nigricans

A

Thickened rough skin found in axilla and on elbows, velvety texture w insulin resistance

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11
Q

Hirsutism differentials

A

Medications
Ovarian or adrenal tumours -> androgens
Cushings syndrome
Congenital adrenal hyperplasia

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12
Q

What medications can cause hirsutism

A

Phenytoin
Ciclosporin
Corticosteroids
Testosterone
Anabolic steroids

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13
Q

Why PCOS linked with insulin resistance

A

Insulin promotes androgen release and supresses sec hormone binding globulin (liver), further promoting hyperandrogenism
High insulin -> haltinng follicle development -> annovulation
Diet, exercise and weigh tloss help manage

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14
Q

Blood tests to diagnose PCOS and exclude other pathology

A

Testosterone
Sex hormone-binding globulin
Luteinising hormone
Follicle-stimulating hormone
Prolactin - mild elevation
TSH

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15
Q

Typical hormonal picture pCOS

A

Raised LH, LH:FSH ratio, testosterone, insulin
Normal or raised oestrogen

16
Q

What is gold standard for visualising ovaries

A

Transvaginal US

17
Q

Diagnostic criteria for PCOS on US

A

> 12 developing follicles in one ovary
Ovarian volume >10cm

18
Q

What is the screening test of choice for diabetes in patients with PCOS

A

2-hour 75g oral glucose tolerance test
Prior to breakfast

19
Q

What do results of OGTT signal

A
  • Impaired fasting glucose – fasting glucose of 6.1 – 6.9 mmol/l (before the glucose drink)
  • Impaired glucose tolerance – plasma glucose at 2 hours of 7.8 – 11.1 mmol/l
  • Diabetes – plasma glucose at 2 hours above 11.1 mmol/l
20
Q

What is important to reduce risk of in PCOS

A

Obesity
T2DM
hypercholesterolaemia
CVD

21
Q

How reduce risks ass with PCOS

A

Weight loss
low glycaemic index, calorie controlled diet
Exercise
Smoking cessation
AntiHPTN meds where required
Statins indicated (QRISK >10%)

22
Q

What should patients be assessed and managed for (ass features and complications of PCOS)

A
  • Endometrial hyperplasia and cancer
  • Infertility
  • Hirsutism
  • Acne
  • Obstructive sleep apnoea
  • Depression and anxiety
23
Q

What can weight loss do for PCOS

A

Ovulation - restore fertility and regular menstruation
Improve insulin resistance
Reduce hirsutism and reduce risks ass conditions

24
Q

What can prescribe for weight loss if women have BMI >30

A

Orlistat = lipase inhibitor stops absorption of fat in intestines

25
Q

What PCOS have risk factors for endometrial cancer

A

Obesity
Diabetes
Insulin resistance
Amenorrhea

26
Q

Why does PCOS increase risk of endometrial cnacer

A

No corpus luteum due to annovulation = oestrogen without progesterone eg unopposed

27
Q

How to reduce risk of endometrial cancer in PCOS

A

Mirena coil
Inducing a withdrawal bleed every 3-4 months with cyclical progesterons (medroxyprogesterone acetate)
COCP

28
Q

Specialist options for managing infertility

A

Clomifene
Laparascopic ovarian drilling
IVF
(Metformin and letrozole may restore ovulation under specialist, evidence unclear)

29
Q

What is laprascopic ovarian drilling

A

Surgeon punctures holes in ovaries using diathermy or laser therapy
Improve womans hormonal profile and result in regular ovulation and fertility

30
Q

What do pregnant women with PCOS need testing for

A

Gestational diabetes using OGTT
before pregnancy
24-28 weeks

31
Q

What COCP is used for hirsutism and acne

A

Co-cyprindiol (dianette)

32
Q

Pros and cons of co-cyprindiol

A

Licensed for hirsutism + acne
anti-androgenic effect - regulates periods
Significant increase VTE - stopped after 3 months of use

33
Q

What can be used for topical hirsutism on face

A

6-8 weeks to see significant improvement
Will return within two months of stopping use

34
Q

Options for hirsutism

A

Electrolysis
Laser hair removal
Spirinolactone - mineralcorticoid, anti-androgen effects
Finasteride - 5 alpha reductas inhibitor decreases testosterone production
Flutamide - non steroidal anti-androgen
Cyproterone acetate - anti-androgen and progestin

35
Q

What is first line for acne in PCOS

A

COCP - co-cyprindiol

36
Q

Other standard treatments for acne

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

Reproductive Health (69 decks)

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