Polycystic ovarian syndrome Flashcards
What is PCOS
Common condition causing metabolic and reproductive problems in women
Characteristic features of PCOS
Multiple ovarian cysts
Infertility
Oligomenorrhea
Hyperandrogenism
Insulin resistance
What is oligovulation
Irregular, infrequent menstrual periods
What is oligomenorrhea
Irregular, infrequent menstrual periods
What is oligomenorrhea
Irregular, infrequent menstrual periods
What is hirsutism
Growth of thick dark hair, often in a male pattern eg facial hair
What criteria is used for PCOS
Rotterdam
What is the Rotterdam criteria
At least 2 of:
Oligoovulation or anovulation - irregular or absent periods
Hyperandrogenism - hirsutism + acne
Polycsystic ovaries on US or ovarian volume >10cm3
Presentation of PCOS
Acne
Hirsutism
Hair loss in male pattern
Obesity
Infertility
Oligomenorrhea or amneorrhea
Other related features of PCOS not characterising
Insulin resistance and diabetes
Acanthosis nigricans
CVD
Hypercholesterolemia
Endometrial hyperplasia and cancer
Obstructive sleep apnoea
Depression and anxiwty
Sexual problems
What is acanthosis nigricans
Thickened rough skin found in axilla and on elbows, velvety texture w insulin resistance
Hirsutism differentials
Medications
Ovarian or adrenal tumours -> androgens
Cushings syndrome
Congenital adrenal hyperplasia
What medications can cause hirsutism
Phenytoin
Ciclosporin
Corticosteroids
Testosterone
Anabolic steroids
Why PCOS linked with insulin resistance
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
Blood tests to diagnose PCOS and exclude other pathology
Testosterone
Sex hormone-binding globulin
Luteinising hormone
Follicle-stimulating hormone
Prolactin - mild elevation
TSH
Typical hormonal picture pCOS
Raised LH, LH:FSH ratio, testosterone, insulin
Normal or raised oestrogen
What is gold standard for visualising ovaries
Transvaginal US
Diagnostic criteria for PCOS on US
> 12 developing follicles in one ovary
Ovarian volume >10cm
What is the screening test of choice for diabetes in patients with PCOS
2-hour 75g oral glucose tolerance test
Prior to breakfast
What do results of OGTT signal
- 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
What is important to reduce risk of in PCOS
Obesity
T2DM
hypercholesterolaemia
CVD
How reduce risks ass with PCOS
Weight loss
low glycaemic index, calorie controlled diet
Exercise
Smoking cessation
AntiHPTN meds where required
Statins indicated (QRISK >10%)
What should patients be assessed and managed for (ass features and complications of PCOS)
- Endometrial hyperplasia and cancer
- Infertility
- Hirsutism
- Acne
- Obstructive sleep apnoea
- Depression and anxiety
What can weight loss do for PCOS
Ovulation - restore fertility and regular menstruation
Improve insulin resistance
Reduce hirsutism and reduce risks ass conditions
What can prescribe for weight loss if women have BMI >30
Orlistat = lipase inhibitor stops absorption of fat in intestines
What PCOS have risk factors for endometrial cancer
Obesity
Diabetes
Insulin resistance
Amenorrhea
Why does PCOS increase risk of endometrial cnacer
No corpus luteum due to annovulation = oestrogen without progesterone eg unopposed
How to reduce risk of endometrial cancer in PCOS
Mirena coil
Inducing a withdrawal bleed every 3-4 months with cyclical progesterons (medroxyprogesterone acetate)
COCP
Specialist options for managing infertility
Clomifene
Laparascopic ovarian drilling
IVF
(Metformin and letrozole may restore ovulation under specialist, evidence unclear)
What is laprascopic ovarian drilling
Surgeon punctures holes in ovaries using diathermy or laser therapy
Improve womans hormonal profile and result in regular ovulation and fertility
What do pregnant women with PCOS need testing for
Gestational diabetes using OGTT
before pregnancy
24-28 weeks
What COCP is used for hirsutism and acne
Co-cyprindiol (dianette)
Pros and cons of co-cyprindiol
Licensed for hirsutism + acne
anti-androgenic effect - regulates periods
Significant increase VTE - stopped after 3 months of use
What can be used for topical hirsutism on face
6-8 weeks to see significant improvement
Will return within two months of stopping use
Options for hirsutism
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
What is first line for acne in PCOS
COCP - co-cyprindiol
Other standard treatments for acne
- Topical adapalene (a retinoid)
- Topical antibiotics (e.g. clindamycin 1% with benzoyl peroxide 5%)
- Topical azelaic acid 20%
- Oral tetracycline antibiotics (e.g. lymecycline)
