Polycystic Ovarian Syndrome

Question 1

Define polycystic ovarian syndrome

Answer 1

Rotterdam criteria (2003)
1. PCO on US
2. Irregular periods (>35 days apart)
3. Hirsutism: clinical (Acne or excess body hair) and/or biochemical (raised testosterone)

Question 2

Aetiology and risk factors of Polycystic ovarian syndrome

Answer 2

Raised LH and insulin, insulin resistance → ovarian androgen production + reduced steroid-hormone binding globulin (SHBG) → raised androgen levels

RF:
Family history of PCOS
Premature adrenarche
Obesity
T2DM

Question 3

Symptoms and signs of polycystic ovarian syndrome

Answer 3

Amenorrhoea/oligomenorrhoea
Infertility
Hirsutism (terminal hairs on upper lip, chin, chest, back, abdomen, thigh, butt (androgen-dependent))
Acne
Increased BMI
Alopecia
Oily skin - Hyper-hidrosis and/or seborrhoea

Acanthosis nigricans
Hypertension

Question 4

Investigations for polycystic ovarian syndrome

Answer 4

Urine pregnancy

Total/free testosterone: raised
Serum LH/FSH: raised ratio >3
Serum AMH: raised
Serum DHEAS: raised
17-hydroxyprogesterone
prolactin
TFTs
OGTT
Lipid profile

Pelvic US: >12 follicles in each ovary (2-9mm diameter)
± ovarian volume >10ml

Question 5

Management for polycystic ovarian syndrome

Answer 5

Conservative: weight loss/exercise + education

Medical:
Co-cyprindrol (reduces hirsutism + promotes regular menstruation
COCP
Metformin (treat the T2DM)

Fertility:
Clomiphene
Gonadotrophin therapy
Laparoscopic ovarian drillling

Question 6

Complications of polycystic ovarian syndrome

Answer 6

Infertility
Pregnancy complications
T2DM
NASH
CVD
Endometrial hyperplasia or cancer
Metabolic syndrome
Dyslipidaemia
Psychological complications