Polycystic ovarian syndrome Flashcards
What does PCOS stand for?
PolyCystic Ovarian Syndrome
Def: Anovulation
Absence of ovulation
Def: Oligoovulation
Irregular infrequent ovulation
Def: Hyperandrogenism
Effects of high levels of androgens (Male sex hormones such as testosterone)
Def: Hirsutism
Growth of thick, dark hair, often in a male pattern (E.g. Male pattern facial hair)
Def: Insulin resistance
Lack of response to insulin, resulting in high blood sugar levels
What criteria is used to diagnose PCOS?
Rotterdam criteria
What are the Rotterdam criteria for PCOS?
2 of 3:
1 - Oligoovulation or anovulation
2 - Hyperandrogenism
3 - Polycystic ovaries on USS (Ovarian volume >10cm)
How common are ovarian cysts on USS?
20% of reproductive age women
What are some presentations of PCOS
- Oligomenorrhoea or amenorrhoea
- Infertility
- Obesity (in about 70% of patients with PCOS)
- Hirsutism
- Acne
- Hair loss in a male pattern
What are some conditions that can occur due to PCOS?
- Insulin resistance and diabetes
- Acanthosis nigricans
- Cardiovascular disease
- Hypercholesterolaemia
- Endometrial hyperplasia and cancer
- Obstructive sleep apnoea
- Depression and anxiety
- Sexual problems
What is acanthosis nigricans?
thickened, rough skin, typically found in the axilla and on the elbows.
Differentials of hirsutism
Polycystic Ovarian Syndrome (PCOS)
Medications
Ovarian or adrenal tumours
Cushing’s syndrome
Congenital adrenal hyperplasia
What are some medications that can cause hirsutism?
Phenytoin
Ciclosporin
Corticosteroids
Testosterone
Anabolic steroids
Describe the role of insulin resistance in PCOS
Pancreas increases insulin production
Insulin promotes androgen release from ovaries and adrenal glands and suppresses sex-hormone-binding globulin production by the liver
This promotes hyperandrogegism and halts development of follicles in the ovaries causing anovulation and multiple partially developed follicles (Cysts)
What blood tests are required to diagnose PCOS?
- Testosterone
- Sex hormone-binding globulin
- Luteinizing hormone
- Follicle-stimulating hormone
- Prolactin (may be mildly elevated in PCOS)
- Thyroid-stimulating hormone
What will blood testing usually show in PCOS
Raised LH
Raised LH:FSH
Raised testosterone
Raised insulin
Normal oestrogen
What tests are required to diagnose PCOS?
Blood hormone testing
Pelvic USS (Trans-vaginal)
What are the diagnostic criteria for PCOS on pelvic USS?
12 or more developing follicles in one ovary (String of pearls appearance)
Ovarian volume >3cm
Diagnosis: String of pearls appearance on pelvic ultrasound
Polycystic ovarian syndrome
In whom is pelvic US not reliable in PCOS?
Adolescents
What screening is required in PCOS?
Diabetes screening with oral glucose tolerance testing
Oral glucose tolerance testing results suggestive of diabetes
- 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 are some management option for PCOS
- Weight loss
- Low glycaemic index, calorie-controlled diet
- Exercise
- Smoking cessation
- Antihypertensive medications where required
- Statins where indicated (QRISK >10%)
What are some other features of PCOS that need to be managed?
- Endometrial hyperplasia and cancer
- Infertility
- Hirsutism
- Acne
- Obstructive sleep apnoea
- Depression and anxiety
What medication can be given to help weight loss in PCOS?
Orlistat
To whom is orlistat given in PCOS?
Women with a BMI > 30
MOA of orlistat
Lipase inhibitor preventing the absorption of fat in the intestines
What are some options for reducing risk of endometrial cancer and hyperplasia in PCOS?
Mirena coil
COC
Cyclical progesterones to induce a withdrawal bleed every 1-3 months
How does PCOS increase risk of endometrial hyperplasia?
Women with PCOS don’t ovulate so don’t produce a corpus luteum and therefore don’t produce progesterone
This means that oestrogen goes unopposed and therefore increases risk of hyperplasia
What are some methods of managing infertility in PCOS?
Weight loss
Clomifene
Laparoscopic ovarian drilling
IVF
Metformin and letrozole
What are some methods of managing hirsutism in PCOS
Weight loss
Co-cyprindiol (Dianette) - COC
Topical eflornithin (6-8 weeks to work)
Laser hair removal
Spironolactone
What are some management options for acne in PCOS
COC
Co-cyprindiol (Dianette)
Adapalene (Retinoid)
Antibiotics
Azelaic acid
Tetracycline antibiotics
