Polycystic Ovarian Syndrome

Question 1

What are its features?

Answer 1

Weight gain
Hirsuitism
Infrequent or absent ovulation resulting in oligomenorrhoea or amenorrhoea and poor fertility
Acanthosis nigricans
Impaired glucose tolerance

Question 2

What are the hormone levels?

Answer 2

LH is raised
LH to FSH ratio is raised
Insulin can be raised
Testosterone can be raised

Question 3

What is the Rotterdam Criteria for diagnosis?

Answer 3

Requires two of three to make a diagnosis

Infrequent or absent ovulation
Hyperandrogenism (e.g. hirsutism)
Polycystic ovaries on ultrasound (or ovarian volume >10mls)

Question 4

Describe the link between PCOS and insulin resistance

Answer 4

Insulin resistance is common in women with PCOS.

High levels of insulin result result in higher levels of androgens (such as testosterone). Insulin promotes the release of androgens from the ovaries and adrenal glands. It also suppresses sex hormone-binding globulin production by the liver, which normally binds to androgens and suppresses their function.

Metformin can be used to improve insulin resistance and reduce circulating insulin levels in women with PCOS to improve their chances of ovulating and becoming pregnant. Diet, exercise and weight loss also improve insulin resistance and have the same effect

Question 5

How is PCOS managed?

Answer 5

Weight loss

Combined oral contraceptive pill

Question 6

How is infertility in PCOS managed?

Answer 6

This is done in a stepwise approach as below. When one is unsuccessful, you move on to the next step.

Weight loss
Metformin
Clomifene

Question 7

How is hirsuitism managed?

Answer 7

Co-cyprindiol (Dianette)

Has an anti-androgenic effect
Contraceptive
Increased risk of VTE
Topical eflornithine

Specialist medications:

Spironolactone (mineralocorticoid antagonist)
Finasteride (5α-reductase inhibitor that decreases testosterone production)
Flutamide (nonsteroidal antiandrogen)