polycystic ovarian syndrome

Question 1

polycystic ovarian syndrome

- diagnostic criteria (broadly)

Answer 1

any 2 of these 3

• irregular menstrual cycle
• hyperandrogenism (clinical or biochemical)
• polycystic ovaries on ultrasound

Question 2

polycystic ovarian syndrome

- what menstrual cycle patterns qualify as irregular (4)

Answer 2

• no period by age of 15
• cycles > 90 days 1 year after menarche
• cycles <21 or >45 days, 1-3 years after menarche
• (cycles <21 days or >35 days), >3 years after menarche

Question 3

polycystic ovarian syndrome - signs of hyperandrogenism

• clinical (3)
• biochemical (2)

Answer 3

clinical

• hirsutism
• acne
• male pattern alopecia (when older)

biochemical

• raised free androgen index
• raised total testosterone

Question 4

polycystic ovarian syndrome - ultrasound findings that count for a dx. (1)

Answer 4

• cumulative 10 small cysts on each ovary (20 total?)

Question 5

polycystic ovarian syndrome

- earliest you can do an ultrasound, relative to menarche

Answer 5

> 8 years after menarche

Question 6

polycystic ovarian syndrome management

- indications for endocrinology referral (3)

Answer 6

• hormone levels >20% normal levels
• hypervirilisation or severe hyperandrogenism
• clinically significant hyperandrogenism

Question 7

polycystic ovarian syndrome management

- indications for fertility specialist referral (1)

Answer 7

> 35 and trying to get pregnant

Question 8

polycystic ovarian syndrome management

- issues that metformin can help with (2)

Answer 8

helps with

• subfertility
• irregular periods

Question 9

polycystic ovarian syndrome management

- long term health problem screening (4)

Answer 9

screen for metabolic syndrome

• BP annually
• lipids every 2-4 years
• OGTT at diagnosis, then every 3 years

monitor for sleep apnoea

Question 10

polycystic ovarian syndrome management

- issues metformin doesn’t help with (1)

Answer 10

hirsutism

Question 11

polycystic ovarian syndrome

- management of hirsutism

Answer 11

laser therapy

COCP

Question 12

polycystic ovarian syndrome - management of irreguiar menstrual cycle

• first line
• 2nd line if first line contraindicated
• nonhormonal

Answer 12

COCP

if not, progesterone

• medroxyprogesterone 10mg PO OD, same 12 days of every calendar month
• norethisterone 5mg PO OD, same 12 days of every calendar month

if not above,then
metformin 250-500mg PO OD, increasing by 500mg per week until max 2g