Polycystic Ovarian Syndrome

Question 1

Define

Answer 1

Syndrome of polycystic ovaries
In association with systemic symptoms causing reproductive, metabolic and psychological disturbances

 Characterized by oligomenorrhoea/amenorrhoea and hyperandrogenism

Question 2

Causes

Answer 2

Causes → unknown
Involves: environmental factors (e.g. diet, obesity) and genetic variants (?genes regulating gonadotrophin, insulin and androgen)

Risk factors

Frequently associated with:

• Obesity
• Insulin resistance
• T2DM
• Dyslipidaemia.

Hyperinsulinaemia results in increased ovarian androgen synthesis and reduced hepatic sex hormone binding globulin (SHBG) synthesis

This leads to an increase in free androgens (which gives rise to the symptoms)

Question 3

Epidemiology

Answer 3

PCOS is the MOST COMMON cause of infertility in women

Affects 6-8% of women

Question 4

Symptom

Answer 4

• Mental irregularities (oligomenorrhoea or amenorrhoea)
• Dysfunctional uterine bleeding
• Infertility
• Symptoms of hyperandrogenism: hirsutism, male-

pattern hair loss, acne

• Psych: mood swings, depression, anxiety Sleep apnoea

Question 5

Signs

Answer 5

±Acanthosis nigricans (sign of severe insulin resistance): velvety thickening and hyperpigmentation of the skin of axillae or neck

US – bilateral polycystic ovaries ↑ LH, ↑LH:FSH ratio (>3)

↑Testosterone, androstenedione and DHEA-S. ↓SHBG.

Hirsuritism

Male-pattern hair loss

Acne

Question 6

Investigations

Answer 6

Bloods

• High LH
• High LH: FSH ratio
• High testosterone, androstenedione and DHEA-S
• Low sex hormone binding globulin

Other things to test for:

• Hyperprolactinaemia
• Hypo/hyperthyroidism
• Congenital adrenal hyperplasia (check 17OH-progesterone levels)
• Cushing’s syndrome

Look for impaired glucose tolerance/T2DM:

• Fasting blood glucose
• HbA1c

Fasting lipid profile

Transvaginal USS: look for ovarian follicles and an increase in ovarian volume