Polycystic ovarian syndrome (PCOS)

Question 1

Define polycystic ovarian syndrome

Answer 1

Characterised by oligomenorrhoea/amenorrhoea & hyperandrogenism (clinical or biochemical)

Question 2

Associations of polycystic ovarian syndrome

4

Answer 2

obesity
insulin resistance
T2DM
dyslipidaemia

Question 3

Aetiology of polycystic ovarian syndrome

3

Answer 3

Environmental factors
Genetic variants
Hyperinsulinaemia results in increased ovarian androgen synthesis & reduced hepatic sex hormone binding globulin (SHBG) synthesis —> increased free androgens —> symptoms

Question 4

Epidemiology of polycystic ovarian syndrome

infertility, prevalence

Answer 4

MOST COMMON cause of infertility in women

Affects 6-8% women

Question 5

Presenting symptoms of polycystic ovarian syndrome

6

Answer 5

Menstrual irregularities
Dysfunctional uterine bleeding
Infertility

Symptoms of hyperandrogenism
hirsutism
male pattern hair loss
acne

Question 6

Signs of polycystic ovarian syndrome on physical examination
(4)

Answer 6

Hirsuitism
Male pattern hair loss
Acne
Acanthosis nigricans (sign of severe insulin resistance)

Question 7

Investigations for polycystic ovarian syndrome

5 groups

Answer 7

Bloods
Fasting lipid profile
Impaired glucose tolerance/T2DM
Transvaginal US
Other things to test for

Question 8

Investigations for polycystic ovarian syndrome - bloods

4

Answer 8

High LH
High LH:FSH ratio
High testoterone, androstenedione & DHEA-S
Low sex hormone binding globulin (SHBG)

Question 9

Investigations for polycystic ovarian syndrome - impaired glucose tolerance/T2DM
(2)

Answer 9

Fasting blood glucose

HbA1c

Question 10

Investigations for polycystic ovarian syndrome - transvaginal US

Answer 10

Look for ovarian follicles & increased ovarian volume

Question 11

Investigations for polycystic ovarian syndrome - other things to test for
(4)

Answer 11

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