Polycystic Ovarian Syndrome (PCOS)

Question 1

Define Polycystic Ovarian Syndrome (PCOS)

Answer 1

Polycystic Ovarian Syndrome (PCOS) is an heterogeneous endocrine condition characterised by menstrual dysfunction and features of hyperandrogenism (oligomenorrhea, hirsutism and acne)

Question 2

When do features of Polycystic Ovarian Syndrome (PCOS) often develope

Answer 2

At puberty

Question 3

Define the term heterogenous condition

Answer 3

It refers to a condition that has several aetiologies/causes

Question 4

What is the most common endocrine disorders in women of reproductive age

Answer 4

Polycystic Ovarian Syndrome (PCOS)

Question 5

What is the aetiology of Polycystic Ovarian Syndrome (PCOS)

Answer 5

The aetiology of PCOS is not fully understood.

Combination of genetics, high LH levels and insulin resistance

Increased LH to FSH radio leads to excess androgens production by the theca cells of the ovary

Insulin resistance results in hyperinsulinemia, which in turn stimulates theca cells causing secretion of excess androgens

Question 6

What are androgens

Answer 6

They are male sex hormones e.g. testosterone

Question 7

Name the clinical features of Polycystic Ovarian Syndrome (PCOS)

Answer 7

• Oligomenorrhoea or amenorrhoea
• Hyperandrogenism (e.g acne, hirsutism)
• Anovulation – absence of ovulation.
• Subfertility and infertility
• Obesity
• Acanthosis nigricans – dark skin in the armpits, neck or groin. Sign of insulin resistance

Question 8

Define the term “Oligomenorrhoea”

Answer 8

Refers to irregular, infrequent ovulation

Question 9

Define the term “Amenorrhoea”

Answer 9

Refers to absence of menstrual periods

Question 10

Hyperandrogenism is a key feature of Polycystic Ovarian Syndrome (PCOS).

Name some of the features of Hyperandrogenism

Answer 10

Acne

Hirsutism

Question 11

Define the term “Hirsutism”

Answer 11

Refers to the growth of thick dark hair, often in a male pattern e.g. facial hair

Question 12

Define the term “Anovulation”

Answer 12

Absence of ovulation

Question 13

Acanthosis nigricans refers to dark skin in the armpits, neck or groin.

If it is present, what is it suggestive of

Answer 13

Sign of insulin resistance

Question 14

What criteria is used for the diagnosis of PCOS

Answer 14

Rotterdam Criteria

Question 15

Rotterdam Criteria is used for the diagnosis of PCOS.

Describe the criteria

Answer 15

Diagnosis requires at least two of the three key features:

• Oligomenorrhoea or amenorrhoea
• Hyperandrogenism (e.g acne, hirsutism)
• Polycystic ovaries (number of small ovarian cysts) on transvaginal ultrasound

Question 16

Polycystic Ovarian Syndrome (PCOS) can be investigated by blood test and imaging.

What blood tests are used to investigate PCOS

Answer 16

Hormonal blood tests

• Raised LH
• Raised LH to FSH ratio

Question 17

Polycystic Ovarian Syndrome (PCOS) can be investigated by blood test and imaging.

What imaging modalities are used to investigate PCOS

Answer 17

Transvaginal ultrasound

Pelvic ultrasound

Question 18

What imaging modalities are the gold standard for visualising the ovaries

Answer 18

Transvaginal ultrasound

Question 19

String of pearl appearance of the ovaries under transvaginal ultrasound is a sign of what condition

Answer 19

Polycystic Ovarian Syndrome (PCOS)

Question 20

What is the diagnostic criteria for Polycystic Ovarian Syndrome (PCOS) in transvaginal ultrasound

Answer 20

>=12 follicles in one ovary

OR

Ovarian volume more than 10cm³

Question 21

In what patients group is pelvic ultrasound is not reliable to detect Polycystic Ovarian Syndrome (PCOS)

Answer 21

Adolescents