Polycystic ovarian syndrome (PCOS) Flashcards
What is polycystic ovarian syndrome?
Polycystic ovarian syndrome (PCOS) is a common condition causing metabolic and reproductive problems in women.
How to differentiate between menopause/ovarian failure and PCOS as a cause of amenorrhoea (lack of menstruation) and infertility?
Measure LH, FSH and oestrogen
Low oestrogen = menopause/ovarian failure
High oestrogen = PCOS
What are the 3 diagnostic criteria for PCOS?
Any 2 from the following 3:
- Hyperandrogenism
- Polycystic ovaries on USS
- Amenorrhoea
What is the name for the diagnostic criteria for PCOS?
Rotterdam criteria
Only 1 feature of the Rotterdam criteria is needed to diagnose PCOS. True/false?
False
At least 2 of the 3 components are required to diagnose PCOS
Key features of PCOS?
Oligomenorrhoea (irregular menstrual periods) or amenorrhoea (lack of menstrual periods)
Infertility
Obesity (in about 70% of patients with PCOS)
Hirsutism
Acne
Hair loss in a male pattern
What investigations can be used for PCOS?
Testosterone
Sex hormone-binding globulin
Luteinizing hormone
Follicle-stimulating hormone
Prolactin (may be mildly elevated in PCOS)
Thyroid-stimulating hormone
What hormonal blood test readings are typically shown in PCOS?
Raised luteinising hormone
Raised LH to FSH ratio (high LH compared with FSH)
Raised testosterone
Raised insulin
In PCOS, a common hormonal blood test reading is raised FSH with increased FSH:LH ratio. True/false?
False
Raised LH and raised LH:FSH ratio (high LH compared to FSH)
Imaging method used in suspected PCOS?
Pelvic ultrasound
What imaging technique is gold standard for visualising the ovaries?
Transvaginal ultrasound
What is the common appearance of the ovarian follicles in PCOS when viewed in imaging?
The follicles may be arranged around the periphery of the ovary, giving a “string of pearls” appearance.
What is a significant lifestyle management factor for PCOS?
Weight loss
Weight loss alone can result in ovulation and restore fertility and regular menstruation, improve insulin resistance, reduce hirsutism and reduce the risks of associated conditions.
General management for PCOS?
Weight loss
Low glycaemic index, calorie-controlled diet
Exercise
Smoking cessation
Antihypertensive medications where required
Statins where indicated (QRISK >10%)
What can PCOS increase the risk of?
Obesity, type 2 diabetes, hypercholesterolaemia and cardiovascular disease.
General management of PCOS aims to reduce the risks of these developing.
What is the difference between hirsutism and hypertrichosis?
Hypertrichosis refers to excessive hair growth beyond normal variation for a patient’s age, sex, or race or for a particular body area.
Hirsutism refers to an abnormal excess of hair growth solely in androgen-dependent areas of the body in females i.e. beard and moustache.
When are antihypertensives used in PCOS?
When QRISK score > 10%.
QRISK score will tell you whether patient is at low, moderate or high risk of developing CVD in the next 10 years.
What is insulin resistance?
Refers to a lack of response to the hormone insulin, resulting in high blood sugar levels
What features and complications should be checked for in patients with PCOS?
Endometrial hyperplasia and cancer
Infertility
Hirsutism
Acne
Obstructive sleep apnoea
Depression and anxiety
What is the initial management for infertility in PCOS?
Weight loss - can restore regular ovulation
What is the initial management for hirsutism in PCOS?
Weight loss may improve and is usually explored as an option after options for hair removal, such as waxing, shaving and plucking have proven ineffective
What is the first-line management for acne in PCOS?
COCP (combined oral contraceptive pill)
What can COCP use increase the risk of?
Can increase the risk of VTE (venous thromboembolism).
