Polycystic Ovarian Syndrome (PCOS)

Question 1

What is seen biochemically in PCOS?

Answer 1

hyperinsulinaemia and high levels of luteinizing hormone (LH)

Question 2

When can PCOS diagnosis be reached clinically?

Answer 2

At least 2 of the 3:
1. Hyperandrogenism e.g. hirsutism, acne, weight gain and diabetes/hyperinsulinaemia
2. Polycystic ovaries on USS
3. Oligomenorrhea (irregular and infrequent periods)

Question 3

What is the general management of PCOS in primary care?

Answer 3

1. Weight reduction
2. If the woman requires contraception, the COCP can regulate cycle

Question 4

How is Hirsutism and acne managed in PCOS?

Answer 4

1. COCP (third generation that has fewer androgenic effects e.g. Millinette® 30/75 and Gedarel® 30/150
2. If it doesn’t respond to COCP, topical eflornithine can be tried
3. Only under specialist supervision, spironolactone can be used if the other options fail

Question 5

Which drug is used for fertility treatment in PCOS?

Answer 5

clomifene - however this carries a risk of multiple pregnancies.

metformin is usually used alongside clomifene in patients who are obese but is not first line