Polycystic ovary disease

Question 1

Define PCOS

Answer 1

Polycystic ovary syndrome (PCOS)

• complex condition of ovarian dysfunction
• Affects 5-20% of women of reproductive age

Question 2

What causes PCOS?

Answer 2

Multifactorial
Hypersecretion LH
Genetic
Insulin receptor defect
Hyperandrogenism
Obesity

Question 3

What are the 3 possible criteria features of PCOS?

Answer 3

DEFINED AS AT LEAST 2 of FOLLOWING 3:

1. > 12 cysts on one ovary on USS
2. Irregular or absent ovulation (>42days)
3. Clinical/biochemical signs of hyperandrogenism

OTHER SIGNS
Infertility
Obesity
acanthosis nigricans - hyperpigmentation of skin usually in folds (due to insulin resistance)

Question 4

What are clinical signs of hyperandrogenism?

Answer 4

Hirsutism
Alopecia - male pattern balding
Acne

Question 5

What investigations are there for PCOS?

Answer 5

BLOODS
-FSH, LH, prolactin, TSH, and testosterone
(IF testosterone markedly raised consider other causes)
-Glucose tolerance

IMAGING
-Pelvis USS - multiple cysts on ovaries

Question 6

How is PCOS conservatively managed?

Answer 6

WEIGHT LOSS (mainstay)
Cosmetic hair removal

Question 7

How is PCOS medically managed?

Answer 7

COCP - induce regular bleeds

Metformin - if insulin resistance

Anti-androgens

• Finasteride
• Spironolactone

Question 8

How can PCOS be managed surgically?

Answer 8

Laparoscopic ovarian diathermy

IVF