Polycystic ovary syndrome Flashcards
Define PCOS.
Hyper-androgenism, oligo/anovulation, and polycystic ovarian morphology on ultrasound.
What is the aetiology of PCOS? What are the risk factors for PCOS?
The exact aetiology of PCOS is unknown.
Environmental factors: Diet, exercise, obesity
Genetic factors: Family history, Regulation in insulin, gonadotrophin, androgen sensitivity
Summarise the epidemiology of PCOS.
Very common - 6% to 8% of women of reproductive age
PCOS accounts for 80% to 90% of cases of hyper-androgenism in women
What are the signs and symptoms of PCOS?
Irregular menstruation
Infertility
Hirsutism
Acne
Overweight or obesity
Hypertension
What investigations should be performed for PCOS?
LH HIGH!
LH:FSH ratio >3T3/T4 (hyper or hypothyroid)
Oestrogen, androstenedione, SHBG, testosterone.
TVUSS: 12+ cysts in both ovaries, or ovarian volume >10mL
What are differential dignoses for PCOS?
Cushings: Measure cortisol
Hyperprolactinaemia: Measure prolactin
Hyper/hypothyroidism: T3/T4
What is the management of PCOS?
Weight loss, Exercise, Stop smoking
OCP: Treat amenhorea + hirtuitism. Use antiandrogenic contraceptives
Anti androgen agent can be added (ie. Sprinolactone) if required
Clomifene citrate (induce ovulation if not restored with OCP and weight loss)
Metformin may be appropriate for overweight patients
Eflornithine hydrochloride (vaniqua) to prevent hair growth
What are complications associated with PCOS?
Infertility
Pregnancy complications
Type 2 diabetes
Non-alcoholic fatty liver disease (NAFLD)
Cardiovascular disease (CVD)
Endometrial hyperplasia or cancer
Metabolic syndrome
Dyslipidaemia
Psychological complications
Obstructive sleep apnoea
What is the prognosis for PCOS?
PCOS is a chronic condition. There is no cure. Thus, management options are targeted at alleviating the signs and symptoms to reduce morbidity.
