Polycystic Ovary Syndrome

Question 1

what are some androgens that could be in the blood?

Answer 1

• DHEAS
• Androstendione
• free testosterone
• total testosterone

Question 2

Where are some common sites of hirtuism

Answer 2

Androgen dependent areas
* Face, chin, neck, between & around breasts, lower abdome, back, arms/legs

Question 3

lack of ovulation on a regular basis- usually defined as less than 8 menses a year
cycles usually > 35 days

Answer 3

Oligo-Ovulation

Question 4

what is a polycystic ovary?

Answer 4

• ovarian volume >10ml
• 12 subscapular follicles, each 2-9mm in a “string of pearls” configuration

Question 5

Risk associated with PCOS?

Answer 5

Infertility
dyfunctional uterine bleeding
endometrial cancer
Type 2 diabetes
Metabolic syndrome

Question 6

When making the diagnosis of PCOS what should you keep in mind about labs?

Answer 6

Labs don’t diagnose PCOS but help to exclude other diseases

Question 7

what are causes of PCOS?

Answer 7

Genetics
* more likely to have mothers, sisters & daugters with PCOS
* more likely to have faters with type 2 diabetes
* more likely to have brothers with metabolic syndrome

insulin resistance
* more free androgen = oligo ovulation and hyperandrogenism
* weight gain, carbohydrate craving

Question 8

Ways to treat PCOS?

Answer 8

weight loss- diet/physical activity

metformin
oral contraceptive therapy
spironolactone
vaniqua

Question 8

how can weight loss treat PCOS?

Answer 8

decreases insulin resistance
10% weight loss improves ovulation

Question 9

how does metfomin treat PCOS?

Answer 9

• improves insulin sensitivity
• improves weight loss
• improves ovulation
• improves hyperandrogenism
• follow liver enzymes & annual B12 level

Question 10

How do OCPs treat PCOS

Answer 10

• Improves balance between estrogen and androgen
• decreases acne & hirtuism
• improves menstrual cycles

Question 11

how does spironolactone treat PCOS?

Answer 11

it is an androgen receptor blocker
improves acne and hirsutism

Question 12

how is vaniqa cream used to treat PCOS?

Answer 12

• blocks enzyme in hair follicle
• prevents hair growth
• must be applied twice a day

Question 13

ways to induce fertility in a patient with PCOS?

Answer 13

• OCP 4-6 weeks, then clomiphene or recombinant FSH for ovulation
• addition of metformin to decrease insulin resistance
• aromatase inhibitor- decrease estrogen feed back to hypothalamus, increasing LHRH pulss to pituitary, increasing LH and FSH secretion